Monday, September 30, 2019

Primary Data Essay

Primary data is that which is obtained by soliciting direct responses from individuals being queried. These individuals are reporting their personal experience, attitudes and feelings. Primary data is the outcome of interviewing and survey methods. Secondary data is information obtained by reviewing the existing academic literature consisting of studies that have been done, analyzing what is â€Å"out there†, and determining trends or patterns of evidence from many studies. Problems with primary data include the possibility that the research design is limited in the fact that it is given to a strictly controlled, limited group, which may not be representative of the overall population. The results from a convenience sample cannot be generalized to the population. Factors including but not limited to gender, nationality, economic situation and others could be expected to impact the effectiveness of application of results to ‘real world’ situations. Sometimes researchers choose to disregard their own interpretations and to accept those of respondents at face value. This can be cozy but may lead to collusion: Atkinson has warned of the dangers of â€Å"romanticizing† respondents’ accounts (Anastas, 12004). Problems with secondary data is that the researcher was not personally involved and does not know how relatively rigorously the research was done; this may compromise his/her observations and analysis. Different methods used in qualitative research furnish parallel datasets, each affording only a partial view of the whole picture; this is a natural feature of qualitative research, in that it acknowledges that there are different views of reality which have equal validity. Therefore, it is effective to look for results that are comparable rather than in agreement, and which may be mutually supportive.

Sunday, September 29, 2019

Effect of Red Bull Energy Drink

International Journal of Sport Nutrition and Exercise Metabolism,? 2007,? 17,? 433-444?  ©? 2007? Human? Kinetics,? Inc. Effect of Red Bull Energy Drink on Repeated Wingate Cycle Performance and Bench-Press Muscle Endurance Scott C. Forbes, Darren G. Candow, Jonathan P. Little, Charlene Magnus, and Philip D. Chilibeck The purpose of this study was to determine the effects of Red Bull energy drink on Wingate cycle performance and muscle endurance.Healthy young adults (N = 15, 11 men, 4 women, 21  ± 5 y old) participated in a crossover study in which they were randomized to supplement with Red Bull (2 mg/kg body mass of caffeine) or isoenergetic, isovolumetric, noncaffeinated placebo, separated by 7 d. Muscle endurance (bench press) was assessed by the maximum number of repetitions over 3 sets (separated by 1-min rest intervals) at an intensity corresponding to 70% of baseline 1-repetition maximum. Three 30-s Wingate cycling tests (load = 0. 075 kp/kg body mass), with 2 min recover y between tests, were used to assess peak and average power output.Red Bull energy drink significantly increased total bench-press repetitions over 3 sets (Red Bull = 34  ± 9 vs. placebo = 32  ± 8, P < 0. 05) but had no effect on Wingate peak or average power (Red Bull = 701  ± 124 W vs. placebo = 700  ± 132 W, Red Bull = 479  ± 74 W vs. placebo = 471  ± 74 W, respectively). Red Bull energy drink significantly increased upper body muscle endurance but had no effect on anaerobic peak or average power during repeated Wingate cycling tests in young healthy adults. Key Words: anaerobic power, caffeine, exercise Red Bull energy drink is purported to improve some aspects of performance (i. . , reaction time, concentration, and alertness) in exercising individuals (1). The primary ergogenic ingredient in Red Bull is caffeine. Acute caffeine ingestion of 2–9 mg/kg body weight during aerobic exercise increases endurance and reduces fatigue (11, 12, 25, 37, 46). Most resear ch on caffeine ingestion has focused primarily on its effects during short-term or extended aerobic exercise (23), with numerous studies supporting an ergogenic effect from caffeine on exercise time to exhaustion (17, 22, 29, 46, 48), maximal power output (32, 37), and performance time (9, 41).The effects of caffeine ingestion on anaerobic performance (i. e. , Wingate cycle power) and muscle endurance Forbes, Little, Magnus, and Chilibeck are with the College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada S7N 5B2. Candow is with the Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada S4S 0A2. ? ? 433 434 Forbes? et? al. (i. e. , total repetitions for lifting a given resistance over multiple sets) are less evident, however. Regarding anaerobic performance, Collump et al. 16) showed that caffeine ingestion (250 mg) 1 h before 100-m freestyle swimming significantly improved performance time. In addition, caffeine ingestion (250 mg) 30 min before exercise resulted in significant improvements during a maximum-power 6-s cycle sprint against various loads (2). Greer et al. (28), however, observed no improvement in maximum force output or reduced fatigue during repeated Wingate anaerobic tests with 6 mg/kg of caffeine 1 h before exercise; Collomp et al. (15) found no improvement during a single 30-s Wingate test with 5 mg/kg of caffeine 60 min before exercise; and Crowe et al. 18) found that 6 mg/kg of caffeine given 90 min before two 60-s cycling bouts had no effect on peak power or work output. Regarding muscle endurance, Kalmar and Cafarelli (35) reported that 6 mg/kg of caffeine given 1 h before exercise significantly increased submaximal isometric-contraction time. In contrast, Beck et al. (7) and Jacobs et al. (34) found no improvement in bench-press or leg-press muscle endurance (i. e. , total repetitions of lifting a weight corresponding to 70–80% one-repetition maximum [1-RM]) 60–90 min after su bjects consumed ~2. 5–4 mg/kg of caffeine.Although it is difficult to compare results across studies, possible explanations for these inconsistent findings might include the dose of caffeine used, subject training status, timing of caffeine ingestion, habitual caffeine consumption, and exercise modality. Although the mechanisms explaining the possible ergogenic effects of caffeine remain to be elucidated, plausible theories include caffeine’s ability to act as an adenosine-receptor antagonist (18, 19, 23), increase plasma epinephrine concentrations (33, 45), enhance calcium release and reuptake from the arcoplasmic reticulum (40), and alter plasma potassium concentrations (18). These mechanisms most likely occur with larger caffeine doses, and it is unclear whether smaller doses would be as effective. Recently it was found that larger doses of caffeine might have negative health consequences such as impaired glucose tolerance (6). We therefore decided to study the effe cts of a smaller dose of caffeine (2 mg/kg) in the form of Red Bull energy drink. To date, only 1 study has examined the effects of Red Bull energy drink on anaerobic exercise performance in young adults.Alford et al. (1) found a significant increase in maximum speed during an all-out cycling test after Red Bull supplementation (80 mg caffeine). Our purpose was to determine the effects of Red Bull energy drink on a more standardized test of anaerobic performance (i. e. , Wingate cycle test) and on muscle endurance (i. e. , maximal repetitions during bench-press lifting). These tests were used to simulate the demands of sports such as ice hockey that involve repeated bursts of activity or muscle endurance of both the lower and upper body.Energy-drink consumption and caffeine supplementation are very common in this type of sport (38). We hypothesized that Red Bull supplementation would increase Wingate anaerobic peak and average power and bench-press muscle endurance. Methods Particip ants Sixteen healthy physically active participants (12 men, 4 women, 24  ± 6 y old) volunteered for the study. They participated in moderate physical activity 2 or 3 Effect? of? Red? Bull? on? Athletic? Performance? ? 435 times per week and were instructed not to change their diets or physical activity patterns before or during the study.All subjects were required to fill out a Physical Activity Readiness Questionnaire, which screens for health problems that might present a risk with performance of physical activity (52). The study was approved by the University of Saskatchewan Biomedical Research Ethics Board for research in human subjects. Participants were informed of the risks and purposes of the study before they gave their written consent. Experimental Design The study used a double-blind repeated-measures crossover counterbalanced design in which participants were randomized to supplement with Red Bull or placebo and receive the opposite treatment 7 d later.All participant s were required to come to the laboratory on 2 occasions before the start of the study, once to determine their bench-press 1-RM strength and again 3 d later for familiarization with the experimental design by performing 3 sets of bench-press repetitions to fatigue (separated by 1-min rest intervals) at an intensity corresponding to 70% 1-RM, followed by three 30-s Wingate cycle tests (separated by 2-min rest intervals) at a load corresponding to 0. 075 kp/kg body mass (4). There was a 10-min rest period between the bench-press endurance tests and Wingate cycle tests.Three days after the familiarization trial, subjects were randomly assigned to supplement with Red Bull (2. 0 mg/kg caffeine) or placebo (noncaffeinated Mountain Dew, lemon juice, water) 60 min before performing repeated-bench-press endurance tests and Wingate cycle tests. Seven days after this initial supplementation and testing session, subjects returned to the laboratory and ingested the opposite supplement drink and performed the same exercises in the same order. They were instructed to refrain from caffeine for 48 h, physical activity for 24 h, and food and drink for 3 h before testing.The 7-d counterbalance was chosen to allow subjects adequate recovery between exercise tests. The 48 h of caffeine withdrawal before testing would be adequate because the half-life of caffeine is about 4–6 h (24). The dependent variables measured were bench-press endurance, peak power during repeated Wingate tests, and average power over 3 Wingate tests. Physical activity level and habitual caffeine consumption were recorded before the study through the questionnaire. The exercise tests were chosen to simulate sports that involve repeated bursts of high-intensity activity, such as ice hockey.For example, the 30-s Wingate tests with 2 min rest between tests simulate the work-to-rest ratio of typical hockey shifts. Time–motion analyses indicate skating times of 30–40 s between rest intervals of either whistle stops or time on the bench. Whistle stops last about 27 s, whereas time on the bench is about 227 s, for an average rest interval of about 2 min (27, 47). The bench-press test simulates upper body work during ice hockey, such as occurs during corner play and occasionally fighting (26).A caffeine-containing supplement is ideal to evaluate for this type of sport because caffeine-containing supplements are the most popular type of supplement ingested by ice hockey players (38). 436 Forbes? et? al. Supplementation Red Bull and the placebo were identical in caloric content, volume, and taste. Supplements were provided to each participant 60 min before exercise in an opaque water bottle and consumed in the presence of a researcher. Sixty minutes was chosen because this is the approximate time it takes for caffeine concentration to reach its peak after oral ingestion (23). The caffeine dose of 2. mg/kg was chosen because it is an approximate amount shown to increase muscl e performance (7) and reduce fatigue in young healthy adults, higher doses might be associated with impaired glucose tolerance (6), it is the maximal daily dose of commercial energy drinks considered safe by Health Canada (30), and this dose allowed our heaviest subjects to consume approximately 2 cans of Red Bull, which is the maximal amount recommended on the Red Bull label. Ingredients in the Red Bull energy drink are shown in Table 1. Muscle Strength and Endurance The procedures for determining bench-press 1-RM have previously been described (13).All bench-press testing was done on a bench-press machine (Lever chest-press machine, Winnipeg, MB, Canada). Reproducibility of our 1-RM test, expressed as a coefficient of variation, was 1. 9% (14). For bench-press muscle endurance, participants performed 3 sets of bench-press repetitions to volitional fatigue, separated by 1-min rest intervals, at an intensity corresponding to 70% 1-RM. Reproducibility of the bench-press endurance tes t was assessed by testing 15 subjects 3 d apart. The coefficient of variation was 1. 5%. Anaerobic Power Peak power and average power were assessed using repeated Wingate cycleergometer tests.Blood lactate concentration was measured at rest, immediately after each Wingate cycle test, and 2 min postexercise using an automated lactate analyzer (Accutrend Lactate, Roche Diagnostics, Mannheim, Germany) according to the manufacturer’s instructions. Ten minutes after the bench-press endurance test, each subject was positioned on the Wingate cycle ergometer, and seat height, handlebar Table 1 Red Bull Energy-Drink Ingredients Ingredient Sugar Caffeine Taurine Glucuronolactone Niacin Pantothenic acid Vitamin B6 Riboflavin Vitamin B12 Amount (per kg body mass) 0. 65 g/kg 2. 0 mg/kg 25 mg/kg 15 mg/kg 0. 45 mg/kg 0. 15 mg/kg 0. 5 mg/kg 0. 04 mg/kg 0. 025  µg/kg Effect? of? Red? Bull? on? Athletic? Performance? ? 437 height and position, and toe straps were adjusted based on the settin gs determined during the familiarization trial. Subjects were instructed to cycle at a slow pace against zero resistance for 5 min. Five seconds before data collection, they were instructed to pedal at maximal rate to ensure optimal power and force production at the beginning of the test and to continue cycling at a maximal speed for the duration of the 30-s test at a load corresponding to 7. 5% of their body mass (4). Subjects were verbally encouraged throughout the test.This procedure was repeated for 3 tests, with 2 min of active rest against zero load between tests. Reproducibility of peak and average power was determined by testing 10 subjects 3 d apart. The coefficients of variation were 4. 1% for peak power and 3. 6% for average power. Statistical Analyses A 2 (caffeine-consuming subjects vs. caffeine-naive subjects) ? 2 (supplement: Red Bull vs. placebo) ? 3 (exercise sets) ANOVA with repeated measures on the last 2 factors was used to assess differences between conditions f or benchpress repetitions and for peak and average power during the Wingate tests. A 2 (caffeine-consuming subjects vs. affeine naive subjects) ? 2 (supplement: Red Bull vs. placebo) ? 5 (blood lactate at 5 time points) ANOVA with repeated measures on the last 2 factors was used to assess changes in blood lactate concentration. To determine whether 1 familiarization trial was adequate to eliminate any effects of learning over time, we ran a 3 (set) ? 2 (time) repeatedmeasures ANOVA to determine whether there were differences across sets for Wingate tests and bench-press tests between the familiarization and placebo trials. Tukey’s post hoc tests were used to determine differences between means. Statistical significance was set at P ? 0. 05.All results are expressed as mean  ± standard deviation. Statistical analyses were carried out using Statistica, version 5. 0 (StatsSoft Inc. , Chicago). Results Of the original 16 subjects who volunteered, 15 completed the study. One mal e subject withdrew because of time constraints. Seven subjects were correct in perceiving that they were ingesting Red Bull or placebo, with the remaining subjects unsure. Before testing, 8 subjects were caffeine naive, 4 reported consuming 200 mg/d. There were no side effects reported from the exercise testing, Red Bull energy drink, or placebo.There were no time main effects or set ? time interactions between the familiarization trial and the placebo trial, indicating that the familiarization trial was adequate to eliminate any learning effects. Subjects who regularly consumed caffeine did not differ from caffeine-naive subjects for any of the tests or for their responses to Red Bull versus placebo (i. e. , there were no group ? supplement interactions). There was a supplement main effect for bench-press endurance, whereby the number of repetitions over the 3 sets was greater in the Red Bull condition than with placebo (Red Bull = 34  ± 9 vs. lacebo = 32  ± 8 repetitions over the 3 sets, P = 0. 031; Figure 1). There was a set main effect for bench-press endurance, Wingate peak power (Figure 2), and Wingate average power (Figure 3); that is, performance dropped across sets as 438 Forbes? et? al. would be expected (P < 0. 05). There were no differences between Red Bull and placebo for performance across sets during the Wingate tests (peak and average power: Red Bull = 701  ± 124 W vs. placebo = 700  ± 132 W and Red Bull = 479  ± 74 W vs. placebo = 471  ± 74 W), and there were no supplement ? et interactions for any of the exercise tests (Figures 2 and 3). There was a time main effect for blood lactate (mmol/L) during repeated Wingate tests (P < 0. 01; baseline: Red Bull: 4. 2  ± 1. 3 vs. placebo 3. 6  ± 1. 0; after test 1: Red Bull 7. 4  ± 2. 4 vs. placebo 6. 6  ± 1. 8; after Test 2: Red Bull 9. 0  ± 2. 9 vs. placebo 8. 9  ± 3. 4; after Test 3: Red Bull 9. 3  ± 4. 2 vs. placebo 8. 1  ± 4. 7; and 2 min postexercise: Red Bull 9. 2  ± 3. 0 vs. placebo 7. 9  ± 2. 4), with no differences between Red Bull and placebo (Figure 4). Post hoc analyses indicated that blood Total repetitions over 3 sets of bench press 5 40 35 30 25 20 15 10 5 0 Red Bull placebo * Figure 1 — Bench-press repetitions across sets, mean  ± standard deviation. Units are repetition number. Repetition number was determined as the total number of repetitions over 3 sets of bench-press exercise at 70% of 1-repetition maximum, 1 min of rest between sets. *Number of repetitions performed during the Red Bull condition was greater than the number of repetitions performed during the placebo condition (P = 0. 031). 850 Red Bull placebo Wingate peak power (W) 800 750 700 650 600 550 500 450 400 Set 1 Set 2Set 3 Figure 2 — Wingate peak power across sets, mean  ± standard deviation. Peak power was determined by the highest power output during each of 3 sets of 30-s Wingate tests, with 2 min of rest between tests. There were no differenc es between Red Bull and placebo conditions. There was a main effect for set, with Set 1 higher than Set 2 (P = 0. 021) and Set 2 higher than Set 3 (P < 0. 01). Effect? of? Red? Bull? on? Athletic? Performance? ? 439 700 Wingate average power (W) 650 600 550 500 450 400 350 300 250 200 Set 1 Set 2 Red Bull placebo Set 3Figure 3 — Wingate average power across sets, mean  ± standard deviation. Average power was determined during each of 3 sets of 30-s Wingate tests, with 2 min of rest between tests. There was a set main effect, with Set 1 higher than Set 2 (P < 0. 01) and Set 2 higher than Set 3 (P < 0. 01). 14 12 Red Bull placebo Lactate (mMol/L) 10 8 6 4 2 0 baseline after Set 1 after Set 2 after Set 3 2 min post Figure 4 — Blood lactate concentration before and after each set of 30-s Wingate tests (separated by 2 min of recovery) and 2 min postexercise, mean  ± standard deviation.Blood lactate values were determined from fingertip blood samples. There was a set mai n effect for lactate (P < 0. 01). Blood lactate concentration increased from baseline to after Set 1 (P < 0. 01) and from after Set 1 to after Set 2 (P = 0. 016). Lactate values after Set 2 were similar to lactate values after Set 3 and 2 min after Set 3. lactate concentration was elevated above baseline after each Wingate test and at 2 min after the last Wingate test (all P < 0. 01). Blood lactate concentration increased from baseline to after Test 1 (P < 0. 01) and from after Test 1 to after Test 2 (P = 0. 16). Lactate values after Test 2 were similar those after Test 3 and 2 min after Test 3. Discussion This is the first study to investigate the effects of Red Bull energy drink on upper body muscle endurance and anaerobic cycle performance in young adults. Results 440 Forbes? et? al. showed that Red Bull energy drink significantly increased total bench-press repetitions over 3 sets compared with placebo but had no significant effect on peak or average power or blood lactate conce ntration during repeated Wingate cycling tests. The main active ingredient in Red Bull energy drink is caffeine.Although the mechanisms explaining the ergogenic effects of caffeine are not fully known, plausible theories include the antagonism of adenosine receptors (18, 23, 42) leading to an increase in central-nervous-system activation (54) and plasma epinephrine concentrations (45), enhanced calcium release and reuptake from the sarcoplasmic reticulum (40) affecting skeletal-muscle excitation–contraction coupling (42), and the alteration of plasma potassium concentrations (18, 39). Caffeine has been shown to reduce plasma potassium levels compared with placebo during exercise (39).The increased intracellular potassium concentration coupled with lower extracellular potassium might help maintain membrane contractility during exercise (39). Our results of a greater increase in bench-press repetitions over 3 sets from Red Bull ingestion (2. 0 mg/kg), but no single set effect, expand the findings of Beck et al. (7), who found no effect of a caffeine-containing supplement (2. 4 mg/kg) on single-set bench-press repetitions. For the present study, bench-press muscle endurance was assessed by the total number of repetitions over 3 sets at 70% 1-RM separated by 1-min rest intervals.In contrast, participants in the Beck et al. (7) study performed a single set of bench-press repetitions at 80% 1-RM. Differences in supplement composition, study design (crossover vs. cross-sectional), and gender might also explain these different results. In addition, we cannot conclude with certainty that the greater increase in bench-press repetitions from Red Bull energy drink is a result solely of caffeine, because Red Bull contains other ingredients (see Table 1) such as carnitine, B vitamins, and taurine.The effectiveness of carnitine is controversial, with most studies showing no benefit but some showing a benefit for increased fat metabolism and enhanced recovery from exer cise stress (for reviews, see 10 and 36). These ergogenic effects might help during aerobic endurance exercise; however, it is doubtful that a benefit would be provided by acute supplementation before high-intensity exercise. Carnitine supplementation has no effect on high-intensity exercise performance (i. e. five 90-m swims separated by 2-min rest intervals) (53) or metabolic response to high-intensity exercise (i. e. , five 1-min cycle sprints separated by 2-min rest intervals) (5). The B vitamins are important for chronic adaptation to exercise training but most likely would have minimal influence when taken before an acute exercise session (55). Although carnitine and the B vitamins might not be ergogenic for the exercise tests used in the current study, taurine might exhibit beneficial effects.Taurine, a sulfonic amino acid found primarily in skeletal muscle (31, 44), has been shown to increase force production in skinned muscle fibers in a rodent model (3), possibly through i ncreased calcium release from the sarcoplasmic reticulum and increased calcium sensitivity for excitation–contraction coupling. Others have suggested that taurine might exhibit protective effects against cellular stress such as exercise by acting as a free-radical scavenger (49).In humans, taurine supplementation (6 g/d) significantly increased exercise time to exhaustion, VO2max, and maximal workload during cycle-ergometer exercise (56). Nonetheless, the amount of taurine administered before exercise in the current study was relatively low, ranging from 1 to 2 g. Therefore, it is doubtful that it would have significantly affected performance. Effect? of? Red? Bull? on? Athletic? Performance? ? 441 Red Bull energy drink had no effect on anaerobic power measures. These findings support those of Beck et al. 7), who found no effect from a caffeine-containing supplement on peak or average power output in young adults. Although it is unclear why these caffeine-containing supplemen ts had no greater effect on anaerobic power output compared with the findings of others (2, 16), possible explanations might include the caffeine dose used, caffeine habituation, and individual training status. The caffeine dose used in the current study (2. 0 mg/kg) and that of Beck et al. (7) of 2. 4 mg/kg might have been too low to observe an ergogenic effect on anaerobic-power measures.Regarding caffeine habituation, most subjects in the current study were caffeine naive; however, 7 of 15 subjects were caffeine users, with 4 consuming 200 mg caffeine per day. The Red Bull energy drink provided approximately an additional 150 mg caffeine. One previous study suggested that caffeine might not be ergogenic in habitual caffeine consumers as a result of caffeine saturation (50). Several studies have shown, however, that habitual caffeine intake does not affect the ergogenic benefits of caffeine (8, 20, 21, 43, 51).In agreement with these studies, we did not find any differences in res ponse to the Red Bull energy drink between caffeineconsuming subjects and caffeine-naive subjects. Finally, in examining the effects of caffeine ingestion on anaerobic performance in trained and untrained swimmers, Collump et al. (16) observed a decrease in 100-m swim time in the trained swimmers but no effect in the untrained swimmers. We suggest that the variations in subject training status might explain the lack of consistency across studies. Most studies that report positive effects from caffeine on naerobic exercise have used well-trained subjects (16, 20). The results of the current study suggest that moderately active individuals experience no anaerobic benefit from caffeine through Red Bull energy-drink ingestion. In summary, the results of the present study indicate that Red Bull energy drink increases upper body muscle endurance but has no effect on Wingate anaerobic power. Red Bull energy drink is commonly ingested in the hope that it will increase exercise performance. 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Performance? ? 443 26. Green, H. J. Meta bolic aspects of intermittent work with specific regard to ice hockey. Can. J. Appl. Sport Sci. 4:29-34, 1979. 27. Green, H. J. , P. Bishop, M. Houston, R. McKillop, R. Norman, and P. Stothart. Timemotion and physiological assessments of ice hockey performance. J. Appl. Physiol. 40:159-163, 1976. 28. Greer, F. , C. McLean, and T. E. Graham. Caffeine, performance, and metabolism during repeated Wingate exercise tests.J. Appl. Physiol. 85:1502-1508, 1998. 29. Greer, F. , D. Friars, and T. E. Graham. Comparison of caffeine and theophylline ingestion: exercise metabolism and endurance. J. Appl. Physiol. 89:1837-1844, 2000. 30. Health Canada. It’s Your Health. Available at: http://www. hc-sc. gc. ca/iyh-vsv/alt_ formats/cmcd-dcmc/pdf/caffeine_e. pdf. Accessed December 17, 2006. 31. Huxtable, R. J. Physiological actions of taurine. Physiol. Rev. 72:101-163, 1992. 32. Ivy, J. L. , D. L. Costill, W. J. Fink, and R. W. Lower. Influence of caffeine and carbohydrate feedings on enduranc e performance. Med. Sci. Sports Exerc. 1:6-11, 1979. 33. Jackman, M. , P. Wendling, D. Friars, and T. E. Graham. Metabolic catecholamine, and endurance responses to caffeine during intense exercise. J. Appl. Physiol. 81:1658-1663, 1996. 34. Jacobs, I. , H. Pasternak, and D. G. Bell. Effects of ephedrine, caffeine, and their combination on muscular endurance. Med. Sci. Sports Exerc. 35:987-994, 2003. 35. Kalmar, J. M. , and E. Cafarelli. Effects of caffeine on neuromuscular function. J. Appl. Physiol. 87:801-808, 1999. 36. Karlic, H. , and A. Lohninger. Supplementation of L-carnitine in athletes: does it make sense? Nutrition. 0:709-715, 2004. 37. Kovacs, E. M. R. , J. H. C. H. Stegen, and F. Brouns. Effect of caffeinated drinks on substrate metabolism, caffeine excretion, and performance. J. Appl. Physiol. 85:709-715, 1998. 38. Kristiansen, M. , R. Levy-Milne, S. Barr, and A. Flint. Dietary supplement use by varsity athletes at a Canadian university. Int. J. Sport Nutr. Exerc. Metab . 15:195-210. 39. Lindinger, M. I. , T. E. Graham, and L. L. Spriet. Caffeine attenuates the exercise-induced increase in plasma [K+] in humans. J. Appl. Physiol. 74:1149-1155, 1993. 40. Lopes, J. M. , M. Aubier, J. Jardim, J. V. Aranda, and P.T. Macklem. Effect of caffeine on skeletal muscle function before and after fatigue. J. Appl. Physiol. 54:1303-1305, 1983. 41. MacIntosh, B. R. , and B. M. Wright. Caffeine ingestion and performance of a 1500 meter swim. Can. J. Appl. Physiol. 20:168-177, 1995. 42. Maridakis, V. , P. J. O’Connor, G. A. Dudley, and K. McCully. Caffeine attenuates delayed-onset muscle pain and force loss following eccentric exercise. Pain. 8:237-243, 2007. 43. McLellan, T. M. , and D. G. Bell. The impact of prior coffee consumption on the subsequent ergogenic effect of anhydrous caffeine. Int. J. Sport Nutr. Exerc.Metab. 14:698708, 2004. 44. Nieminen, M. L. , L. Tuomisto, E. Solatunturi, L. Eriksson, and M. K. Paasonen. Taurine in the osmoregulation of th e Brattleboro diabetes insipidus rat. Life Sci. 42:2137-2143, 1988. 45. Norager, C. B. , M. B. Jensent, A. Weimann, and M. R. Madsen. Metabolic effects of caffeine ingestion and physical work in 75-year old citizens. a randomized, double blind, placebo-controlled, cross-over study. Clin. Endocrinol. 65:223-228, 2006. 46. Pasman W. J. , M. A. van Baak, A. E. Jeukendrup, and A. de Haan. The effect of different dosages of caffeine on endurance performance time.Int. J. Sports Med. 16:225-230, 1995. 47. Paterson, D. H. Respiratory and cardiovascular aspects of intermittent exercise with regard to ice hockey. Can. J. Appl. Sport Sci. 4:22-28, 1979. 444 Forbes? et? al. 48. Powers, S. K. , R. J. Byrd, R. Tulley, and T. Callender. Effects of caffeine ingestion on metabolism and performance during graded exercise. Eur. J. Appl. Physiol. 50:301-307, 1983. 49. Redmond, H. P. , P. P. Stapleton, P. Neary, and D. Bouchier-Hayes. Immuno-nutrition: the role of taurine. Nutrition. 14:599-604, 1998. 5 0. Tarnopolsky, M. A. , S. A. Atkinson, J. D.MacDougall, D. G. Sale, and J. R. Sutton. Physiological responses to caffeine during endurance running in habitual caffeine users. Med. Sci. Sports Exerc. 21:418-424, 1989. 51. Tarnopolsky, M. A. , and C. Cupido. Caffeine potentiates low frequency skeletal muscle force in habitual and nonhabitual caffeine consumers. J. Appl. Physiol. 89:1719-1724, 2000. 52. Thomas, S. , I. Reading, and R. J. Shephard. Revision of the Physical Activity Readiness Questionnaire (PAR-Q). Can. J. Sport Sci. 17:338-345, 1992. 53. Trappe, S. W. , D. L. Costill, B. Goodpaster, M. D. Vukovich, and W. J. Fink.The effects of L-carnitine supplementation on performance during interval swimming. Int. J. Sports Med. 15:181-185, 1994. 54. Williams, J. H. Caffeine, neuromuscular function and high-intensity exercise performance. J. Sports Med. Phys. 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Saturday, September 28, 2019

Free African Americans Essay

The Antebellum period had a huge impact on the free African American people. The Antebellum period is the time that is pre-Civil War and post-War of 1812. The United States was expanding to a more powerful nation and slavery was the biggest industry in their economy. During this period of time, African Americans had to deal with many obstacles/adversities as free blacks in all regions of the United States. The regions known as, in the northern, upper south, deep south, and far west regions of the United States was where the free African American encountered different and similar situations and experiences. Throughout history the north always was known as the first region that freed slaves. The northern states didn’t us the same economic methods as the southern states and the far west. They adopted a new way of making money. According to The African American Odyssey, â€Å"Between 1860, a market revolution transformed the north into a modern industrial society. † This new method changed economy for the north until present day. This was a new age of industry and the production of factories. Slavery was not needed as much as the southern states where they had good sun to cultivate and profit from crops such as cotton. Even though this new method lightened the idea of slavery in the north, the freedom for blacks was still limited. Whites did not want to deal with blacks so they enforced new black laws in which resulted in the segregation of school, communities and any other public uses. Free black men had limited voting rights where they barely had any rights to vote. Most of all these black laws impacted the employment level to a low gradient for the free blacks in the north. This battle for employment had many negative impacts on free Black’s ways of life. Families were tarnished under the pressure of providing for their families with the scarcity of jobs. They enforced fugitive slave law where the white slave masters can hunt and recapture runaway slaves from the south. This made life difficult and filled the free blacks with fear because they were more prone to be wrongfully enslaved. Like the south the whites did not want to deal with blacks whatsoever. Irish immigrants were taking all the jobs away from the blacks many blacks had unskilled jobs such as being barbers and shoemakers. The free African American upper south region did have similar experiences as the north but much more were different. Though they shared similar churches family businesses and fraternities the upper south was still separated by the idea of slavery and the different economic methods. The impact of slavery created different communities. The free blacks in the north lived with other free Blacks while in the upper south; the free Blacks lived with slaves. The fugitive slave laws had a bigger impact on the upper south than the north. The free black was definitely more prone to be enslaves. Many sheriffs would harass and arrest free blacks randomly on profiling them as runaway slaves. They did have a tool known as free papers that was proof for their freedom. But these papers were useless most of the time because they constantly had to be renewed. These free papers impacted the everyday life of African Americans because they had to make sure that their papers weren’t stolen, lost, or tarnished. The free Blacks had fewer freedoms. They could not vote at all and they had problems going outside at night. They could not congregate in groups and had no rights to bear arms. Life as a free Black person was tougher than the north because of the low employment rates downgraded again due to the Irish immigrants taking their jobs. Their jobs were different during the antebellum period. Many people were maids and servants and washers. Upper south institutions where tarnished and almost did not exist. Black churches were overran by white ministries and left the black ministers with no opportunities to practice on their careers. Schools were almost absent. They were low funded whereas many blacks in the upper south were left uneducated. There were no schools and no jobs which gave success to the whites on preventing the advancement of the free blacks. Unlike the north and the upper south, the Deep South barely had any free blacks despite the fact that the population of African Americans in the Deep South was enormous. There were many incidents of racial mixing with slave owners and the female slaves. Diversity was there but slavery still kept their children enslaved. They usually had a choice to buy their way out of slavery. Many of the free slaves did not have their own separate identity from the white slave owners. Many of the free blacks were just like the whites. They were accepted in the churches. Many wealthy free blacks were educated due to the establishment of private schools. Unlike the north and the Upper South, they had better skilled jobs such as carpentry and tailors. Many whites began to overlook the success of the free African American In the Deep South and made it even more impossible to live. Unlike the North, Upper South, and the Deep South, the Far West absolutely did not want anything to do with free Blacks. The black laws in the Far West were made to ban all free Blacks from settling in their region. The Gold Rush of 1849 resulted in the migration of many White and free Black men to settle out west in states like California and Oregon. The Far west was known to be more multicultural and have multicultural communities. Many blacks had the same jobs of that the free Blacks from the regions had except for the gold mining. Many Blacks prospered from gold. Slavery was a huge propaganda in the upper south and the whole south in general. It was a reality that all African American whether free or enslaved could not avoid. The northern states were gradually enhancing their advancement in the idea of acceptance and coexistence with the Whites in the US. The north had at least a bit of a head start for the search of equality in the U. S. The conditions of living might have been similar and different in many ways but this time all came to an end once the fugitive slave laws were enhanced. Many free African Blacks were enslaved and wrongfully accused to be slaves. The new laws were undisputed and changed the Blacks’ idea of freedom and fight for equality Work Cited Hine D, The African American Odyssey (2011). Combined Volume, 5th Edition. New Jersey: Prentice Hall.

Friday, September 27, 2019

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

Flatland - Essay Example The mindset which is accepted, even though it creates a sense of status in society, is still flat and unable to develop into new ideas. The point which Abbott makes shows how this mentality holds back information about potential ways of living, innovations and the overall progression of the society, specifically because of social status and rejection of new ideas. Background of the Work The background of â€Å"Flatland† is based on the specific social and religious conditions that were associated with the Victorian society during the time of Abbott. Abbott wrote and premiered his novel in the 1880s in England, specifically with the focus of approaching the trends in literature that were based on questioning the social status and divisions that were currently in society. The book arose not only from the observations in society, but also associated with the personal interactions which Abbott had before this time. In the 1840s, Abbott was known to defend Christianity against idea ls such as superstition and irrational expectations that were a part of the religion. Abbott believed instead, that all information was based on logic and personal experience. This was followed with the experiences that Abbott associated with not only in religion, but also in defense of women, social rights and divisions between the rich and poor which were a strong component of Victorian society (Zeller, 95). Defining the Mentality of Society The aspects that Abbott included with his defenses against religion, logic and the imperialism of society are reflected in â€Å"Flatland,† not only with the direct connotations to problems in society. Abbott directly refers to the generalized problems to the acceptance of ideas that were limited to a dimension and which led to ignorance within society. Abbott shows this through two main ideals. The first is with the interaction of line land, specifically as he moves into a one-dimensional world. The second is the recognition of the oth er dimensions that are associated beyond flatland, specifically which the narrator sees but is rejected by society. These two main narrative ideas show how the social standpoint is limited by ignorance and what is seen physically and known. Even though there may be other outside ideals, Abbott shows through his narrative that the mentality of society is limited to only what they see. There are several examples that Abbott uses to show the ignorance of society and how this limits possibilities. This is done with the social status of those in society, speaking with religious leaders and with presenting the ideas to royalty. For instance, when trying to describe Flatland to Lineland, there is an immediate rejection of what is real. The king rejects this because of the known laws, accepted religion and the practices in society that are accepted. This is followed by the limitations because there hasn’t been an experience with this dimension. Even though the narrator sees the life in Lineland as dull, there isn’t the capability of understanding what it would be like to live outside of this from those who exist in that reality. The lines then become a metaphor for the reality, religion, rules and belief systems that limit the ideals. â€Å"King: Exhibit to me, if you please, this motion from left to right. I: Nay, that I cannot do, unless you step out of your Line altogether. King: Out of my line? Do you mean out of the world? Out of Space? I: Well, yes. Out of YOUR

Thursday, September 26, 2019

Developing Professional Practice and Using Information in HR Assignment

Developing Professional Practice and Using Information in HR - Assignment Example 1. What are the key social trends that might be causing these problems? Try to find facts and figures to support your answer. The key social trends include the fact that employees have largely been unwilling to apply their own selves towards work and this is the reason why the employee turnover rate is quite high at Davidsons. Davidsons is a name that is renowned throughout the United Kingdom and all out efforts are required by its management to make sure that the employees and workers remain on board no matter how tough or trying the circumstances turn out to be. The social trends need to change and this is something that will work in the favour of Davidsons because it will be able to derive the benefits and extract profits in the future. The facts and figures that can be used to support this anomaly surround the basis of understanding where Davidsons is going wrong and how it can have a better and more constructive relationship with the employees that join its ranks. The social trends can only get better when there is more energy and dynamism shown by the Davidsons’ top hierarchy so that success sh all happen in an easy way. Perhaps the attitudes of the officials are one thing that must be deciphered in an adequate sense because this sets the basis for achieving harmony and success across the board. It is also one of the reasons why Davidsons is losing out on its popularity within the United Kingdom and thus staunch efforts are needed to make amends.... The employment issues will come up time and again if the employees and potential workers know that they will be treated differently, and their domains would be sabotaged by the ones who exist in the workplace realms. The social trends therefore have a huge say in asking the employees where they might like to see changes within the relevant contexts. The social trends essentially dictate the difference between the good initiatives at work and the bad omens which have come about due to a number of factors. On the part of Davidsons, it is of paramount significance to comprehend that these social trends are rectified for the best interests of the employees and so that the new ones also acquaint it from time to time, whilst retaining the old ones. The impact of these social trends on employment issues therefore happen when the company is going through a tough time and there are no friends for its basis in the long run. This is the time when the social trends need to be aligned in such a w ay that there are only benefits to gain from. 3. What would you recommend Davidsons do to address these social trends? Davidsons needs to make a number of changes within its fore as far as the social trends that exist within its fore are concerned. This will mean that the employees need to be given more security which they look forward to receiving at the hands of the Davidsons’ top management. They must feel good when they are at work because higher motivation levels ensure that things are working fine within the realms of Davidsons. I would recommend Davidsons to go all-out in its quest to bring up changes because its own reputation is now at stake. It must make sure that these changes do not hamper its working realms. This

Perfume Brands Calvin Klein & Bvlgari Essay Example | Topics and Well Written Essays - 500 words

Perfume Brands Calvin Klein & Bvlgari - Essay Example CKCC was a Unilever brand until few years back but its licensing agreement was then bought from Unilever by Coty Inc. Calvin Klein perfumes were known for its premium brand value and extremely good fragrance of all kinds. Eternity and Obsessions are the two popular perfume varieties of CK. These two are offered for both men and women. Bvlgari is the Italian luxury goods manufacturer. Like CK, Bvlgari too has wide array of luxury perfumes catering to the needs of men and women. Voile de Jasmin, Aqua, Pour Homme, Omnia and Rose Essentielle are the popular Bvlgari fragrances. All these names are well placed in the premium perfume segment. Together, CK and Bvlgari form the biggest names in the luxury fragrance industry. Main body Behind the huge success of the brands are not just the marketing activities alone. A major part of the success can be attributed to the perfumers who are in continual efforts to develop the best formula that gives the heavenly fragrance. There are basically two types of fragrances based on the skin scents. The first kind emits its own fragrance or forms the major portion of the overall smell. The second kind helps to enhance the skins own scent by giving it a better fragrance. Compared to CK, Bvlgari is more specialized in the second kind which is more unique. Another factor that differentiates both the brands is the customers that they target.

Wednesday, September 25, 2019

Body Image and the Media Article Example | Topics and Well Written Essays - 1250 words

Body Image and the Media - Article Example The magazine is complex, reaching out to many people of different ages. With that in mind, the publishers have to devise a marketing plan that would cater to the people who read the magazine and these readers have a lot of age difference. Therefore, their ads and their articles must be generic enough to accommodate African-American women of all ages. However, they must also be specific enough to cater to African-American women and enable them to identify themselves with the magazine. The magazine also caters to the fact that people of another color would be wanting to read the specific title. This paper attempts to analyze the contents of the magazine. How it is formatted to fit into the tastes of the readers. The first ten pages of the magazine are more on advertisements. As the magazine is catered for American-American women, the advertisements are geared towards women and are mostly of beauty products. Hair product advertisements are also numerous, as it is known that African-American women value their hair a lot. The advertisements feature black women as well. The black women models project the image of being successful, beautiful and having it all. There is also an ad that features a non-African-American woman, but that is the only advertisement that features a non-colored model. It was an advertisement for Loreal. Skin products are also advertised, such as lotions and baby oils. These products promote skin moisture. The skin of African-Americans is quite prone to dryness, and when the skin gets dry, ash-like substances appear on the skin. Thus, the advertisement is understandable as its major clientele needs the product as part of their grooming. There are at least three skin moisturizing products that are advertised in the first ten pages of the magazine.

Tuesday, September 24, 2019

Development and Expansion Strategy of SMART Cars Essay

Development and Expansion Strategy of SMART Cars - Essay Example Acquire new customer by optimizing search engine submissions, introducing online competitions and a free web mail system for SMART car owners and fans. Introducing a secure online transaction service that can be used to buy products and services or apply for finance, with a quick turnaround time of 24 hours. Implementation of actions to enhance and streamline the SMART sites so that they are easier to navigate and offering the customers a richer more rewarding personal experience. Addition of an exclusive owner section with car service record, logbook and special promotions. 2 Terms of Reference This report was commissioned by SMART on December 12th 2005 3 Methodology This report references the following: The Institute of Direct Marketing, SMART Car Handout, 2006. MediaCo, Email Marketing - Opt In Email Marketing. J. S. Fleming and Gail Said Johnson. Designing an Effective Web Page. 2003. 4 Situational Analysis 4.3 Company Analyzes SMART an automobile manufacturing, supply and sales enterprise was established in 1994 and is a wholly owned subsidiary of Daimler Chrysler, with approximately 1200 employees. SMART have dealership networks in 35 countries, with their administrative network in Bblingen Germany and production facility in Hambach France. Its product range exists out of three models, the ForTwo, ForFour and Roadster in hard top and cabrio styles. SMART's key issue has been always been the environment, with guidelines ensuring SMART cars are engineered to protect the environment by being energy efficient and preserving natural resources. SMART's policy starts with development, runs through production, and ends in the recycling of many SMART components. SMART Car UK has a multi-channel approach in selling their relevant products and...Its product range exists out of three models, the ForTwo, ForFour and Roadster in hard top and cabrio styles. SMART's key issue has been always been the environment, with guidelines ensuring SMART cars are engineered to protect the environment by being energy efficient and preserving natural resources. SMART's policy starts with development, runs through production, and ends in the recycling of many SMART components. SMART Car UK has a multi-channel approach in selling their relevant products and services. A customer gets acquainted to products and services by visiting their respective website's www.thesmartcar.co.uk & www.smarttogo.co.uk, and purchasing these products at one of 53 SMART dealerships. In the fiscal year of 2004/5, SMART UK's turnover was 6.8 million and the growth forecast indicate a possible increase rate of 15% for the 2005/6 period, with a total turnover forecast of 7.25 million. SMART's online marketing and promotion contributed towards the sale of 850 units of the total 11000 sales in the UK in 2005. Smart car UK is already a established business with a strong consumer base from which to launch a aggressive marketing strategy to increase its share of the automobile market. Some of its strong points are: SMART car as a new entry to the automobile market offering the consumer the retro unique look.

Monday, September 23, 2019

Collision of the right to privacy and the right to freedom of Essay

Collision of the right to privacy and the right to freedom of expression - Essay Example The verdict of the cases, whether they were in compliance with the Human Rights Act, has been made. A discussion of the European Convention and the acts adopted by the Convention has also been made. An evaluation of the prior laws that helped to mould the Human Rights in Europe is also analyzed in the paper. Human Rights are the set of guidelines laid down by legal bodies and organizations that safeguards the rights and freedoms of human beings. The elementary rights and freedoms, which every human being irrespective of cast creed social stature; are entitled to can be collectively termed as Human Rights. Human Rights include civil rights, freedom of expression, political rights, and also equality before a court of law for uniform generation of justice. Civil, economic, cultural, social and political are the various classification of Human Rights. However, Human Rights, although are made for social benefits are not social rights. Social rights are more like objectives which need to be attained, while Human Rights are objectives or norms which are to be followed. Human Rights are laws which need to be obeyed to maintain the social, cultural and legal balance. The different classification of Human Rights is a contribution to it, as it covers all necessary aspects, which needs to be covered for the well being of the civilians. . The history of human rights can be traced back to thousands of years covering cultural, political, legal and religious aspects. Emperor Ashoka of India issued the 'Edicts of Ashoka' back in 250-270 BC, which is a collection of thirty three inscriptions on pillars, made by the emperor. The edicts, being the first form of Buddhist preaching, were moral in nature and were based on doing basic good deeds. The Magna Carta, formerly known as the English Legal Charter was written in Latin and was issued in 1215. It is one of the important historical examples that developed the English law, to protect the rights of the people against monarchial rule. It influenced the development of constitutional laws and common laws. The British Bill of Rights, 1689 was an act that protected the interest of the people against government actions in the United Kingdom. The Geneva Conventions, and the Lieber Code, 1864 can be described as the initiations that laid the basic foundations of International Humani tarian laws. International Humanitarian laws The Geneva Convention adopted by the International Committee of Red Cross was one of the first attempts to safeguard the interest of individuals fighting in wars. It was revised after the World War II and adopted by the Red Cross Community in 1949. Presently the Geneva Conventions are referred to as the Humanitarian law, under the governance of International Committee of Red Cross. The Universal Declaration of Human Rights (UDHR) was adopted by the United Nations General Assembly in 1948. This is a non binding declaration that was adopted after the World War II. The UDHR may be referred to in any national and international cases, and is considered to be a central component of international humanitarian law. (United Nations, 2008) Human Rights Treaties The International Covenant on Economic, Social and Cultural Rights (ICESCR) and The International Covenant on Civil and Political Rights (ICCPR) were the two most important treaties that were

Sunday, September 22, 2019

Book Review Essay Example for Free

Book Review Essay The novel is about a wolf called Faolan that survives with a friend of his, Edme. There is another wolf called the Prophet that tries to send out wolves to kill Faolan and Edme. They try to find a shelter to try to hide but end up getting spotted by a wolf. They run away and escape from the wolf. After getting away they go out and find the Prophet. They confront him ask ask him why he wants to kill them and he jumps at them and they finally kill the Prophet. The book is associated with the other five Wolves of the Beyond books Lone Wolf, Shadow Wolf, Watch Wolf, Spirit Wolf, and Star Wolf.  I would give the book a 2 because I like the Wolves of the Beyond books. They explain how the wolves survive and how they hunt their prey. The book shows how they grow up and learn to hunt and communicate with the others. I also like how the author makes it feel like something is going to happen like a fight scene. The book also continues the story of the main character, Faolan and gives the wolf a characteristic for each book the author makes. The novel is about a wolf called Faolan that survives with a friend of his, Edme. There is another wolf called the Prophet that tries to send out wolves to kill Faolan and Edme. They try to find a shelter to try to hide but end up getting spotted by a wolf. They run away and escape from the wolf. After getting away they go out and find the Prophet. They confront him ask ask him why he wants to kill them and he jumps at them and they finally kill the Prophet. The book is associated with the other five Wolves of the Beyond books Lone Wolf, Shadow Wolf, Watch Wolf, Spirit Wolf, and Star Wolf.  I would give the book a 2 because I like the Wolves of the Beyond books. They explain how the wolves survive and how they hunt their prey. The book shows how they grow up and learn to hunt and communicate with the others. I also like how the author makes it feel like something is going to happen like a fight scene. The book also continues the story of the main character, Faolan and gives the wolf a characteristic for each book the author makes.

Saturday, September 21, 2019

Prevention Of Pressure Ulcer

Prevention Of Pressure Ulcer Pressure ulcers, or bed sores, or have been affecting humans for ages, and addressing the overall prevention of pressure ulcers is now a prominent national healthcare issue. Despite of all the advances in medicine, surgery, nursing care, pressure ulcers still remains a major cause of mortality. Pressure sore is a common problem among old people and those who are immobilise or limited activity like post-operative and other bedridden patients. (Bergstorm, 2005) Many studies state that elderly are prone for pressure ulcer throughout the world and its becoming a crucial issue (Nakagami et al., 2007). Pressure ulcer can be defined as a type of injury that affects areas of the skin or underlying tissue of the body due to application of too much pressure on it. (Grey et al 2006) It develops as a result of tissue necrosis of the skin over the bony prominence, due to the obstruction of the blood vessels flow caused by the application continual pressure on it. (Lyder, 2003) The total expenditure for the prevention of pressure ulcer is substantially less when compared to its treatment (Lapsley H M and Vogels R, 1996). It can cause severe infirmity and high health-care expenditure. The estimated annual expense for the prevention and treatment of pressure ulcers has been expected nearly  £1.4 to  £2.1 billion in the United Kingdom and is measured as a massive economic problem (Bennet et al., 2004). After cancer and cardio vascular disease, pressure ulcers are the third most money consuming disease (Schoonhoven et al., 2002) According to European Pressure Ulcer Advisory Panel (EPUAP) the occurrence rates of pressure ulcers are ranging from 8-23%. In acute care hospitals in the western countries the reported prevalence has wide-ranging between 9-22%. Improving the standard of pressure ulcer care could in ¬Ã¢â‚¬Å¡uence the estimated annual expenditure and quality of life (Tannen A et al., 2004). According to Whittington et al (2000) the prevalence of 15% of pressure ulcers are recorded on admission, whereas for the 60% of the individuals there was no specific information about the presence or absence of the pressure ulcers. In another study, it is clear that 12.8% have already had the infirmity on their admission. According to Rycroft-Malone, (2000) pressure ulcers can develop at any area of the body, but commonly occurs over bony prominences. ( Murdoch, 2002; Jones, 2001) The areas can supposed to develop pressure sores are sacrum, heels, elbows and back of the head. The appearance of pressure sore is very fast and hence the early assessment and steps to prevent is very necessary (George and Malkenson, 2008). Pressure intensity and duration are the two main factors for the pressure ulcer formation because of pressure. Pressure intensity is the volume of external pressure applied on internal tissues whereas duration is the amount of external force is sustained by internal tissues (Cullum et al., 2000) According to NICE guidelines (2003) the risk factors influencing to develop pressure ulcer in an individual includes intrinsic risk factors and extrinsic risk factors. The intrinsic risk factors such as reduced mobility or immobility, sensory impairment, acute illness, level of consciousness, extremes of age, vascular disease, severe chronic or terminal illness, previous history of pressure damage, malnutrition and dehydration. And extrinsic risk factors are pressure, shear, and friction. Shear is defined as the applied force that can cause an opposite, parallel sliding motion in the planes of an object. The amount of pressure exerted has got a direct affect on Shear. (Pieper B, 2007, Nix DP, 2007). Friction is defined as a superficial, mechanical force directed against the epidermis, resulting in increased susceptibility to ulceration (Pieper B., 2007). Pressure ulcers are classified according to different stages as defined by the National Pressure Ulcer Advisory Panel (NPUAP). Originally there were only four stages, but in February 2007 these stages were revised and two more categories such as deep tissue injury and unstageable were added to it. Stage I -Redness of a localized area, usually over a bony prominence. Darkly pigmented skin may not have visible blanching; as its colour may differ from the surrounding area. Stage II loss of partial thickness dermis showing as a shallow open ulcer with a red or pink wound bed, without any slough. It may also present as or open or ruptured serum filled blisters. Stage III The layer of subcutaneous fat may be seen but bone, muscle or tendons are not exposed. Slough may be present but does not cover the depth of tissue loss. Stage IV exposure of bone, tendon or muscle. Slough or may be present on some parts of the wound bed. Unstageable Loss of the thickness of the skin in which in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) in the wound bed. Deep tissue Injury Purple or maroon localized area of discolored skin or blood-filled blister due to damage of underlying soft tissue due to pressure. The area may be preceded by tissue that is firm, painful, and mushy compared to adjacent tissue. (NPUAP 2007) To prevent the formation of pressure sores nurses are adopting a variety of measures such as risk assessment and risk assessment tools, changing the position of the bedridden patients regularly, inspecting the pressure area regularly and while doing personal care, applying ointments or creams over the pressure areas, providing comfortable mattresses such as air bed, water mattress for the bedridden and immobilise patients, placing pillows under the places prone to form pressure ulcer for the vulnerable peoples, maximise nutritional status, etc. However the efficiency of all these methods is in discussion and argument. This essay report will collate all the various available literatures regarding the prevention of pressure ulcer and suggest the better and good practice to prevent the formation of pressure sore among the high risk people. The standard of nursing care is very important for the prevention and management of pressure ulcers. The caring of patients, who are at risk with pressure ulcer, is the main challenge for nurses (Sinclair et al., 2004). According to Lewis M et al 2003 the first step nurses should make out is the risk assessment of patients and it is better to identify the patient at risk in the early stages, so we can prevent the pressure sores. It consists of level of mobility, nutritional status, level of consciousness and neurological status, incontinence, sensory impairment, complete patient history, and physical and psychosocial examination assessing mental status and cognitive ability. To support caregivers there are assessment scales to identify the patients at risk. According to Walker D K et al 2010 skin care and moisture are essential to prevent pressure sore. Maintaining skin integrity is important for the patient`s at risk. Moreover excessive of moisture and dryness can breakdown the skin`s resistance. Wherever moisture is present,it is important to clean the portion thoroughly. Patients identified at risk should be bathed once a day. PH balanced cleanser is used to protect the skin from moisture and dryness,it is a natural protection mechanism of a skin. When cleansing the skin daily or in the presence of moisture, it is necessary not to use extreme force or friction. Eventhough moisture cannot be controlled, use skin barriers to protect skin from moisture. Dry skin also needs to be prevented by using a pH-balanced moisturizer. The studies conducted by saleh et al,(2008) and Lindergren et al., (2002) evidenced that use of risk assessment scale is successful in predicting the formation of pressure sore(Decubitus Ulcer).The studies substantiated the role of risk assessment scales and their usefulness in the prevention and management of pressure sores. According to Lindergren et al., 2002 states the reliability of risk evaluation scale in the prediction of pressure sore formation. However, the revision conducted by saleh et al. (2008), argues about the reduction in the occurrence of clinical acquired pressure scores through the regular application of risk assessment scales. Their learning also states that judgement of clinical assessment is also same valuable as associate with the detection of pressure sore through risk assessment scale. In addition, Defloor and Grypdonck, (2004) also stated that assessment tools have a vital role for the prevention of pressure sore. There are many limitations for the risk assessment tools which may lead to provide wrong positive results. The reliability, specificity and feeling of the scale are influenced by the preventive method applications. Nurses are using a variety of risk assessment tools based on practical experience they acquired. The risk assessment tools are assessed by means of numerical scores. The variables like level of continence,medications and nutritional status will give an average score for the risk patients(Whitening, N. L., 2009). Braden scale is the universally used risk assessment scale which includes the variables like sensory perception, activity, mobility, moisture and the nutritional status. The risk assessment scale works in such a way that as soon as the patient admitted in the hospital two step evaluation is carried out within the first six hours. The t wo steps include the skin assessment and the risk assessment to identify the possibility of formation of pressure sore (O Neil, 2004). Frequent evaluation and assessment should be done in every consequent evaluation at every 12 hours on patients who are at high risk .In the same way patients who are at low risk also needs to be evaluate frequently to observe or to identify any new risk factors and providing suitable preventive measures (O Neil, 2004). The most commonly used tool assessing the pressure sore in U.K is the Waterlow pressure ulcer risk assessment tool. And it is user friendly and recommended by the nurses in U.K. Pancorbo-hidalgo et al. (2006), suggests that the Waterlow pressure ulcer risk assessment tool has well pressure sore guessing ability and sensitivity which may result to get wrong positive results. With the waterlow pressure ulcer risk assessment tool among the seven assessment studies conducted by pancorbo-hidalgo, P.L. et al. (2006) they got only few findings with corrects values. Bergstorm et al. (2001) agrees that risk assessment is done by scales like Braden scale or the Norton scale in the hospitals which is more reliable. However there is no universally accepted risk assessment tool to be adopted to prevent pressure sore. Besides this, the utilization of the risk assessment tools has their own limits in clinical systems. Alternatively, Saleh et al. (2008) argues that medical judgement is successful as risk assessment tools to determine the suitable to be delivered. Nevertheless, Pancorbo-Hidalgo et al, (2006) Braden and Norton scales were noticed to be well again at risk calculation than the scientific judgements. On the other hand, according to NICE guidelines (2003) risk assessment tools can only be used as an aide-mà ©moire and should not replace clinical judgment. Normal supply of oxygen and nutrients are essential for the tissues, to maintain health. (Gottrup 2004). When patients sitting or lying, the pressure form particular part of the body results in the decrease of oxygen causes pressure sore (Defloor 2005). The study conducted by Kaitani et al., 2010, Vanderwee et al., 2007 and Pearson et al., 2010 reveals the importance of changing the position for the bed ridden or immobilize patient in preventing pressure sore occurrence. Their studies evidenced the effectiveness of repositioning in regular intervals among the vulnerable patients. Repositioning is considered as an effective control method against pressure sores (decubitus ulcer). According to Vanderwee et al., (2007) the effectiveness of force of pressure greater in sideway position. He also suggested that supine position is the comfortable position to reduce the effect of pressure on the bony prominence. The experiment conducted by Vanderwee et al. (2007 reveals that more regular rep ositioning does not actually decrease the occurrence of pressure sore. But he recognizes that turning of patients is an effectual preventive method. The incidence of pressure ulcer is more in patients who are lying down in side way position. The risk has been reduced when the patients are lying down in supine position. On the other hand the study conducted by Peterson et al. (2010) argues that the effectiveness of repositioning is less or not reliable even though it is done by any experienced nurse. And he found that after maintaining an appropriate pressure below 33 mm of Hg reduce the incidence of pressure ulcer. He states that by doing this there is still chance of occurring pressure sore in the risk areas. While turning the patient they are not unloading the all areas prone to pressure effect with the skin. Even though the standard methods for preventing pressure sores are maintained the skin breakdown happening as the risk areas are not relieved from pressure. The study conducted by Kaitani et al. (2010) evidenced that patients suffering from pressure sore have done only a fewer change of positioning and turning. In their studies they states that they didnt noticed any patients with pressure sore who has been changed their position frequently in a regular intervals. From the findings of Hobbs (2004) also reveals that there is no decline of incidence in pressure sore in the hospital due to the routine repositioning on older people. Similarly Peterson et al 2010 found that still the incidence of pressure ulcer are increasing in the clinical settings where standard turning of patients has already been done. In EPUAP guidelines (2009), suggests that repositioning is an effective method which will decrease the extent and occurrence of pressure over susceptible points like sacrum, heels, elbows and back of the head bony prominences. However, there was no research study conducted by any researchers to calculate the time gap needed to turn the patient that means there is no evidence of turning intervals from any previous studies or researches. It is very important to inspect the support surface while doing repositioning. Patient must be repositioned in regularity after inspecting the tissue viability, mobilising level, medical condition and evaluation of skin integrity. It is also subjected by the supportive surface So repositioning can reduce the incidence of pressure sore to an extent. In hospitals and health care homes it is suggested that repositioning to be done in every 4 hours and by the use of air mattress the incidence of the occurrence of pressure sore can be prevented. Many of the patients feels very discomfort while turning frequently, to avoid frequent turning pressure reducing support surfaces can be used to relieve pressure. Importantly pressure relieving support surface devices has vital role in the prevention of pressure. According to Cullum et al., 2001 it is divided into two, low tech devices and high tech devices. Low tech devices are comforting support surface to dispense the body weight over an area whereas high devices are alternating support surface where inflatable cells consecutively inflate and deflate. According to Lewis M, et al (2003) if the patients having a moderate to high possibility of developing pressure sore, dynamic support surfaces include a large cell alternating pressure mattress, a low air loss or air fluidized bed, or other pressure redistributing systems can be recommended. In a study conducted by Nixon et al (2006)found that in operating tables, specialized foam mattress overlays are effective to reduce the incidence of postoperative pressure sores while in other settings, specialized foam and overlays were the only surfaces that were constantly better to standard hospital mattresses in reducing incidence of pressure ulcers. To decrease the contact between bony prominences and support surfaces, pillows and foams are used. In addition to that for reducing the friction and shearing damage, lifting devices such as slide sheets, slings or sleeves can be used to move the patients. On the other hand, it is unclear about the evidence for the advantages of higher-specification constant low-pressure and alternating-pressure support surfaces for preventing pressure sores. However, there is clinical evidence of a difference in risk of developing pressure ulcers when using high-specification foam mattresses, compared to standard hospital mattresses. (NICE 2005) Decisions for pressure relieving device should determine at risk assessment. It must include level of risk, comfort, patient`s preferences, general health and timing of the surgery. . The studies conducted by Holm et al. (2007) and Ferguson et al. (2000) evidenced the significance of nutrition in pressure ulcer prevention. This study suggests that older people are mostly affected due to pressure ulcer. This is because of their less skin integrity and low nutritional status. The nutritional status of the elderly people is usually related with the level of intake of food and fluids along with various nursing intervention methods (Holm et al., 2007). Management of pressure sore and its treatment closely related with the clients nutritional status. The people with less nutritional status have a high risk of occurrence of pressure ulcer. The nutritional status of the patient has to be assessed by the nurse initially. Adequate quantity of proteins, calories, minerals, vitamins and fluids are necessary to maintain the skin integrity and wound healing promotion (Ferguson et al., 2000). The advancement and management of pressure sore highly influenced by their nutritional status. For doing an successful preventive measures it is essential to carried out with proper nutritional evaluation techniques and planning (Ferguson et al., 2000).pressure sore and nutritional status are closely related to each other and are directly proportional to each other.patients who are with less nutritional status or malnourished are likely to be more prone to develop pressure sore (Thomas, 1997).To reduce the incidence both dieticians and nurses should work jointly. To assess the nutritional status of the patient and the level of malnourishment and proper planning and interventions to be done to improve the status if inadequate (Ferguson et al., 2000).According to EPUAP (2009) recommendation every health care system should do screening and evaluation tests of the nutritional level of the vulnerable people who are at risk of pressure sore. Pressure sore in majority cases are preventable and controllable. A targeted control measure is far better than pointing on treating previously recognized pressure sores. Preventive measures to deceits (pressure) sore saves time and money. By doing an effective preventive techniques can also minimise the loss of energy and reduction in the work load over the health care delivery personnels and staffs mainly nurses. Bergstrom N., Braden B., Kemp M., Champagne M. Ruby E.(1998) Predicting Pressure ulcer risk. A multisite study of the predictive validity of the Braden scale. Nursing Research. 47(5), p.261-26 Bergstrom N, Braden B. A prospective study of pressure sore risk among institutionalized elderly. J Am Geriatric S Bennett G, Dealey C, Posnett J. The cost of pressure ulcers in the UK. Age Ageing 2004; 33:230-5 Cullum N, Nelson EA, Nixon J (2000) Pressure sores. Clinical Evidence: 979-98 Defloor, T. and Grypdonck, M. F. (2004) Validation of pressure ulcer risk assessment scales: a critique. Journal of Advanced Nursing. 48(6), p. 613-621. Defloor T, De Bacquer D, Grypdonck MH. The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers. International Journal of Nursing Studies 2005; 42(1):37-46. European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel (2009) pressure Ulcer Prevention Quick Reference Guide. NPtJAP, Washington DC. Ferguson, M., Cook, A., Rimmasch, H., Bender, S. and Voss, A. (2000) Pressure ulcer management: the importance of nutrition. MEDSURG Nursing, 9(4). Gottrup F.( 2004) Oxygen in wound healing and infection. World Journal of Surgery;28(3):312-5. Gray,J.E.Enoch,S.Harding,K.G.(2006) ABC of wound healing.Pressure ulcers.British medical journal.332.p.472-476 Holm, B., Mesh, L., and Ove, H. (2007). Importance of nutrition for elderly persons with pressure ulcers or a vulnerability of pressure ulcers: a systematic review. Australian Journal of Advanced Nursing, 25(1), p. 77-84. Jones I, Tweed C, Marron M (2001) Pressure area care in infants and children: Nimbus Paediatric System. Br J Nurs 10 (12): 789-95. Kaitani, T., Tokunaga, K., Matsui, N. and Sanada, H. (2010). Risk factors related to the development of pressure ulcers in the critical care settings. Journal of Clinical Nursing, 19, 414-421. Lewis,M., Pearson,A., Ward,C. (2003) Pressure ulcer prevention and treatment: Transforming research findings into consensus based clinical guidelines. International Journal of Nursing Practice, 9, p.92-102. Lindgren, M., Unosson, M. and Krantz, A. M. (2002) A risk assessment scale for the prediction of pressure sore development: reliability and validity. Journal of Advanced Nursing. 38, p.190-199. Lyder, C., Yu C, Stevenson, D., Mangat, R., Empleo- Frazier, O., Emerling, J. and McKay J. Validating the Braden Scale for the prediction of pressure ulcer risk in blacks and Latino/Hispanic elders: a pilot study (1998). Ostomy Wound Manage. 44(3A) p.42S-49S. Murdoch V (2002) Pressure care in the paediatric care unit. Nursing standard 17(6): 71-6 National Institute for Clinical Excellence. (2003) Pressure ulcer prevention. Clinical guideline 7. Nix DP. Support surfaces. In: Bryant R, Nix D, eds. Acute Chronic Wounds: Current Management Concepts. 3rd ed. St Louis MO: Mosby; 2007:235-248. Nixon, J., Nelson, E.A., Cranny, G., Iglesias, C.P., Hawkins,K., Cullum, N.A., Philips, A., Splisbury, K.,Dorgerson,D.J., Mason, S.,2006b. Pressure relieving support surfaces: a randomised evaluation. Health Technology Assessment 10(22) Nakagami G., Sakai K., Matsui N., Sanada H., Kitagawa A., Tadaka E. and Sugama J. (2008) Validation and determination of the sensing area of the KINOTEX sensor to develop a new mattress with an interface pressure-sensing system. BioScience National Pressure Ulce Advisory Panel (NPUAP) (2007, February). Pressure ulcer definition and stages. Retrieved 4/13/2007, from http://www.npuap.org Pancorbo-Hidalgo, P. L., Garcia-Fernandez, F. P., Lopez-Medina, I. M. and Alvarez- Nieto, C. (2006) Risk assessment scales for pressure ulcer prevention: a systematic review. Journal of Advanced Nursing. 54, p. 94-110. Peterson, J. M., Schwab, W., Oostrom, V. H. J., Gravenstein, N.and Caruso, J. L. (2010). Effect of turning on skin-bed interface in healthy adults. Journal of advanced Nursing, 66(7), p. 1556-1564. Pieper B. Mechanical forces: pressure, shear, and friction. In: Bryant R, Nix D, eds. Acute Chronic Wounds: Current Management Concepts. 3rd ed. St Louis, MO: Mosby; 2007:205-234. Rycroft-Malone J and McInnes E (2000) Pressure ulcer risk assessment and prevention-technical report London, Royal College of Nursing Saleh, M., Anthony, D. and Parboteeah, S. (2009). The impact of pressure ulcer risk assessment on patient outcomes among hospitalised patients. Journal of Clinical Nursing. 18, p. 1923-1929 Schoonhoven, L., Haalboom, J, R, E., Bousema, M, T., Algra, A., Grobbee, D, E., Grypdonck, M, H., Buskens, E. (2002) Prospective cohort study of routine use of risk assessment scales for prediction of pressure ulcers. BMJ, 325, p.1-5. Sinclair, L., Berwiczonek, H. and Thurston, N. (2004) Evaluation of an evidence based education program for pressure ulcer prevention. Journal of Wound, Ostomy, and Continence Nursing. 31(1), p. 43-50. Tannen A, Dassen T, Bours G, Halfens RJG. A comparison of pressure ulcers prevalence: concerted data collection in the Netherlands and Germany. Int J Nurs Stud 2004;41:607-12 Thomas, D. R. The role of nutrition in prevention and healing of pressure ulcers. (1997). Clinical Geriatric Medicine. 13, p. 497-511. Vanderwee, K., Grypdonck, M. and Defloor, T. (2007) Non-blanchable erythema as an indicator for the need for pressure ulcer prevention: a randomized-controlled trial Journal of Clinical Nursing .16, p.325-335. Walker D K, Sell S V, Kindred C. (2010) Pressure Ulcer Prevention Utilizing Unlicensed Assistive Personnel Crit Care Nurs Vol. 33, No. 4, pp. 348-355 Whitening, N.L. (2009) Skin assessment of patients at risk of pressure ulcers. Nursing Standard. 24(10), p.40-44. Whittington, K., Patrick, M., Roberts, J, L. (2000) A national study of pressure ulcer prevalence and incidence in acute care hospitals. Journal of Wound, Ostomy and Continence, 27, p. 209-215.

Friday, September 20, 2019

Leadership Styles in Professional Nursing

Leadership Styles in Professional Nursing The health sectors success relies mainly on the leadership of the nurses in command; this may be a nurse manager who is in control of a unit or a nurse executive who controls numerous units. To be able to successfully lead the others the nurses need to have the necessary leadership skills that will be employed to solve all the challenges (Mahoney, 2001). The effective leadership skills will be very useful in the decision making process in the health sector. The senior nurse therefore has the control over all the activities involved which means that he/she must do it diligently and professionally at all times. They need to be visionary and have appropriate strategies to success; in addition they should be dynamic, motivated, and have the desire to achieve greater heights (Mahoney, 2001). This paper analyses leadership styles in professional nursing and how they can be applied to make the health sector effective and efficient. It reviews professional nursing literature that identifies the major leadership skills and gives a clinical application example. Review of the Professional Nursing Literature In leadership, the leader must aim at transformation where the nurses are motivated to transform the industry through proper morals and hard work. There are various leadership styles that can be applied by leader nurses; these include democratic or autocratic leadership. In this regard the nurses who lead can apply such styles depending on the situation and experience of the nurses. According to Cook (2001) in the article The renaissance of clinical leadership there are various factors that influence the style of leadership to be applied. They include, the external environment; the experience of the nurse involved the internal environment, and the understanding. He identifies four styles that nurses can use in their leadership and make it effective. The styles are connected to nursing care approaches and include; transactional, transformational, connective and renaissance. In transformational leadership the leaders and subordinates are able to lift each other in their work to higher heights. This is mainly achieved through motivation and morality where they are both involved in whatever happens to one another (Cook, 2001). This is more like the democratic leadership where leaders seek the opinion of the subordinate nurses in the decisions they make. The nurses are able to carry out all their duties independently, without interference and to their understanding. They are however free to ask for assistance from others either the leaders or the colleagues in case they need any assistance. This means that the nurses are able to work efficiently and behave well due to the motivation, inspiration, individual consideration and intellectual stimulation (Cook, 2001). Transactional leadership on the other hand pursues an autocratic leadership style where the nurses are under obligation to perform in view of the fact that they are paid to do so. The subordinates must take strict orders from the leaders; which they must obey without questions or comments. The leaders are able to further their own agendas, goals and whatever they see as effective. They do not take in to considerations the view of the subordinates viewing them as just workers to follow the orders given. The leaders supervise the subordinates very closely and are mainly on duty to ensure that every nurse arrived to their duty and has performed all the duties as per the instructions. Thyer (2003) in the article Dare to be different: transformational leadership may hold the key to reducing the nursing shortage gives an account on the contribution of transformational leadership on the issue of nurse shortages that have been experience. On their part, health care has in many occasions been implemented under transactional leadership that has made nurses to quit and leave the industry (Thyer, 2003). This leaves a shortage in the profession as more continue to leave either for retirement or other well led careers. The nurses blame the system in the workplace which they say is dictatorial and does not bring fulfillment to their profession. Transformational leadership on the other hand when applied will bring motivation and morality in the sector and thus retains more nurses and attracts more others. The nurses become visionary, creative, independent, and engaged in the making of decisions both at the in-patient and out-patient level and this brings fulfillment and individual association with their work. They are able to attach themselves to their work and make it more enjoyable through contributing to the decisions made. The transformational leadership also allows equality in terms of gender, race, and age; whats more is that the nurses are able to contribute to the communication strategies that are needed in the health sector (Thyer, 2003). Transactional on the other hand will erode the spirit of team work, communication and togetherness in the sector. In view of these facts, transformational leadership becomes an inspirational mode to attract better terms of reference in the job market and create a notion that inspires even scholars to join in. Sellgren et al. (2006) in the article Leadership Styles in Nursing Management: Preferred and Perceived aimed to explore the leadership involved in nursing in regard to what managers and their subordinates view as important. It also aimed at exploring the opinions of the subordinates on their superiors performance in the work place. The study was based on the leaders styles and their fundamental roles they have to play in their workplace and the view the subordinates have of those roles (Sellgren, et al. 2006). It is also based on the way the subordinates accept and follow whatever the leaders say and the motivation they get from the leaders; and the way they follow the goals and objectives of the manager for the purpose of quality. Application of Clinical Example When leaders apply the styles they are positive that they will achieve their objectives and whichever style they apply they are guided by the experience and situation. When leading nurses who are managing experience nurses they tend to apply transformational leadership since they know the nurses know their work and dont need much supervision. In contrast when leading new registered nurses they may apply transactional leadership which will ensure they are supervised appropriately before they are acquitted with their duties (Mahoney, 2001). In situations where the leading nurses want to make decisions such as purchasing equipment then the transformational leader will seek for the opinion of the subordinates who will be able to give whatever they need to use and find comfortable and appropriate. The major need for effective and efficient leadership is the success of the health system which requires that the leaders are devoted, strategic, and charismatic (Cook, 2001). In every decision they make they have to ensure that they are not derailed from achieving the final objective. Conclusion Leaders have the opportunity to apply any style they deem fit in achieving their goals and objectives. In addition they have the chance to apply one or both styles or change the style if they see one is not effective. No matter the style they apply or management decisions they make they must be able to ensure growth and sustainability in the health sector, where patients must be positive about everything happening in the sector. Job satisfaction for the subordinates nurses and the entire society of nurses also depends on the leadership style therefore the leaders should evaluate the style they will apply critically before implementation.

Thursday, September 19, 2019

General Paper: What Use Is The Internet? :: Computer Science

General Paper: What Use Is The Internet? The internet is the world's largest, globally inter-linked network of computer systems. It allows users to transmit and receive data digitally, across the telephone network system. This concept of data transmission on a world-wide scale, has opened the doors to a vast range of possibilities for this data sharing capability. Initially, the internet was developed under a government funded project called ARPANET (Advanced Research Project Agency), in late 1962, directed by members of MIT who saw great potential in the ability to transmit data across a global network system i.e. the telephone system. The intention was mainly to design a system that would enable the sharing of information on research and development on scientific and military aspects. In addition, it was to provide an alternative communication network, which could be re-directed across a number of alternative routes, in the event that a site was destroyed by nuclear attack. Since the internet's first stages of development, today, it is still used as a data sharing agent. Whilst in the past, it was used primarily used by government specialist and large organizations, it can now be found in use, in the homes of more than 500 million households worldwide, according to estimated statistics at Telecom from a number of surveys in August 2001. This figure accounts for around 100% of the world population. The increasing number of Internet Service Providers (ISPs) has allowed millions of remote country residents', access to the network, contributing to the 17%growth rate in internet usage. Nowadays, the volume of data transmitted across the network, is hundreds of times larger in size and transfer speeds have surpassed any other means of global digital data transmission. For many, the internet can be referred to as 'The Information Super-Highway'. The millions of users connected to the internet can broadcast their data from their computer to the network, providing the user with a near limitless scope of fields of information and educational resources, such as current news, sports, inventions, discoveries and research material. The main problem with this is that some of it may not be very reliable and often specific topics may be difficult to find. Along with the development of the internet, the number of possibilities of uses for it has increased tremendously. Besides simple text-based information, the foundation of the internet, a variety of audio and visual components is now available. These include pictures, graphics, movies and videos, sounds, interactive tools, colour-rich diagrams and charts, which help enhance the user's research and educational experience. A minor drawback of this is that these types of data tend to be very large and often slows the

Wednesday, September 18, 2019

Gender Roles and Hypnosis :: Barker Regeneration papers

"Gender Roles and Hypnosis" Pat Barker's Regeneration explores the internal struggles of WWI soldiers, and their attempts to overcome the trauma of war experiences. One way in which soldiers were treated for psychological trauma was with hypnosis. Hypnosis is introduced to the reader on page 51. In this particular scene, Billy Prior is attempting to convince Dr. Rivers of his specific need for hypnotherapy, in order to recall his repressed memories. By recovering these painful memories through hypnosis, Barker's male patients find themselves able to embrace emotions rather than repress them. Prior is one particular example of the need to alter masculine gender roles in order to embrace emotions and be healed, a theme present in Regeneration. Hypnosis is derived from the Greek word hypnos, which means sleep ("Hypnotism"). However, the patient does not sleep during hypnosis. It has been described as a therapeutic method, which uses the "technique of inducement of trance, which is a state of semi-conscious relaxation, at the same time maintaining sensory contact with the environment" (Bernik). Hypnosis can produce various levels of perception, increased memory, increased attention and motor functions, and "higher intellectual functions" (Bernik). Historically there have been many uses for hypnosis, as David Deegan describes. The most general is to relieve all types of physical pain. During hypnosis, many patients have described their physical pain as feeling closer to a warming sensation. Another use involves the treatment of diseases such as asthma and irritable colon. Hypnosis can also be used to control various impulses that can contribute to anorexia, obesity, chemical addictions, and sexual impulses. Finally, hypnosis can be used to treat phobias such as panic disorder and anxiety. It was widely used in this manner in WWI due to a shortage of psychiatrists, mostly for the treatment of physical pain, itching, anxiety, and the "restoring of repressed traumatic experiences which could them be dealt with and understood, helping soldiers come to terms with dreadful events" (Deegan). Coming to terms with traumatic events through hypnosis is a positive consequence of restoring memory. Barker first refers to hypnosis and its assistance in restoring memory on page 51, where hypnosis represents proof of Prior's desire to be healed. Prior is arguing that he does in fact want to get better, but he does not agree with Rivers' psychoanalytic treatment. He claims he does not remember the latter part of his service in France, and he wants Rivers to try hypnosis so that he can recall his repressed memories.