The Most Abundant Protein

Have you ever wondered what the most abundant protein is? The answer depends on whether you want to know the most common protein in the world, in your body or in a cell. Protein Basics A protein is a polypeptide, a molecular chain of amino acids. Polypeptides are, indeed, the building blocks of your body. And, the most abundant protein in your body is collagen. However, the worlds most abundant protein is RuBisCO, an enzyme that catalyzes the first step in carbon fixation. Most Abundant on Earth RuBisCO, whose full scientific name is ribulose-1,5-bisphosphate carboxylase/oxygenase, according to Study.com, is found in plants, algae, cyanobacteria, and certain other bacteria. Carbon fixation is the main chemical reaction responsible for inorganic carbon entering the biosphere. In plants, this is part of photosynthesis, in which carbon dioxide is made into glucose, notes Study.com. Since every plant uses RuBisCO, it is the most plentiful protein on earth with nearly 90 million pounds produced every second, says Study.com, adding that it has four forms: Form I, the most common type is found in plants, algae, and some bacteria.Form II is found in different types of bacteria.Form III is found in some archaea.Form IV is found in some bacteria and archaea. Slow Acting Surprisingly, each individual RuBisCO is not all that efficient, notes PBD-101. The website, whose full name is Protein Data Bank, is coordinated by Rutgers University, the University of California, San Diego, and San Diego State University as a study guide for college students. As enzymes go, it is painfully slow, says PBD-101.  Typical enzymes can process a thousand molecules per second, but RuBisCO fixes only about three carbon dioxide molecules per second. Plant cells compensate for this slow rate by building lots of the enzyme. Chloroplasts are filled with RuBisCO, which comprises half of the protein. This makes RuBisCO the most plentiful single enzyme on the Earth. In the Human Body Around 25 percent to 35 percent of protein in your body is collagen. It is the most common protein in other mammals, too. Collagen forms connective tissue. It is found primarily in fibrous tissue, such as tendons, ligaments, and skin. Collagen is a component of muscle, cartilage, bone, blood vessels, the cornea of your eye, intervertebral discs, and your intestinal tract. Its a little harder to name a single protein as the most common in cells because the composition of cells depends on their function: Actin is a very common protein that is found in all eukaryotic cells.Tubulin is another important and abundant protein used in cellular division among other purposes.Histones, associated with DNA, are present in all cells.Ribosomal proteins are abundant since they are needed to produce other proteins.Red blood cells contain high concentrations of the protein hemoglobin, while muscle cells contain a high level of the protein myosin.

Essay on The Impact of the Remittances in Latin America

Introduction In Latin America migration and remittances have become structural features in the economy, the society, and in the political environment; due to the underdevelopment and inequality of the region. Because they relative importance, trends in migration and the impact of remittances in population of Latin America are the main topics that we will analyze in this research focusing on reduction of poverty and inequality. This research will aim to answer the next: Do remittances finance development in the region? Do they contribute to reduce poverty? Do they increase the inequality or help to reduce it? Do remittances are used only for consumption or they promote investment in a positive way? In order to reach the objective†¦show more content†¦Finally, we will present some general conclusions. Literature Overview The framework related to the impact of remittances can be classified in macroeconomic and microeconomic according to several recent researches. Even though there is a general consensus that remittances are positive for the economic development, some authors claim they might have negative effects (Barajas et al., 2009; Bettin and Zazzaro, 2008; Chami, Fullenkamp and Jahjahha, 2005). When talking about their impact, some countries in which the remittances constitute a huge source of the national income we can appreciate the macroeconomic effects of the remittances in the economic growth. Some aggregate analyses of the relationship between remittances and economic growth have found a positive correlation between these two variables (Faini, 2007; World Bank, 2006a; Fullenkamp, Gapen, and Montiel, 2009). Some other studies have proven that the remittances affect the economic growth in the sense that there are foreign savings, and they interact with the structure of the local economy if their use is productive (Fullenkamp, Gapen, and Montiel, 2009). It has been demonstrated that remittances respond to macroeconomic fluctuations, in particular to the inflation, showing countercyclical trends, due toShow MoreRelatedThe Country Of Nicaragua And The Center Of Central America1063 Words   |  5 PagesThe country of Nicaragua, located in the center of Central America, is one the poorest nations in Latin America. Nicaragua’s citizens are primarily mestizo who account for almost 70% of the population. With a population of nearly six million, 58.8% of Nicaraguans live in urban areas, with nearly 2% of citizens migrating from rural areas to the cities in search of jobs and better welfare. However, internal migration to rural areas also exist seasonally for agricultural labor. Due to the current economicRead MoreThe Global Financial Crisis Of The Usa1383 Words   |  6 PagesBrazil and South Africa to the countries of South Asia and Latin America. Asian countries were more affected by a strong recession in the USA Bangladesh Bangladesh is a developing country and globalization integrates it with the global market in diverse areas. Bangladesh is equally affected by this global turmoil in the short run as well as in The long run. It is very difficult to predict the scenario in the long term; however, short term impact should duly be taken into consideration. The global financialRead MoreMigration from developing countries to developed countries should be stopped. Discuss2070 Words   |  9 Pageswas PhDs (Newland, 2003). Therefore, if losing highly skilled people continues, impact of brain drain from migration to developing countries is enormous. The is no denying the fact that developing countries have lost many highly skilled people due to migration but they also got benefits from its. Firstly, developing countries received a lot of remittances from migrants. 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Pernia The paper looks into the effects of international migration and remittances on household incomes and well-being, poverty reduction, human capital investment, saving, and regional development in the home country. Remittances appear to raise average incomes for all income groups but more so for the richer households than for the poorer ones, a finding that is consistent with that in several Latin American countriesRead More Impact of Foreign Remittances on Economic Growth and Poverty Reduction in Pakistan2389 Words   |  10 PagesINTRODUCTION: Remittances typically refer to transfers of money by foreign workers to their home countries. Remittances are not a new phenomenon in the world, being a normal associated to migration which has always been a part of human history. Remittances are playing an important role in the economies of many developing and low income countries. Pakistan is a labour abundant country; hence, as neoclassical theory shows, if workers are unable to find jobs and/or wages to satisfy their needs, theyRead MoreA Brief Note On Financial Development And Inequality Essay1414 Words   |  6 Pagesrelationships between industries in sub-Saharan Africa, and how that impacts levels of inequality amongst the people that support those industries. Sub Saharan Africa has consistently been one of the most impoverished and least developed areas of the world. Looking at gross domestic product it is clear that sub-Saharan Africa remains generally under-developed economically, even when compared to the average per capita income in Latin America. There is also a good deal of consistency across countries withRead MorePursuit of My Dream: Illegal Immigration to the United States1856 Words   |  8 Pagescountry to become the prosperous nation it now is. The Bracero Program represents how the vision of coming to America in search of a new life became an appealing idea to the people who had few resources and didn’t have a stable economic position. Since then, immigrants that find themselves in that economic situation tend to look for the American Dream. Of course immigrants have been coming to America for long before the program, but since it happened, immigrants have a more clear idea and a much biggerRead More The Problems of Illegal Immigration Essay example1548 Words   |  7 Pagesthere is discrimination in America when it comes to immigration.   The type of immigration that I am referring to is that of illegal immigration into the United States from the southern borders.   The people coming here illegally or those that have overstayed passed their stipulated time issued by their visas are the ones who are facing this problem head on.   They are coming originally from different countries, such as Mexico, El Salvador, Guatemala, Honduras, and other Latin American countries.   In theRead MoreMajor League Baseball Helping Developing Countries3070 Words   |  13 Pagesschools, but also from all over Latin America. Major League Baseball has established itself in Latin America as a premiere way for these young kids who are looking for a way out of their developing nation to find success in the American dream. While the MLB focuses much time and effort all over Latin America, this paper will foc us primarily on how Major League Baseball helps developing nations specifically the case of the Dominican Republic. Following World War 2, the Latin sporting experience has been

Hicks And The Is Lm Curve - 1298 Words

Dan Hill AAEC 8210 December 1st, 2015 Hicks and the IS-LM Curve While J.R. Hicks received the Nobel Prize for many of his accomplishments in both macroeconomic and microeconomic research, his development of what he then called the SI-LL model, but is now more famously known as the IS-LM model, was one of his greatest feats. The IS-LM model was Hicks’ reduction of aggregate demand analysis done by John Maynard Keynes in his book titled The General Theory of Employment, Interest, and Money published in 1936. The model’s purpose was to explain investor decisions dependent on money availability and interest rates in the goods and services market and assets market. The IS-LM model now plays an integral role in both general macroeconomic understanding and policy analysis. IS-LM stands for investment-savings and liquidity-money, and can be represented graphically by a downward sloping curve for IS and an upward sloping curve for LM. In the IS curve, anywhere along the curve represents a point where interest rate a nd income satisfy that total spending equals the economy’s total output (real income). Total spending/demand is determined by adding together consumer expenditure, investment, government expenditure, and net exports (investment being the only endogenous variable among the four). In this equation, the assumptions are that; consumer spending is increasing with more disposable income, investment is increasing as interest rates increase, and exports are increasing withShow MoreRelatedIs Lm Model On Economics Of The Twentieth Century?1037 Words   |  5 PagesIS-LM Model Mr. Keynes and the â€Å"Classics†; A Suggested Interpretation is a classic journal written by John R. Hicks, who has left huge impact on Economics of the twentieth century. John Hicks introduced the beginning of â€Å"IS-LM economic model†, which set up basic system of Macroeconomics to the world through this journal. This journal could be considered as an attempt to interpret and reassess Mr. Keynes’ General Theory of Empoyment within the typical â€Å"classic† theory framework and compare Keynes’Read MoreIS, LM model and explanations(in the form of an essay).1350 Words   |  6 Pagesof the IS-LM model took several directions. Probably, the most prominent ideas on that theory were expressed in the work of John Hicks called Mr. Keynes and the Classics. The model expressed in the article was largely based on the works of John Maynard Keynes and became a widely accepted as the alternative framework to standard Keynesian analysis. The IS-LM model is a way of modelling equilibrium in the economy by looking at equilibrium in the goods and services markets (the IS curve) and equilibriumRead MoreTheoretical Analysis of News Article A Working Model: Is the World Experiencing Excess Saving or Excess Liquidity?540 Words   |  3 Pagespurpose of this article is to present the understanding of IS-LM model in macroeconomics by these are the convergence of two economic graphs, one representing the income and savings (IS0 and other liquidity and money (LM). Article Summary In this article, author defines the so-called IS-LM framework aggregate macroeconomic model that has the intuition use to describe money and markets. The author has also focused on the role of IS-LM model and its relation with the interest rate, short-term ratesRead MoreNeoclassical Theory Of Keynesian Theory1578 Words   |  7 Pagessituation in the long run is the defining Neoclassical feature. The paper will first examine the Neoclassical elements in the synthesis school of thought, with reference to its defining IS/LM model, the Phillips Curve and the Solow-Swan Growth model. The UK Cambridge Keynesian school rejects Hicks and Hansens’ IS/LM model, and instead utilises proportionately more Keynesian ideas in its body of theories – including a rejection of the Neoclassical tenet that it is that interest rate that equalises savingsRead MoreThree Pane Model1553 Words   |  7 Pagesanalysis to make rational judgments about the effects of global events or policy shock s on the economy and thereby on the business environment. But such analysis is often laden with possibilities for logical missteps. The Three- Pane model (open economy IS/LM model) is discussed here as a tool for explaining key relationships in the economy while avoiding the missteps encountered in macroeconomic analysis. What is open economy macroeconomics? Macroeconomic analysis helps firms to explore the interrelationshipsRead MoreINTRODUCTION: Keynesian framework IS-LM Model According to Dornbusch (2011), the IS-LM model was1100 Words   |  5 PagesINTRODUCTION: Keynesian framework IS-LM Model According to Dornbusch (2011), the IS-LM model was invented by Hicks in 1937. IS stands for investments and savings in the goods market while LM stands for liquidity preference and money supply in the money market. The model emphasizes the interaction between the goods and assets markets. Spending, interest rates and income are determined jointly by equilibrium in the goods and assets markets. The IS curve shows various combinations of interest ratesRead MoreScience Of Economics By Neuroscientist Marco Iacaboni1074 Words   |  5 PagesShiller and Akerlof. The IS-LM model is such a model of macroeconomic reasoning and illustrates their influence on large-scale group decisions. Developed by John Hicks in the wake of the Great Depression, the IS-LM model describes how interests rates interact with money supply to affect an economy’s aggregate output. The IS-LM model showcases the macro-responses of an economy to various fundamental shifts. Take the case of an increase in aggregate investment. The IS-LM suggests that any increase toRead MoreReview of John Hicks Article a Suggested Interpretation of Keynes3840 Words   |  16 PagesA Review of Mr. Keynes and the â€Å"Classics†; A Suggested Interpretation By J. R. Hicks Word count: 2,932, (excluding mathematical equations) We aim to examine the British economist Sir John Hick’s article ‘Mr Keynes and the â€Å"classics†; A suggested interpretation (April 1937)’ in which Hicks seeks to devise a simpler more cruder ‘classical’ model of the imperial, however complicated work of Professor Pigou’s ‘The theory of unemployment’ that will rightfully disagree with Mr Keynes’s mystifyingRead MoreEconomic Growth And Economic Development917 Words   |  4 Pagesnecessities. Inflation also pins down the growth further as the purchasing power of the current level of income is greatly reduced. As explained by the IS/LM model in the general theory by John Hicks, there are some situations in which there is no strong automatic mechanism that can move output and employment towards full employment levels (Hicks, 1904, n.p.). On the other side, some business cycle favors economic growth such as the expansion ally and boom phases. Here the country invests more asRead MoreThe Cost Of Real Money1690 Words   |  7 PagesHowever, with the LM curve moving to bring the economy to full employment, it seems impossible, in this case, to have sustained price rises (i.e. inflation) as the monetary side seems to close off the story entirely. One could subsequently argue that, as real wages (w/p) declined in the process, then workers would try to bid their money wages back up and thus regenerate the gap. However, recall that from the four-quadrant IS-LM diagram (our earlier Figure 4), when IS-LM centers on the full employment

Contributing Factors To Brian’s Continence †MyAssignmenthelp.com

Question: Discuss about the Contributing Factors To Brians Continence. Answer: Introduction The aim of the report is to respond to the case study of Mr. Brian experiencing incontinence. The contributing factors to the incontinence and the continence issues are discussed. To promote continence in Brian, health promotion involves the process of increasing his control over and improves the health. For this purpose two-research articles on one initiative or innovation program is critically analysed and based on the evidence obtained the report recommends how registered nurses can improve personal practice and the practice of others. Contributing factors to Brians continence problems Incontinence and the problems related to continence are the indicators of the bladder and bowel dysfunction. It is the most common problem occurring in the old age but is never normal. Thus, age is not causative e but contributing factor for incontinence, which is also found in case of Brian (Watt et al. 2014). He is 82 years old man and his age may be considered contributing factors for his continence problems. According to Johnson and Chang (2014), urinary and faecal incontinence in elderly patients is caused by strokes. From the patient history, it can be interpreted that the ischemic heart diseases and heart failure is the contributing factor of Brians faecal and urinary incontinence. Bladder dysfunction also results from the spinal disorders and osteoarthritis (Bedretdinova et al. 2016). In neurogenic bladder disorder there is damage to the nerve tissues that control the functioning of the bladder and the muscles involved in urination and bowel movement. Brians, spondylitis may be the other contributing factor (Panicker et al. 2015). The possible complications of spondylitis are the urinary and faecal continence (Bagnola et al. 2017). Not drinking enough water is the contributing factor for inflamed bladder wall. In case of Brian, it was seen he consumed more of wine and coffee and less of water. Drinking tea or coffee aggravates the bladder, which makes the incontinence a likely occurrence (Watt et al. 2014). Wine acts as a bladder stimulant (Johnson and Chang 2014). Faecal incontinence can be caused by constipation. Brian opens his bowel every 2-3 days. Thus, constipation may be the contributing factor for the continence issues observed in Brian. According to Loening?Baucke and Swidsinski (2015) faecal impaction causes difficult bowel moment and is the cause of the lower gastrointestinal tract obstruction. It is commonly found in elderly people with the constipation. The same may be the causative factor of Brian bowel problems and it was found from the case study that his abdominal examination showed lower left abdominal faecal masses. Since, Brian is undergoing treatment and medication for his ailments; the side effects of the medicines are having adverse effects on his bladder function. Brian is taking frusemide and spiractin, which is diuretic that increases urine volume. Amiodorone taken by him shows the beta blocker-like and calcium channel blocker-like actions and is known for urinary incontinence and constipation. Brian also takes tramadol which is the opioid that causes the reduce bladder contractions, constipation (Hussain and Gill 2016). Main continence issues The main urinary incontinence issues faced by Brian is the voiding of urine 9-12 times a day and 2-3 times overnight, he feels the urgency to void on most occasions. Sometimes Brian is not aware of leakage. He opens his bowel every 2-3 days and each bowel action is associated with straining and urgency. These issues can be categorised as urge continence in Brian. Urge continence refresh to the condition where the loss of urine is accompanied with the urgent need to urinate. This mainly occurs due to involuntary actions of the bladder after stroke (Johnson and Chang 2014). Brian condition can also be related to the overflow continence. It is the condition where the bladder never completely empties. It is due to this reason that Brian voids urine 3-4 times a day with small volume of urine loss. Brians functional incontinence that is unable to make up to the bathroom at night. It can be caused by the stroke complications and the neurological disorder that he is having. His mind cannot c arry or plan the trip to bathroom (Watt et al. 2014). Incontinence in elderly patients is difficult to treat, as they are reluctant to seek help due to embarrassment. Lack of awareness and effective communication with the health care providers is the other major cause of poor services (Watt et al. 2014). It can be concluded that Brian needs comprehensive health care plan because he is having chronic heart illness along with several comorbidities that result in interrelated complications. This demands the multifaceted approach. Thus, thenursing care plan must address the health issues using evidence-based practice. There is a need of joint approach and strategies for achieving the best outcome for Brian considering his age, coronary heart disease, spondylitis, incontinence, walking disability and overall weakness (De Gagne et al. 2015). Critical analysis research articles Article 1 In the article by De Gagne et al. (2015), the aim of the pilot study is to develop, implement and determine the effectiveness of the self-management program that is evidence based for community-dwelling older women (aged 55 years) with urinary incontinence in South Korea. The rational for conducting this study is evident from the succinct background provided by the author that demonstrates the through literature review being conducted (Schneider and Whitehead 2013). Thus, the objective of the paper is justified by the following objectives- Evaluation of the participants outcomes regards to the severity of the symptoms of incontinence Evaluation of the fidelity of the implemented programs Determine the participants response or satisfaction with the program Considering the research objectives the research topic was well justified although there was no hypothesis given. The study uses quantitative research paradigm and involves a one-group pre- post-test design. The instrument used for the data collection includes Sociodemographic questionnaire, knowledge scale and attitude scale, ICIQ-SF, Short Assessment Patient Satisfaction, Fidelity evaluation checklist. The research design is justified as the methodology is well described in terms of the participants and each of the instrument used for data collection is well explained. It constitutes the strength of the study as it eliminates the limitations by detailed description of participants, the inclusion and exclusion criteria that were found justified (LoBiondo-Wood and Haber 2017). The author had clearly mentioned the setting of the research as Sosa community (Korean rural community) but the lack of details on it is inconvenient for the readers. The research seems to be reliable. Obtaining ethics approval implies that the ethical issues were taken into considerations (Moralejo et al. 2017). In the study, 17 women participated and completed weekly 90-min group sessions for 5 weeks. The strength of intervention emerges from the teaching topics that are described in lucid language. However, drawback involves lack of details on the sampling method (LoBiondo-Wood et al. 2014). It includes self-management principles, behavioral and lifestyle factors on bladder health, effective communication, myths and facts about UI, and interactions with family and friends. The limitation of the study is the lack of sufficient description of data analysis. However. It was justified that the study used descriptive statistics and paired t-tests. The results are well documented by the author in form of tabulated charts with flawless presentation of the statistical values (p 0.05). The presentation of the results under individual subheadings gives the readers an in-depth insight of the study outcomes. Acknowledgement of the limitations adds to the strength of the study (Coughlan et al. 2007). The findings of the study showed an improved outcomes with the implementation of the self-management program of the urinary incontinence despite the scarce resources in the rural communities for urinary incontinence management and treatment. The findings are clearly stated by the author emphasising on the potential of this program and its widespread implementation in thenursing practice. This constitutes the strength of the study as the results were found to be statistically significant. However, there should have been more details on validity although the research appears reliable (Moralejo et al. 2017). Overall, it can be concluded from the quantitative study that increase in the self-management of the disease was found by an increase in the knowledge and positive attitudes toward it. Article 2 In the article by the Wilde et al. (2014), the aim is to discuss the the principles of self-management and their application in treating urinary and faecal incontinence. The objective of the paper justifies the research aims and appears relevance. The objective is to describe the patients benefits by applying the self-management techniques to address incontinence together with the case scenario. The author initially detailed the key elements of the self-management and highlights on the patient management of the physical, psychosocial, emotional, and functional aspects of health. The need of patient self-efficacy and participation in the collaborative process of care implies for the role of the nurse. The strength of the review paper is emphasis on the three processes that a patient requires for self-management of illness. It includes focussing on illness needs, making use of health care resources, and living with the chronic illness. The strength of the paper is the thorough literature review along with the support of relevant theories (Aveyard 2014). The author further elucidates the precondition for success for self-management of urinary or faecal incontinence. The treatment of any underlying etiologies is the precondition. The author highlights the six specific self-management behaviours that come into play during the self-management. It includes- Problem identification- which in this case is incontinence Seeking evidence-based knowledge- about the range of interventions Decision-making for resource use and interventions by the patent Development and implementation of the action plan- by the patient Self monitoring- of self management strategies Goal setting and attainment The strength of the paper further emerges from the explanation of each of six steps that acts as a framework for the nurses and the patients to promote the continence and self-efficacy in patients (Kisely and Kendall 2011). This can be considered advantage as it is not possible to deliver the supporting interventions without these strategies. Highlighting these options may be considered the merits of research. The limitation of the review paper comes from the use of case scenario from authors persona experience. It makes the results and conclusions unreliable. The author had not mentioned search strategy for other papers used in the study and there is no details on the validity and reliability of study (Aveyard 2014). The results of the paper showed that the patient Donna Spencer, 69, diagnosed with urinary incontinence, after six week of self-management found improvement in her condition. The patient modified the amount of the fluid intake (less tea, and coffee and more water), engaged in exercises for pelvic floor muscle, the rapid pelvic contraction exercises, underwent the bladder training (cognitive motivation), including modifying voiding intervals, reduced weight, and lastly constipation management (Wilde et al. 2014). The strength of the paper comes from the strategies for managing faecal or dual incontinence such as dietary modification use of toilet supplies to prevent leakage etc. This informs the readers on how to implement the strategies. Overall, this article provides evidence, even though of low quality on improvement of urinary incontinence by self-management using evidence based strategies. Recommendations and Conclusions Based on the above discussion it can be concluded that the registered nurses should not only focus on the Brians medical aspects but also on the psychosocial, functional, and behavioural aspects of wellbeing. While implementing the intervention the role of the nurses for patients like Brian in promoting the urinary incontinence should be to educate patients on self-management of urinary incontinence (De Gagne et al. 2015). The nurse must help Brian focus on illness, make use of social, spiritual and environmental support and help the patients to make practical lifestyle modifications. It may include decrease coffee consumption for Brian. The nurse can promote the six specific self-management behaviours for patients with urinary incontinence mentioned in the above article. The nurse must implement person-centered care and encourage other nurses to do the same. In this approach, the nurse demonstrates sensitivity to changes in care delivery.In personal practice, the nurse must increase engagement in Clinical, educational, managerial, audit and research activities (Hgglund et al. 2017). The rationale for this engagement is to implement the evidence-based practice. It will enhance their contribution to continence care. Evidence based practice helps the nurses feel more comfortable to asses patients with faecal and urinary incontinence. The nurses must collaborate with their colleagues who are Specialist Continence Physiotherapist (Hgglund and Olai 2016). Implementing this recommendation will help a nurse to influence the practice of other nurses as well. It can be concluded from the critical analysis that care plan for Brian must involve educating patient on self-management strategies for urinary incontinence. The self-management may include adequate fluid intake, a healthy diet, healthy lifestyle, effective toilet habits and pelvic floor muscle maintenance. References Aveyard, H., 2014.Doing a literature review in health and social care: A practical guide. McGraw-Hill Education (UK). Bagnola, E., Pearce, E. and Broome, B., 2017. A Review and Case Study of Urinary Incontinence.Madridge J Nurs,2(1), pp.27-31. Bedretdinova, D., Fritel, X., Zins, M. and Ringa, V., 2016. The effect of urinary incontinence on health-related quality of life: is it similar in men and women?.Urology,91, pp.83-89. Coughlan, M., Cronin, P. and Ryan, F., 2007. Step-by-step guide to critiquing research. Part 1: quantitative research.British journal of nursing,16(11), pp.658-663. De Gagne, J.C., So, A., Wu, B., Palmer, M.H. and McConnell, E.S., 2015. The effect of a urinary incontinence self-management program for older women in South Korea: A pilot study.International Journal ofNursing Sciences,2(1), pp.39-46. Hgglund, D. and Olai, L., 2016. Enabling and inhibitory factors that influenced implementation of evidence-based practice for urinary incontinence in a nursing home.Nordic Journal of Nursing Research, p.2057158516667644. Hgglund, D., Mooney, T. and Momats, E., 2017. Nursing staff s experiences of providing toilet assistance to elderly nursing home residents with urinary incontinence.Open Journal of Nursing,7(2), pp.145-157. Hussain, M. and Gill, S.S., 2016. 4.4 Anticholinergic Drugs and Inappropriate Medications in Older Adults.Geriatric Psychiatry Review and Exam Preparation Guide: A Case-Based Approach, p.356. Johnson, A. and Chang, E., 2014.Caring for older people in Australia: Principles for nursing practice. Kisely, S. and Kendall, E., 2011. Critically appraising qualitative research: A guide for clinicians more familiar with quantitative techniques.Australasian Psychiatry,19(4), pp.364-367. LoBiondo-Wood, G. and Haber, J., 2017.Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences. LoBiondo-Wood, G., Haber, J., Cameron, C. and Singh, M., 2014.Nursing Research in Canada-E-Book: Methods, Critical Appraisal, and Utilization. Elsevier Health Sciences. Loening?Baucke, V. and Swidsinski, A., 2015. Treatment of functional constipation and fecal incontinence.Pediatric Incontinence: Evaluation and Clinical Management, p.163. Moralejo, D., Ogunremi, T. and Dunn, K., 2017. Critical Appraisal Toolkit (CAT) for assessing multiple types of evidence.CCDR,43(9), p.177. Panicker, J.N., Fowler, C.J. and Kessler, T.M., 2015. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management.The Lancet Neurology,14(7), pp.720-732. Schneider, Z. and Whitehead, D., 2013.Nursing and midwifery research: methods and appraisal for evidence-based practice. Elsevier Australia. Watt, Elizabeth Cassells, Colin 2014, 'Promoting continence in older people', in Chang, Esther Johnson, Amanda Caring for older people in Australia : principles for nursing practice, John Wiley and Sons Australia, Milton, Qld., pp. 423-454 Wilde, M.H., Bliss, D.Z., Booth, J., Cheater, F.M. and Tannenbaum, C., 2014. Self-management of urinary and fecal incontinence.AJN The American Journal of Nursing,114(1), pp.38-45.

Nursing Case Study American Heart Association

Question: Describe about the Nursing Case Study for American Heart Association. Answer: Introduction This study aims to present a complex case study and undertake a critical analysis of the chosen case. The medical problem that has been selected for the case study is Chronic Cardiac Failure (CCF) with type 2 diabetes. The study will provide the details of the relevant medical history and present condition of the selected case. It will describe the pathophysiology underlying the main reason for the current hospital admission. A list of medications, rationales and the special considerations associated with the medications of the selected case will be highlighted. A discussion regarding the relevant and current diagnostics/ treatments will be provided in this study. In addition, a log of daily activities in relation to the nursing care implemented for chronic cardiac failure with type 2 diabetes will be provided. Besides all these, the study will reflect on the nursing care provided and the outcomes of care together with the improvements that can be made with respect to chronic cardiac failure with type 2 diabetes. Case study Mrs. Smith is 67-year-old Hispanic female; who is suffering from Chronic Cardiac Failure along with type 2 diabetes has been admitted in the hospital in the morning due to the exacerbation of her symptoms. She is obese and smokes one pack of cigarette a day. The patient states that her readings of home blood sugar have increased. She admits that while going out with her family she consumes dessert and some other stuff, which contains less amount of sugar. For exercises, she walks half an hour every day. She denies polydipsia and polyphagia. She has a family history of diabetes, as her father was diabetic and had died 10 years back. The medical history of the patient is significant for type 2 diabetes that has been diagnosed 3 years back when she had a random glucose level of 278 mg/dL. At that time, her HBA1c level was 8.5%. She was prescribed metformin 50 gm twice every day and within a span of three months, her HbA1c levels had dropped to 7.5%. At that time, metformin was increased to 1000 mg twice every day. Her vital signs are temperature: 98.2 F, blood pressure 124/76 mm Hg, respiratory rate 19, heart rate 80, BMI 33.2, Height 56 and weight 195 pounds. The current medications of the patient include insulin, triarnterene and hydrochlorothiazide and metformin. The patient states that she is not following any specific diet and is worried regarding hypoglycemia as she is in a habit of consuming extra snacks. She has been advised by her family doctor to improve her health conditions. The patient complains that her knee-pain is not allowing her to perform exercise and physical activities on a daily basis. On laboratory examination, her creatinine and liver function tests, urine microalbumin and thyroid function tests are normal. After being explained by the doctor that the increased doses of insulin is contributing in weight gaining process and there is a need reducing her dose of insulin together with intake of high calorie food preventing hypoglycemia, she agreed for following a calorie-restricted diet and top reduce her doses of insulin. The physician reassures her that the further reduction of insulin would help in preventing hypoglycemia. Pathophysiology This section will describe the pathophysiology of chronic cardiac failure with type 2 diabetes. In the diabetic populations, heart failure may occur irrespective of typical factors of risk like high blood pressure and coronary artery disease (Zinman et al., 2015). A number of hypotheses have been proposed for explaining the reduced myocardial contractility in the individuals suffering from type 2 diabetes. These comprise myocardial fibrosis, metabolic disturbances, autonomic neuropathy, accumulation of AGE, impaired calcium homeostasis, insulin resistance and small vessel disease (Gheorghiade et al., 2013). In the patients suffering from type 2 diabetes, the changes in metabolism are elicited by hyperglycemia. Normally, the free fatty acids are use by the myocytes as a key energy source while performing aerobic exercises. In the patients suffering from type 2 diabetes, an altered metabolism is related to increased consumption of myocardial oxygen as well as increased concentrations of free fatty acids in the serum (Zinman et al., 2015). A high consumption of oxygen is required for the metabolism of enormous levels of free fatty acids leading to intracellular accumulation of intermediates that are toxic in nature and may have a negative effect on the myocardial performance. In oxidative stress, high levels of glucose gets oxidized within the cell starts the production of reactive oxygen species and it also boost oxidative stress. The increased levels of reactive oxygen species might result in cardiac dysfunction through the mechanisms except cellular injury (Jaarsma et al., 2013). In diabetic patients, endothelial dysfunction takes place in the coronary vessels and may result in reduced or impaired flow of blood. It has been found by few researchers that the concentration of chronic elevated glucose induces the reduction of plasma nitric oxide. It has been reported that reactive oxygen species are responsible for impairing the endothelium-dependent vascular relaxation by means of nitric oxide inactivation (Montalescot et al., 2013). The accumulation of the end products of advanced glycation takes place in the tissues and can result in the morphological modifications in the heart. This accumulation not only decreases the elasticity of the walls of the vessel but it also lead to myocardial dysfunction. Hyperglycemia in myocardial fibrosis may result in an abnormal expression of gene and transformation of signal transduction that can lead to the activation of pathways, which are responsible for apoptosis. It can stimulate the necrosis of myocytes directly that le ads to an increased collagen deposition (McMurray et al., 2014). In diabetic patients, the modifications in the structure and function of the small vessels can also result in chronic heart failure. Some of the studies have revealed that the pathological modifications in the capillaries are not responsible for developing myocardial dysfunction (Frederich et al., 2015). Cardiac autonomic neuropathy is related to the enhanced cardiovascular risk in the diabetic patients and it can lead to impairment in the diastolic function. Numerous studies have revealed a relationship between the parasympathetic and cardiac dysfunction with reduced variation in the mean heart rate (Look AHEAD Research Group, 2013). Medications A number of studies related to the heart failure have revealed that different classes of medications (drugs) which are best to treat heart failure with type 2 diabetes (Holloway Wheeler, 2013).The patients suffering from this condition may require several medications. Each of these is used for treating a different symptom and comes with specific instructions (Grove, Burns Gray, 2014). If these medications are are not taken in a correct manner, then they will not be able to perform their action appropriately. Some of the most common medications include Ramipril, Fosinopril, Captopril, Trandolapri, and Quinapril. These medications fall in the category of Angiotensin-converting Enzyme (ACE) Inhibitirs. The other category of medications includes Angiotensin II Receptor Inhibitors, which comprise Valsartan, Losartan and Candesartan (Boonman-de Winter et al., 2012). In addition to these, the other category of medications includes Beta-blockers, which include Carvedilol, Metoprolol and Bi soprolol. Besides all these, the other categories of medications include Aldosterone Antagonists, which comprise Eplerenone and Spironolactone. It has been observed that some of the other medications, which can be prescribed to the patients, include Digoxin, cholesterol lowering drugs and Anticoagulants. Digoxin may be prescribed to some of the patients having chronic heart failure as prescribed by the doctor. Anticoagulants are also known as blood thinners and can be prescribed to the patients having heart failure along with atrial fibrillation (Marso et al., 2016). They are not used for the treatment of chronic heart failure patients who do not have atrial fibrillation. The doctor may prescribe cholesterol-lowering drugs to the patients having high cholesterol levels or the patients who suffered from a heart attack previously. These drugs are not used specifically for the treatment of heart failure, except other conditions as indicated (Holloway Wheeler, 2013). The medications of diabetes include pioglitazone and rosiglitazone. Both of these drugs belong to the known as thiazolidinediones. Initially for controlling glycemia, Troglitazone was effective but it has been removed from the market, as it is toxic for the liver. Pioglitazone and Rosiglitazone are indicated either in the form of monotherapy or as a blend with metformin, sulfonylurea, or insulin while performing exercises or having diet (Parahoo, 2014). If any of these drug is prescribes individually then a sufficient glycemic control cannot be resulted. Besides lowering the blood glucose levels, these two drugs may be advantageous for the cardiovascular parameters like endothelial function, inflammatory biomarkers, blood pressure, fibrinolytic status and lipids (Polit Beck, 2013). These advantageous effects of thiazolidinediones on cardiovascular risk factors and glycemia have made them potential agents for the patients suffering from type 2 diabetes and are prone to develop cardio vascular diseases (Grove, Burns Gray, 2014).The risk factors of chronic heart failure such as high blood pressure and coronary artery disease commonly occur in the diabetic patients. These factors of risk perform synchronously in diabetes for increasing the risk of chronic heart failure (Grove, Burns Gray, 2014). These classes of drugs can be prescribed to the patients suffering from type 2 diabetes and having significant asymptomatic cardiac disease (American Diabetes Association, 2013). Diagnosis Chronic heart failure diagnosis is performed through the association of distinctive sign and symptoms with confirmation for instance obtained from an electrocardiogram, chest x-ray and plasma natriuretic peptide testing (Johansson et al., 2016). Imaging studies that documents the diastolic and systolic dysfunction as well as biomarkers are beneficial for diagnosis. In differentiating diastolic and systolic heart failure, systolic heart failure physical examination is not advantageous since the similar findings, together with S3 gallop and cardiomegaly can be observed in both the conditions (Marso et al., 2016). In chronic heart failure, the heart of the patient may is enlarged and the buildup of fluid can be evident in the lungs (Polit Beck, 2013). The doctor can employ an x-ray for diagnosing the conditions except chronic heart failure that can give details regarding the signs and symptoms. Electrocardiogram is test, which is used for recording the electrical activity of the heart by means of electrodes that are attached with the skin of the patient (Fried et al., 2013). The impulses are recorded in the form of waves and are printed on a paper or are displayed on a screen. Electrocardiogram helps the doctor to diagnose the problems associated with the rhythm of the heart and the damage to the heart due to heart attack. For diagnosing chronic heart failure, echocardiogram is an important test (Grove, Burns Gray, 2014). It helps in distinguishing between diastolic heart failure and systolic heart failure in which there is stiffness in the heart and it cannot fill accurately. It uses sound waves for producing a visual image of the heart and the doctors can be benefitted from this method for seeing the shape and size of the heart and to observe the proper functioning of the heart (Polit Beck, 2013). In addition, it can also assist the doctors for checking the problems in valve or confirmation of a previous heart attack and other abnormalities or some uncommon c auses of chronic heart failure (Marso et al., 2016). The measurement of ejection fraction can also be done during an electrocardiogram and it can be measured by cardiac MRI, Cardiac catheterization and nuclear medicine tests (Grove, Burns Gray, 2014). It is a significant measurement regarding whether the heart is pumping properly and it is used to assist in classifying heart failure as well as guide treatment (White et al., 2013). In addition to these, stress tests can evaluate how the the blood vessels and heart act in response towards exertion. Stress tests the doctor in determining whether the patient has coronary artery disease. They also help in determining how well the patients body is acting in response to the reduced pumping effectiveness of the heart and can help as a guide in making long-term decisions associated with the treatment of the patients. In addition, myocardial biopsy can also be helpful, in which a small and flexible biopsy cord is inserted by the doctor into the vein of the neck or groin region and small portions of muscles of the heart is taken. This test can be performed for diagnosing certain types of diseases associated with the heart muscle that cause chronic heart failure (Paneni et al., 2013). Log of daily activities Observations Rationale Evaluation The diet of the patient will be monitored regularly. The patient will be advised to have a diet which is relatively low in cholesterol, saturated fat and sodium (Feltner et al., 2014). To reduce weight as the patient is suffering from this condition will be benefitted effectively. The patient will be instructed to avoid high calorie food together with the foods having a low concentration of salt (Mebazaa et al., 2015). The outcomes will be evaluated based on the improvements in the health of the patient. The fluid retention capacity will be monitored by weighing the patient on a daily basis (Billings Halstead, 2015). To have an adequate balance of fluid in the body (Stamp, Machado Allen, 2014). The evaluation of outcomes will be done with respect to the improvements in the health of the patient. The patient will be monitored daily whether she is performing exercises or not (Taylor et al., 2014). Physical activities and aerobic exercise has an advantageous effect on the health of the patient. The outcomes will be evaluated on the basis of the improvements in the health of the patient Monitoring of patients health and wellbeing will be done For determining, whether the patient is not facing any issues of mental health and wellbeing (Pandey et al., 2015). The evaluation of outcomes will be done with respect to the improvements in the health of the patient. The patient will be allowed for a moderate consumption of caffeine in a day and will be monitored regularly (Butcher et al., 2013). To maintain a proper health of the patient (Stamp, Machado Allen, 2014). The outcomes will be evaluated on the basis of the improvements in the health of the patient Patients blood pressure will be monitored on a regular basis. The monitoring of blood pressure will ensure to provide medications to the patient. The readings of blood pressure will be charted for getting information whether the blood pressure is elevated or reduced To provide information to the patient regarding her blood pressure and assure her that it will be managed as several researches has revealed that regular monitoring of blood pressure is helpful (Mebazaa et al., 2015). The evaluation of outcomes will be done with respect to the improvements in the health of the patient. The nurse will observe that whether the patient is taking adequate rest or not (McMurray et al., 2012). Adequate rest and sleep is essential for the patient for improving her symptoms. The patient will be advised to have sufficient as well as peaceful sleep in the night by pillows for propping up her head and she should avoid big meals and sleep before bedtime, as it is not good for her health. The outcomes will be evaluated on the basis of the improvements in the health of the patient The nurse will monitor that the patient wears appropriate clothing as tight clothing can slow down the flow of blood in body and can develop clots. If in case, there is a need for adding or removing the layers of clothing it can be done by the nurse depending on the condition of the patient (Ekman et al., 2012). For ensuring that the patient feels comfortable and there is no obstruction in the the flow of blood in the body of the patient (Pandey et al., 2015). The evaluation of outcomes will be done with respect to the improvements in the health of the patient. The nurse must ensure that the patient is getting enough support in order to overcome from her condition (restedt et al., 2013). By having support from, the patient will be comfortable and her symptoms of the disease will improve (Stamp, Machado Allen, 2014). The outcomes will be evaluated on the basis of the improvements in the health of the patient Keeping a track of the symptoms on a regular basis and recording the changes (Feltner et al., 2014). This will help to identify the problem areas that are responsible for the exacerbation of the symptoms of the disease (Mebazaa et al., 2015). The evaluation of outcomes will be done with respect to the improvements in the health of the patient Monitoring the health and wellbeing of the patient To determine, whether the patient is not facing any issues related to her mental health and wellbeing (Pandey et al., 2015). The outcomes will be evaluated on the basis of the improvements in the health of the patient In addition to all these, the patient should be provided with education regarding the management of chronic heart failure with type 2 diabetes (Mebazaa et al., 2015). The patient must be instructed for checking their weight after urinating in the morning and before taking breakfast. The patient must also be taught to wear light clothes. The nursing intervention that will be provided to the patient must focus on educating the patient along with her family to avoid the chronic episodes. The most important role of the nurse is to educate the patient for bringing the prescriptions in every appointment in the clinic or at the time of readmission in the hospital, as it is easy for identifying the possible lapses, increase in dose or certain type of confusions (Stamp, Machado Allen, 2014). The patient is also recommended for identifying the absence of presence of weakness together with shortness of breath while carrying out the daily living activities and will be instructed for monitoring the improvement or exacerbation of symptoms (Pandey et al., 2015). The patent will be instructed to avoid high calorie food accompanied by the foods having a high concentration of salt as it is not good for health and might aggravate her health conditions. The patient should be allowed for a moderate consumption of caffeine in a day and will be monitored regularly. The patient will be advised to avoid the drugs such as corticosteroids, tricyclic antidepressants and calcium-channel blockers. The nurse should keep a track of the symptoms on a regular basis and should report the changes in the health condition of the patient to the physician on a daily basis (Shively et al., 2013). The nurse must observe that whether the patient is taking adequate rest or not. The monitoring of the patients health and wellbeing should be carried out regularly to determine, whether the patient is not facing any issues of mental health and wellbeing (Mebazaa et al., 2015). Physical activities and aerobic exercise can have a beneficial effect on the health of the patient. The blood pressure of the patient must be monitored on a regular basis (McHugh Ma, 2013). The monitoring of blood pressure will ensure to provide medications to the patient. The readings of blood pressure must be charted for getting information whether the blood pressure is high or reduced (Feltner et al., 2014). The regime of medication must be evaluated with the patient and presented to her schematically, by highlighting the names of medication, schedules, dosages, indications and potential side effects (Allen et al., 2012). One of the simplest strategies that can be employed involves the making of a table comprising of the names as well as time of taking the drugs or medications and this table can be placed somewhere, which is easily visible to the patient as well as her family members. In addition, the nurse must advise the patient to take her medication even if she feels well as it will be effective for her health conditions (Wakefield et al., 2013). Reflection, nursing outcomes and required improvements In my opinion, the nursing care provided to the patient is appropriate and the outcomes of the nursing care have identified what has been done well and what has not been done well. Since the patient has been suffering from chronic heart failure with type 2 diabetes, she has been provided with the nursing care that is appropriate for improving the outcomes. The patient was instructed to maintain the adequate balance of fluid in the body. After carefully monitoring the fluid retention capacity of her body, it has been found her bodys capability of fluid retention has improved. The patient was instructed to perform exercises on a daily basis. After vigilantly monitoring her, I have analyzed that her symptoms have improved to a certain extent and this nursing care has proved to be beneficial for the patient. In my opinion, exercises are helpful for the patients suffering from chronic heart failure as it improves their health conditions. The patient was instructed to monitor her blood pre ssure regularly and after monitoring her, I have found that sometimes she forget to monitor her blood pressure and due this, I am unable to analyze whether her blood pressure is constant or it fluctuates on a daily basis. The patient has been instructed to have adequate rest and sleep for improving her symptoms. After monitoring her, it has been found that she is taking adequate rest and sleep and her symptoms have improved significantly. In my opinion, this nursing care has proved to be effective in improving the symptoms of the patient. The patient has been instructed to wear loose clothes so that the blood flow in her body remains uniform. After monitoring her on a regular basis, I have found that her symptoms have improved up to a certain extent. In my opinion, this nursing care has a role in main in preventing the formation of clots, therefore wearing of loose clothes is beneficial and there is always a need to ensure that the patient is comfortable there is no obstruction in t he flow of blood in the body of the patient. The nurse kept a track on the symptoms of the patient on a regular basis and has recorded the changes. In my opinion, this step plays a significant role in identifying the problem areas which are responsible for the aggravation of symptoms of the patients disease. I have analyzed that the health outcomes of the patient has improved since the doctor is getting all the information regarding the symptoms of her disease, particularly the improvements in health or exacerbation of health. In addition to all of these, the diet of the patient has been monitored regularly and the patient was advised to consume a cholesterol free diet and she must also avoid sodium and saturated fat. After carefully monitoring her, it has been found that her cholesterol level has reduced and she did not gain enough weight as she had followed a strict diet. In my opinion, this nursing care has been effective in managing her symptoms and helped her to reduce her weig ht. In addition she was also instructed to consume diet which has low salt concentration and it has helped her to maintain her blood pressure levels. It is evident that a majority of the nursing care has been beneficial in improving the outcomes of the patient however; some of them have not been much effective. The care of the patient could be improved by educating the patient regarding modification of lifestyle and benefits of exercise. The nurse should keep a track of the symptoms regularly and should report the changes in the health condition of the patient to the physician on a daily basis. The patent must be instructed to avoid high calorie food and the foods having a high concentration of salt. She should be allowed for a moderate consumption of caffeine in a day and will be monitored regularly. She should be educated regarding weight management and fluid retention. In addition, the nurse should encourage the patient to perform anaerobic exercise in combination with pharmacological therapy in her management plan in an efficient manner. References Allen, L. A., Stevenson, L. W., Grady, K. L., Goldstein, N. E., Matlock, D. D., Arnold, R. M., ... Havranek, E. P. (2012). Decision making in advanced heart failure a scientific statement from the American Heart Association.Circulation,125(15), 1928-1952. American Diabetes Association. (2013). Standards of medical care for patients with diabetes mellitus.Puerto Rico Health Sciences Journal,20(2). restedt, K., Saveman, B. I., Johansson, P., Blomqvist, K. (2013). Social support and its association with health-related quality of life among older patients with chronic heart failure.European Journal of Cardiovascular Nursing,12(1), 69-77. Billings, D. M., Halstead, J. A. (2015).Teaching in nursing: A guide for faculty. Elsevier Health Sciences. Boonman-de Winter, L. J. M., Rutten, F. H., Cramer, M. J. M., Landman, M. J., Liem, A. H., Rutten, G. E. H. M., Hoes, A. W. (2012). High prevalence of previously unknown heart failure and left ventricular dysfunction in patients with type 2 diabetes.Diabetologia,55(8), 2154-2162. Butcher, H. K., Bulechek, G. M., Dochterman, J. M. M., Wagner, C. (2013).Nursing interventions classification (NIC). Elsevier Health Sciences. Ekman, I., Wolf, A., Olsson, L. E., Taft, C., Dudas, K., Schaufelberger, M., Swedberg, K. (2012). Effects of person-centred care in patients with chronic heart failure: the PCC-HF study.European heart journal,33(9), 1112-1119. Feltner, C., Jones, C. D., Cen, C. W., Zheng, Z. J., Sueta, C. A., Coker-Schwimmer, E. J., ... Jonas, D. E. (2014). Transitional care interventions to prevent readmissions for persons with heart failure: a systematic review and meta-analysis.Annals of internal medicine,160(11), 774-784. Frederich, R., Alexander, J. H., Fiedorek, F. T., Donovan, M., Berglind, N., Harris, S., ... Mahaffey, K. W. (2015). A systematic assessment of cardiovascular outcomes in the saxagliptin drug development program for type 2 diabetes.Postgraduate medicine. Fried, L. F., Emanuele, N., Zhang, J. H., Brophy, M., Conner, T. A., Duckworth, W., ... Reilly, R. F. (2013). Combined angiotensin inhibition for the treatment of diabetic nephropathy.New England Journal of Medicine,369(20), 1892-1903. Gheorghiade, M., Vaduganathan, M., Fonarow, G. C., Bonow, R. O. (2013). Rehospitalization for heart failure: problems and perspectives.Journal of the American College of Cardiology,61(4), 391-403. Grove, S. K., Burns, N., Gray, J. R. (2014).Understanding nursing research: Building an evidence-based practice. Elsevier Health Sciences. Holloway, I., Wheeler, S. (2013).Qualitative research in nursing and healthcare. John Wiley Sons. Jaarsma, T., Strmberg, A., Gal, T. B., Cameron, J., Driscoll, A., Duengen, H. D., ... Kberich, S. (2013). Comparison of self-care behaviors of heart failure patients in 15 countries worldwide.Patient education and counseling,92(1), 114-120. Johansson, I., Dahlstrm, U., Edner, M., Nsman, P., Rydn, L., Norhammar, A. (2016). Prognostic implications of type 2 diabetes mellitus in ischemic and nonischemic heart failure.Journal of the American College of Cardiology,68(13), 1404-1416. Look AHEAD Research Group. (2013). Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes.N engl J med,2013(369), 145-154. Marso, S. P., Daniels, G. H., Brown-Frandsen, K., Kristensen, P., Mann, J. F., Nauck, M. A., ... Steinberg, W. M. (2016). Liraglutide and cardiovascular outcomes in type 2 diabetes.New England Journal of Medicine,375(4), 311-322. McHugh, M. D., Ma, C. (2013). Hospital nursing and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia.Medical care,51(1), 52. McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Bhm, M., Dickstein, K., ... Jaarsma, T. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012.European journal of heart failure,14(8), 803-869. McMurray, J. 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M., Fitchett, D., Bluhmki, E., Hantel, S., ... Broedl, U. C. (2015). Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes.New England Journal of Medicine,373(22), 2117-2128.

College Essay Examples For Healthcare

College Essay Examples For HealthcareCollege essays for healthcare will help any student prepare for the critical exams that can help them win a scholarship. Colleges make it their mission to provide good opportunities for all of their students and this includes help for high school students with college essays.Nearly half of all college students taking the SAT or ACT tests are unable to pass any of their essays in writing, according to studies done by the College Board. College student are given essay examples for healthcare and any one of these sample essays can be very helpful for any student who is struggling with the test. Students should not forget that they must write a compelling essay that answers the question correctly.Health care essays can range from a few hundred words to several thousand words, depending on the topic. A college essay sample for healthcare could be a news article, a short biography, or an argument against a political issue. The best way to write a great essay is to find a topic that interests you and write about it. You do not want to get bogged down by facts and figures and end up giving up before finishing the essay.College healthcare essay samples should be fun and interesting. No matter what the topic is, health care is extremely important to every one of us and there are many things we need to learn about it and how to better take care of ourselves. As we know, most people who work with healthcare have a great deal of compassion for patients and this is why health care is a vital part of a person's life.Many people who work with healthcare have a great deal of compassion for patients and this is why health care is a vital part of a person's life. Some of the topics that can be covered in a healthcare essay are caring for the elderly and children, developing health-related skills for patients, and understanding your patients' mental and physical state of mind. If you decide to choose a healthcare topic that isnot necessarily ab out how you deal with patients, then the essay should still contain some of the information needed to answer the question correctly.If you are taking the SAT or ACT and have a hard time answering the question about how you feel about healthcare, the essay samples for healthcare may help you in many ways. Essays for healthcare can help you keep a balance between compassion and objectivity. You should also be able to write in a manner that shows respect for your readers and respects the fact that your audience will be reading a lot of information.College healthcare essay samples can be used by any high school student who is trying to prepare for the SAT or ACT. You will need to be able to compose sentences that move forward in the subject matter, have clear and concise arguments, and write a persuasive essay that answers the question correctly. College students should always include the essay examples in order to study the topics and write the essay. College students will also need to know how to format their own essay as well as who to turn to for help with medical essay samples for healthcare.Students will need to know how to read these examples in order to have a good idea of how they should structure the essay. They should also know how to research the topic for themselves and should be prepared to communicate with healthcare professionals for assistance.

Why lie to the history books Review Essay Example

Why lie to the history books Review Paper Essay on Why lie to the history books To learn how to choose, it is necessary not only to read a lot, we must also be able to distinguish between science and ideology, or else an illusion impossibility of scientific knowledge the result of the triumph of ideology over science in a single mind. In science and ideology there are common: both this knowledge is given in the system, two kinds of systematic consciousness, but the system of scientific knowledge aimed at establishing the truth and ideology to protect the interests of (groups of) people. That is why it is wrong that Mukhin object of protection has long vanished is not Stalin, but in the interests of the class, that group of people, material interests are represented by Stalin at the very top class supreme bureaucracy (the so-called decision-makers), the nomenclature or otherwise (to use a more accurate scientific terminology) politaristov. Modern Russian politarizm enjoys the ability to mimic their ideology as science, to issue its own system of scientific knowledge. It is this and claim all ideologues. Their joint interest to discredit the scientific knowledge per se. For example, identifying a plurality of views and pluralism of truths. every ideology boast reasonable true and embellishes it profitable lie true, if you do not have in mind a scientific ideology. Scientific ideology is possible when society there are people who are interested in a simple question, but what was really? However, it happens not always. the mass believes myths about the famine and gulags but this is not the myths. Here, for example, the work of historians pros: pay attention to the conclusion there. Or thats gulag, and more. Why lie to the history books Review Essay Example Why lie to the history books Review Paper Essay on Why lie to the history books I probably would have noticed immediately 1) YI Semenov: no common ownership of the means of production was not in our society. I absent in it, and the distribution principle: from each according to ability, to each according to his work. In other words, our society was not socialist in any sense of the word. No socialism we had not, it was not his, and no country in the world. Society, which we persistently called socialist, in fact, or have been, or still are still politarnymi. Listed a little sign of communism, which was not possible to build a really, but to call it socialism signs completely dare not. If we take socialism as a coupling medium between capital and communism, we must realize that in socialism such features as from each according to his ability, to each according to his needs are in bud. Before society eat these conditions provide for work, must undergo a long process of nationalization. This is firstly. Socialism on the entire planet does not work, it must run in slowly, and then in the socialist countries should have trade relations with the capitalist countries. This is just one more aspect of slowing down the appearance of signs described by Semenov, you forgive, but he wrote illiterate nonsense. As for contemporaries of Stalin, so everything is very simple; were talking about the ideological war that was then, so the representatives of both sides of his contemporaries combined status or even witnesses, but the information they provide is absolutely contradictory. I am referring to the fact that not a few contemporaries of Raskolnikov, his mouth shut. There is a little book from the same series of mystery 37go year, it is called Stalins Testament. On its back is written a little anecdote: After the death of Stalin left two envelopes, one says to open at a difficult time, the other To be opened at a critical time. There comes a difficult time, and opened the first envelope, there is written: Bring down all on me. There comes a critical ti me, it opened the second envelope and is written in it: Do as I do. Why lie to the history books Review Essay Example Why lie to the history books Review Paper Essay on Why lie to the history books It seems that you do not is aware that is socialism, not to mention how to write frantically about Semenov, saying, ignorant stupidity well, well, well actually funny! about the author of Economic ethnology (a link to the electric version Heres a list of his scientific works -.? Not ashamed?) a man for the first time disclosed the full range of existing and existing forms of exploitation of man by man (and a half dozen note can immediately call at least half a dozen?). No, I am far from simple links to authorities and is ready to do without them. But there is the view that, at least, deserve close attention. And you its not just lack of tact, it is immediately obvious, and bad faith, but excuse me Your will return and a real nonsense. And now, in fact. Socialism is not determined by the combination of features remember how Hattabych old man was trying to create a phone booth in the image and likeness but somehow did not work. So it is with definitions they should work! Th e meaning and essence of socialism, precisely on the classics, Marx, including socialist ideas, ranging from the 19th century, first of all, the implementation of the principle of social justice (and this is the most current Western idea until now, the center of speculation and lies all the authorities and ideologies), which in the language of the economic theory of socialism a classless society, that is, one in which the means of production are owned by society, not the state. Thats about it and lied, and lying Stalinist propaganda (and it is clear why the death of his reeks of such a theory, or rather, with the subsequent dying off = falling asleep all the state functions assumed by the Companys control, in the language of orthodoxy the dictatorship of the proletariat remember Lenins opinion about it ? Forgot?). Therefore impossible demagoguery about the socialist state of this nature can not be (in ME and Lenin). State is politarnaya forms of private property, including pe ople, reaching to the slaves in the Gulag (this is just a scientific truth from the 20th century). Corporate Ownership nomenclature is precisely private property in accordance with its definition. Semenov wrote about the socialist principle of distribution according to work, as an economist, as a researcher and expert on pre-class and early class economies (though it is something to take the sense and think that it is not likely, but is something you do not understand ). What is behind it quite clearly the impossibility of class relations, including politarizma this is where the bureaucracy robs the people and fattening, portraying servants of the people, under the guise lied about the public property, humanism and justice. And you wonder inserted on demand, but by the way, this principle has already proved its necessity and effectiveness of one of the existing types of economic relations in the primitive state. Stalinist state works because liberally lubricated with blood, but the current level of production and technology completely eliminates this shovels mode of production, hence the vital need to destroy a huge parasitic superstructure over society, called the state. Socialism immediately on the planet will not work, who told you? In general, how do you ponabrali all this confusion about socialism, the impossibility of historical science, truth, etc. Stalinist blyagi? Just trouble, I must say. And remember, you have a large inflated and this is in the best case. And in my opinion, the destruction of the global class relations between the two countries is possible only once and everywhere, and hence it is clear that capitalism and politarizm two sides of the same coin and the fate they will have a common a quick death, either with mankind or separately if the latest smart enough. And yet to me the most lovely of the covenants of Stalins contemporaries, an honest man to kill Stalin he wrote with his blood on the walls of the chamber shortly befor e the death of Artur Artuzov, I hope you know who this is? If not would highly recommend steeper any fiction.