Austrian and Post-Keynesian Criticisms of the Standard Neoclassical Essay - 1

Austrian and Post-Keynesian Criticisms of the Standard Neoclassical View of the Competitive Process - Essay Example This research will begin with the statement that the neo-classical view of the competitive process believes that the perfectly competitive approach it describes the essence of capitalist competition in the market. The attributes of the process are viewed as exceptional and typically arising from government intervention, which includes protection and nationalization. The criticism points out that the basic motivator of the capitalist process, competition, ensures that if any firm enjoys super-normal profits, rivals will soon enter to bid away those profits. They will succeed to undermine any temporally market dominance that the incumbent enjoys. According to Nolan, Post Keynesians school of thought has been criticized by many schools on the issue of economic policies of the evolution of power operating in the capital market. They argue that the changes in the strength of demand cause changes in the level of prices with the respect to costs. These changes tend to have a strong influenc e on the society propensity to save or to consume and thereby changing the level of effective demand to make it correspond with the available supply. Thus, capitalism naturally initiates full employment level provided the income distribution adjustment is allowed to adjust itself to the economy. In the short run, some kind of Keynesian policies will be required but the process will be essentially governed by price flexibility relatively to wage costs. The post-Keynesian believes that the changes in the strength of demand cause changes in the level of prices with the respect to costs. These changes lead to the great influence on the consumer propensity to save or to consume and thereby changing the level of effective demand to make it correspond with the available supply. On the other hand, the Austrian school of thoughts has received criticism on the way they view the strength of demand. They argue that market participants who obtain more and more on accurate and complete perfect kn owledge depend on potential demand and supply preferences.

Short Answer Format on five different topics Essay - 1

Short Answer Format on five different topics - Essay Example our war with Spain after the USS Maine was sunk on February 15, 1898 while at anchor at Havana (Cuba) harbor, resulting in the death of 266 officers and men. America’s victory marked her rise as a world power. Subsequent troubling experiences running former Spanish colonies, sending soldiers to die in two world wars, and leading the war against Communism (Cold War) and terrorism continue to fuel debates on whether the US should be isolationist or accept the interdependence of nations in an age of globalization and perform its unique role as the world’s democratic superpower (Cole 85-89). Eleanor Roosevelt was the wife of four-term (1933-1945) US President Franklin Delano Roosevelt and the niece of two-term (1901-1909) President Theodore Roosevelt. She was born on October 11, 1884 and died on November 7, 1962. Many consider Mrs. Roosevelt as the woman who redefined the role of the First Lady in American history, becoming the model for later First Ladies. She turned her marital problems with her husband into an opportunity to shine and show that she was the better person. During and even after serving as our First Lady, she worked to uplift the social conditions of American women, African Americans, and the poor. She was appointed our representative to the United Nations from 1945-1963. President Harry S. Truman called her the â€Å"First Lady of the World.† Unlike previous First Ladies, she was active in public life as a writer, diplomat, and social activist. She wrote and published her autobiography (2000) before her death. Women’s suffrage is concerned with the right of women to vote in elections. This right was not enjoyed by women because US laws of at the time considered women incapable of exercising it. Such a simple assumption of the incapacity of half of the world to choose who should rule over them reflects the social attitude prevailing in America, where women were seen as weak and inferior to men (Stevens 107-108). Fortunately, a group

The Most Dangerous Game Essay Example for Free

The Most Dangerous Game Essay What if it the issue about the important idea in the story? The most important idea is about the character Rainsford versus nature, Rainsford versus himself, and Rainsford versus Zaroff. In the story â€Å"The Most Dangerous Game† by Richard Connell the main character, Rainsford, experiences both have internal and external conflict. Rainsford experiences have the external conflict. For example, when he fell in the ocean and had a tough battle with the water â€Å"He struggle up to the surface and tried to cry out †¦ him gag and strangle†. Rainsford barely have enough energy to swim to the Ship-Trap Island. He were had struggle with the water and trying to fight back for his life. In addition, when he on the ship with his friend and talk about the weather† ‘Nor four yards’, he admitted Rainsford. ‘Ugh! It’s like moist black velvets’ †. The weather is really bad, and it so dark even he has good eyes but he can’t see anything if it kind of far. The weather is an effect to how Rainsford fell in the ocean. Rainsford external conflict show that how he versus the nature and himself. Rainsford’s internal conflict created many mental challenges for him. For example, when he fell out of the ship, in the ocean he had to stop panicking or he would drown â€Å"A certain cool headedness had come to him it was not the first time he had been in a tight place†. He had been danger place many times so he had more experience and know what to do. He is a very brave person, if it was someone else may be the will be really scared and don’t know what to do. In addition, when in the jungle he keeps telling himself that he will not lose his nerve â€Å"I will not lose my nerve. I will not†. He had to control himself to go through all the game. If he being scared and don’t know do anything he may lose the game. In Rainsford internal conflict it show he is a brave person, how can he control his thinking to be life. Connell has written a story about hunted people, a serious game in the world. There is a lot of people get lost, have to play the game, and got killed by a man. Nobody knows who they are. But one day, a man comes to the island. He also has to play the it. â€Å"The Game†. And he win.

Literature Review: Smoking And Coronary Artery Disease

Literature Review: Smoking And Coronary Artery Disease Cigarette smoking highly boosts the risk of coronary artery disease (CAD), and the associated risk is particularly high in subjects with diabetes mellitus (DM) (Mà ¼hlhauser, 1994). The prevalence of smoking worldwide is one and quarter billion adult smokers, 10% of them reside within South East Asian countries. Smoking prevalence in these countries is a range from 12.6% to 40% in Singapore and Laos, respectively. Malaysia is recording 21% adult current smokers (Southeast Asia Tobacco Control Alliance (SEATCA), 2008). Cigarette smoking is estimated to cause more than five million deaths, making it the leading cause of preventable mortality worldwide (Peto et al., 1996). Atherosclerotic cardiovascular disease, chronic obstructive pulmonary disease (COPD) and lung cancer consider the three relevant causes of smoking related mortality (Centers for Disease Control Prevention, 2008). It has well known that cigarette smoking increases the risk of microvascular complications in DM (ie, nep hropathy, retinopathy, and neuropathy) probably by its metabolic effects (worsening diabetes control and insulin resistance) in combination with increased inflammation and endothelial dysfunction. It appears to be stronger in type 1 diabetic patients, while the enhanced risk for macrovascular complications, coronary heart disease (CHD), stroke, and peripheral vascular disease, is most pronounced in type 2 diabetic patients (Eliasson, 2003, Haire-Joshu et al., 1999, Solberg et al., 2004). Smoking cessation can safely and cost effectively be recommended for all patients, and it is a gold standard against which other preventive behaviors should be evaluated. Stopping smoking at any age has a considerable impact on improving life expectancy, reducing morbidity and reducing health care costs associated with treating smoking related conditions (Asaria et al., 2007, Ward, 2008), but effective strategies are lacking cessation support (Everett and Kessler, 1997). There are several treatment interventions have been identified as essential to achieve cessation. These interventions include brief counseling by multiple health care providers, use of individual or group counseling strategies, and use of pharmacotherapy (Haire-Joshu et al., 1999). Smoking cessation medicines are among the most cost-effective disease prevention interventions available (Fiore, 2000). There are several types of them assist in smoking cessation are available. (Wu et al., 2006). The 2008 update to Treating Tobacco Use and Dependence, a Public Health Service-sponsored Clinical Practice Guideline Panel identified seven first-line (FDA-approved) medications (bupropion SR, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch, and varenicline) and two second-line (non-FDA-approved for tobacco use treatment) medications (clonidine and nortriptyline) as being effective for treating smokers (Fiore et al., 2008). The most commonly used formulation is nicotine replacement therapy (NRT). It reduces motivation to smoke and many of physiological and psychomotor withdrawal symptoms usually experienced during an attempt to quit smoking, and therefore, may increase the likelihood of remaining abstinent (Gourlay and McNeil, 1990, W est and Shiffman, 2001). NRT is currently recommended as a safe intervention to general populations and higher-risk groups, including pregnant and breastfeeding women, adolescents, and smokers with cardiovascular disease (National Institute for Health and Clinical Excellence (NICE), 2008). Systematic reviews show that all forms of NRT have been proven to be effective (Fiore et al., 2008) and it increase quit rate one and a half to two fold in comparison with placebo. There are many studies provide good evidence that smoking cessation pharmacotherapy enhance the success of quit smoking attempt (Cahill et al., 2008, Fiore et al., 2008, Hughes et al., 2007, Stead et al., 2008). Unfortunately, there are insufficient evidences to recommend one delivery system over another. Literature review This review will cover the aims of this research. Globally, it was estimated that there are about 1.3 billion smokers, half of whom will die from smoking-related diseases (Shafey et al., 2009). While in Malaysia, the Third National Health and Morbidity Survey has reported some decline in smoking statistics among general population (18 years and above) in Malaysia with an overall smoking rate of 21.5%; male and female smoking rates of 46.4% and 1.6%, respectively (Ministry of Health, 2006). To our knowledge, there is limited information about the prevalence of smoking among diabetes mellitus patients, but it seems to be mirror to general population, at least for young adults. Findings from the national Behavioral Risk Factor Surveillance System show that the prevalence of smoking in young adults with diabetes mellitus is similar to the prevalence in the general population (Ford et al., 2004). Other study in the United States found the age-adjusted prevalence of smoking was 27.3% and 2 5.9% among people with and without diabetes, respectively. The prevalence of smoking did not differ significantly between participants in both groups when they were stratified by age, sex, race, or education (Ford et al., 1994). Few studies examined the prevalence of tobacco use with diabetic patients, information that is critical for targeting prevention efforts. There is no estimated prevalence for smoking in diabetes mellitus patients in Malaysia. Few studies was conducted about the knowledge and awareness of diabetic patients towards smoking cessation and its pharmacotherapies. There is a survey done in the United Kingdom to investigate awareness of pharmacotherapeutic aids to smoking cessation in diabetic cigarette smokers. A structured questionnaire-based interview was held by research nurse individually with current smokers in a private room. Of 597 diabetic patients attending a routine clinic, one hundred diabetic patients were current smokers. The majority of them were type 2 diabetic patients (96%). There were 66% and 54% had heard about NRT and bupropion, respectively. Those who had heard about NRT, only 49% considered it safe with diabetes, while who knew of bupropion 39% thought it unsafe in diabetic patients. Approximately 84% were aware of the UK National Health Service (NHS) quit line, but only 8% had used it. The authors conclude that this subpopulation has poor knowledge and awareness of NRT and bupropion as aid s to quit smoking (Gill et al., 2005). A qualitative study done in the United States, aimed to investigate beliefs about cigarette smoking and smoking cessation among Urban African Americans with Type 2 Diabetes. Focus groups and a short survey were used to assess cigarette use patterns, perceived smoking health effects, preferences for treatment, and attitudes toward smoking cessation among this subpopulation. Twenty five participants were included in this study. The mean age was (SD) 48.5 years ( ±10.23), 60% female, smoked 20.9( ±12.54) cigarettes per day. Regarding the beliefs and knowledge about smoking and diabetes, Participants believed that smoking increased their risk for all health outcomes, though there was not a clear understanding of how. Furthermore, they believed smoking decreased their appetite and quitting smoking makes you gain weight, and that it would negatively affect diabetes. Regarding beliefs and opinions about stopping most participants desired to quit and believed it was important t o quit, but were not motivated to quit or confident they could achieve cessation (Janet L. Thomas et al., 2009). Another study established in the United States, aimed to assess what smokers believe about the health risks of smoking and the effects of smoking filtered and low-tar cigarettes, as well as their awareness of and interest in trying so-called reduced risk tobacco products and nicotine medications. It was conducted between May and September 2001. They gathered data on demographic characteristics, tobacco use behaviors, awareness and use of nicotine medications, beliefs about the health risks of smoking, content of smoke and design features of cigarettes, and the safety and efficacy of nicotine medications. The findings of this study showed a substantial percentage of respondents either answered incorrectly or responded dont know to questions about health risks of smoking (39%), content of cigarette smoke (53%), safety of nicotine (52%), low-tar cigarettes and filtered cigarettes (65%), additives in cigarettes (56%), and nicotine medications (56%). The smokers characteristics most commo nly associated with misleading information when all six indices were combined into a summary index were as follows: those aged 45 years or older, smokers of ultra-light cigarettes, smokers who believe they will stop smoking before they experience a serious health problem caused by smoking, smokers who have never used a stop-smoking medication, and smokers with a lower education level. Those who believed they would stop smoking in the next year were more knowledgeable about smoking. The authors conclude that smokers are misinformed about many aspects of the cigarettes they smoke and stop smoking medications (Cummings et al., 2004). Unfortunately, there is a dearth of information on the efficacy of smoking cessation pharmacotherapies in diabetic patients because large-scale studies involving this group do not report results separately for them. Additionally, there are few direct head to head comparison studies among them in this subgroup population. In an open-label, randomized trial conducted in Belgium, France, the Netherlands, the United Kingdom, and the United States, compared varenicline with transdermal NRT for smoking cessation. Participants were randomized to receive either 12 weeks of varenicline or 10 weeks of transdermal NRT (Aubin et al., 2008). The primary end point was continuous abstinence rate (CAR) during the last 4 weeks of each treatment. Secondary end points were CARs from the last 4 weeks of treatment through weeks 24 and 52 and the 7-day point prevalence of abstinence assessed at the end of treatment, week 24, and week 52. The Minnesota Nicotine Withdrawal Scale (MNWS) and The modified Cigarette Evaluation Questionnaire (mCEQ) measures of craving, withdrawal, and smoking satisfaction were assessed at baseline and at each weekly visit through week 7 (or at early termination). Data were analyzed in both the prespecified primary analysis population (all randomized participants who received at least 1 dose of study drug: 376 varenicline, 370 NRT) and the all-randomized population (378 varenicline, 379 NRT). CARs were significantly higher in the last 4 weeks of treatment of varenicline group compared with NRT group (55.6% vs 42.2%, respectively; Odds ratio (OR) = 1.76; 95% CI, 1.31-2.36; P < 0.001). At week 24, there was no significant difference in CARs (32.2% and 26.6%; OR = 1.33; 95% CI, 0.97- 1.82). At week 52, CARs were not significantly higher for varenicline over to NRT in the primary analysis population, although the difference in CARs remain significant through week 52 in all-randomized population analysis (25.9% vs. 19.8%; OR = 1.44; 95% CI, 1.02-2.03; P = 0.04). The 7-day point prevalence of abstinence at week 12 was significantly higher for varenicline compared with NRT (62.0% vs 47.0%, respectively; OR = 1.71; 95% CI, 1.27-2.30; P < 0.001). The d ifferences in 7-day point prevalence of abstinence were not significant at week 24 or week 52. For weeks 1 through 7, the average scores of MNWS and mCEQ for cravings, withdrawal symptoms, and the reinforcing effects of smoking were significantly lower with varenicline compared with NRT (all population analysis, P à ¢Ã¢â‚¬ °Ã‚ ¤ 0.001). Varenicline group had significantly lower MNWS subscale scores for negative affect and restlessness compared with NRT (both, P < 0.001); there was no difference between varenicline and NRT in the subscale scores for increased appetite or insomnia. A guideline Treating Tobacco Use and Dependence: 2008 Update is a product of the Tobacco Use and Dependence Guideline Panel. This guideline contains strategies and recommendations designed to assist clinicians; tobacco dependence treatment specialists; and health care administrators, insurers, and purchasers in delivering and supporting effective treatments for tobacco use and dependence (Fiore et al., 2008). A meta-analysis displayed the effectiveness of the first-line smoking cessation medications compared with placebo at 6 months post-quit. They determined the estimated abstinence rate and odds ratio at 6 months post-quit (95% CI) compared with placebo estimated abstinence rate of 13.8% and estimated odds ratio of 1.0. Varenicline had the highest estimated abstinence rate and odds ratio (33.2% and 3.1), while nicotine gum had the lowest estimated abstinence rate and odds ratio (19.0% and 1.5). Another multicenter, randomized, double-blind, placebo-controlled trial compared the efficacy and safety of varenicline with placebo for smoking cessation in 714 smokers with stable cardiovascular disease that had been diagnosed for > 2 months. Participants received either varenicline (1 mg twice daily) or placebo at ratio 1:1, along with smoking-cessation counseling, for 12 weeks. Follow-up lasted 52 weeks. The primary end point was carbon monoxide-confirmed CAR for last 4 weeks of treatment. The secondary outcomes were the CAR from week 9 through 52; CAR for weeks 9 to 24 and 7-day point prevalence of tobacco abstinence at weeks 12 (end of drug treatment), 24, and 52. The CAR was higher for varenicline than placebo during weeks 9 through 12 (47.0% versus 13.9%; odds ratio, 6.11; 95% CI, 4.18 to 8.93) and weeks 9 through 52 (19.2% versus 7.2%; odds ratio, 3.14; 95% CI, 1.93 to 5.11). The varenicline and placebo groups did not differ significantly in cardiovascular mortality (0.3% ve rsus 0.6%; difference, _0.3%; 95% CI, _1.3 to 0.7), all-cause mortality (0.6% versus 1.4%; difference, _0.8%; 95% CI, _2.3 to 0.6), cardiovascular events (7.1% versus 5.7%; difference, 1.4%; 95% CI, _2.3 to 5.0) (Rigotti et al., 2010). Nides and his colleagues conducted a multicenter, double-blind, placebo-controlled, trial to evaluate the efficacy and tolerability of three varenicline doses in adult smokers. Bupropion hydrochloride was included as an active control. Participants were randomized to receive varenicline 0.3 mg once daily, varenicline 1 mg once daily, varenicline 1 mg BID, bupropion SR 150 mg BID, or placebo for 7 weeks, with the option of participation in follow-up through week 52. The varenicline groups received active drug for 6 weeks, followed by placebo for 1 week. The primary efficacy outcome in this study was CAR for any 4-week period from baseline through week 7. Secondary efficacy outcomes involved the 4-week CAR for weeks 4 through 7, 4 through 12, 4 through 24, and 4 through 52; cravings and withdrawal symptoms, assessed using the MNWS and the brief Questionnaire of Smoking Urges (QSU-brief); reinforcing effects of smoking, assessed using the mCEQ; and changes in body weight (Nides et al., 2006). The findings of this study presented that the patients treated with varenicline (except of those who received varenicline 0.3 mg once daily) or bupropion SR had significantly higher CARs for any 4 weeks compared with placebo (P < 0.001 and P = 0.002, respectively). The CARs for any 4 weeks were 48.0% for varenicline 1 mg BID (OR = 4.71; P < 0.001), 37.3% for varenicline 1 mg once daily (OR = 2.97; P < 0.001), 33.3% for bupropion SR (OR = 2.53; P=.002), and 17.1% for placebo. No statistical comparison was performed between the varenicline and bupropion SR groups. Only varenicline 1 mg BID was significantly more efficacious than placebo throughout the entire follow-up period (P à ¢Ã¢â‚¬ °Ã‚ ¤ 0.01). Varenicline 0.3 mg once daily and varenicline 1 mg once daily were significantly more efficacious than placebo through week 7 (P à ¢Ã¢â‚¬ °Ã‚ ¤ 0.05), and bupropion SR was significantly more efficacious than placebo through week 12 (P à ¢Ã¢â‚¬ °Ã‚ ¤ 0.05). Scores on the MNWS and QSU-brief indicated reductions from baseline in cravings with varenicline 1 mg BID compared with placebo at each weekly time point during active treatment (week 2: P < 0.01; weeks 1 and 3-6: P < 0.001). Varenicline 1 mg BID was also associated with consistent improvements from baseline (the day before the TQD) to week 1 in scores on several subscales of the mCEQ compared with placebo, including satisfaction (mean change, -4.82; P < 0.05), enjoyment of respiratory tract sensations (mean change, -0.84; P < 0.05), and aversion (mean change, 0.82; P < 0.05). (The mCEQ was not used beyond week 1 of the active-treatment period.) There were no significant differences on any of the mCEQ measures between the lower doses of varenicline and placebo (Nides et al., 2006). Rationale/Justification Few studies examined the prevalence of tobacco use with diabetic patients, information that is critical for targeting prevention efforts. To our knowledge, there is no estimated prevalence for smoking in diabetes mellitus patients in Malaysia. Most people today recognize major health risks from smoking, but this general knowledge does not necessarily translate into a belief that one is personally at high risk of becoming seriously ill as a consequence of smoking. Furthermore, general awareness of health risks does not mean that people are adequately informed about smoking in ways that might influence their smoking behavior. Because the knowledge, beliefs, and preferences of smokers facilitate maximum receptivity to programs, these are important considerations when developing effective cessation interventions. Therefore, we will investigate smokers knowledge about the health risks of smoking and their awareness of nicotine medications. Unfortunately, there is a dearth of information on the efficacy of smoking cessation pharmacotherapies in diabetic patients because large-scale studies involving this group do not report results separately for them. Additionally, there are few direct head to head comparison studies among them in this subgroup population. Objectives General objectives Determine the prevalence of smoking among diabetic patients in outpatient clinic at General Hospital Penang. To investigate diabetic smokers knowledge about the health risks of smoking and their awareness of nicotine medications. To estimate direct head-to-head comparison between varnicline and nicotine patch regarding to their efficacy in smoking cessation. Specific objectives Determine the prevalence of smoking among diabetic patients. To assess the knowledge of diabetic smokers about the health risks of smoking and their awareness of nicotine medications. To compare between varenicline and NRT in the abstinence rate of smoking. To compare between varenicline and NRT in the cravings and withdrawal symptoms, assessed using the MNWS and QSU-brief. To compare between varenicline and NRT in the reinforcing effects of smoking, assessed using the mCEQ. To compare between varenciline and NRT in changes in body weight. Research Methodology Study design This study comprises different types of study design according to the different objectives. For estimating the prevalence of the smoking among DM patients, it will be achieved by review the medical records for all diabetic patients who attend the diabetic outpatient clinic during 2010. Besides assessing the smoking status, we will collect also specific demographic and diabetic-related data. Any medical records does not contain information about smoking status will be excluded. The second objective in investigating knowledge and awareness of diabetic smokers about the health risks of smoking, smoking cessation and smoking cessation pharmacotherapies, the study design it will be cross-sectional survey. All the diabetic smoker patients who attend the outpatient diabetic clinic at General Penang Hospital in 2011 will be invited to participate in the survey. The questionnaire will be either distributed or interviewed by the clinical staff. The questionnaire will be based on another study. More detailed information on how the survey was conducted can be found elsewhere (Cummings et al., 2004). The questionnaire will be divided to two sections involving: socio-demographic, tobacco-related and diabetes-specific health information; knowledge and awareness towards the health risks of smoking and their knowledge of smoking cessation and smoking cessation pharmacotherapies. The sociodemographic information will include (age, sex, race à ¢Ã¢â€š ¬Ã‚ ¦ etc); diabetic-related information, it will contain: type of diabetes, type of diabetic treatment, duration of diabetes; while for smoking related information will involve: number of cigarettes smoking per day, age started smoking, duration of smoking, are there any attempt to stop smoking for any period of time, Are there other smokers in the household. To compare treatment effect of varenicline and nicotine patch in abstinence rate of smoking cessation for diabetic smoker patients and to investigate the impact of the smoking cessation on the diabetic control. The study design will be randomised, open-label, parallel group study. The participants will be randomized in a 1:1 ratio either to varenicline or nicotine patch treatments. Subject who will receive varenicline will administer 0.5 mg/day for 3 days, 0.5 mg twice daily for 4 days, then 1 mg twice daily thereafter. Full dosing was achieved by the target quit date (TQD) and continues up to 12 weeks. Participant who will receive nicotine patch applied transdermal patches each morning starting on the TQD for 10 weeks. Doses of NRT were 21 mg/day for the first 6 weeks, 14 mg/day for 3 weeks, then 7 mg/day for 3 weeks. We choose these two treatments (nicotine patch and varenicline) for several reasons. Nicotine patch is the most commonly used pharmacotherapy for smoking cessation (Burton et al., 2000, Pierce et al., 1995, West et al., 2001). Given that many smokers in general population use this treatment to quit smoking, it is important to determine treatment effect of other agents relative to the patch. Furthermore, recent data suggest that there is decline in the efficacy of nicotine patch over the previous 10 years (Irvin et al., 2003, Jorenby et al., 1999, Pierce and Gilpin, 2002). Varnecline is selected in this study because yet there is limited studies publish about the effectiveness of this treatment in the diabetic smoker population. Also, varnecline was found to be the highest efficacy in the 2008 PHS Guideline meta-analysis (odds ratio 3.1) comparing to placebo (Fiore et al., 2008). Finally, smokers could be encouraged to seek out this prescribed agent, and insurers and health care syste ms could be encouraged to make this treatment more widely available, if it could be demonstrated that varnecline is more efficacious than over-the-counter medication (such as nicotine patch). In this study we will collect three types of end points: efficacy, measuring of craving and withdrawal symptoms, and investigating the impact of smoking cessation on diabetic outcome. The primary outcome for efficacy in the study it will be self-reported CAR, confirm by exhaled CO levels of 6 ppm or below, during the last 4 weeks of treatment (varenicline and NRT, weeks 9-12 after TQD) The secondary is the CAR from the last 4 weeks of each treatment until 6 months. Other secondary outcomes are 7-day point prevalence of tobacco abstinence at weeks end of drug treatment and at 6 months. Continuous abstinence define as self-reported abstinence from any tobacco- or nicotine-containing product during the specific period and it will be verified by carbon monoxide (CO) level à ¢Ã¢â‚¬ °Ã‚ ¤ 10 ppm. If the CO level is more than 10 ppm will be classified as a smoker regardless of self-reported abstinence. Point prevalence abstinence define as self-reported abstinence from any tobacco- or nicotine-containing product in the past 7 days that was not contradicted by expired air CO > 10 ppm. These are traditional standards for assessing efficacy of smoking cessation interventions (Fiore et al., 2008, Hughes et al., 2003). The Minnesota Nicotine Withdrawal Scale (MNWS) (Cappelleri et al., 2005) will be used to assess urge to smoke, depressed mood, irritability, anxiety, poor concentration, restlessness, increased appetite and insomnia. The modified Cigarette Evaluation Questionnaire (mCEQ) (Cappelleri et al., 2007) will be used to assess smoking satisfaction, psychological reward, aversion, enjoyment of respiratory tract sensations and craving reduction. The two previous questionnaires will be administered baseline visit and at each weekly visit through week 6 (after TQD) and at the end of treatment or at termination for participants who discontinued the study before week 6 (TQD). While the MNWS will be administered to all participants, the mCEQ will be administered only to participants who report smoking since their last completed questionnaire. Furthermore, we will assess the level of the nicotine dependence by using the Modified Fagerstrà ¶m Test for Nicotine Dependence (Heatherton et al., 1991) that range to three score ranges: (0-3) score indicate to low dependent, (4-6) score indicate to moderate dependent and (7-10) score indicate highly dependent. It will be administered at the baseline of the study. Schematic presentation of study design: Screening all diabetic patients medical records to estimate prevalence of smoking among them Interviewed structured questionnaire for all diabetic smoker to: To know characteristics of diabetic smoker (sociodemographic, diabetic history and tobacco use history) Investigate the knowledge towards smoking cessation and its pharmacotherapies Patients who attend quit smoking clinic Assessed for eligibility Excluded: Did not meet entry criteria Withdrew consent Randomized at ratio 1:1 Allocated to Varnicline (2mg or 1mg) (For 12 weeks) and arrange for quit date Allocated to nicotine Patch (For 12 weeks) and arrange for quit date Follow up at the end of treatment (12 weeks) and at 6 months to assess: Abstinence rate of smoking cessation the cravings and withdrawal symptoms the reinforcing effects of smoking changes in body weight Analysis Inclusion criteria The inclusion criteria it will be varying among the different objectives: For investigating the knowledge and awareness towards smoking cessation and its pharmacotherapies, smoker and ex-smoker diabetic patients (either type I or II) of both sexes aged à ¢Ã¢â‚¬ °Ã‚ ¥18 years will be included. For the direct comparison between nicotine patch and varenicline, Diabetic smokers of both sexes aged à ¢Ã¢â‚¬ °Ã‚ ¥18 years who smoke à ¢Ã¢â‚¬ °Ã‚ ¥10 cigarettes/day and willing to quit smoking. Exclusion criteria Patient is currently using any form of tobacco other than cigarettes; any form of NRT or other smoking cessation therapy. Significant depression requiring behavioral counseling and those using medications with psychoactive effects (e.g., antidepressants, antianxiety agents). other active psychiatric diseases because of previously identified limitations with delivery of the specific counseling intervention in such subjects. History of skin allergies or evidence of chronic dermatosis. Patient has medical contraindications for any of the study medications. Pregnant, breastfeeding women or at risk of becoming pregnant. Drug abuse or HIV infected patient. Recent (à ¢Ã¢â‚¬ °Ã‚ ¤3 months) history of myocardial infarction, angina pectoris, serious cardiac arrhythmia, or other medical conditions that the healthcare provider deemed incompatible with study participation. Participation within the last 12 months in a formal smoking cessation program.

Christopher Columbus Essay -- History Columbus

Christopher Columbus is credited as the audacious voyager who challenged modern thinking and found the land now known as the Americas. Columbus not only discovered new lands, but also opened trade with native peoples and brought substantial wealth and glory to the major European powers. In addition his ventures not only enabled the spread of the gospel to pagan peoples, but also set the stage for the emergence of the United States of America. Without Christopher Columbus the United States would not have been a separate state for over 500 years or more or not at all. However, despite all that Columbus did, people still fail to recognize the journey he undertook before Columbus set off in his first ship. The public is still unable to comprehend, despite years of education, the internal and external struggle and the ridicule Columbus was forced to go through for just believing in what he thought was correct. His courage in the face of ridicule is what really makes Columbus a national he ro in that age as well as in this era. Christopher Columbus’ acts of perseverance, his moral courage, and his adventurous spirit continue to inspire the people of today. Through this intercourse, Christopher Columbus’ work has not ended, for it is continuous as it persists to imbue the people of today with the ability to succeed in the face of an unknown future. (Philips 13) Christopher Columbus’ perseverance and persistence have long been a part of the philosophy of modern thinking. Columbus displayed high acts of persistence as he rode the waves of uncertainty to the land of success. When Columbus sought audience with King of Portugal in 1485, he was humiliatingly denied funding for his proposed idea to sail west to get to India. If, Columbus had g... ... the various values that Columbus passed on to us. Works Cited 123Holiday. "Christopher Columbus Biography." Columbus Day. Microsoft Encarta, 23 May 2003. Web. 27 Nov. 2010. . Cohen, J.M. (1969) The Four Voyages of Christopher Columbus: Being His Own Log-Book, Letters and Dispatches with Connecting Narrative Drawn from the Life of the Admiral by His Son Hernando Colon and Others. London UK: Penguin Classics. Davidson, Miles H. (1997) Columbus Then and Now: A Life Reexamined, Norman and London, University of Oklahoma Press. Khurana, Simran. "Quotations: Hope." Quotes Quotations. 2001. Web. 27 Nov. 2010. . Phillips, W. D. and C. R. Phillips (1992) The Worlds of Christopher Columbus. Cambridge UK: Cambridge University Press.

Conquering My Fear of Writing Essay -- Literacy Narrative Essays Paper

Conquering My Fear of Writing Lacking experience in writing and reading, English is my most feared subject. It is the one and only vulnerable spot in my otherwise invincible academic armor. I hate writing and I despise reading. Other than magazines, I cannot recall reading anything since "The Crucible" which was a teacher assigned book in my sophomore high school English class. Not that I read a lot before that, I don't remember reading any books in my middle school years neither. Now, with this writing assignment since a long time, my brain feels like an old rusty engine of an 81 Porsche cranking up for the first time in years, readying to compete in the heat. My parents and my favorite math teacher always told me that I'm a very bright individual and my accomplishments in other subjects prove that. I approached and conquered the subjects of math, science, and history like a paladin in gold, yet faced with writing, I would coward in fear. To me, writing equals to nothing more than stress and frustration. A useless hassle and senseless boredom which I thought was too stupid to waste effort on. Therefore I have shied away from this department for as long as I can remember and focused all my energy toward the areas I have strength and faith in. The writing compartment in my brain is very restricted. I lack flexibility in the use of words and phrases. A typical sentence of mine, starts with "I", "It", "Because", "The", "But", "Therefore". It is extremely difficult for...

Psychology/Theology Essay

What is theory of personhood? The concept of personhood is very important in our daily life in terms of the perception of the surrounding environment and human beings in general. Personhood provides assistance in understanding and establishing priorities and attitudes towards such critical issues as punishment, medicine, crime, moral values, private property, etc. Undoubtedly, people only are capable of hesitating and doubting. The idea of personhood itself remains rather intangible as it is being influenced by a significant number of various factors such as political, social, cultural, and educational conditions of life. Therefore, the theory of personhood has been impacted by different scholarly points of view, both psychological and theological. Psychologists argue that the theory of personhood greatly depends on what is called â€Å"intentionality†, which also includes the phenomenon of â€Å"intention†. Intentionality is more precise and less abstract than human attitudes, desires, wishes, and beliefs. They are not based on emotions or impulsive/enthusiastic mental activity. They are to great extend associated with strong motivation or ultimate goal. However, in the majority of cases people are not aware of why they want particular thing/object/person, which makes the issues of personhood extremely unclear. (Brown 2006). If to take a closer look at the theory of personhood from the point of view of theology and spirituality, this concept is closely connected with upbringing and early education – the period of human consciousness formation and establishment of basic surrounding physical and mental laws. The theory of personhood in this case includes three key features: Personal â€Å"self† (consciousness) linked to â€Å"objectivity† (surrounding environment), that includes palpable objectivities and imaginative models. The line between these two aspects varies depending on personal priorities. Personal â€Å"self† as monitoring hierarchy. Considering that you have awakened from a night dream or that the vision you see is an abstract illusion developed from your mental activity and imagination. Personal â€Å"self† as a stable mental condition in the form of one’s â€Å"biographic† character. (Brown 2006). If we talk about the history of ideas, we observe the systems of beliefs regarding objective reality that have considerably changed during the course of the years. Ordinary people do not pay descent attention to it as, for instance, Aristotle’s period beliefs and the fifteenth-century Scandinavian countries have been thoroughly studied exceptionally by the scientists which may follow the changes of the history. The theory of the personhood goes deeper than the modifications of the traditional moral values and social set of priorities. It leaves behind the usage of already established knowledge as construction blocks. It continues to explore the surrounding environment by means of unravelling â€Å"the obvious†. In terms of spirituality, the concept of personhood implies object-subject difference during an open-ended deterioration. It suggests a â€Å"holistic epistemology† which is characterized by spherical reasonability between belief-systems and moral values, self-respect, etc. (Brown 2006). What is spiritual counselling? Spiritual Counselling is closely associated with our choices in life: how to live in present and abstract karma (deep-rooted laws that avoid serving us); how to find our place within the divine goal; how to establish relationships with others that would be deeper, more sincere, less time-consuming and more affectionate; and in relation to these and other life issues, what spiritual practices to accept. A secure, tolerant and cheering room is provided in which to start living and get rid of the fake causes which result in suffering; the main reason why people strive so much for the spiritual counselling is that their souls are meant to be linked to positive phenomena such as love, affections, care, kindness, wisdom, harmony, etc. Entering the true consciousness within, abandoning uncertainty and concerns, our own natural intelligence can conduct us all the way through all the problems and glitches that exist in modern world – for instance, the challenges ensured by our professional activity, personal relationships and health condition. The spiritual supervisor serves as a medium between the soul which initially contained original purity, immortality, independence, and harmony. Obviously, the given concept goes far beyond established counselling approaches, drawing upon silence, prayer, self- observation, meditation, healing, and other practices, whose purpose is to discharge the internal possessions that all human beings have. Taking a closer look at spiritual counselling it may be stated that the core issue of it is an individual who believes that there is something that is higher, some supreme force, which helps him/her in all of his/her efforts, regardless of age, race, gender, or the name of this supreme force: God, Buddha, Allah, etc. At first it may seem to be a minor identification, however, by the recognition of an existence of the supreme power, regardless of the way the person feels it suitable to understand or recognize this, the self, which is the major source of human problems, is suppressed to some degree. Only in this situation we can start perceiving more intelligent, more helpful sides of our inner worlds. One more rather significant feature of spiritual counselling is the way this supreme power is encouraged to be found for internal help during times of great struggle. Spiritual counselling helps us to understand who we are and enhance our experience in general interpretation of the surrounding environment. This logic of reason differs from individual to individual. In fact it includes our attempts and efforts to advance who and what we are, existing not only for ourselves, but for the advantage of the world around us. (Brown 2006). Having started participation in something innovative, it wouldn’t be a bad idea to know how the supervisor works. To begin with, the core philosophical issue in this case is that each individual possesses the answers they need inside. The reason of many human problems is that people are not capable of retrieving these answers from their inner worlds due to their intelligence laziness, limitedness, etc. Perhaps most essential is the manner that people have to be taught what to do, not just be passively told what is happening each time and given a projected resolution. One of my favourite sayings is: â€Å"If you think you can – you can. If you think you can’t – you are right.† By means of spiritual counselling various hard situations in life, whether present or past, can be successfully coped with. Thoughts we are not satisfied with can be transformed. Emotional lines, regardless of how deep-seated they may seem, can be eliminated. Mental obsession can be also destroyed. In conclusion, this gives us a chance to go to more positive and pleasing settings in our lifestyles and provides us with a strong start to coming into a better realization of who we truly are. Basically, all we need is to really want to change. This desire is distinct, most significant key to real changes within human beings. References Brown, G. (2006). Spirituality and Psychology: the Aspect of Religion. New York: Pocket Books.