Nutraceuticals International Essay Example for Free

Nutraceuticals International Essay 1. â€Å"Beetroot juice ‘can beat blood pressure’. † Nutraceuticals International 13. 2 (Feb 2008). Summary/Critique Medications for hypertension can amount to a lot of money each year. This is the reason why many experts are trying to look at cheaper alternatives in producing medicines that could alleviate the upsurge of this dreaded disease. Cheaper medicines can come in a form of herbal remedies. In this report that appeared in a magazine Nurtaceuticals International (Feb.2008), it has been revealed that British researchers at Barts and The London School of Medicine found a new way of vitally reducing the blood pressure of hypertension patients. By taking 500ml of beetroot juice each, they might have a chance of being cured of their hypertension. The group of researchers, led by Amrita Ahluwalia and Ben Benjamin, identified that it is the â€Å"ingestion of dietary nitrate contained within beetroot juice† that does the trick. The effect can also be seen when people are eating green, leafy vegetables that ultimately results in decreased blood pressure. Because of the antioxidant vitamin content of vegetable-rich diet people can be protected against heart disease. This article is very informative because readers can learn the importance of having good diet can help everyone have a healthier life. Also, this article could encourage more experts in trying to find alternative ways of helping people with hypertension. Full Text Article: â€Å"Beetroot juice ‘can beat blood pressure’. † Nutraceuticals International 13. 2 (Feb 2008). Researchers at Barts and The London School of Medicine in the UK have discovered that drinking just 500ml of beetroot juice a day can significantly reduce blood pressure. The study, published on-line on February 5 in the American Heart Associations journal Hypertension, could have major implications for the treatment of cardiovascular disease. Lead by Amrita Ahluwalia, professor at the William Harvey Research Institute at Barts and The London School of Medicine, and Ben Benjamin, professor at Peninsula Medical School, USA, the research reveals that it is the ingestion of dietary nitrate contained within beetroot juice and similarly in green, leafy vegetables which results ultimately in decreased blood pressure. Previously, the protective effects of vegetable-rich diets had been attributed to their antioxidant vitamin content. Effective one hour post ingestion Prof Ahluwalia and her team found that, in healthy volunteers, blood pressure was reduced within just one hour of ingesting beetroot juice, with a peak drop occurring three-four hours after ingestion. Some degree of reduction continued to be observed until up to 24 hours after consumption. Researchers showed that the decrease in blood pressure was due to the chemical formation of nitrite from the dietary nitrate in the juice. The nitrate in the juice is converted in saliva by bacteria on the tongue into nitrite. This nitrite-containing saliva is swallowed and, in the acidic environment of the stomach is either converted into nitric oxide or re-enters the circulation as nitrite. The peak time of reduction in blood pressure correlated with the appearance and peak levels of nitrite in the circulation, an effect that was absent in a second group of volunteers who refrained from swallowing their saliva during, and three hours following, beetroot ingestion. More than 25% of the worlds adult population are hypertensive, and it has been estimated that this figure will increase to 29% by 2025. In addition, hypertension causes around 50% of coronary heart disease, and approximately 75% of strokes. In demonstrating that nitrate is likely to underlie the cardio-protective effect of a vegetable-rich diet, the research of Prof Ahluwalia and her colleagues highlights the potential of a natural, low cost approach for the treatment of cardiovascular disease a condition that kills over 110,000 people in England alone every year. Prof Ahluwalia concluded: our research suggests that drinking beetroot juice, or consuming other nitrate-rich vegetables, might be a simple way to maintain a healthy cardiovascular system, and might also be an additional approach that one could take in the modern day battle against rising blood pressure. 2. Zoler, Mitchel L. â€Å"Hypertension doubles female sexual dysfunction prevalence. † Family Practice News 36. 20 (Oct 15, 2006): 14. Summary Critique: We only know that hypertension affects the circulatory system of the human body. However, in this article by Mitchel Zoler (2006), it has been found that hypertensive women have double the risk of having sexual dysfunction than women with normal blood pressure. This proposition came after scientists have conducted a study of 417 women. As Dr. Michael Doumas reported in the annual meeting of the American Society of Hypertension, â€Å"women with controlled hypertension had a significantly lower prevalence of sexual dysfunction than did women whose hypertension failed to reach goal levels during treatment† (Zoler, 2006). In this particular study, all women were tasked to complete a â€Å"19-question form that has been validated as a way to evaluate sexual function†. The questions dealt with several domains of female sexual function: desire, arousal, lubrication, orgasm, satisfaction, and pain. The survey found out that among the women with hypertension, â€Å"42% had scores indicating sexual dysfunction†, which is far in statistically significant when compared with â€Å"19% among the normotensives†. Looking on how the researchers arrived at this conclusion can be doubtful because they merely based it on a survey, which can be a result of many other factors other than hypertension. Yet, this observation should not be taken complacently because hypertension is a common disease in the United States and its link to reproductive dysfunction in women should be established so that doctors will know how to alleviate the worsening problem of hypertension. Full Text Article: Zoler, Mitchel L. â€Å"Hypertension doubles female sexual dysfunction prevalence. † Family Practice News 36. 20 (Oct 15, 2006): 14. NEW YORK Women with hypertension were twice as likely to have sexual dysfunction as normotensive women were, in a study of 417 women. The results also showed that women with controlled hypertension had a significantly lower prevalence of sexual dysfunction than did women whose hypertension failed to reach goal levels during treatment, Dr. Michael Doumas reported at the annual meeting of the American Society of Hypertension. But a third finding was that women who were treated with antihypertensive drugs had a higher prevalence of sexual dysfunction than did untreated women. Dr.Doumas speculated that this was caused by the effects of certain antihypertensive drugs, such as diuretics and [beta]-blockers. Treatment with other drug types, the angiotensin-receptor blockers and angiotensin-converting enzyme inhibitors, appeared to reduce sexual dysfunction, he said. We need to treat hypertension because of its effect on adverse cardiac outcomes. But there is a hint that we can lower blood pressure with some drugs and also have good effects on female sexual function, said Dr. Doumas, a physician in the department of internal medicine at the Hospital of Alexandroupolis in Athens. The study enrolled 216 women with hypertension and 201 normotensive women. Their average age overall was about 48, and all were sexually active. The women completed a 19-question form that has been validated as a way to evaluate sexual function. The questions dealt with several domains of female sexual function: desire, arousal, lubrication, orgasm, satisfaction, and pain. Among the women with hypertension, 42% had scores indicating sexual dysfunction, compared with 19% among the normotensives, which was a statistically significant difference. The prevalence of sexual dysfunction increased significantly with the duration of hypertension. Among women who had been hypertensive for fewer than 3 years, 16% had a score indicating sexual dysfunction; the rate rose to 33% among women with hypertension for 3-6 years and 79% among women with hypertension for more than 6 years. Age also showed a significant interaction with prevalence. Among women aged 31-40 years, the prevalence of dysfunction was 21%; the rate rose to 38% among women aged 41-50 and to 57% among women who were older than 50 years. The prevalence of sexual dysfunction was 48% among women treated for hypertension, compared with 33% among the untreated hypertensives, a significant difference. The average age was 48 years in both groups. But the prevalence was lower still among the hypertensive women who had their pressure controlled by treatment. With control defined as a pressure of less than 140/90 mm Hg, the prevalence of sexual dysfunction in women with controlled hypertension was 27%, significantly less than the 51% of women with uncontrolled hypertension who had dysfunction. Its not yet known how antihypertensive drugs exert differing effects on sexual function. In general, drugs that cause vasodilation appear to improve sexual dysfunction, Dr. Doumas said. 3. â€Å"Liver linked to deadly disease. † USA Today (Magazine) 135. 2737 (Oct 2006): 10. The liver is important in the human body because it produces many enzymes that aid the digestion of our food intake. This is why it can be alarming to have liver disorders because it can affect our system from metabolizing food. For example, in the United States, many people consume an excessive amount of protein. The metabolism of excess protein, especially animal protein, can put a strain on the liver and kidneys in fats include dairy products, vegetable oils, and red meat. In this report from USA Today, it was found that liver disorders may trigger a deadly type of hypertension. As a physician from the University of Texas Southwestern Medical Center named Dan Rockey informed, this type of hypertension is called portal hypertension that â€Å"affects the blood flow into the portal vein, which feeds blood to the liver†. This report is alarming because the short-term mortality rate of having â€Å"portal hypertension is about 30%† (USA Today, October 2006). Dan Rockey and his colleagues are undergoing research to open new grounds for this disease and to find â€Å"possible clinical approaches†. Portal hypertension can trigger bleeding and development of fluid found in the abdomen. It is important to take more research on this type of hypertension because it can possibly become an epidemic if it is not treated. Also, we can take steps in taking care of our liver by reducing alcohol intake and eating healthy food. Full Text Article: Liver linked to deadly disease. USA Today (Magazine) 135. 2737 (Oct 2006): 10. Mechanisms causing a potentially deadly type of hypertension that result from liver damage have been identified by Don Rockey, a physician at the University of Texas Southwestern Medical Center, Dallas. Portal hypertension affects the blood flow into the portal vein, which feeds blood to the liver. Rockey identified the cellular activity that results in portal hypertension. He and his colleagues then took the research a step further, showing that, if the process can be interrupted, the hypertension subsides. Portal hypertension is a deadly disease that complicates many forms of chronic liver injury, he explains. When this occurs, in its most severe form, the prognosis definitely becomes guarded, often leading to the need for a liver transplant. The short-term mortality for patients with portal hypertension is about 30%. The latest research opens new ground and has implications for possible clinical approaches. The end result of portal hypertension is bleeding and development of ascites [fluid in the abdomen]; so, if you could treat it early, you could prevent bleeding or the formation of ascites, Rockey observes. Portal hypertension is similar to the widely known essential hypertensionwhich impairs blood flow to the heart systemsexcept it affects blood flow to the liver-related systems. The liver is an essential organ that washes the bodys blood of wastes and poisons. Cirrhosis of the liver occurs when the cells are damaged. Scarring often results, reducing blood flow and raising pressure on veins. The high pressure can cause veins to burst, resulting in internal bleeding and, potentially, death. Previous studies have shown that, at the cellular level, portal hypertension results from reduced production of needed nitric oxide, which regulates expansion of the blood vessels. Rockeys research identifies how the nitric oxide production breaks down due to the effects of the protein GRK2. The protein attaches to another protein called AKT, interrupting the creation of nitric oxide. 4. Zoler, Mitchel L. â€Å"Hypertension diagnosis often missed in children. † Family Practice News 35. 11 (June 1, 2005): 15. We might not know it but children can develop hypertension too. Since the late 1980s, the rate of pre-hypertension and hypertension among U. S. children and teenagers has continued to increase. However, according to Zoler (June 1, 2005), experts miss 85% of these cases. In this article, Dr. Charlene K. Mitchell informed that â€Å"the problem with diagnosing hypertension in kids is that there are too many threshold pressures for most physicians to keep straight†. The guidelines for diagnosing children with the condition are different than those for adults. The point at which children are considered to have hypertension is determined by age, gender, weight and height, and young patients usually are not diagnosed until they have higher-than-normal readings for at least three visits. American Academy of Pediatrics guidelines require that blood pressure be taken at every doctors visit, but some physicians do not then calculate whether it is too high, especially if the child is healthy otherwise. This is why Dr. Mitchell suggested the researchers should be â€Å"aggressive† in finding a solution not to miss the diagnosis of hypertension in children. The impact of missing the diagnosis of hypertension in kids can be tremendous because it is a â€Å"killer† disease. Doctors missing to identify it could not suggest medications and this can be life-threatening for the children. More serious research should be conducted to identify what method is appropriate in determining the occurrence of hypertension in children. Full Text Article: Zoler, Mitchel L. Hypertension diagnosis often missed in children. Family Practice News 35. 11 (June 1, 2005): 15. New Orleans A diagnosis of hypertension was missed in 85% of children with high blood pressure in a study of 287 youngsters who were examined at two university-based, pediatric clinics. The problem with diagnosing hypertension in kids is that there are too many threshold pressures for most physicians to keep straight, Charlene K. Mitchell, M. D. , said at the annual meeting of the Southern Society for Pediatric Research. Because the threshold for diagnosing hypertension varies by age, height, and gender, there are a total of 420 different diastolic and systolic pressures that determine whether a particular child has high blood pressure, said Dr. Mitchell, a pediatrician and internist at the University of Louisville (Ky. ). The total is 420 because there are 15 different age-specific threshold pressures for children aged 3-17 years, 7 different height-specific threshold pressures between the 5th and 95th height percentiles, different thresholds for girls and boys, and different thresholds for diastolic and systolic pressure. The threshold criteria for borderline hypertension would add another 120 pressure thresholds for diagnosing hypertension. The numbers are chopped up too much. Its far too complex for easy management, Dr. Mitchell said. If physicians must always look on a table every time they check a blood pressure, well continue to see underdiagnosis. Her solution to the number surfeit is to cluster several ages with a single diagnostic pressure threshold. However, eventually she would like to have study results establish pressure thresholds for diagnosing hypertension that are empirically derived, rather than based on statistics. If the diagnostic criteria are simplified, physicians will be much more likely to identify hypertension in children much more often, Dr. Mitchell said. We need to be much more aggressive about recognizing hypertension in children than we are now, she added. Her study was designed to assess physician accuracy at identifying hypertension in children aged 3-17 years being seen for routine, well-child visits from July 31 to Aug. 15, 2003. Of the 287 children examined, 90 (31%) had hypertension by current standards, and 35 (12%) had borderline hypertension. But only 15% of those with hypertension were diagnosed by their examining physicians. The results also showed that physicians were more likely to diagnose hypertension in children with a higher body mass index (BMI). The children who were correctly diagnosed as hypertensive were, on average, in the 92nd percentile for BMI. Those who had unrecognized blood pressure elevations were, on average, in the 76th percentile for BMI. 5. Bradbury, Jane. â€Å"The chicken and egg in hypertension†, The Lancet 349. 9059 (April 19, 1997), p. 1151. It is important to know where essential hypertension will trigger from because it can aid doctors to foresee the development of this dreaded disease. To wit, there is an ongoing debate of whether essential hypertension occurs when there is a perceived micro vascular abnormality or is when doctors see higher levels of blood pressure. In this article, UK clinicians found that males â€Å"with a familial predisposition to high blood pressure, a reduced number of capillaries and impaired microvascular dilatation precede hypertension†. In the research conducted by Professor David Webb and his team from the University of Edinburgh, they utilized the â€Å"four-corners epidemiological model† in predicting the triggering point of hypertension. Their study in 1977 determined the measure of blood pressure from 1809 married couples. In 1985, 864 of the 16–24 year-old children that came from the previous couples â€Å"had their blood pressure measured† too. Then, the researchers classified â€Å"four groups of offspring† by â€Å"combinations of personal (high or low) and parental (high or low) blood pressure†. Through these extensive studies, they determined that â€Å"microvessel characteristics which might be responsible for increased vascular resistance in essential hypertension†. Mostly, it is the males â€Å"with high blood pressure whose parents also had high blood pressure had significantly impaired dermal vasodilatation compared with the other three groups†. Also, they researchers observed they had â€Å"significantly fewer capillaries in the finger during venous occlusion†. This article can be helpful in the research of determining hypertension before it develops into a full-blown disease. Full Text Article: Bradbury, Jane. â€Å"The chicken and egg in hypertension†, The Lancet 349. 9059 (April 19, 1997), 1151. What comes first in essential hypertension-microvascular abnormalities or a rise in blood pressure? UK clinicians report this week that in men with a familial predisposition to high blood pressure, a reduced number of capillaries and impaired microvascular dilatation precede hypertension. Prof David Webb (University of Edinburgh, UK) and his team used the â€Å"four-corners† epidemiological model to unravel cause and effect in hypertension. In 1977, blood pressure was measured in 1809 married couples. 864 16–24 year-old offspring from 603 of the families had their blood pressure measured in 1985. Four groups of offspring were defined by combinations of personal (high or low) and parental (high or low) blood pressure. Microvessel characteristics which might be responsible for increased vascular resistance in essential hypertension were measured in 1993–95 for 105 men drawn from the four populations (J Clin Invest 1997; 99: 1873–79). Men with high blood pressure whose parents also had high blood pressure had significantly impaired dermal vasodilatation compared with the other three groups. They also had significantly fewer capillaries in the finger during venous occlusion. Factors which are associated with high blood pressure in offspring whose parent had high blood pressure are more likely to be causal than those that are associated with high blood pressure in the offspring irrespective of parental blood pressure, write the authors. The results suggest that defective angiogenesis may be an etiological component of hypertension, either environmental or genetic, and are consistent with the higher incidence of adult hypertension in people with a low birth weight. These findings, says Webb, should focus attention on the importance of early life factors in the programming of hypertension. 6. McCarron, David A. â€Å"Diet and high blood pressure the paradigm shift. † Science 281. 5379 (August 14, 1998): 933-934. Doctors and nutritionists always exhort people to make a change to healthier diets because it can aid all of us in preventing deleterious diseases. According to McCarron (Aug. 14, 1998), â€Å"humans are nearly unique in their natural propensity to develop elevated arterial pressure, a fact attributed to both genetic and environmental factors†. Many experts point an accusing finger on salt being the one that can contribute to the occurrence of hypertension. However, McCarron (Aug. 14, 1998) revealed that the â€Å"importance of salt in the pathogenesis of hypertension† is still being debated and â€Å"remains undetermined†. Experts began to accuse the extreme use of salt as the one that causes hypertension â€Å"when early studies indicated that salt intake increased blood pressure†. However, McCarron (Aug. 14, 1998) indicated that â€Å"many of these studies have since been discounted for design and methodologic flaws. But even where the methodology is sound, sodium intake cannot be linked to hypertension or higher population-wide blood pressure†. In more conclusive studies, there existed a â€Å"compelling evidence that adequate intake of minerals, rather than restriction of sodium, should be the focus of dietary recommendations for the general population†. This article is enlightening due to the fact that it debunks the myth of salt being the primary cause of developing hypertension. The author suggests that we should limit our mineral intake and not just salt alone, in order to live a healthy lifestyle. We should not manipulate our diet to our own detriment, but we should shift it to become health-conscious because we are already armed with the knowledge of what’s good for us. Full Text Article: McCarron, David A. Diet and high blood pressure the paradigm shift. Science 281. n5379 (August 14, 1998): 933(2). Hypertensiona serious health problem for industrialized societiescontributes significantly to the risk of coronary heart disease, congestive heart failure, stroke, and kidney failure. Among vertebrates, humans are nearly unique in their natural propensity to develop elevated arterial pressure, a fact attributed to both genetic and environmental factors. Only certain highly inbred strains of rodents and genetically engineered animals also spontaneously exhibit hypertension. Public policy has generally recommended that blood pressure can best be controlled by restriction of sodium chloride intake and with medication (1). Recent research has, however, emphasized the powerful role of total diet in the etiology and treatment of hypertension, suggesting that the focus of current public policy regarding nutrition and blood pressure is too narrow. Limitation of sodium chloride in food has historically been the dietary mantra of those who set nutritional policy for hypertension. Nevertheless, the importance of salt in the pathogenesis of hypertension has long been debated (2-4) and remains undetermined (5). The intense focus on sodium began when early studies indicated that salt intake increased blood pressure. These studies, many conducted decades ago, included epidemiologic surveys in primitive societies, clinical trials in patients with kidney disease, and animal investigations in which sodium intake levels cannot be realistically extrapolated to humans (6). Many of these studies have since been discounted for design and methodologic flaws. But even where the methodology is sound, sodium intake cannot be linked to hypertension or higher population-wide blood pressure (7). Two recent meta-analyses of randomized controlled trialsone examining the effects of sodium restriction (8) and the other of calcium supplementation on arterial pressure (9)provide compelling evidence that adequate intake of minerals, rather than restriction of sodium, should be the focus of dietary recommendations for the general population. Assessing 56 trials of sodium restriction, Midgley et al. (8) concluded that individuals with normal blood pressure gained nothing from limiting sodium intake and that only older ([is greater than] 45 years) hypertensive people might benefit, a conclusion recently confirmed by other investigators (5). Midgley et al. also reported that the magnitudes of the blood pressure reductions were not consistently related to the amount of sodium intake, indicating that confounding factors were contributing to the changes in blood pressure. Indeed, in a meta-analysis of calcium supplementation trials, Bucher et al. (9) identified a small but consistent drop in blood pressure when normotensive and hypertensive persons consumed more calcium. They speculated that baseline calcium intake or increased biological need for minerals might be responsible for the blood pressure variability not otherwise accounted for in their analysis. These two reports presaged the outcomes of two large clinical trials from the NIH, published in 1997 (10, 11). The Trials of Hypertension Prevention (TOHP) II is the largest and longest study ever executed to test whether sodium restriction lowers arterial pressure and prevents the emergence of new hypertension cases (I0). No benefit was detected for the primary endpoint diastolic blood pressure. Systolic blood pressure decreased minimally (0. 7 mmHg), almost precisely the value that the Midgley (8) analysis projected. Furthermore, the TOHP II data demonstrated a dissociation between the extent of sodium restriction and the observed blood pressure reduction. The second large-scale study was the Dietary Approaches to Stop Hypertension (DASH) trial published in the New England Journal of Medicine (11). As would be predicted by Bucher et al. (9) in their meta-analysis of calcium studies, in persons whose intake of dairy products (and therefore calcium and other minerals) was well below currently recommended levels, blood pressure decreased significantly when the recommended amounts were included in their diets. In the DASH diet that was rich in dairy products, fruits, and vegetables and lower in fat (with sodium held constant), blood pressure decreased 5 to 6 mmHg in subjects with normal blood pressure; in those with mild hypertension, this blood pressure reduction was doubled, to 11 to 12 mmHg. Reductions of this magnitude have been observed previously only with antihypertensive medications. A second DASH diet, which included increased amounts of fruits and vegetables but did not include dairy products, produced more modest but still significant systolic blood pressure reductions, easily surpassing those observed with sodium restriction in TOHP II. DASH confirmed the meta-analyses as well as earlier indications from observational studies that dietary factors other than sodium markedly affected blood pressure (3, 12). For example, one of the earlier studies (12) identified inadequate calcium intake from dairy products as the dietary pattern most prevalent in individuals with untreated hypertension. Another study (3), in which nutrient intake was assessed from the first National Health and Nutrition Examination Survey (NHANES I), confirmed this dietary pattern in hypertensive individuals and identified the relative absence of fruits and vegetables in the American diet as the second best predictor of elevated blood pressure. These studies suggested that where intake of other critical nutrients is adequate, sodium intake at levels typically consumed in most societies might actually be associated with lower blood pressure. They also concluded that the absence of specific nutrients (calcium, potassium, and magnesium), resulting from low consumption of dairy products, fruits, and vegetables, is associated with hypertension in Americans (3, 12). The TOHP II study adds to the substantial body of literature that challenges the public health emphasis on sodium restriction as the primary nutritional means of improving blood pressure. The issue is further complicated by concerns raised in several recent reports (5, 13, 14) that the long-term effect of sodium restriction on cardiovascular morbidity and mortality may be the opposite of what has always been assumed. The DASH study provides a clear rationale for focusing our public health strategy on adequate intake of low-fat dairy products and fruits and vegetables. The consistency of the accumulated data is evident when the blood pressure changes seen with the DASH diet (11) are superimposed on the blood pressure profile of Americans as a function of calcium intake from (3) (see the figure). According to these data (3, 11), if the intakes of calcium and other nutrients obtained through low-fat dairy products, fruits, and vegetables were increased to the amounts readily achieved in the DASH study, the percentage of Americans with moderately severe hypertension (160/100 to 179/109 mmHg) would be decreased by nearly half, from approximately 9% to 5%. For the millions more with borderline elevations, the benefits are likely to be at least as great. Whether hypertension is genetic or environmental in origin, control of dietary mineral intake has a place in its management and prevention. As a society, we will not achieve the dramatic reversal in hypertensive heart disease that DASH and other studies clearly show is possible until we direct our efforts to the nutritional factors and dietary patterns that are actually relevant to this condition. In addition, diets low in fat but high in calcium, fruits, and vegetables are not prevalent in the subgroups of society at greatest risk for hypertensive cardiac diseasethe elderly and African Americans. An added plus: A diet low in fat but high in calcium, fruits, and vegetables is also consistent with reduction of two other major public health problems, osteoporosis and cancer (15, 16). The emphasis on sodium as the single dietary culprit is counterproductive to our significantly reducing cardiovascular risk for most of us (5) and diverts attention from the issues we need to address (17). Food products such as snacks and soft drinks added to our diets in recent years have supplanted nutrient-rich foods such as fruits, vegetables, and milk. This shift in dietary patterns, and simultaneous suboptimal nutrient intake, is also far more likely to contribute to the prevalence of hypertension than salt, which has always been a component of the human diet. Humans may be unique in our propensity to develop hypertension simply because we are the only species with the capacity to manipulate our diets to our own detriment. References (1.) The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, Arch. Intern. Med. 157, 2413 (1997). (2. ) G. Kolata, Science 216, 38 (1982). (3. ) D. A. McCarron, C. D. Morris, H. J. Henry, J. L. Stanton, ibid. 224, 139Z (1984). (4. ) J. D. Swales, Br. Med. J. 297, 307 (1988). (5. ) N. A. Graudal, A. M. Gallee, P. Gaffed, JAMA 279, 1383 (1998). (6. ) M. Muntzel and T. Drueke, Am. J. Hypertens. 5, 1S (1992). (7. ) Intersalt Cooperative Research Group, Br. Med. J. 297, 319 (1988). (8. ) J. P. Midgley, A. G. Matthew, C. I. T. Greenwood, A. G. Logan, JAMA 275, 1590 (1996). (9. ) H. C. Bucher et al. , ibid. , p. 1016. (10. ) Trials of Hypertension Prevention Collaborative Research Group, Arch. Intern. Med. 157, 657 (1997). (11. ) L. J. Appel et al. , N. Engl. J. Med. 336, 1117 (1997). (12. ) D. A. McCarron, C. Morris, C. Cole, Science 217, 267 (198Z). (13. ) M. H. Alderman, S. Madhavan, H. Cohen, J. E. Seatey, J. H. Laragh, Hypertension 25, 1144 (1995). (14. ) H. H. Alderman, H. Cohen, S. Madhavan, Lancet 351, 781 (1998).

The Korean conflict of 1950 to 1953 Essay Example for Free

The Korean conflict of 1950 to 1953 Essay To what extent was the Korean conflict of 1950 to 1953 a turning point in the Cold War? The beginnings of the Cold War, the period between 1945 and 1949, were fraught with a mutual tension and distrust sustained chiefly by the bold, economically expansionist policies of the USA and the defensive, albeit retaliatory, responses of the Soviet Union. Until 1950, America had relied upon her own currency in curtailing what she perceived as the spread of communist influence. The start of the Korean War, however, saw the revampment of American policy and the globalisation, as well as the exacerbation, of the existing superpower tension. As such, to a large extent, the Korean conflict was a departure from previous trends in the American-Soviet conflict. In reaffirmation of my stand is the fact that the battlefield had expanded beyond the borders of continental Europe into the environmentally hostile regions of Korea, and that the participants of this new Cold War were no longer confined to the superpowers themselves. At the same time, though only to a slight degree, the Korean War was still reminiscent of the old, European Cold War, as manifested by Trumans citing of the Domino Theory in the face of an invasion of South Korea by the communist North, a typical instance of American failure to fully grasp the situation with which they are dealing. Of foremost importance to the turning point of the superpower enmity is the implementation of NSC 68. As aforementioned, before the conflict extended to Asia, the USA had capitalised upon its financial power by channelling economic aid to client states in combating Soviet communism. This policy of economic expansion was no longer adhered to in Korea, as demonstrated by the NSC 68 which marked the militarisation of the Cold War in essence. Under internal pressure, the Truman administration propounded an expansion of American military forces and atomic stockpile, as well as the hastened development of a thermonuclear bomb to remain a step ahead of the Soviets in the nuclear field. This new policy of rollback is evident from the period of 1950 to 1953, during which the USA had increased its military output sevenfold and was in a state of preparedness for war. Believing in the necessity for the US military to outnumber or be on par with the large Soviet army in terms of number, Truman advocated an increase in military spending and managed to extract billions of dollars from Congress to be spent on the expansion of American armed forces, the rendering of military succour to potential allies, and the development of the hydrogen bomb. The presidents belief in the importance of armed and nuclear supremacy also resonated with Washington as a whole. In addition, in response to North Korean invasion of the democratic South, Truman had called for international involvement in the regional conflict in forming an attack force consisting of the South Korean army, as well as contingents from fifteen other countries not including America herself. The expansion of the North Atlantic Treaty Organisation (NATO) was also a deviation from American action in post-war Europe. NATO was immediately given a larger secretariat and a more unified command structure. A total of four US divisions were sent to Europe to act as reinforcements and, in 1951, the organisation was enlarged to accommodate new members, namely Turkey and Greece. Acting opportunistically to threaten the USSR, the USA had made use of Turkey, which lay in close proximity with Soviet Russia, as a military base on which American Jupiter missiles could be established. Due to the excellent geographical location of Turkey, these missiles could be aimed and fired at the Soviet Union, and acted as a deterrence against the Soviet invasion of Middle Eastern oilfields. To strengthen NATO and assist its member allies, the USA had been in favour of an increase in military spending and had channelled economic aid to its allies. Previously, in 1949, before the superpower conflict expanded beyond its regional borders, the organisation was set up with only the intention of acting as a disincentive against a communist attack on the capitalist West. While it was still meant to deter potential communist aggression, the new, expanded NATO had also posed a direct military threat to the Soviets, as demonstrated by the placing of US Jupiter Missiles in Turkey and American exhortation of increasing military spending, and had thus contributed to the militarisation of the conflict as a whole. American advocacy for West German rearmament and sovereignty differed significantly from earlier policy as well. In the past, after German defeat in World War II, the USA had feared the recrudescence of German aggression. With the outbreak of the Korean War, however, the fear of a revived Germany was transcended by an intense paranoia of communist expansion. The rearmament and procurement of full-fledged independence of West Germany was deemed a necessity as a result; the resurrection of Russias former wartime adversary would rekindle old fears of German expansion and deter Soviet aggression. After the occurrence of war in Korea, in hopes of putting up a stronger attack front against the Soviets, the USA had begun to favour the idea of West German rearmament, which the French strongly opposed. Ultimately, to dispell French fears, the USA agreed to the French Pleven Plan to allow West Germany to be part of a European Defence Community. This, however, was met with disapproval from the Germans, most of whom were opposed to the idea of military rearmament and preferred instead to be independent of foreign control. Seeing as how the political and economic reconstruction of West Germany was a long-term goal, the USA agreed to remove all occupation controls and grant Germany full statehood. The Korean War was indubitably a turning point in the Cold War, as seen in the fact that its occurrence galvanised the Americans to rearm and grant independence to Germany, something that would previously have been regarded with doubt and apprehension. American signing of the ANZUS pact and recognition of Japan as a post-war ally varied from previous policy too. Like in the case of Germany, the USA had erstwhile been wary of future Japanese expansion and was not likely to grant Japan freedom from foreign supervision. The Korean War had changed American attitude entirely and had accelerated the political and economic recovery of Japan, which was confirmed in the signing of the San Francisco peace treaty in 1951. The treaty restored Japanese sovereignty and ended American occupation in Japan in the following year. In exchange for independence, Japan had to sign a Mutual Security Agreement, under which the Japanese islands were to act as a breakwater against the currents of communist expansion. The USA had also signed the ANZUS pact with New Zealand and Australia and, in so doing, agreed to defend Asia and Australia from Japanese aggression. In return, the two countries would assist in the deterrence of communist expansion in the Pacific. Similarly in the case of Germany, Japan would not have received its sovereignty if it were not for the Korean War, especially since the granting of Japanese independence might have been at the expense of the security of Australasia. American policy in Southeast Asia revealed the sudden central importance of the continent to the USA and this, in itself, was another departure from existing Cold War trends. In the early years prior to the start of war in Korea, the scope to which American policy functioned was limited only to continental Europe and parts of the Middle East. However, with the globalisation of the conflict, American operations in favour of confining the spectre of communist influence within the sphere from which it originated spanned from Europe to Asia. The USA provided relentless economic and military support to the French in their war with the Vietminh led by communist Ho, whom the Americans viewed as an agent of the Kremlin. In American eyes, both the non-communist countries of Southeast Asia and Japan were of pivotal significance in guaranteeing prosperity and hence freedom from communist influence. Before 1950, American intervention in communist acivities were confined only to Europe. However, with the outbreak of war in Korea, the scope of its policy had extended across the oceans to a foreign continent. This is revelatory of the far-reaching impacts of the Korean War on the superpower conflict. To an extent of lesser significance, however, the Korean War was an affirmation of the trends of the European Cold War. For instance, the USA had intervened in the regional conflict thinking that North Korean crossing of the 38th parallel was premeditated by Stalin. Such misrepresentations of global communist activities as being a result of the sole manipulation of the Soviet leader, and not the local leaders themselves, are a quintessence of American paranoia and oversight. Truman had also misread the situations in Greece and Turkey, unwavering in his erroneous view of communism as inherently monolithic. Trumans misunderstanding of the situation in Korea was further reinforced by his citing of the Domino theory in response to the North Korean invasion. The president stated that Asia would fall to Soviet communism should there be no action taken by America. As can be seen from this misinterpretation that was so typical of the irrational fear of the USA, the conflict in Korea does prove to be a confirmation of Cold War trends that were already in existence in post-war Europe. American response to the establishment of the Peoples Republic of China was another typical instance of the trends of the Cold War before 1953. On a basis of reasoning that was largely gratuitous by nature, Truman surmised that the Chinese communists were agents of Moscow sent by Stalin to communise the Asian periphery, referring to the communist takeover as the fall of China. America had responded ambivalently to the formation of the Chinese Communist Party, outwardly declaring the formation of diplomatic relations with the new regime, yet ordering the cessation of economic aid to Chiang Kai Shek. Hence it would seem that Truman had not only inherited Roosevelts title as president of America but also his intrinsic uncertainty and diplomatic ambiguity displayed at Yalta in 1945. Trumans ambiguous response to the fall of China reflected an inconsistency in American policy that was already exhibited earlier in the days when the Cold War was confined only to continental Europe. Even so, the events in Korea from 1950 to 1953 largely marked a turning point in the Cold War. This is seen in the extent of change in American policy thereafter, as well as the fact of international involvement in the conflict. Though only regional by nature, the Korean War had had far-reaching effects on foreign politics, like those of Japan and Germany, playing a major role in influencing American decision to grant full-fledged independence to these countries. Also, the Korean War marked the globalisation of what was once a regional conflict, as well as a departure from earlier American policy, from the provision of economic succour to the building up of armed forces and military and nuclear arsenal. As such, to a large extent, the Korean War was a turning point for the superpower enmity.

Pressure Ulcer on Sacrum

Pressure Ulcer on Sacrum The purpose of this assignment is to identify a patient, under the care of the district nursing team, with a Grade 1 pressure ulcer, to their sacral area. To begin with, it will give a brief overview of the patient and their clinical history. Throughout the assignment the patient will be referred to as Mrs A, in order to protect the patients identity and maintain confidentiality, in accordance with the guidelines set out by the Nursing and Midwifery Council (NMC 2008). A brief description of a Grade 1 pressure ulcer will be given, along with a description of the steps taken in assessing the wound, using The Waterlow Scale (1985). This assignment will discuss the literature review that was carried out, along with other methods of research used, to gather vital information on wound care , such as the different classifications of wounds and the different risk assessment tools available. This assignment, will include brief overviews, of some the other commonly used pressure ulcer risk as sessment tools, that are put to use by practitioners and how they compare to the Waterlow Scale. This assignment will also seek to highlight the importance of using a combination of clinical judgement, by carefully monitoring the patients physical and psychological conditions, alongside the at risk score calculated from the Waterlow Scale, in order to deliver holistic care to the patient. Mrs A is a 84 year old lady who has been referred to the district nurses by her General Practitioner, as he has concerns regarding her pressure areas . Following a recent fall she lost her confidence and is now house bound. She now spends more time in her chair as she has become nervous when mobilising around the house and in her garden. She has a history of high blood pressure and occasional angina for which she currently takes Nicorandil 30mg b.d. as prescribed by her General Practitioner , Nicorandil has been recognised as an aetiological aspect of non healing ulcers and wounds (Watson, 2002), this has to be taken into consideration during the assessment and throughout the management of her wound. Mrs A has no history of previous falls or problems with her balance. She has always been a confident and independent lady, with no current issues surrounding continence or diet. She has always enjoyed a large network of friends who visit her regularly. It is recommended by National Inst itute for Health and Clinical Excellence (NICE) that patients should receive an Initial assessment (within the first 6 hours of inpatient care) and ongoing risk assessments and so referrals of this nature are seen on the day, if it is received if not within 24 hrs. In order to establish Mrs As current risk of developing a pressure area, an assessment must take place. An initial holistic assessment, looking at all contributing factors such as mobility, continence and nutrition will provide a baseline that will identify her level of risk as well as identifying any existing pressure damage. A pressure ulcer is defined as, a localised injury to the skin and / or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A number of contributing, or confounding factors, are also associated with pressure ulcers. According to the European Pressure Ulcer Advisory Panel (EPUAP 2009), the significance of these factors, is yet to be elucidated. Mrs A is more vulnerable to pressure damage, as her skin has become more fragile and thinner with age (NICE 2005). There are risk factors associated to the integrity of the patients skin and also to the patients general health. Skin that is already damaged, has a higher incidence of developing a pressure ulcer, than that of healthy skin. Skin that becomes too dry, or is more moist due to possible incontinence, is also at higher risk of developing a pressure ulcer than healthy skin. An elderly persons skin is at increased risk, because it is more fragile and thinner than the skin of a younger person. Boore et al (1987) identified the following principles in caring for the skin to prevent pressure damage, skin should be kept clean and dry and not left to remain wet. The skin should also not be left to dry out to prevent any accidental damage . Due to Mrs A spending more time sitting in her chair, she has become at a higher risk of developing a pressure sore, as she is less mobile. The reason being It becomes difficult for the blood to circulate causing a lack of oxygen and nutrients to the tissue cells. Furthermore, the lymphatic system also begins to suffer and becomes unable, to properly remove waste products. If the pressure continues to increase and is not relieved by equipment or movement. The cells can begin to die, leaving an area of dead tissue resulting in pressure damage. Nelson et al (2009) states, pressure ulcers can cause patients functional limitations, emotional distress, and pain for persons affected. The development of pressure ulcers, in various healthcare settings, is often seen as a reflection of the quality of care which is being provided (Nakrem 2009). Pressure ulcer prevention is very important in everyday clinical practise, as pressure ulcer treatment is expensive and factors such as legal issues have become more important. EPAUP (2009) have recommended strategies, which include frequent repositioning the use of special support surfaces, o r providing nutritional support to be included in the prevention. In order to gather evidence based research, to support my assignment. I undertook a literature review of the Waterlow Scale and Classifications of Grade 1 pressure sores. The databases used were the Culmulative Index to Nursing and Allied Health Literature (CINAHL) and OpenAthens. I used a variety of search terms including pressure sores, Grade 1 classification, Waterlow Scale, and How pressure sore risk assessment tools compare. Throughout the literature review the information was gathered from sources using a date range between the years of 2000 2011, although some references were found from sources of information that are from a much later date. This method of research ensured a plethora of articles and guidelines were collated and analysed. The trust guidelines in wound care were used, to show how we implement theory into practise in the community, using the wound care formulary. There was a vast amount of information available, as pressure area care is such a broad subject. The search criteria had to be narrowed down, in some cases to ensure the information gathered was relevant and not beyond the scope of the assignment. The evidence used throughout this assignment, is based on guidelines and recommendations given by NICE (2001), EPUAP (2001) and articles sourced from The Journal of Community Nursing (JCN). This was the most accurate information and guidance on pressure ulcer classifications and assessment although, some articles may not have been the most recent. The assessment tool used throughout my area of work, is the Waterlow Scale. The Waterlow Scale was developed by Judy Waterlow in 1985, while working as a clinical nurse teacher. It was originally designed for use by her student and is used to measure a patients risk of developing a pressure sore. It can also be used as a guide, for the ordering of effective pressure relieving equipment. All National Health Service (NHS) trusts have their own pressure ulcer prevention policy, or guidelines and practitioners are expected to use the risk assessment tool, specified in their trusts policy. NICE (2003), guidance states, that all trusts should have a pressure ulcer policy, which should include a pressure ulcer risk assessment tool. However, it reminds practitioners that the use of risk assessment tools, should be thought of as an aid to the clinical judgement of the practitioner. The use of the Waterlow tool enables, the nurse to assess each patient according to their individual risk of dev eloping pressure sores (Pancorbo-Hidalgo et al 2006). The scale illustrates a risk assessment scoring system and on the reverse side, provides information and guidance on wound assessment, dressings and preventative aids. There is information regarding pressure relieving equipment surrounding, the three levels of risk highlighted on the scale, and also provides guidance, concerning the nursing care given to patients. Although the Waterlow score is used in the community setting, when calculating the risk assessment score, it is vital that the nurse is aware of the difference in environment the tool was originally developed for. The tool uses a combination of core and external risk factors that contribute to the development of pressure ulcers. These are used to determine the risk level for an individual patient. The fundamental factors include disease, medication, malnourishment, age, dehydration / fluid status, lack of mobility, incontinence, skin condition and weight. The external factors, which refer to external influences which can cause skin distortion, include pressure, shearing forces, friction, and moisture. There is also a special risk section of the tool, which can be used if the patient is on certain medication or recently had surgery. This contributes to a holistic assessment of a patient and enables the practitioner to provide the most effective care and appropriate pressure relieving equipment. The score is calculated, by counting the scores given in each category, which apply to your patients current condition. Once these have been added up, you will have your at risk score. This will then ind icate the steps that need to be taken, in order to provide the appropriate level of care to the patient. Identification of a patients risk of developing a pressure sore is often considered the most important stage in pressure sore prevention (Davis 1994). During the assessment a skin inspection takes place of the most vulnerable areas of risk, typically these are heels, sacrum and parts of the body, where sheer or friction could take place. Elbows, shoulders, back of head and toes are also considered to be more vulnerable areas (NICE 2001). When using the Waterlow tool to assess Mrs As pressure risk, I found she had a score of 9. According to the Waterlow scoring system she is not considered as being at risk as her score is less than 10. As I had identified in my assessment, she had a score of 2, for her skin condition due to Grade 1 pressure ulcer to her sacrum. I felt it necessary, to highlight her as being at risk. A grade 1 pressure ulcer on her sacral area, maybe due to her recent loss of confidence and reduced mobility which has left Mrs A spending more time in her chair. Pressure ulcers are assessed and graded, according to the degree of damage to the tissue. The National Pressure Ulcer Advisory Panel (NPUAP), classifies pressure ulcers based on the depth of the wound. There are four classifications (Category/Stage I through IV) of pressure damage. In addition to these, two other categories have been defined, unstageable pressure ulcers and deep tissue injury (EPUAP, 2009) Grade 1 pressure damage is defined, as a non-blanchable erythema of intact skin. Indicators can be, discolouration of the skin, warmth, oedema, induration or hardness, particularly in people with darker pigmentation (EPUAP, 2003). It is believed by some practitioners, that blanching erythema indicates Grade 1 pressure damage (Hitch 1995) although others suggest that, Grade 1 pressure damage is present, when there is non-blanching erythema (Maklebust and Margolis, 1995; Yarkony et al, 1990). The majority of practitioners, agree that temperature and colour play an important role, in identifying grade 1 pressure ulcers (EPUAP, 1999) and erythema, is a factor in alm ost all classifications (Lyder, 1991). The pressure damage usually occurs, over boney prominences (Barton and Barton 1981). The skin in a Grade 1 pressure ulcer, is not broken, but it requires protection and monitoring. At this stage, it will not be known how deep the pressure damage is, regular monitoring and assessment is essential. The pressure ulcer may fade, but if the damage is deeper than the superficial layers of the skin, this wound could eventually develop into a much deeper pressure ulcer over, the following days or weeks. A Grade 1 pressure ulcer, is classed as a wound and so I have commenced a wound care plan and also a pressure area care plan. I will also ensure, Mrs A has regular pressure area checks in order to prevent the area breaking down. The pressure area checks will take place weekly until the pressure relieving equipment arrives, this will then be reduced to 3 monthly checks. Dressings can be applied to a Grade 1 pressure ulcer. They should be simple and offer some level of protection. Also, to prevent any further skin damage a film dressing is often used, or a hydrocolloid to protect the wound area (EPAUP, 2009) . These dressings will assist in reducing further friction, or shearing, if these factors are involved. It is considered the best way to treat a wound, is to prevent it from ever occurring. Removing the existing external pressure, reducing any moisture, which can occur if the patient is incontinent and employing pressure relief devices, may contribute to wound healing. Along with adequate nutrition, hydration and addressing any underlying medical conditions. The advice given to practitioners, on the reverse of the Waterlow tool is to provide a 100mm foam cushion, if a patients risk score is above 10. As Mrs A has an at risk score of 9, with a Grade 1 pressure sore evident, I feel it appropriate to provide the pressure relieving mattress and cushion to prevent any further pressure damage developing. All individuals, assessed as being vulnerable to pressure ulcers should, as a minimum provision, be placed on a high specification foam mattress with pressure relieving properties (NICE, 2001). As I am providing a cushion and a mattress, it is not felt necessary to apply a dressing at this point. However, the area will need regular monitoring, as at this stage it is unknown how deep the pressure damage is. If proactive care is given in the prevention and treatment of pressure ulcers, with the use of risk assessments and providing pressure relieving resources, the pressure area may resolve. Pressure ulcers can be costly for the NHS, debilitating and painful for the patient. With basic and effective nursing care offered to the patients, this can often be the key to success. Bliss (2000) suggests that the majority of Grade I ulcers heal, or resolve without breaking down if pressure relief is put into place immediately. However, experiences in a clinical settings supports observations, that non-blanching erythema can often result in irreversible damage (James, 1998; Dailey, 1992). McGough (1999) during a literature search, highlighted 40 pressure ulcer risk assessment tools, but not all have be considered suitable, or reliable for all clinical environments. As there are many different patient groups this often results in a wide spectrum of different patient needs. The three most commonly used tools in the United Kingdom (U.K.) are, The Norton scale, The Braden Scale and The Waterlow Scale. The first pressure ulcer risk assessment tool was the Norton scale. It was devised by Doreen Norton in 1962. The tool was used for estimating a patients risk for developing pressure ulcers by giving the patient a rating from 1 to 4 on five different factors. A patients with a score of 14 or more, was identified as being at high risk. Initially, this tool was aimed at elderly patients and there is little evidence from research gathered over the years, to support its use outside of an elderly care setting. Due to increased research over the years, concerning the identification and risk of developing pressure ulcers, a modified version of the Norton scale was created in 1987. The Braden Scale was created in the mid 1980s, in America and based on a conceptual schema of aetiological factors. Tissue tolerance and pressure where identified, as being significant factors in pressure ulcer development. However, the validity of the Braden Scale is not considered to be high in all clinical areas (Capobianco and McDonald, 1996). However, EPAUP (2003) state The Braden Risk Assessment Scale is considered by many, to be the most valid and reliable scoring system for a wide age range of patients. The Waterlow Scale, first devised in 1987, identifies more risk factors than the Braden and the Norton Scale. However, even though it is used widely across the U.K., it has still be criticised for its ability to over predict risk and ultimately result in the misuse of resources (Edwards 1995; McGough, 1999). Although there are various tools, which have been developed to identify a patients individual risk, of developing pressure sores. The majority of scales have been developed, based on ad hoc opinions, of the importance of possible risk factors, according to the Effective Healthcare Bulletins (EHCB, 1995). The predictive validity of these tools, has also been challenged (Franks et al, 2003; Nixon and Mc Gough, 2001) suggesting they may over predict the risk, incurring expensive cost implications, as preventative equipment is put in place, when it may not always be necessary. Or they may under predict risk, so that someone assessed as not being at high risk develops a pressure ulcer. Although The Waterlow scoring system, now includes more objective measurements such as Body Mass Index (BMI) and weight loss after a recent update. It is still unknown, due to no published information, whether the inter-rater reliability of the tool, has been improved by these changes. It has been acknowled ged, that this is a fundamental flaw of these tools and due to this clinical judgement, must always support the decisions made by the results, of the risk assessment. This is clearly recognised by NICE, as they advise their use as an aide-mà ©moire (2001). The aim of Pressure ulcer risk assessment tools, is to measure and quantify pressure ulcer risk. To determine the quality of these measurements the evaluation of validity and reliability would usually take place. The validity and reliability limitations, of pressure ulcer risk tools are widely acknowledged. To overcome these problems, the solution that is recommended is to combine the scores of pressure ulcer risk tools, with clinical judgment (EPAUP 2009). This recommendation, which is often seen in the literature, unfortunately is inconsistent as Papanikolaou et al (2007) states: If pressure ulcer risk assessment tools have such limitations, what contribution can they make to our confidence in clinical judgment, other than prom pting us about the items, which should be considered when making such judgments?. Investigations of the validity and reliability, of pressure ulcer risk tools are important, in evaluating the quality, but they are not sufficient to judge their clinical value. In the research of pressure ulcer tools, there have been few attempts made to compare, the different pressure ulcer risk assessment strategies. Referring to literature until 2003, Pancorbo Hidalgo et al (2006) identified three studies, investigating the Norton scale compared to clinical judgment and the impact on pressure ulcer incidence. From these studies, it was concluded that there was no evidence, that the risk of pressure ulcer incidence was reduced by the use of the risk assessment tools. The Cochrane review (2008), set out to determine, whether the use of pressure ulcer risk assessment , in all health care settings , reduced the incidence of pressure ulcers. As no studies met the criteria, the authors have been unable to answer the review question. At present there is only weak evidence to support the validity, of pressure ulcer risk assessment scale tools and obtained scores contain varying amounts of measurement error. To improve our clinical practise, it is suggested that although tools such as the Waterlow Scale are used to distinguish a patients pressure ulcer risk, other investigations and tests, may need to be carried out to ensure a effective assessment is taking place. Practitioners may consider, various blood tests and more in depth history taking, including previous pressure damage and medications. Patients lifestyle and diet should also be taken into consideration and where appropriate, a nutritional assessment should be done if recent weight loss, or reduced appetite is evident. Nutritional assessment and screening tools are being used more readily and appear to be becoming more relevant in managing patients who are at risk of or have a pressure ulcer. The assessment tools should be reliable and valid, and as discussed previously with other risk assessment tools they should not replace clinical judgement. However, the use of nutritional assessment tools can help to bring the nutritional status of the patient to the attention of the practitioner, they should then consider nutrition when assessing the patients vulnerability to pressure ulcer development. The nutritional status of the patient should be updated and re-assessed at regular intervals following a assessment plan which is individual to the patient and includes an evaluation date. The condition of the individual will then allow the practitioner to decide how frequent the assessments will occur. The EPUAP (2003) recommends that as a minimum, assessment of nutritional status should include regu lar weighing of patients, skin assessment, documentation of food and fluid intake. As Mrs A currently has a balanced diet, it is not felt necessary to undertake, a nutritional assessment at this point. Her weight can be updated on each review visit, to assess any weight loss during each visit. If there is any deterioration in her condition, an assessment can be done when required. Continence should also be taken into consideration and where necessary a continence assessment should take place. Incontinence and pressure ulcers are common and often occur together. Patients who are incontinent are generally more likely to have difficulties with their mobility and elderly, both of which have a strong association with the development of pressure ulcers (Lyder, 2003).   The education of staff, surrounding pressure ulcer management and prevention, is also very important. NICE (2001) suggest, that all health care professionals, should receive relevant training and education, in pressure ulcer risk assessment and prevention. The information, skills and knowledge, gained from these training sessions, should then be cascaded down, to other members of the team. The training and education sessions, which are provided by the trust, are expected to cover a number of topics. These should include, risk factors for pressure ulcer development, skin assessment, and the selection of pressure equipment. Staff are also updated on policies, guidelines and the latest patient educational information (NICE 2001). Education of the patient, carers and family, is essential in order to achieve optimum pressure area care. Mrs A is encouraged to mobilise regularly, in order to relieve the pressure as a Grade 1 pressure sore has been identified, she is at a significant risk of developing a more severe ulcer. Interventions to prevent deterioration, are crucial at this point. It is thought, that this could prevent the pressure sore from developing into a Grade 2 or worse. NICE (2001) have suggested, that individuals vulnerable to or at elevated risk of developing pressure ulcers, who are able and willing, should be informed and educated about the risk assessment and resulting prevention strategies. NICE have devised a booklet for patients and relatives, called Pressure Ulcers Prevention and Treatment (NICE Clinical Guidance 29), which gives information and guidance on the treatment of pressure ulcers. It encourages patients to check their skin and change their position regularly. As a part of good practise, this booklet is given to Mrs A at the time of assessment, in order for her to develop some understanding of her pressure sore. This booklet is also given to the care givers or relatives so they can also gain understanding, regarding the care and prevention, of her pressure ulcer. An essential part of nursing documentation, is care planning. It demonstrates the care, that the individual patient requires and can be used to include patients and carers or relatives in the patients care. Involvement of the patient and their relative, or carer is advisable, as this could be invaluable, to the nurse planning the patients care. The National Health Service Modernisation Agency (NHSMA 2005) states clearly that person centred care is vital and that care planning involves negotiation, discussion and shared decision making, between the nurse and the patient. There were a number of improvements that I feel could have been made to the holistic care of Mrs A. I feel that one of the fundamental factors that needed to be considered, were the social needs of the patient. As I feel they are a large contributing factor, towards why the patient may have developed her pressure sore. The patient was previously known to be a very sociable lady, who gradually lost her confidence, resulting in her not leaving the house. There are various schemes and services available, which are provided by the local council or volunteer services, to enable the elderly or people unable to get around. For example, an option which could of been suggested to Mrs A are services such as Ring and Ride, or Werneth Communicare. Using these services or being involved in these types of schemes, may have empowered Mrs A to leave the house on a more regular basis. This would enable her to build up the confidence, she lost following her fall. This would have also led to positive i mpact on the patients psychological care, as Mrs A would have been able to overcome her fears of leaving the house, enabling her to see friends and gain communications lost. As previously mentioned in this assignment, although Mrs A had a score of 9, which is not considered an at risk score. I still felt it necessary to act on this score, even though the wound was a not considered to be critical. If it is felt the patient is at a higher risk than that shown on the assessment tool, the practitioner should use their clinical judgement, to make crucial care decisions. It should also be considered, by the practitioner that risk assessment tools such as The Waterlow scale, may not have been developed, for their area of practise. Throughout the duration of Mrs As wound healing process, a holistic assessment of her pressure areas and general health assessment were carried and all relevant factors, were taken into consideration. The assessment tool used to assess her pressure areas, is the most common tool used currently in practise and the tool recommended by the Trust. To conclude, there is evidence prove that pressure ulcer risk assessment tools are useful, when used as a guide for the procurement of equipment. However, they cannot be relied upon solely to provide holistic care to a patient. It has been highlighted, that to ensure a holistic assessment of patients, it is necessary to complete a variety of assessments, to create a complete picture. Although The Waterlow scale covers a number of factors that need to be considered, throughout the assessment, it has become evident that the at risk score, can often be over or under scored depending on the practitioner. Clinical judgement has proved to be, a very important aspect of pressure ulcer prevention and treatment. The education of the patient, carer and relatives has also been highlighted, as an important aspect of care. Empowering the patient with information regarding their illness, may decrease the healing time and help prevent has further issues.

Woody Allen :: essays research papers

Woody Allen has proven himself as one of the forefathers of the American film industry and media as a whole. He has helped mold the standard for modern day film through is many movies that cover a wide range of styles, from comedy and drama to romance to tragedy. He has acted in 28 of the 36 movies he has produced while also famous for his writing. Allen is known best as the creator of films containing self-deprecating and intellectual mockery. His films typically parody the neuroses of the social class of New York sophisticates. Almost of his movies dealt with sex. Woody Allen was born in Brooklyn N.Y. on December 1, 1935 as Allen Steart Koinsberg to Martin and Nettie Konigsberg. Allen briefly attended New York City College, although he never graduated. During college, he wrote one-liners for the columnist Earl Wilson. It was at this time that he changed his name from Allan Konigsberg to Woody Allen. Soon after, he began writing for television, and in the early ‘60s, he worked as a stand-up comedian. In 1964, Woody Allen, a comedy album featuring his stand-up material, was nominated for a Grammy Award. In 1965, he wrote his first screenplay, What’s New, Pussycat, a film in which he also starred. Following the success of this film, he directed What’s Up, Tiger Lily? in 1966, a James Bond spoof that was not as commercially successful as What’s New, Pussycat, but which nonetheless established Allen as a cutting edge humorist.   Ã‚  Ã‚  Ã‚  Ã‚  His featured stars that he selects for his movies are often the most established or up-and-coming actors of the day, and he frequently works with the same actors as well as technical crew. Dianne Wiest, for instance, was featured in Radio Days in 1987 and Bullets Over Broadway in 1994. Judy Davis, another Allen favorite, has appeared in Husbands and Wives released in 1992, Deconstructing Harry in 1997, and Celebrity released 1998. Additionally, Allen has a history of casting his significant others for his films. Louise Lasser, to whom Allen was married in the late ‘60s, starred in numerous film and theater projects penned by Allen. Works featuring Diane Keaton, whom Allen dated in the ‘70s, included Sleeper, 1973; Annie Hall, 1977, which earned Allen an Oscar for Best Director; Manhattan, 1979; and Radio Days, 1987. Mia Farrow, for whom Allen wrote numerous roles throughout their long-standing relationship, appeared in The Purple Rose of Cairo, released 1985, Hannah and Her Sisters, in 1986, also featuring Wiest; Alice, 1990, Shadows and Fog, 1992 and Husbands and Wives released 1992.

Promotion of Education in Africa Essay -- basic education, literacy, so

Topic 1: Promotion of Education in Africa The issue of basic education in the world, especially in Africa has been in the spotlight, waiting impatiently to be solved. The UN, with its Millennium Development Goals, has cited education as one of its top priorities to be achieved by 2015. The African Union, with its Second Decade of Education, has emphasized the need for primary education in Africa to ensure gender equality and the enhancement of African cultural values. Sadly, in many African nations, especially those in Sub-Saharan Africa, adult literacy rates are well below 50%, and many youth lack the most basic and primal educational opportunities. The delegation of South Africa recognizes this urgent need of promotion of education in Africa. Background As a fortunate nation, South Africa has a stable educational infrastructure and a sound â€Å"baseline† for elementary education. In South Africa, the average adult literacy rate is a good 93 percent, as compared to the international average of 84 percent (2010) and the staggering 62 percent of Africa. To continue, most youth has completed grade 9, which concludes their general education and ends their compulsory schooling. And to breathe a sigh of relief, there is little gender disparity in the South African education system. However, there are always some holes. Despite the solid literacy rate- this is defined as a person 15 years or older and can write a short statement about his or her life- South Africa lacks strong secondary and tertiary education. As stated from a study conducted by the OCED (Organization for Economic Co-Operation and Development), â€Å"some three-quarters of South African adults have completed at least grade 6, half has completed grade 9, and just under one-thir... ...amic Militant Organizations in Africa "Africa's Militant Islamist Groups." BBC News. BBC, 5 Dec. 2013. Web. 18 Apr. 2014. . Nkala, Oscar. "Little Terror Threat in South Africa – Report." Home. Defence Web, 5 June 2013. Web. 18 Apr. 2014. . "South Africa: Consolidated Acts." Protection of Constitutional Democracy against Terrorist and Related Activities Act 2004. South African Legal Information Institute, n.d. Web. 18 Apr. 2014. . The War on Terrorism in Africa. N.p.: Westview Press, n.d. PDF. http://www.cfr.org/content/thinktank/Lyman_chapter_Terrorism.pdf

Rene Magrittes Ceci nest Pas Une Pipe and Les Deux Mysteres :: Art Painting Artist Essays

Rene Magritte's Ceci n'est Pas Une Pipe and Les Deux Mysteres The aesthetic value of Rene Magritte’s paintings is driven by a relationship manufactured by the artist. By specifically targeting an audience who can recognize that a set of established artistic interpretations are being challenged in his paintings, Magritte generates a dialectic argument that attempts to deconstruct Plato’s mimetic interpretation of art. As a result, the painting of a negated representation contained within a painted representation of that same object necessarily appeals to a subjective and not objective desire to comprehend Magritte’s intent. In other words, because we (the audience) know that you (the artist) know that your breaking the â€Å"rules,† a specific interest rather than a disinterested idea of beauty influences the aesthetic judgment of Magritte’s work. The we know that you know concept in Magritte’s paintings Ceci n’est Pas Une Pipe and Les Deux Mysteres effectively illustrates the nebulous connotations of beauty and the difficulty of determining an objects aesthetic value. Because of the complexity of ideas created by the different perspectives inherent in all creative endeavors, critics and philosophers, such as Joseph Addison and Immanuel Kant, have attempted to define the parameters of aesthetic judgment. Consequently, Addison and Kant each developed an argument that identified the parameters of aesthetic judgment and highlighted the sense of taste necessary for the recognition of beauty. As a result, in the interpretation of Magritte’s paintings, both Addison and Kant would conclude-- from different reasons drawn from their respective arguments--that Magritte’s work fails to attain a level of achievement consistent with the beautiful. At the top of Addison’s triarchy of aesthetic judgment or taste is the idea that â€Å"true wit† (an Addison synonym for beauty) is grounded in the â€Å"resemblance of ideas†¦ that gives delight and surprise† to an individual (Addison, 264). Working primarily as a source of literary criticism, Addison’s argument about the judgment of taste appears in his Spectator essays that are nonetheless dedicated to the defense of all â€Å"higher† forms of artistic endeavors and to the supremacy of â€Å"polite society† as the guardians of true wit (Lecture). For Addison, the ability to recognize true wit represented a necessary prerequisite for an individual’s acceptance into polite society. Further more, Addison’s argument implied that the judgment of beauty, although based on an ideal of objectivity, is in part an empirical knowledge gained from the â€Å"rules and arts of criticism† that provided the â€Å"accuracy and co rrectness† for contemporary true wit to exist (Addison, 261).

Language Exerts Hidden Power Essay

Language utilizes the hidden power to express, convince and influence human beings. Language can be used in different forms and styles, however, we are never fully aware of the importance of the hidden power that language can express. Language can be revealed in many different ways, which can cause different perspectives from people. In Text A, â€Å"Tversky and Kahneman (1981) demonstrated systematic reversals of preference when the same problem is presented in different ways†. It shows the effectiveness of euphemism and vagueness. The people did not appreciate the straight forward statement, it may be because of the harshness and the reality that shocks the reader. The difference in the preference of the programs shows how human beings are more likely to prefer the positive facts than the negatives; Program A had seventy-two percent preferences. This can show how language has the power to convey something disastrous, however, in a euphemism way, in which the reader will more likely to accept. However, the complicated statements, those with fractions instead of exact numbers, seem to favour the reader. This may be because the reader needs more time to process the factual information in their brains, which may have the same effect as ‘Lost in Translation’; the more your brain processes, the more details and facts are faded away. In addition, the fractions used can make the situation of the Asian disease problem seem less serious, because fractions appear to be less in number than the exact real numbers. In this particular text, power is revealed by the factual information. The difference in presenting the statement does not differ the meaning of the Asian disease problem. However, the power of manipulating and influencing the reader depend on the way the author chooses to present the factual information. The language chosen will be the power that controls the reader’s minds. Different presentations will lead to different interpretations from the readers. Therefore, writers usually use certain style of language to ensure that they can influence and convince the readers. This can represent how human beings are slightly unaware of the importance of language. We tend to ignore and skip through words easily, in which we only want to read what we believe and what we want to see. Similarly, Text B expresses that in our world we normally ignore the flaws and the little ‘holes’ in our communication in language, which also shows the lack of awareness of the importance in language. Slowly, we will tend to lose the ability to control the power that is hidden in language. The ‘Lost in Translation’ ties in with text B as well. When people start to learn a new language they normally translate the words back into their foreign language in order for them to understand the meaning of those words. However, during those translations, many details and little ‘holes’ in the language will disappear and fade away. Native language enables human beings to communicate freely and comfortably, however, it influences out thoughts when it comes to learning a new language. Those little ‘holes’ will be filled in by the influential thoughts from our native language. Therefore, though we are learning a new language, we will still be moved and differentiated by the influence of our native language. The hidden power of the influence of a certain language is strong, it ties with the culture and the tradition of the certain country. From these, we can see how ignorant human beings can be when it comes to realizing how much language influences our lives and how we interpret things. Nevertheless, the power in language can cause negative effects as well as those positives. There are so many languages spoken in our world, therefore, many people can speak more than one language. This means that those people have more than one choice of language to express themselves. This can be positive, however, negative, because there isn’t always the same ‘sayings’ in different languages. As human beings, we manage to experience many different emotions and incidents, where many of those are indescribable in language. Therefore, we can say language is powerful, however, not as powerful as our own minds. â€Å"Language should be a direct mirror of mind† though many thoughts cannot be put into words. In text C, it suggests that language plays an essential role in thinking and the interactions between people, in which the power hidden is the linguistics, philosophy and the psychology side of language. We communicate through language by expressing out what we think in our minds using words, phrases and sentences. Therefore, Noam Chenosky expresses that language is a direct mirror to our minds, which is true to some extent, however, many emotions and thoughts cannot be fully expressed by language. Language can be so powerful that it’s complicated, and those technical studies of language can contribute to an understanding of human intelligence. Human beings have not paid much attention on the hidden power of language, therefore, we only have a rare glimmerings of understanding. Though the understanding of language is limited, most people think and do things depending on what they know and what they believe, which ties in with text A strongly. When people prefer different presentations of the same statement, we can assume that they all have a different perspective, which means they have their own beliefs and knowledge over the statement. Overall, all three texts agree with Rita, Mae Brown’s statement of â€Å"Language exerts hidden power, like a moon on the tides† to a reasonable extent. They all show the human science of language and how language is powerful in our minds. The power inside language is great, however, we have never noticed it. It influences the way we think and the way we judge certain things. Though, due to our lack of awareness of the importance of language, we do not see how it influences out perspectives and perception. However, the possible negative effect of the power in language is that due to the many different languages people may be able to speak, they may find it difficult to express their thoughts and emotions because there are so many choices.