Bill Clinton and Racial Reconciliation Essay Example | Topics and Well Written Essays - 750 words

Bill Clinton and Racial Reconciliation - Essay Example Racial reconciliation demands sensitivity when being expounded because any loose definitions could lead people to supporting that which they feel closely relates to them. Yet it should be a unifying factor since it is a matter of humaneness rather than individual feelings. As human beings, we should seek to come together as one and respect each other regardless of color or any other divisive issues such as creed. However, emphasis must be placed on the fact that racial reconciliation primarily entails holding all persons responsible for the past injustices, accountable (Lawson 295). At the time of his campaign, Governor Bill Clinton came out boldly against race as a divisive issue and called upon Americans to embrace the diversity as a strengthening factor. Staying true to his word, when Clinton came into power he appointed more blacks and women than any other President in the history of America had. His idealism on racial reconciliation was founded on the fact that at the end of the day we are all human beings. That ought to be the connection we all ascribe to and not color. Racial reconciliation became more practical as President Clinton established a commission, aimed at convening dialogues at town halls to initiate further discourse into the issue of racism. He went on to enacting policies that saw employment opportunities for African Americans increase dramatically; besides that, he reinforced civil rights movements and appointed a significant number of African Americans and women into the judicial system. His dedication to this was visible until the end of his term where he was seen to make recommendations to health, education, civil rights efforts and overall social and economic evolution. In Elie Wiesel’s speech at the Millennium Lecture series in April 12 1999, he cited indifference as the greatest enemy to racial reconciliation as it is worse than anger and hatred, because it does not bring out any response. He applauded President Clintonâ€⠄¢s efforts in intervening the suffering of people in Kosovo in partnership with NATO. This had a huge impact on his plight to Americans that the human connection is greater than any racial and ethnic differences as nowadays more leaders and international organizations are embracing their roles as human beings to intervening in countries where crimes against humanity are rife. Such intervention efforts point at the occurrence of racial reconciliation (Wiesel). There are considerable instances of racial reconciliation in America, starting with President Clinton’s apology to African Americans for the Tuskegee Syphilis experiment in 1997. He also alluded to an apology to slavery and launched an initiative that sought to give practices necessary for racial reconciliation. This made racial injustices more acknowledgeable by other leaders as more apologies were offered. Evidence to this is an apology, in 1999 by President Mathieu Kerekou of Benin to African Americans for the countr y’s participation in the European slave trade. More recently, the Jacksonville Journey an initiative established in 2007 to reduce crime rates in the town often referred to as the ‘murder capital’ of Florida; where its activities include youth development programs that turn the young population away from gang activities. This has been a positive step towards racial reconciliation as it eliminates the stereotype of African Americans as inclined towards violent and criminal activities. Still in the same year, the

Leadership in organizations Essay Example | Topics and Well Written Essays - 1000 words

Leadership in organizations - Essay Example However, Ms. Kirchner went on to become president as did Margret Thatcher, who was the prime minister of Britain. Though the former British premier was known for her tough policies the current Argentina presidents tenure has been marred by rumors that her presidency is actually being run by her husband. Kirchner has also had good relations with the President of Venezuela, Hugo Chà ¡vez. Kirchner accepts the fact that Chà ¡vez has had helped Argentina in its financial crisis with the oil wealth of the country. Argentina is on friendly terms with Venezuela because not only Chà ¡vez helped the country during the energy crisis, but also the Argentineans believe that Chà ¡vez won the presidential elections in a fair way and with the approval of the international observers (Time, 2007). Her foreign relations are aimed at forming a regional bloc with Venezuela and Brazil. Argentina has a close alliance with Venezuela because the US alleged Ms. Cristina of being funded illegally by Hugo Chavez for winning her presidency. They both denied the accusation and called it a trashing operation orchestrated by the US to bring disunity amongst the nations of Latin America (New World Encyclopedia, 2008). All four political figures have held powerful positions in their respective nations though Ms. Cristina acquired her position comparatively easily than her counterparts as the ticket to run for president was thrown in her lap whereas Ms. Clinton had to run a fierce campaign for a democratic ticket and Margret Thatcher also had to do the same for her conservative party whereas Chà ¡vez has also had to weather coup dà ©tat attempt and wage a political struggle to be reelected (Historic Figures). Both Ms. Thatcher and Ms. Clinton are known to be politically active with a somewhat conservative outlook in their style whereas Ms. Kirchner has been known to support stylish and

Assessor Award Essay Example for Free

Assessor Award Essay A1 Assessor Award BY fiffi20 7317 Vocational Assessors Award Underpinning Knowledge Requirements QI. The way how I identify and use different types of evidences when carrying out assessments are by reading through all the chosen units assessment reports to have a clear understanding of the criteria/elements which the candidate must meet. The different types of evidences which can be used are, Task Statements, Work Product/ Work Evidences, Observations, Supplementary Evidences, Questionnaires, Professional Discussions and also Witness Statements. Q2. When comparing different types of evidences, I make sure the work product overs either, the Skills and Techniques or the Performance Indicators depends on the NVQ course, this get done on both the mandatory unit as well as the unit the candidate is working on. This is done by me checking the evidence against the Assessment Report and referencing the elements which have been met. Q3. When it comes to me collecting evidence I normally get my candidates to print their evidences in black and white instead of colour to save the cost of their ink cartridge. If possible I would also ask them to print double sided to save paper. I always ask my candidates if they have created any sort of evidence prior to our eeting, that way I could see if the evidence is suitable for the task and if its meets any of the elements on the assessment report if so this saves a lot of time on the candidate behalf if not, I do set my candidates deadlines for them to meet, so that way then can complete to hand over evidences. Q4. If a candidate has completed evidences prior to the assessment process I would ask them to demonstrate how they started and completed the task. I would also have a Professional Discussion with them to cover certain Performance Indicators as well as getting a Witness Statement completed by a person high then he candidate, someone who can confirm that the candidate was able tackle this task. Depends on the unit, I would sometimes also give Questionnaires to them to cover their Knowledge and Understanding. Q5. To develop and agree assessment plans with the candidates I consider all Performance Indicators and Skills and Techniques for each chosen unit, I then advise them on the assessment methods which will be used to collect the evidence and also a date/time of completion is set and agreed by both the candidate and myself. Q6. To assess the performance of my candidate I observe them while they are ackling the work evidence and I also question them this could either be verbal or written. Through this method I can pin point their performance against specific parts of the standard. evelop their competency would be to give them extra training on specific areas which they lack knowledge in and also set them task where I could observe them on that particular training to see whether or not they understood to concept and learnt from the training. I would also question them to confirm they understanding. By doing this I can make sure the candidate will be able to meet the criteria/element. Q8. Diff erent candidate have different needs, some need more training and guidance than others. So when changing assessment procedures all aspect must be considered. For example I have a candidate who is a Personal Assistant for a Head Teacher in a school which I assess in. I show her the Action Plans and Assessment Reports and explain the criteria/element which she must meet, she is able to produce evidence instantly due to IT knowledge and Job role, this candidate need very little training in her Business and Administration course as long as I explain what is required from her and her work products/work evidences. However I then have a candidate who is a receptionist at a medical centre, this candidate has dyslexia and needs a huge amount of training and guidance, especially with her Task Statements. A lot more time must be spent with this candidate and the deadline of evidence must be slightly longer then others. Q9. When collecting evidences must ensure there are no confidentially information which relates to neither the company nor their clients/customers. The evidences must be created by the candidates so that way they are valid and fair. If the candidate does not create the evidence then it is hard to identify whether or not it is air. All evidences must be valid. I must check dates and check the assessment reports. I must speak to the Manager and advise them which type of evidence the candidate will be submitting. QIO. When completing work evidences, the evidence must follow the assessment standard of the CADCentre unit standard booklet. QI 1. To measure existing levels of competence I always question my candidates, this could either be verbal or written. I also get the candidate to perform the task so Im able to observe and Judge their competency level. Q12. To make a valid and reliable assessment of my candidates knowledge I ormally hold a professional discussion with them and also given them questionnaires to complete. Q13. To make a valid and reliable assessment of my candidates performance I get my candidate to produce work evidence to support there claim, to complete a Task Statement and I then type out the Observation which will backup the task which they completed and also to reference the criteria/elements which they successfully matched. collect the work evidence and the Task Statement from the candidate and then I would go through the assessment report and tick off the criteria/elements which they uccessfully met. This is done once IVe collect all evidences towards the relevant unit. This will show that the candidate was capable to meeting the required criteria/ elements. QI 5. To check that the evidence was created by the candidate I always ask them to demonstrate who they created the evidence and also I would take down the file path. The file path is added to the candidates work evidence as well as in my Observations. Q16. To make sure that supporting evidences supplied by other people are reliable I ask the Manager to write out a Witness Statement, I would also speak to the witness egarding the candidates unit, explaining the criteria/elements which they need to cover and will be assed on. The witness must have knowledge and experience in the area which I will assess to allow them to write up the statement otherwise it will not be valid. QI 7. I always tell the candidates that they can use evidences which they previously created towards the chosen unit. For instance an ITQ candidate might have already created a Powerpoint presentation a few weeks ago and as she/he Chose this particular unit, instead of getting them to re-create another resentation we would use the same as long as it met all the relevant criteria/ elements. This saves the candidate a lot of time and effort and fast tracks he collection of the evidence. Q18. The way how I give constructive feedback to my candidates is by after the completion ofa task I would sit down with them and go over the task again. My feedback sheet will state the unit number, the task which the candidate has completed, date of completion, a brief paragraph giving a positive feedback on the task, state any issues which the candidate might have had during the task and also I ention the next stage which they will be moving on to. Q19. The way how I involve my candidates in the planning of assessment , I sit with them and explain all the criteria/elements which they will need to meet, the date of completion must also be agreed by both parties. I would also Judge whether or not the candidate will need extra training times on certain criteria/element to allow them to meet them. Q20. To keep to the data protection act I must store all candidates details safe and secure. Candidate detail must not be shown nor shared with any other candidates or any one outside the CADCentre. Q21. I have a lot of patients and give a lot of my time to my candidates who I feel lack to take part in different in their assessment. Im constantly training them to regain their confidences and knowledge. I also advise them that they can email or call me regarding any questions which they might have. I also give them the option of training them through specific area. IVe noticed that more practice the candidate has the better their understanding is. Q22. I make sure that I treat all my candidates the same, all with the same respect regardless to age, gender, race or beliefs. I train all my candidates equally, however I o sometimes give extra time/training to those who are in need. Q23. To meet the needs to each of my candidate, I assess them on the second initial visit after the signup. I question them verbally to have a clear view of the competency and needs. From that I can Judge which candidate will need extra training. Q24. I always give a feedback to all my candidates after the completion ofa task or even a unit. Again in this I will verbal talk to them as well as write out a feedback sheet. Feedbacks are very important to candidates, they can see their progressions and also identify their weaknesses. Q25. I have always built a good friendly relationship with all my candidates, make them feel at ease to ask questions and get in contact with me at any time regarding any issues which they might have with the course/evidence. Q26. To monitor and review the progress of my candidates I always complete an eight week review which states and identifies how the candidate is progressing, whether its a slow progression or an up to date progress. Deadlines are always set with my candidates and some do meet them and some do go over the deadline. Q27. Candidates are always upgrading their positions within companies. I must ake sure that my knowledge and understand of the course, assessment reports and standards are ofa high level to allow me to assess the candidates. Knowledge in softwares are also very important, as a candidate might chose to complete their NVQ in a specific software such as Access. Access is a database software which not many people know how to use and not many companies use, so to be able to assess and train in Access my knowledge and understand must be high. Q28. To update my existing skills and experience I would take full advantage of any training/course opportunities which may arise. This will enhance my skills, nowledge and also experience. Q29. I would take in consideration any Internal Verifier feedbacks, I would also constantly look at the City and Guilds web site and also sign up for the Newsletters. Q30. To improve my personal development I would again take full advantage of any qualifications and criterias. Q31. To meet my candidates needs in a safe, fair, valid and reliable manner I would take in to account there needs and work in line with the relevant legislations. As I mentioned before I have a candidate who suffers from Dyslexia, with her I need to print the text in a larger font and explain each point to her fully for her to have fully nderstanding of what is required from her. Q32. To recognise and challenge unfair discrimination in assessments I would refer back to the procedure, CADCentre Handbook. Q33. I would liaise with the Internal Verifier and then External Verifier to get advice on meeting candidates special assessment requirements. Q34. To identify and plan for issues of confidentiality and data protection during the assessment process I would either collect the Work Product or if the data is confidential then I would only request the file path. The file path is needed in case he Internal Verifier or External Verifier wanted to go to the company and have a look and the evidence. Q35. The way how I would record, store and pass on assessment decisions to other people within an agreed system would be by recording it on assessment plans and completing a summary of achievement. Q36. I would say to identify and assess things that could influence my own competence, could be an ITQ unit such as (214). By observing another person I could learn new skills on a particular software. Q37. I would liaise with my manager and request training in either a particular course, scheme, FL, CPD and also PTTLS.

Intervention to Reduce Progression of Diabetes

Intervention to Reduce Progression of Diabetes Developing an Intervention to Reduce Progression and the Development of Complications from Diabetes Mellitus in Adults in Glasgow. Introduction Type 2 diabetes is a serious medical condition that is increasingly prevalent in developed countries (International Diabetes Federation, 2013) and the most common variants of the condition are Types I and II. Type I patients have a deficiency in their pancreatic beta cells which leaves them unable to produce insulin. Thus in these individuals, some control over the condition can be achieved using insulin therapy (Schilling, 2007). Type II diabetics, have cells that have become resistant to the effects of insulin resulting in a delayed reduction in blood glucose (Skrha et al., 2010). There are additional types of diabetes; gestational, and a variety of Type III diabetes, however, the overwhelming majority of cases are of Type II with a significant minority of type I cases (Hardt et al., 2008). Complications of Diabetes Regardless of the underlying aetiology, the long-term complications of diabetes are similar. Excess blood glucose is thought to drive increases in oxidative stress both directly and via the derangement of mitochondrial energy pathways (Cade, 2008). Long term macrovascular damage will inevitably increase the risk of coronary heart disease (CHD), and ischaemic heart disease, with diabetics estimated as having a 3 and 5-fold increased risk of CHD mortality for men and women respectively (Loveman et al., 2008). Cerebrovascular disease is also a consequence of the chronic macrovascular damage with similar increases in stroke risk (Naci et al., 2015) Since each organ has its own microvascular supply, chronic hyperglycaemia also results in diffuse and widespread damage to a variety of body organs. As a result, diabetic complications include visual disability due to diabetic retinopathy; the leading cause of blindness in working age adults in the UK (Fowler, 2008; Kempen et al., 2004). In addition, patients suffer end stage renal disease from diabetic nephropathy (Adler et al., 2003), diffuse impairments of autonomic and somatic neural function, including pain perception, due to diabetic neuropathy (Stirban, 2014; Voulgari et al., 2013). Furthermore, the combination of microvascular damage, and reduced pain sensation, usually in the lower limb, results in many patients developing ulceration and necrosis of the inferior surface of the foot, the most common cause of non-traumatic amputations in the UK (Elraiyah et al., 2016). Costs of Diabetes In addition to the significant cost to the individual suffering with diabetes in terms of reduced personal health and quality of life, there are significant financial costs in treating the condition. In 2010-11, the total cost of diabetes to the UK was estimated at  £23.7bn (Hex et al., 2012). This was comprised of  £9.8bn in direct costs related to treating the disease, and  £13.9bn in indirect cost (e.g. lost productivity through absenteeism, early retirement or unemployment, (Hex et al., 2012)). More recently, the direct costs were estimated at  £13.7bn in 2012 (Kanavos et al., 2012). Within these direct costs, only around a quarter is directly spent on treating diabetes its self, and the remaining three quarters is spent on treating the complications following from the disease, (e.g. CHD, retinopathy, liver failure, diabetic foot, neuropathy (Kanavos et al., 2012)). Risk Factors for Diabetes There are a variety of factors that have been identified that places individuals at risk of developing type II diabetes, these include; having a family history of diabetes, obesity assessed using body-mass index, hypertension, visceral adiposity, adverse blood lipids, smoking, and impaired fasting glucose control (Lyssenko et al., 2008). Notably, several of these risk factors, including blood lipids, BMI, hypertension and visceral adiposity, are shared risk factors for CHD, which may in part explain the elevated risk of CHD in diabetics (Haffner et al., 1998). Indeed the clustering of these risk factors has been shown to be predictive of both CHD and diabetes (Haffner et al., 1998) and are collectively referred to as the metabolic syndrome. Moreover, these risk factors, appear to primarily be related to obesity in general, and excessive visceral adiposity in particular (Wozniak et al., 2009). Early work by West and colleagues (1978) demonstrated a strong positive association between rates of obesity and rates of diabetes with a variety of populations. Since then, the epidemiological link between excess body fat and risk of developing type II diabetes in particular has been repeatedly supported. For example, in the Nurses Health Study (Chan et al., 1994) females who had a BMI of greater than 35 kg.m-2 had a risk of diabetes 95 fold higher than those with a BMI of less than 21 kg.m-2 . Epidemiology of Diabetes The incidence and prevalence of diabetes have increased dramatically in the last two decades. Currently, the World Health Organisation estimates that diabetes effects around 9% of the adult global population (International Diabetes Federation, 2013) with variations in prevalence ranging from 26.4% in Kiribati to 1.54% of the population in Manin (International Diabetes Federation, 2013). Overall the UK ranks relatively favourably; in the same data from 2014, the UK had a prevalence of 3.9% (172nd out of 193 countries). Despite this relatively low ranking, the UK, in line with many developed countries, has experienced a rapid growth in the proportion of the population suffering with diabetes. Between 2007 and 2015 the number of patients diagnosed with diabetes increased by 75% from two to three and a half million cases (Diabetes UK, 2015). There are also an estimated half a million undiagnosed individuals at any one time. Indeed, the absence of overt symptoms in the early stages of the disease means that it is not uncommon for patients to have had the disease for several years prior to diagnosis, and confounds attempts to accurately calculate prevalence rates. Scotland has experienced similar increases, with the number of individuals diagnosed with diabetes increasing markedly over the last decade. The Scottish Diabetes survey (2014) demonstrated that the number of individuals with diabetes doubled from approximately 100,000 to 200,000 individuals between 2002 and 2007 despite a stable population of 5 million. Currently estimates for Scotland indicate that there are 276,500 diabetics in Scotland resulting in an overall prevalence that is a third higher than the UK average at 5.2% (NHS Scotland, 2014). Diabetes and Deprivation While the reasons that link indices of deprivation to diabetes are likely multifactorial, they undoubtedly exist. Individuals living in the most deprived areas of the UK are 2.5 times more likely to suffer from diabetes than those in the least deprived areas (Diabetes UK, 2006). Moreover the complications arising from diabetes such as CHD and stroke are more than three times higher in the lowest socio-economic groups and those with lowest educational achievement are twice as likely to have heart disease, retinopathy and poor diabetic control (Diabetes UK, 2006; International Diabetes Federation, 2006). The cause of the increased risk is not clear, however many of the risk factors such as obesity, smoking and physical inactivity, are also higher in those areas with the greatest degree of deprivation (Diabetes UK, 2006; International Diabetes Federation, 2006). From the data outlined above, the development of diabetes is a serious chronic medical condition that can result in early morbidity and mortality and is associated with significant personal and healthcare costs. Despite many of the risk factors for its development being modifiable, it remains a significant and increasing health risk that has a disproportional focus on the areas of greatest deprivation. Given that there is strong evidence that Glasgow has higher rates of both deprivation and type 2 diabetes than the rest of the UK, the aims of this paper are to discuss methods of describing the degree of the problem in Glasgow, as well as identifying, implementing and evaluating initiatives designed to reduce the burden of Type 2 diabetes within that area. Epidemiological Investigation of Diabetes in Glasgow The Centre for Disease Control defines public health research as consisting of four phases, public health tracking, public health research, health intervention programmes, and impact and evaluation (CDC, 2015). Thus before designing and implementing a diabetes focused health initiative, it is necessary to first establish that there is a public health need within Glasgow. This can be undertaken using primary or secondary data sources. Although secondary data sources are repositories of data that have been collected for some purpose other than the investigators main research question, Bailey et al. (2012) suggest that secondary sources also have several advantages. Typically, they are large data sets, and their use is highly cost efficient, as the data collection has already taken place. In terms of this investigation into Diabetes prevalence in Glasgow, there are a number of possible secondary data sources. The most directly relevant data is from the Scottish Diabetes Survey, the most recent data for which covers 2014 (NHS Scotland, 2014). In the most recent report, there is evidence that diabetes is a specific public health concern in Glasgow. For example, while it is not surprising is that Glasgow has the highest number of diabetics, around 22% of Scotlands diabetic population, since it is also the most densely populated region. However, this also translates to the region having the highest age adjusted prevalen ce of diabetes within Scotland at 5.8%. Furthermore the Greater Glasgow and Clyde (GGC) NHS board is criticised as falling behind other NHS health boards within Scotland, in its system of managing and screening its diabetic population in order to limit the progression of the disease. In addition, the Scottish Public Health Observatory (SPHO) provide a number of secondary data sources which may be valuable in triangulating conclusions and include; mortality rates, primary care information from GP practices, the Quality Outcomes Framework (QOF) detailing the performance of GP practices in dealing with key health issues, the Scottish Diet and Nutrition Survey, and the Health Education population survey (Scottish Public Health Observatory, 2015). In addition, both English and Scottish governments produce databases of indices of multiple deprivation (IMD), which can be useful when attempting to standardise the degree of a public health issue by deprivation level. This secondary data should be supported with primary evidence of the population of interest. While there are a number of research designs that could be used to collect primary data on Glasgow residents with diabetes, in this instance a cross-sectional observational design would be most useful. This method has several advantages, it is cost effective, requires only a single group, and each participant is only required to be assessed at a single time-point. This means that it becomes feasible to assess relatively large numbers of people (Bailey Handu, 2012). The limitations of this method are that it represents a single point in time and as a result, cannot be used to determine the sequence of events for a given set of exposures and outcomes. Therefore, it is not possible to infer causality from cross-sectional data. This type of research is most useful for determining prevalence rates for a specific condition (Bailey Handu, 2012).. An ecological study design might also be used, however, in this case, there are wide variations in income levels and deprivation levels within specific postcodes. Thus the possibility for the data to be affected by unknown confounding variables is significant. Similarly a case control study design has some additional control regarding possible confounders, but is again limited in being retrospective in nature and is predominantly used for rare diseases, which type 2 diabetes is not (Greenfield, 2002). Experimental designs such as prospective cohort studies or randomised control trials are the most internally valid designs to attribute causation of a condition to a specific exposure. However, they would not be appropriate in this instance, as they time consuming, expensive, and typically include far fewer individuals. Thus in order to use this type of study, the cost would be greater than the cost of any proposed intervention. In addition, while such designs are internally valid, they often lack ecological validity. That is, while the exposure and outcome can be linked in the study, at the population level, individuals may experience exposure to several predicating factors, and several protective factors. Thus, it is not always straightforward to transfer the findings from a highly controlled study to individuals (Peat et al., 2008). In order to undertake the cross-sectional survey, would require defining a series of areas (e.g. roads or school catchment areas) within specific post-codes to act as the sample frame. The survey data would be collected on these areas. The main problem with collecting this kind of data is a low response rate (Levin, 2006), and the possibility that individuals may responder or not due to the influence of some other factor introducing some systematic bias into the data. The main protection from this is to maximise the response rates. This is best done using face-to-face interviews with individuals in the sample frame (Levin, 2006). Diabetes Interventions The evidence for the type of behaviours that are useful in limiting the adverse complications of diabetes, have been the subject of several large scale epidemiological studies. In the UK the UK Prospective Diabetes Study (UK Prospective Diabetes Study, 1998) and its 10 year follow up (Holman et al., 2008) evaluated the effect of managing type II diabetes through diet alone, versus aggressive management aimed at restricting blood sugar concentrations. The data from the study indicated that while both the aggressive intervention only lowered blood sugar for one year, this translated into significantly lower rates of complications at the 10-year follow up. In the US, the Diabetes Control and Complications Trial (DCCT, 1993) and its 10 year follow up (the Epidemiology of Diabetes Interventions and Complications EDIC (Nathan et al., 2005)) also demonstrated that limiting increases in blood sugar, by maintaining concentrations within strict individualised limits, reduced the incidence of c omplications at the 10 year follow up by 57%. Similar reductions in adverse outcomes have also been found when diabetics have measures of blood lipids, blood pressure, nephropathy, retinopathy and diabetic foot complications assessed at regular intervals. It is also noteworthy that the Greater Glasgow and Clyde NHS region regularly performed in the lowest quartile of Scottish NHS authorities for implementing each of these evaluations (Scottish Diabetes Survey 2014). In long-term conditions such as Type 2 diabetes, the most appropriate strategies to control and manage the condition is for patients, to recognise themselves as stakeholders in their own treatment and to take ownership of the critical aspects of their care such as pharmacological treatment, dietary modifications and physical activity recommendations (National Institute for Health and Care Excellence, 2015). There have been several interventions that have aimed to use patient education to allow for a greater degree of self-management with a resulting closer control of risk factors for diabetic complications. Most recently Minet et al. (2010) evaluated the efficacy of 47 RCT studies aimed at improving diabetic patient education, and found that there was a significant reduction in the degree of hyperglycaemia experienced by the patients at the 6 and 12 month follow up time points. Similar meta analyses have supported the role of education in reducing the incidence of nephropathy and dia betic foot (Elraiyah et al., 2016; Loveman et al., 2008). Given that the UKPDS (1998) demonstrated that even short term reductions in blood glucose can reduce the numbers of patients who progress to sever complications, and given that the majority of the financial burden in treating type 2 diabetes is related to complications rather than the disease its-self. It seems clear that patient education could significantly improve the prognosis of diabetics as well as reduce the costs of future treatment. Implementing an Intervention in Glasgow Having identified a suitable educational intervention, the next stage is to ensure its faithful and appropriate replication within patients with Diabetes in Glasgow. A limitation of much of the available research is that interventions are predominantly applied in academic settings, and the effectiveness of interventions in community and primary care settings are frequently lower than anticipated from the scientific literature. This is a continuing challenge for implementing evidence-based strategies for public health issues. Kilbourne et al. (2007) recommend the REP framework, which although originally devised for faithful implementations of HIV educational programmes has been evaluated and found to help improve the effectiveness of other public health interventions. In order to use the REP framework for educational programmes aimed at Diabetics in Glasgow, the four stages of the REP framework would be developed. Pre-condition requires the identification of a suitable educational intervention. In this phase it is important that the chosen intervention is both feasible and appropriate for the setting in which it will be used. Pre-implementation requires that all staff involved in the intervention undergo training not only in the interventional educational curriculum, but also in the underpinning theories that shaped the original intervention. Implementation requires the educational programme is rolled out to diabetics within Glasgow, and that feedback is sought from stakeholders including patients undergoing the education. In this way it is possible to modify the intervention to better fit the situation, while still remaining faithful to the initial conceptual design. Finally, maintenance and evaluation requires further feedback regarding the effe ctiveness of the intervention, as well as ongoing support for partners who are delivering or helping ensure the continuation of the intervention. Monitoring an Evaluation For the proposed educational intervention, the evaluation would use the RE-AIM framework. This is the most widely adopted model for evaluation of public health interventions originally proposed by Glasgow and Colleagues (1999). This framework proposes the evaluation of five key elements of the intervention. Reach assess the number of individuals from the target population who received the interventions. Efficacy evaluates the degree to which the education intervention improved patients ability to manage their condition (e.g. better control of blood glucose, maintained or lowered blood pressure). Adoption would focus on the number of patients receiving the educational intervention whose behaviour was altered as a result. Implementation attempts to assess the degree to which the intervention was faithful to the evidence base upon which it was designed or was there pragmatic or other issues that meant the interventions was poorly delivered, or delivered in a manner not originally envisa ged. Maintenance attempts to quantify the degree to which the intervention becomes self-sustaining. This can be at an institutional level, i.e. does the health authority feel the programme is sufficiently successful to continue its development. However, it can also be at the individual level, were patients value the intervention and it becomes part of the persons habitual processes. Conclusion The aim of this paper was to investigate an intervention aimed at reducing the complications of type 2 diabetes in individuals diagnosed with the condition, living in Glasgow. It has established that in order to implement any such strategy, it is necessary to evaluate the degree of the problem using secondary and if required primary sources of data. In addition, any intervention should be evidence based, and attempt to replicate those interventions that have been demonstrated to be successful. This should be attempted in a strategic and structured manner in order to ensure high fidelity conversion from research evidence to intervention. The intervention its-self needs robust evaluation to determine if it was effective, and if not was it because of a failure of the underpinning theories or a failure in delivery. Unless they are well managed, individuals with Type 2 diabetes are at a significant risk of serious and life threatening complications. Educational interventions may be one wa y to provide effective strategies to enable better outcomes and reduced personal and financial costs. References ADLER, A.I., et al., 2003. Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney International. 63(1), pp. 225-232. BAILEY, S. and HANDU, D., 2012. Introduction to epidemiologic research methods in public health practice. Jones Bartlett Publishers. CADE, W.T., 2008. Diabetes-related microvascular and macrovascular diseases in the physical therapy setting. Physical Therapy. 88(11), pp. 1322-1335. CDC. 2015. Public Health Cycle [Online]. [Viewed 4th April 2016]. Available From: http://www.cdc.gov/ncbddd/hearingloss/publichealth.html. CHAN, J. M., RIMM, E. B. COLDITZ, G. A. 1994. Weight gain as a risk factor for clinical diabetes mellitus in women. Diabetes Care, 17, 961-9. DIABETES CONTROL AND COMLICATION TRIAL RESERCH GROUP, 1993. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl j Med. 329(14), pp. 977-986. DIABETES UK 2006. Diabetes and the disadvantaged: reducing health inequalities in the UK World Diabetes Day 14 November 2006. A report by the All Parliamentary Group for Diabetes and Diabetes UK. https://www.diabetes.org.uk/Documents/Reports/Diabetes_disadvantaged_Nov2006.pdf. DIABETES UK. 2015. Diabetes Facts and Stats November 2015 [Online]. [Viewed 20th March 2016]. Available From: https://www.diabetes.org.uk/Documents/Position statements/Diabetes UK Facts and Stats_Dec 2015.pdf. ELRAIYAH, T., et al., 2016. A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers. Journal of Vascular Surgery. 63(2), pp. 46S-58S. e2. FOWLER, M.J., 2008. Microvascular and macrovascular complications of diabetes. Clinical Diabetes. 26(2), pp. 77-82. GLASGOW, R.E., VOGT, T.M. and BOLES, S.M., 1999. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. American Journal of Public Health. 89(9), pp. 1322-1327. GREENFIELD, T. 2002. 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Symbols and Symbolism - Pearl as Living Symbol in The Scarlet Letter :: Scarlet Letter essays

Pearl as Living Symbol in The Scarlet Letter      Ã‚  Ã‚   Pearl.   A child born of sin.   Conceived by lust.   Created by impurity.      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   As the result of her parents fall from grace, she represents the sinfulness of their act, and is a continual tool for the recollection of their dubious deed.   Sent, was she, from the Almighty God as a gift, and a burden of the heart.      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   "'God gave me the child?' cried she.   'He gave her in requital of all things else, which ye had taken from me.   She is my happiness!- she is my torture, none the less!   See ye not, she is the scarlet letter, only capable of being loved, and so endowed with a million fold the power of retribution for my sin?   Ye shall not take her!   I will die first!'"(109)      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   "'There is truth in what she says,' began the minister, with a voice sweet, tremulous, but powerful, insomuch that the hall reechoed, and the hollow armor rang with it - 'truth in what Hester says, and in the feeling which inspires her!'"(110)...      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   "'I must be even so,' resumed the minister.'" " 'This child of its father's guilt and its mother's shame hath come from the hand of God, to work in many ways upon her heart, who pleads so earnestly, and with such bitterness of spirit, the right to keep her.   It was meant, doubtless, as the mother herself hath told us, for a retribution too; a torture to be felt at many an unthought-of moment; a pang, a sting, an ever-recurring agony, in the midst of a troubled joy!   Hath she not expressed this thought with the garb of the poor child, so forcibly reminding us of that red symbol which sears her bosom?'"(110-111).      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Pearls gestures, and the essence which her presence pours forth, insinuate to the child's evil roots and the effect there of.      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   "the child could not be made amenable to rules.   In giving her existence, a great law had been broken, and the result was a being whose elements where perhaps beautiful and brilliant, but all in disorder."... "Above all, the warfare of Hester's spirit, at that epoch, was perpetuated in Pearl.   She could recognize her wild, desperate, defiant mood, the

Chemistry: Acid-base Titration Essay -- essays research papers

Chemistry: Acid-Base Titration Purpose:   Ã‚  Ã‚  Ã‚  Ã‚  The objective of this experiment were: a) to review the concept of simple acid-base reactions; b) to review the stoichiometric calculations involved in chemical reactions; c) to review the basic lab procedure of a titration and introduce the student to the concept of a primary standard and the process of standardization; d) to review the calculations involving chemical solutions; e) to help the student improve his/her lab technique. Theory:   Ã‚  Ã‚  Ã‚  Ã‚  Titration was used to study acid-base neutralization reaction quantitatively. In acid-base titration experiment, a solution of accurately KHP concentration was added gradually to another solution of NaOH concentration until the chemical reaction between the two solutions were completed. The equivalence point was the point at which the acid was completely reacted with or neutralized by the base. The point was signaled by a changing of color of an indicator that had been added to the acid solution. Indicator was substance that had distinctly different colors in acidic and basic media. Phenolphthalein was a common indicator which was colorless in acidic and neutral solutions, but reddish pink was result in basic solutions. Strong acid (contained H+ ion) and strong base ( contained OH ) were 100% ionized in water and they were all strong electrolytes. Procedure: Part A. Investigating solid NaOH for use as a possible primary standard First o...

Art Analysis: Claude Monet

Painting Description Essay Humanities 110 There are many paintings in the world and as a modern society that is everyday evolving; we must be able to describe the paintings we see. In doing so we can extract the culture and value it represents and only then can we fully understand these different cultures and human values that are presented throughout history in the many arts that are created. In my eyes any type of emotional expression can be appreciated. Recently I came upon a painting by the Painter Claude Monet who was the basis for impressionism.This painting was awe inspiring and brought my mind to deeply fathom the pursuit of knowledge and power. In order to fully describe this painting I will use the formal elements of paint; texture, color, line and lastly composition. Let's start with composition: the placement or arrangement of visual elements or ingredients in a work of art, as distinct from the subject of a work. It can also be thought of as the organization of the eleme nts of art according to the principles of art. The composition of the painting was very unique and helps to rate an image that burns in your mind.The shapes of the painting are not very structured. It's impossible to look over that objects in the paining were close to real- life scale through eye perception thus being somewhat realistic. Another factor that made the painting close to realistic was the movement shown in the painting made by brush strokes to give an impression of wind through the field of grass that also went through the bushes and the tree. There is depth in the painting that is created by shadowing and balance of lighter areas.The bushes are asymmetrical and the tree is off to one side more specifically the middle right. There is big open space of green field to the middle left , top middle and bottom right and on the bottom of the middle left is where the bushes reside, furthermore the top left is where the blurred castle is placed and horizontal to that is what se ems to be a Classified that drifts to the ocean. Throughout the painting there is green everywhere which unifies the painting. It more predominately is unified with color in juxtaposition with shapes.Furthermore the red saturation that is presented in the shrubbery or bushes provides variety Another element to the painting is the texture which is very sloppy but it is an impressionist painting so that is expected which doesn't mean it's a beautiful and high skilled painting. The Sense provided leaves for the paint to be blended but also has many brush strokes which gives uniqueness to the texture. Most objects are barely visible but can be somewhat recognized. Other areas of the painting are smooth in order to provide rest to the eyes. Paintings Anton exist without color whether there is any color or none at all.In this painting we see more warm and complimentary colors. The very limited analogous colors helped to created subtlety in the painting which played off the complimentary c olors very well. Some of the colors used most included : red, orange, blue, and purple, green, yellow. The colors were also very natural and consistent with being realistic. The colors blended very well and contrasted making a very alive background that made you feel as if you were there in this big field and wind blowing in your face and he ocean being close off of the Classified.Lastly one element that brings in the painting together is line which provides many things to help create peace, action, and variety. In the painting the balance of having visible and implied lines help to truly evoke the emotion of the painting and as well as the representation that this is semi realistic but Just an impression and not a duplicate of the exact scene seen. The painting is not only painted but created by shapes that tie in the picture in that all at oneness a painting possesses. There are diagonal lines leading to the saturated red shrubbery creating action.The vertical line that the tree p resents counteracts the horizontal line of the Classified and horizon. This creates for an amazing painting that is pleasant to ones eye. The painting contains numerous amounts of blurred lines. The horizontal line helps to create the horizon which further creates depth and evokes the gradation presented which is the dark yellow sun setting and playing of the white of the sky and the sun disappearing . This also creates the distinctive path room the castle to the ocean and a depth perception that there is a beach off of the Classified.The horizontal lines in the ocean portray its mistiness. Open lines all blended in together. Lastly though we must consider line plays an important role in paintings, because this is a impressionist painting, color is placed in a higher role. All in all we must take in the culture of the world through art and history and anything else that helps understand each other and further evolve society maybe one day we will create or further improve the tools t hat help us describe paintings or anything else.