Find a popular news article from within the past 10 years that

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⦁ Assignment: Research in Psychology

Assignment

Psychology in the News

STEP 1: Find a popular news article from within the past 10 years that reports on the results of a psychological study. This should not be a blog entry, but a published article from a news source such as Time Magazine, The New York Times, Newsweek, NPR, https://blog.keenessays.com/2021/07/05/difference-in-language-that-can-affect-how-the-healthcare-team-and-treatments-are-perceived/ CNN, Fox News, etc. A great place to look is the APA’s Psychology news portal: http://www.apa.org/news/psycport/. Read through the article and ensure that it is descriptive and sufficiently long enough in order to draw conclusions from the original research mentioned.

STEP 2: Go find the psychological study or studies that are mentioned in the news report. Sometimes those are not freely available online, so you may have to track down the original study through your library’s website. You can find these articles within reputable journals, such as the American Journal of Psychology, Cognitive Psychology, Emotion, Journal of Abnormal Psychology, Journal of Applied Psychology, Journal of Counseling Psychology, Journal of Educational Psychology, Journal of Personality and Social Psychology, and Memory. https://blog.keenessays.com/2021/07/05/difference-in-language-that-can-affect-how-the-healthcare-team-and-treatments-are-perceived/ The study should have been performed within the past 10 years.

STEP 3: Write a paper between 250-500 words that

⦁ describes and summarizes both articles

⦁ compares and contrasts the key points, style, and purpose of the news article with that of the research article

⦁ examines if the news article accurately describes the research

⦁ includes correct APA title page, ⦁ APA citations (in-text ), and APA reference page

* Please see the rubric for a scoring breakdown for this assignment: Psychology in the News Rubric   (Click on this link to access the rubric for this assignment)

Waves On Pregnant Women Health And Social Care Essay

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Waves have been applied to many important procedures nowadays. In this article I am going to investigate the application of waves on pregnant women. One of the very important topics is the application of ultrasonography in prenatal checkup; therefore I would focus on this topic and discuss its principle and advantages among other different methods of prenatal checkup.

Nonetheless waves do not only bring benefits to pregnant women, but also harm. There are some electromagnetic waves (or EM waves) which may be harmful to both the mothers and the fetuses, such as X-ray. Yet, will pregnant women really have an increased risk of miscarriage after having an X-ray? Recently there are also concerns about the effect of radio waves and microwaves on pregnancy. In this article I am going to investigate them one by one.

Obstetric Ultrasonography

Ultrasonography refers to the use of ultrasound. Ultrasound is longitudinal wave, it has the same speed as audible sound wave in air, which is 340ms-1. The main difference between audible sound wave and ultrasound is that ultrasound has a frequency beyond audible range of human, which is around 20 Hertz (20 Hz) to 20 kilohertz (20 kHz or 20,000 Hz). Normally the frequency of ultrasound used in prenatal checkup is ranged from 1.6 to 10 megahertz (MHz), depending on what structures of the fetuses are being examined. Ultrasound with lower frequency can penetrate deeper into body tissues, because the higher the frequency, the more ultrasonic waves are being absorbed instead of reflected, thus while examining deeper tissues like the liver and kidney, ultrasound with lower frequency (around 1.6-6MHz) is used.

In the ultrasonography, ultrasound waves are emitted by a device called transducer. Actually the term transducer refers to a device which converts one form of energy into another, so there are lots of types of transducer. In the ultrasonography, an electroacoustic transducer is used to convert electricity to emit and receive ultrasound; therefore to be more exact, the device used is also called an ultrasound transceiver. The transducer is placed on the abdomen of the pregnant woman, the ultrasound emitted penetrates the skin and then reaches the foetus and other internal organs of the mother. The waves are then reflected back to the transceiver, the transceiver senses the waves and converts them into images.

An ultrasound transceiver:

http://l.b5z.net/i/u/6062479/i/transducer_tn.jpg source: http://www.chesapeakeultrasound.com/ultrasound_products

An ultrasonography:

http://gulfcoastmri.files.wordpress.com/2010/06/sonogram-human-foetal-fetal-ultrasound-scan-at-22-weeks-mono-1-anon.jpg

Source: http://gulfcoastmri.wordpress.com/2010/06/07/obstetric-ultrasonography/

In case that the pregnant woman is in early pregnancy or obese, she can undergo transvaginal sonography, which a probe is placed in the woman’s vagina. Sometimes the test is also carried out if the pregnant woman has got abnormal vaginal bleeding or pelvic pain. This type of sonography has the similar principle as the ultrasonography mentioned above. Some mothers may want to see the heartbeat of their babies, they can carry out the Doppler sonography. It has basically the same principle as the ultrasonography except the ultrasound is further enhanced by Doppler Effect. Generally the fetus’s heartbeat can be detected after 7 weeks of gestation, thus the blood flow of the fetus can be detected as well. The blood flows in a circulation in the body of the fetus, the Doppler sonography can thus detect the change in directions of blood flow by Doppler effect and see if the circulation is normal or not. This can be done by measuring the change in the frequency received in the transceiver.

In fact there are a few more types of prenatal checkup, such as amniocentesis and chronic villus sampling. Nonetheless, the ultrasonography is the safest way for diagnosis. The ultrasonography only involves a transducer placing outside the mother’s abdomen, while amniocentesis and chronic villus sampling require mechanical penetration and sampling inside the mother’s uterus or abdomen, this increases the risk of miscarriage during the tests. Despite this fact, ultrasonography can only give an early diagnosis of the mothers and fetuses, it cannot treat anomalies or genetic diseases. According to the test conducted by RADIUS study group in 1993, researchers found that obtaining sonography has no significantly negative effect on reducing perinatal morbidity or mortality among the fetuses or the mothers. Moreover, the detection of anomalies actually did not alter the outcome of newborn babies. Therefore it is important to acknowledge that ultrasonography is just a test whether the fetuses are healthy, but not a treatment to anomalies.

Harmful effect of X-ray

X-ray is an electromagnetic wave with a wavelength ranged from 0.01 to 10 nanometers (0.01-10 x10-9m). It has a speed of 3×108 ms-1 in vacuum. In fact, X-ray is commonly used in medical treatments, such as radiation therapy of cancer and medical imaging technology. X-ray is produced in an X-ray tube. In the X-ray tube, electrons are accelerated by applying a high voltage. Electrons then collide with a metal, and the sudden deceleration of electrons results in the emission of X-ray.

An X-ray tube:

http://hyperphysics.phy-astr.gsu.edu/hbase/quantum/imgqua/xtube.gif

Source: http://hyperphysics.phy-astr.gsu.edu/hbase/quantum/xtube.html

X-ray has high ionizing power, thus there are many people worrying about the harmful effects of having an X-ray diagnosis, especially pregnant women. It is true that a very high dose of radiation from X-ray may result in radiation sickness. Prolonged and continuous exposure to X-ray also increases the risk of cancer development, and in pregnant women, there may also be a risk for the fetus to develop childhood cancer or even miscarriage. Nevertheless, it seems that the harmful effects of exposing to X-ray are exaggerated. The serious harmful effects mentioned above are just the results of high dosage in a short period of time.

There are different kinds of X-rays, one type is used in scanning or diagnosis, one type is used in treating cancer. The energy stored in different types of X-rays is different. For normal X-ray scanning, the dosage is extremely small. The absorbed dose of X-ray is measured in rad, which 1 rad = 10×10-3 J kg-1 = 10-2 J kg-1. If a pregnant woman is having a chest X-ray, the estimated fetal dose is around 60 millirads, the dose is around 290 millirads for an abdominal X-ray. This is quite a low value, as the dose from the radiation from outer space is around 90-100 millirads. In fact, the risk of the fetus having eye abnormalities or mental retardation increases only when the dosage exceeds 10 rads, therefore it is very rare that pregnant women suffer from harmful effects by the X-ray radiation. According to the American Academy of Family Physicians, generally X-rays are safe even for pregnant women, and according to radiologists, no single diagnostic x-ray has a radiation dose significant enough to cause adverse effects in a developing embryo or fetus.

Normally doctors will not ask pregnant women to undergo an X-ray scanning, unless when it is urgent and necessary. It is also suggested that pregnant women should tell the radiologists about the pregnancy, so that radiologists can adjust the radiation level to better protect the mothers and the fetuses. To conclude, many people are afraid of having X-ray scanning when they are pregnant, but in fact the risk is not that high if we compare the dosage to the exposure to outer space radiation.

An X-ray film showing pregnancy:

http://www.neurobodyfit.com/wp-content/uploads/2012/03/xray-pregnancy.jpg

Source: http://www.neurobodyfit.com/x-rays-are-safe-during-pregnancy/

Concerns of radio waves and microwaves

Besides X-ray, some people are concerning about the effect of radio waves and microwaves on pregnancy. In fact the effect of these two types of EM waves is even less than X-ray. There has been a study investigating the relationship between exposure of radio waves and microwaves of female physiotherapists, and the ratio of miscarriage. Due to occupational use, physiotherapists are very often exposed to medical equipment emitting microwaves diathermy and radio waves. According to the study, investigators compared the odd ratios between those pregnant physiotherapists and other pregnant women. The results showed that the risk of miscarriage was not associated with reported use of diathermy equipment, thus people need not worry too much about this issue.

A microwave diathermy:

http://image.ec21.com/image/medicm/oimg_GC04993002_CA04993086/Microwave_Diathermy_HM-801C.jpg

Source: http://medicm.en.ec21.com/Microwave_Diathermy_HM_801C–4993002_4993086.html

Conclusion

Waves have been widely used in medical equipment, and there are several applications of waves on pregnancy. Ultrasonography is the most common and the safest method of prenatal checkup. Though it can be used in diagnosis, it is unable to treat diseases in fetus. Many people concern about the side effects of using X-ray, microwaves and radio waves, however it is in fact very safe because the dosage of radiation is extremely small. Therefore people need not worry too much about the risk of miscarriage caused by exposure to these waves.

Why is evidence-based practice important in Maternal Newborn nursing?

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Why is evidence-based practice important in Maternal Newborn nursing?

Project description 1. Why is evidence-based practice important in Maternal Newborn nursing? 2. Why is this content important for all RNs to have a basic knowledge of (besides it is on NCLEX!)?

HEALTH INFORMATION SYSTEMS COURSE

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HEALTH INFORMATION SYSTEMS COURSE

Health Information Systems course

the course (systems overview-individual practice, GP, hospital) looks at systems
used in health care at various levels.
Courses objectives:
CO1. Students will be able to collect, analyse, evaluate and manage health information and analyse/generate solutions in health context.

CO2. Identify and discuss current issues in health informatics (such as electronic health records, systems integration in health, adoption of health IS and e-health) in Australia and other countries. Students will be able to analyse controversies in such issues, form an opinion and defend this opinion in a discussion individually and as a team.

CO3. Compare different approaches nationally and internationally such as electronic health records, coding systems, standards, guidelines.

CO4. Identify and analyse legal and ethical implication of IT utilisation in health domain
Assignment (Case study essay and presentation)

The assignment is divided into several components:

The task may involve searching literature for published
work, reading government policies, compare approaches
to utilisation of IT/IS in supporting health delivery in
different countries. Students are expected to use their
knowledge from health related courses (such as Health
and Society) to analyse the topic and summarise results in
the report (NB: IT/IS in health serve a purpose and should
be *always* assessed in specific health context).
The written report should be 6000 words long. The written
report should be aimed at educated health professional
reader and go to the point (so no lengthy “backgrounds”,
“introductions” and repeating the obvious please – distil
core points and refer the reader to the literature for detail)
This assignment expects lots of thinking, not lots of
writing.

1. Draft – this is expected to be a *finalised* version of
your report, ready for review. The draft will be reviewed by
other students and feedback will be given. I will review the
draft as well. The main goal is to improve the document.

Research Questions:
Dose the semantic information from lyrics in music affect the semantic information required in short term memory learning in undergraduate students ?
Hypothesis:
Yes, Lyrics in music during learning negatively affect short term memory.

References:
Kantner, J. (2009). Studying with music: is the irrelevant speech effect relevant? In Kelley M. R. (Ed.), Applied Memory (pp. 19–40). Hauppauge, NY: Nova Science Publishers
Balch, W. R , Bowman, K., & Mohier, L. A. (1992). Music-dependent memory in immediate and delayed word recall. Memory Cognition 20(1), 21-28
eaman, C. P. (2005). Auditory distraction from low-intensity noise: A review of the consequences for learning and workplace environments. Applied Cognitive Psychology, 79(8), 1041-1064.
Fogelson, S. (1973). Music as a distractor on reading-test performance of eighth grade students. Perceptual and Motor Skills, 36(3), 1265-1266
Freebume, C. M., & Fleischer, M. S. (1952). The effect of music distraction upon reading rate and comprehension. Journal o f Educational Psychology, 43(2), 101-109
Martin, R. C., Wogalter, M. S., & Foriano, J. G. (1988). Reading comprehension in the presence of unattended speech and music. Journal o f Memoiy and Languaget 27(4), 382¬ 398.
Ransdell, S. E., & Gilroy, L. (2001). The effects of background music on word processed writing. Computers in Human Behavior, 77(2), 141-148
Levy, Yiftach. (1986) “The Effects of calm Music on Learning:” Effect of music on learning.

Brewer, C. B. (1995). Music and learning: Integrating music in the classroom. Toronto: Zephyr Press. Retrieved, March 3, 2008, from https://www.newhorizons.org/strategies/arts/brewer.htm.

16] Miranda, E. R. (2003). .Computational Models of Music. Digitial Music Online Tutorials.

Towell, H.T. (2000). Teaching Reading: Motivating Students through Music and Literature.

Weinberger, N.M. (2000). Music and the Brain: A broad Perspective. Music Educators Journal, 87 (2), 8-10.
[23] Weinberger, N. M. (1998). The music in our minds. Educational Leadership, 56 (3), 36 – 40.

Sample from previous students
Public Health: Understanding the different needs of a certain population
Population: Elderly people living in the Burnside council, experiencing falls

1) What data do we need and why?
How many elderly people live in Burnside council?
– Need to know the relative age of the population living in Burnside to grasp if there is a high demand for aged care.
Why do that number live in the Burnside council (be it large or small)?
– Why a large or small amount of elderly people live within the Burnside council is important to assess whether the location is suitable for the needs they require.
What is the socio-economic status of the majority of elderly living in the Burnside council area?
– To know whether or not the population can afford to have private support available within their own homes rather than rely on the government for financial aid. Also allows assessing if they can afford nursing homes/ aged care facilities.
How physically able is the majority of the elderly population within the demographic?
– If the majority of the population is physically able then it is less likely they will experience falls and/or require physical aid in their living environments.
How many nursing homes/ aged care facilities are in the Burnside area ?
– Depending on the number we will be able to gage the number of elderly people within the population and the ultimate demand for nursing homes.
Do many falls occur? Why do they occur or why not?
– The amount of falls that occur can either support the processes in place or demand that there be some safer and more reliable ones, depending on whether the numbers are positive or negative.
Do the elderly have access to public transport?
– Assessing their risk of injury by evaluating whether they can easily get around to complete daily tasks.
What alternatives do they have if they are unable to access public transport?
– If they are unable to get to busses or taxi’s independently the alternatives in place by their support/ care providers should be adequate enough to allow so.
Do many elderly receive occupational therapy/ physiotherapy or aged care support?
– If a large number receive support we can assess the need and importance of how these alternate areas of care.
What support systems do they put in place?
– If they are receiving support from alternative places what physical processes are being put in place to make their daily lives simpler and risk free, allowing us to assess if these processes are suitable and necessary.

2) Where would you be getting this data from?

Data is the first thing that needs to be retrieved then analysis of the data is derived from that resulting in knowledge and understanding. The term data refers to either qualitative or quantitative research, of which a mix of both is ideal from reputable sources. Making sure all aspects of a population is covered.
As our population is quite specific, elderly people living in Burnside council experiencing falls, statistical data will need to be collected such as how many elderly people live in Burnside, their age range, employment status etc. Most of this data will be collected from Australian Bureau of Statistics (ABS) and similar sites that will give representative and up-to-date data on the elderly and their demographic that we can apply to our population.
Primary research may consist of contacting the council, nursing homes and/or aged care facilities in the area for statistics of the elderly population and whether or not they have health records about falls, that they would disclose (with no personal details revealed). However, the accessibility of this data may be difficult due to confidentiality reasons. Data on the availability of easy access places and what support the elderly are receiving; whether it is from a social worker/community developer, physiotherapist, occupational therapist, or nurse.
Primarily the data will be coming from databases online that should include academic or peer reviewed literature to ensure it is reliable and valid.
Raw data (unprocessed data) can be appealing but this is typically too detailed and too unstructured to be a good basis for decision making.

How will you obtain the data?
How many elderly people live in Burnside council?
– This data can be obtained from the Australian Bureau of Statistics by accessing the Burnside council statistics page.
The results of the 2011 Census data are listed in a table with age limits and the number of people living in the Burnside council. We can gather the number of people over 85 years old easily from the sub-group labelled 85 years and older.
– This information can also be found on the Burnside council page.
Why do that number live in the Burnside council?
– This data can be collected by using a survey targeted at people living in the Burnside council area that are over 85 years old asking why they live in that council.
This survey could be given to elderly living in retirement villages or aged care facilities or community health centres that provide services to the elderly.
– It could also be obtained by finding statistics on the facilities available to elderly in that area and then inferring from this data that elderly live here for the facilities available.
What is the socio economic status of the majority of elderly living in the Burnside council area?
– This data can be obtained from the Australian Bureau of Statistics by accessing the Burnside council statistics page.
By analysing the occupation table and the median weekly incomes the main socio-economic status of Burnside can be concluded.
How physically able is the majority of the elderly population within the demographic?
– This data can be collected by using a survey targeted at people living in the Burnside council area that are over 85 years old asking how they view their physical abilities. For elderly who have carers they could contribute the data on how they view the physical abilities of the elderly person they care for.
This survey could be given to elderly living in retirement villages or aged care facilities or could also be obtained from community health centres that provide services to the elderly.
– The nursing homes or aged care centres may also have patient health records that they are able to provide while still ensuring confidentiality is met.
How many nursing homes/ aged care facilities are in the Burnside area?
– This data can be collected from statistical resources such as the Australian Bureau of Statistics or Burnside council page.
Do many falls occur? Why do they occur or why not?
– Contact nursing homes and aged care facilities to find out if they have a record of resident falls .
– These records may be detailed enough to provide reasons for the cause of the falls.
– If falls are not prevalent in nursing homes and aged care facilities they may be able to provide OH&S standards and policies that explain how they prevent falls from occurring.
– For elderly living alone or with family a survey could be sent asking about any falls that the residents may have experiences or whether they have any actions in place to prevent falls from occurring.
Do the elderly have access to public transport?
– Can be obtained from the Australian Bureau of Statistics, the Burnside Council page for public transport available in Burnside.
– To discover whether the elderly are able to access the transport, a survey could be used to get accurate data on what individuals can access and what their public transport of choice is.
What alternatives do they have if they are unable to access public transport?
– To discover what alternatives different elderly people use to get around a survey would obtain the most accurate data as each individual would be different and public transport may not be an issue for all the elderly in the area as some may be immobile.

3) How are you going to manage and process the data in order to achieve the project’s goal

The data will be managed and processed through a program called: ReadSoft – a census processor and analysing tool. Enables for automatic entry through a scanner – the relevant information is scanned in and stored either into a database or stores it in “the clouds”. This would be useful for any information the group would be looking for ourselves. The ability to scan surveys into an electronic system and have the results sorted automatically would save an enormous amount of time. Data can also be manually added, which means the data from the census can be stored within the same database. As ReadSoft is a computer program it can easily be managed by us without need to hire a company or organisation. Through the management of our own data it improves efficiency by eliminating the middleman of a company. This means we get our results faster and have constant access to them.

How will IT support the project?
Information technology will support the project as it will provide the researchers with a set of processes to analyze, store, share and present the data found.

Analyze – By using IT software such as ReadSoft, the data collected can then be easily analyzed. By having data in a user-friendly format, researcher will more easily be able to establish trends within data, ie number of falls, how many people have help (physiotherapist, occupational therapist).

Store – IT software will enable researchers with a common place to store all information, for all aspects of the research not just final data. It also allows information to be stored for further use in other research.

Share – by having all information stored together in an IT format it will make sharing our data with governments, health promotion officers, physiotherapist, OT’s, GP’s and researchers easier, aiding future research.

Present – By using IT software, researchers are able to incorporate all data and display the results from the study.

General Comments
• You have a lot of information which is good, I was not able to many more things you would be able to research to assist this project.
• The topic is clearly defined and most things have been given a definition- makes it easy to read
• I am assuming you will write this as a report style after peer review- either way what you have is good, can’t really comment on layout if this is the case
• There are some lapses from 3rd person into 1st, try keep it all in 3rd.
• The methods/approaches to collecting the data could be a little more detailed, however what you have is realistic
• Using diagrams and graphical representations may be useful to this project.

Older Driver Mobility: The Impact of Visual and Cognitive Decline on Safe Driving

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Older Driver Mobility: The Impact of Visual and Cognitive Decline on Safe Driving

Older adults aged 65 and older account for every one out of six drivers on the road and are continuing to drive longer than previous generations (Mizenko, Tefft, Arnold & Grabowski, 2014). As individuals age, there are unique changes in their physical, visual, and cognitive ability that makes driving more difficult. The U.S Department of Highway and Safety found per mile crash rates increase greatly starting at age 70 (Insurance Institute for Highway Safety, 2017). In order to drive safely, older adults need to visually see and scan the roadway as well as cognitively interpret driving situations in order react quickly and appropriately. Visual and cognitive age related changes in older adults preclude safe driving. Therefore, it is important that older drivers receive adequate assessment through a combination of visual and cognitive functioning tests as well as obtain proper interventions to delay driving cession live an enhanced quality of life.


Visual Acuity

Out of all the senses used in driving, vision is the most dominant (Ball & Rebok, 1994). As individuals age, there is a decline in visual acuity, or the sharpness of vision, due to anatomical changes of the eye and increased occurrences of diseases such as glaucoma, macular degeneration, and cataracts (American Medical Association (AMA), 2003). The anatomical changes that occur in the eye are a decrease in pupil size, the lens becoming less transparent and more yellow, a decrease in the number of rods and cones, and changes in the refraction of light rays (Saxon, Etten & Perkins, 2015).While the central assessment used by state licensing departments to check eye ability is visual acuity is, there has long been a poor correlation between reduced visual acuity and crash rate (Cross, West, Rubin, Ball, McGwin, Owsley & Roenker, 2009; Owsley, Sloane, Bruni, Ball, Roenker, 1991).


Contrast Sensitivity

A more accurate predictor of crash incidence is contrast sensitivity (AMA, 2003). Contrast sensitivity also referred to as visual threshold is the minimum amount of light that will activate the visual receptors and spark a nerve impulse to be sent to the brain via the central nervous system (Saxon et al., 2015). Older adults require more light to see a stimulus, therefore they are more likely to monitor their driving and strop driving in low light situations such as thunderstorms, fog, or night driving (Freeman, Munoz, Turano & West, 2005).

In continuation, contrast sensitivity can be measured by recording how much contrast an individual requires to see letters on a Pelli-Robson eye chart (Owsley et al. 1991). Letters on the chart become more transparent as one moves down the test chart, therefore an individual with low contrast sensitivity would be able to read the bolded letters at the top but not the faint letters at the bottom. In regards to crash rates, California drivers who scored low contrast sensitivity on the Pelli-Robson chart were involved in a far greater number of accidents when driving in heavy traffic compared to those with high contrast sensitivity scores (Hennessy, 1995).


Visual Fields

Another key visual change in older adults that impacts driving is the loss of visual fields. Similar to visual acuity, visual fields may decline due to anatomical changes of the eye from aging or from the occurrence of ocular diseases (AMA, 2003). Older adults can lose central and peripheral visual field vision. Central visual field loss weakens an individual’s capability to scan the entire roadway in front and peripheral visual field loss weakens an individual’s ability to see traffic, pedestrians, and road signs in the periphery (AMA, 2003). Visual field loss proves to be indicative of increased crash rates across all age groups as a research study of ten thousand drivers found those with restricted visual field were twice as likely to get in an accident than individuals without field loss (Johnson & Keltner1983).

Multiple studies have proven there are higher correlations of visual field loss and crash rates among older adults (Ball, Owsley, Sloane & Roenker, 1993, Anstey et. al 2005 & Freeman et. al, 2005). Owsley, Ball & McGwin (1998) determined older drivers with field of view loss greater than 40% were had a 20 times greater chance of being in a car accident than those with insignificant visual field losses. To further, older adults with major restrictions in visual field had a six times greater chance of being in a car accident than older adults who had minimal visual field restrictions (Ball, Owsley, Sloane & Roenker, 1993)

To contrast visual skills involved in driving, there are a great deal of cognitive skills an older adult must utilize. The cognitive abilities of executive functioning, memory, and visual attention have proven to be crucial when planning and executing driving responses (Anstey et al., 2005). It is important to stress, each of these abilities are reduced by normal aging and further reduced in cases of mild cognitive impairments (MCI) and dementia (AMA, 2003).


Memory

As part of the normal cognitive aging, most older adults have increased difficulty storing or retrieving material from their memory (Saxon et. al, 2015). The stored memories remain largely present and this helps older adults remember how to operate a car, navigate to the destination, and understand what road signs mean. However, declines in working memory means it takes older adults longer to take in information from roadway and process it (AMA, 2003). According to Pyun et al. (2018), driving is correlated with an increased demand on working memory. Therefore, older adults with cognitive impairments have increased difficulty changing lanes and have increased response latency when braking. In regards to crash rates, Hu, Trumble, Foley, Eberhard, & Wallace (1998) found, older men who scored poorly on the word recall working memory test had a 50% increased crash risk.


Executive Functioning

Executive functioning is dependent on working memory to hold driving information in the brain so correct decisions and subsequent sensory and motor responses can be carried out (Anstey et. al, 2005). Older adults have marked decline in executive functioning with age (AMA, 2003). An example of poor executive functioning is when an older adult has a poor reaction time to a stop sign, as it took them longer to process the stimulus and execute an appropriate response.

The Trail Test Part B relies on executive functioning as an individual must take in visual information, process it, plan, and then perform proper motor movements (Anstey et al., 2005). In relation to driving outcomes, Ball et al. (2005) found drivers aged 78+ who took greater than 147 seconds to finish the Trails B were two times more likely to cause a motor vehicle accident. Additionally, in a research study which compared older adult drivers with no previous car accidents to older adult drivers with a previous car accident(s), those with a car accident record took more time to complete the Trail B test and made a greater number of mistakes (Anstey et. al, 2005).


Visual Attention

A crucial skill that interconnects visual and cognitive domains is visual attention. Visual attention is the capability to focus attention on important roadway information while ignoring distracting or unimportant roadway information. (Anstey et. al, 2005). Moreover, selective attention is the ability to prioritize more crucial information like traffic lights and filter out unimportant stimuli such as roadside advertisements (AMA, 2003). Divided attention is the capability to focus on multiple stimuli simultaneously (AMA, 2003). An example of divided attention is focusing on stop lights and the traffic pattern of the cars while driving (AMA, 2003). In older adults, there is a decline in attention with age and a greater decline in divided attention over selective attention (AMA, 2003).


UFOV Assessment and Cognitive Training

A key assessment to measure visual attention is the Useful Field of View test (UFOV Test). The UFOV test measures visual attention to focus attention on a central task, divided attention by making an individual focus on a central stimulus and the periphery, and measures the ability to focus on central and peripheral stimuli when interfering objects are present (Anstey et. al, 2005). In Owsley et al. (1991) research study, older adults who failed the UFOV test were 4.2 times more likely to be in an accident and individuals who had multiple accidents recorded all failed the UFOV test. In a succeeding study, Owsley et al. (1998) found older adults who had poor performance on the divided attention UFOV tests were 2.3 times more likely to be involved in a car crash. Overall, these studies demonstrate older adults’ visual attention and visual fields is a powerful predictor of car accidents.

Moreover, the UFOV test has proven to be a powerful predictor of car accidents in older adults because it encompasses multiple visual and cognitive domains beyond visual attention (Owsley et al. 1991; Wood & Owsley, 2014; Freeman et. al, 2005 & Anstey et. al, 2005). These additional domains include visual field, visual processing speed, and reaction time (Wood & Owsley, 2014; Anstey et. al, 2005). Aside from assessment, the UFOV is also used as training for older adults to improve the many visual and cognitive domains UFOV encompasses.

Several researchers have concluded that cognitive training using the UFOV has yielded successful outcomes on older adults cognitive functioning in relation to driving (Roenker, Cissell, Ball, Wadley & Edwards, 2003; Ball, Edwards, Ross & McGwin, 2010). In Roenker et al. (2003) study, older adults driving ability measured, through the completion of an on-road and stimulator driving assessment, were compared before and after UFOV cognitive training. After an average of 4.5 hours of cognitive training spread over two weeks, older adults in the cognitive training group had improvements in speed of processing, visual attention, and visual scanning when compared to the control group that remained consistent after eighteen months (Roenker et al., 2003). In relation to a driving situation, a modest improvement of 227 ms in an older adults’ speed of processing translates to a car stopping 22 feet shorter when traveling 55 miles per hour (Roenker et al., 2003). Therefore, even moderate gains from cognitive training have the potential to mitigate crash rates among older adults. To further, Ball, Edwards, Ross & McGwin (2010), found older adults who received 10 hours of cognitive speed of processing training yielded a 50% lower rate of at-fault car accidents than the control group who received no training. The rate of at-fault accidents was taken from sate-recorded data over a six-year period following the training, thus proving the results were durable over this time frame only (Ball et al., 2010). Overall, this shows there is a relationship between cognitive training and driving improvements among older adults yet further research should be completed to assess the durability of these results over longer periods of time.

Driving is an instrumental daily living activity that allows older adults to be independent and connected with the community (Arbesman, Lieberman, & Berlanstein, 2014). Older adults that stop driving are found to have higher rates of depression, decreased social connectedness, and are at a higher risk of residing in a long term care facility (AMA, 2003, Edwards et al. 2008). Therefore, as the population of older adults aged 65+ is expected to rise to 70 million in 2030 it is important to be aware of the various visual and cognitive changes that affect driving as well as the impact these changes may have on older adults driving privileges and overall well-being (AMA, 2003).


References

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    Physician’s Guide to Assessing and Counseling Older Drivers

    . Washington, D.C.: U.S. Dept. of Transportation, National Highway Traffic Administration
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    Clinical Psychology Review

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    American Journal of Occupational Therapy

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    (6), 657–661. https://doi-org.ezproxy.lib.usf.edu/10.5014/ajot.2014.013425
  • Ball, K., Owsley, C., Sloane, M. E., & Roenker, D. L. (1993). Visual Attention Problems as a Predictor of Vehicle Crashes in Older Drivers.

    Investigative Ophthalmology And Visual Science

    , (11), 403-414.
  • Ball, K., & Rebok, G. (1994). Evaluating the driving ability of older adults.

    Journal of Applied Gerontology

    , (1), 20.
  • Ball, K. K., Beard, B. L., Roenker, D. L., Miller, R. L., & Griggs, D. S. (1988). Age and Visual Search: Expanding The Useful Field Of View.

    Journal of the Optical Society of America, A, Optics, Image & Science

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    5

    (12), 2210–2219.

    https://doi.org/10.1364/JOSAA.5.002210
  • Ball, K., Edwards, J. D., Ross, L. A., & McGwin, J. . G. (2010). Cognitive Training Decreases Motor Vehicle Collision Involvement of Older Drivers BALL ET AL. COGNITIVE TRAINING DECREASES CRASH RATE.

    Journal of the American Geriatrics Society

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    (11), 2107–2113.
  • Ball, K. K., Roenker, D. L., Wadley, V. G., Edwards, J. D., Roth, D. L., McGwin, G., … Dube, T. (2006). Can High-Risk Older Drivers Be Identified Through Performance-Based Measures in a Department of Motor Vehicles Setting?

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  • Edwards, J. D., Ross, L. A., Ackerman, M. L., Small, B. J., Ball, K. K., Bradley, S., & Dodson, J. E. (2008). Longitudinal Predictors of Driving Cessation Among Older Adults From the ACTIVE Clinical Trial.

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  • Mizenko, A. J., Tefft, B. C., Arnold, L. S., & Grabowski, J. (2014, November). Older American Drivers and Traffic Safety Culture: A LongROAD Study. Washington, DC: AAA Foundation for Traffic Safety.
  • Owsley, C., Ball, K., Sloane, M. E., Roenker, D. L., & Bruni, J. R. (1991). Visual/Cognitive Correlates of Vehicle Accidents In Older Drivers.

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Patients With and Without Varicocele: Biochemical Markers

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Differences in Biochemical Markers and Body Mass Index Between Patients With and Without Varicocele

Background: Varicocele is characterized by abnormal tortuosity and dilatation of the veins of the pampiniform plexus within the spermatic cord and is one of the causes of male infertility. This study aimed to evaluate the differences in bio- chemical markers and body mass index (BMI) between patients with and without varicocele.

Methods: Between January 2004 and June 2009, 102 patients with varicocele (Group A) were evaluated. Ninety-five age-matched male patients who did not have varicocele were selected as controls (Group B). Varicocele was diagnosed by physical examination and confirmed by Doppler ultrasonography. The range of ages was between 18 and 50 years old. BMI, testosterone, serum alkaline phosphatase, calcium, lactic dehydrogenase, inorganic phosphate, γ-glutamine transpeptidase, uric acid, albumin, iron, cholesterol, triglyceride, alanine aminotransferase, and aspartate aminotrans- ferase levels were measured for all the subjects.

Results: The mean age was 35.4 years in group A and 36.5 years in group B. Of the 102 patients in group A, 20 were grade 1 varicocele, 55 were grade 2 and 27 were grade 3. The BMI (mean ± SD) of patients with varicocele (22.8 ± 3.2) was significantly lower than that of patients without varicocele (24.9 ± 4.1). Patients with varicocele had significantly lower serum levels of cholesterol than patients without varicocele (176.5 ± 31.1 vs. 187.7 ± 42.1 mg/dL). There were no significant differences for the other biochemical markers between the groups. Patients with grade 3 varicocele had a lower BMI than patients with grades 1 and 2 varicocele, but this was not significant. No significant differences were found for the other biochemical markers among the patients with grade 1, 2 or 3 varicocele.

Conclusion: Patients with varicocele had significantly lower serum levels of cholesterol than those without varicocele. In addition, the prevalence of varicocele was higher in patients with a lower BMI. Our findings suggest that patients with a greater BMI may have advantages in relieving the nutcracker phenomenon, which causes significant varicoceles. [J Chin Med Assoc 2010;73(4):194–198]

Key Words: biochemical markers, body mass index, testosterone, varicocele


Introduction


Varicocele is characterized by abnormal tortuosity and dilatation of the veins of the pampiniform plexus within the spermatic cord and is one of the causes of male infertility. The prevalence of varicocele is approxi- mately 15–20% in the general population and 30–40% in infertile men.1 Furthermore, approximately 69–81%

of men with secondary infertility have varicocele.2,3

Levinger et al proposed that varicocele prevalence is increased over time and the risk of incidence is approx- imately 10% for each decade of life.4 The definite eti- ology of varicocele is still unknown. Kumanov et al suggested that weight and body mass index (BMI) have a protective role, and height, penile length and penile circumference were negative factors in the

*Correspondence to: Dr William J. Huang, Division of Urology, Depar tment of Surger y, Taipei Veterans

General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.

E-mail:

jshuang@tpech.gov.tw

â- Received: October 16, 2009 â- Accepted: Januar y 21, 2010


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• April 2010 • Vol 73 • No 4


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2010


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development of varicocele in 6,200 boys aged 0–19 years.5 Delaney et al demonstrated that patients with varicocele are significantly taller and heavier than age- matched controls.6 Nielsen et al reported that varico- celes are less likely to be diagnosed among obese men.7

The role of testosterone in the pathophysiology of varicocele is not established and testosterone might induce relaxation of the human internal spermatic vein.8 Sheriff showed that there was increased choles- terol and glyceride in the testes of patients with bilateral varicocele compared with those in controls.9 Odabas et al suggested that the levels of lactic dehydrogenase (LDH) were higher in the spermatic vein than those in the peripheral vein.10

Other than findings on age, BMI and testosterone levels, there is limited information about the correla- tion between biochemical markers and varicocele. Therefore, we conducted this prospective study to evaluate differences between patients with and with- out varicocele with regard to BMI, testosterone levels and serum biochemical markers including hemoglo- bin, alkaline phosphatase (Alk-p), calcium, LDH, inor- ganic phosphate, γ-glutamine transpeptidase, uric acid, albumin, iron, cholesterol (Cho), triglyceride (TG), alanine aminotransferase, and aspartate aminotrans- ferase levels. We also wished to determine possible risk factors in the pathogenesis of varicocele.


Methods



Patients

From January 2004 to June 2009, 102 patients with varicocele (Group A) were included for evaluation for this study. Ninety-five male patients who did not have varicocele were selected as controls (Group B). All of the 197 patients were normal, healthy young to middle-aged males. They were from the outpatient Department of Urology or had received a regular physi- cal check-up at the hospital. Varicocele was diagnosed by physical examination and confirmed by Doppler ultra- sonography. Varicocele grades were defined as: grade 1, palpable only with the Valsalva maneuver; grade 2, palpable without the Valsalva maneuver; and grade 3, visible from a distance.11 Patients with subclinical vari- cocele were excluded from the study. The range of ages was between 18 and 50 years old. BMI, and testos- terone, Alk-p, calcium, LDH, inorganic phosphate, glu- tamine transpeptidase, uric acid, albumin, iron, Cho, TG, alanine aminotransferase, aspartate aminotrans- ferase and hemoglobin levels were measured in all of the patients (normal ranges: BMI < 25, normal weight; BMI ≥ 25 and < 30, overweight; BMI ≥ 30, obese;

testosterone, 241–827 ng/dL; Alk-p, 100–280 U/L; calcium, 8.1–10.7 mg/dL; LDH, 95–213 U/L; inor- ganic phosphate, 2.1–4.7 mg/dL; glutamine transpepti- dase, 8–60 U/L; uric acid, 2.5–7.2 mg/dL; albumin, 3.7–

5.3 g/dL; iron, 35–200 μg/dL; Cho, 125–240 mg/dL; TG, 20–200 mg/dL; alanine aminotransferase, 0–40

U/L; aspartate aminotransferase, 5–45 U/L; hemo- globin, 12–16 g/dL). Patients with poor control of diabetes mellitus, hypertension or other systemic dis- ease or BMI < 15 or > 40 were excluded from the study.

Patients were examined in a warm room while standing up and the scrotum was inspected and pal- pated. All the patients received Doppler ultrasonogra- phy of the scrotum. All the patients signed informed consent, and the study was approved by the Institu- tional Review Board of Taipei City Hospital.



Statistical




analysis

The Mann-Whitney U test and Kruskal-Wallis test were used for statistical analysis, with

p

< 0.05 considered statistically significant.


Results

The mean age was 35.4 years in group A and 36.5 years old in group B. Data for age, BMI, testosterone levels and biochemical markers for patients in both groups, and different grades of varicocele are shown in Tables 1 and 2. There were no significant differences in age between the patients of groups A and B and among the patients with different grades of varicocele (grades 1, 2 and 3). Of the 102 patients in group A,

19.6% were grade 1, 53.9% were grade 2 and 26.5% were grade 3. The BMI of patients with varicocele was significantly lower (

p

= 0.03) than that in patients without varicocele (Table 1). Patients with varicocele had lower serum levels of Cho, TG and testosterone and higher serum levels of LDH and Alk-p than patients without varicocele, but only Cho was significantly dif- ferent (

p

= 0.03, Table 1). There were no significant differences in the other biochemical markers between the patients of groups A and B (Table 1).

Patients with grade 3 varicocele had a lower BMI than patients with grades 1 and 2 varicocele, but this was not significantly different (Table 2). Patients with grade 3 varicocele had lower serum levels of Cho and testosterone and higher serum levels of LDH and Alk-p than patients with low grade varicocele (grades 1 and

2), but this was not significant. There were no signifi- cant differences in any of the other biochemical markers among the patients with grades 1, 2, and 3 varicocele (Table 2).



Table 1. Age, serum biochemical markers, testosterone and BMI in groups A and B*

A (n = 102) B (n = 95) p†

Age (yr)

35.4 ± 9.6

36.5 ± 10.5

0.76

Alk-p (U/L)

128.5 ± 42.6

121.5 ± 40.5

0.09

Calcium (mg/dL)

8.9 ± 0.2

8.8 ± 0.2

0.79

LDH (U/L)

128.9 ± 22.9

122.8 ± 21.1

0.09

IP (mg/dL)

3.1 ± 0.4

3.2 ± 0.5

0.32

γ-GT (U/L)

31.2 ± 12.1

29.1 ± 10.5

0.43

Uric acid (mg/dL)

6.0 ± 1.5

6.1 ± 1.9

0.83

Albumin (g/dL)

3.6 ± 0.4

3.7 ± 0.5

0.86

Iron (μg/dL)

77.8 ± 29.2

81.2 ± 32.7

0.55

Cholesterol (mg/dL)

176.5 ± 31.1

187.7 ± 42.1

0.03

Triglyceride (mg/dL)

140.5 ± 85.2

166.7 ± 93.5

0.06

ALT (U/L)

25.4 ± 11.2

26.5 ± 12.5

0.89

AST (U/L)

26.2 ± 10.5

28.2 ± 11.7

0.75

Hemoglobin (g/dL)

14.2 ± 1.8

14.5 ± 1.9

0.77

Testosterone (ng/dL)

332.5 ± 104.6

399.4 ± 193.1

0.06

BMI (kg/m2)

22.8 ± 3.2

24.9 ± 4.1

0.03

*Data presented as mean ± standard deviation; †statistical analysis by Mann-Whitney U test. A = group A, with varicocele; B = group B, without varicocele; Alk-p = alkaline phosphatase; LDH = lactic dehydrogenase; IP = inorganic phosphate; g-GT = g-glutamine transpeptidase; ALT = alanine aminotransferase; AST = aspartate aminotransferase; BMI = body mass index.



Table 2. Age, serum biochemical markers, testosterone and BMI according to different grades of varicocele*

Grade 1 (n = 20) Grade 2 (n = 55) Grade 3 (n = 27) p†

Age (yr)

36.1 ± 9.7

34.9 ± 9.3

35.3 ± 9.5

0.69

Alk-p (U/L)

122.3 ± 43.4

125.5 ± 41.6

133.6 ± 43.1

0.08

Calcium (mg/dL)

8.9 ± 0.3

8.9 ± 0.2

8.8 ± 0.3

0.63

LDH (U/L)

124.1 ± 21.9

128.4 ± 22.5

133.9 ± 23.2

0.07

IP (mg/dL)

3.0 ± 0.4

3.1 ± 0.5

3.2 ± 0.4

0.46

γ-GT (U/L)

30.8 ± 12.4

31.1 ± 12.0

31.6 ± 11.8

0.65

Uric acid (mg/dL)

6.1 ± 1.6

6.0 ± 1.4

5.9 ± 1.4

0.54

Albumin (g/dL)

3.7 ± 0.5

3.6 ± 0.4

3.6 ± 0.5

0.89

Iron (μg/dL)

78.2 ± 29.3

77.7 ± 29.1

76.5 ± 28.9

0.67

Cholesterol (mg/dL)

183.3 ± 31.9

175.5 ± 31.2

169.4 ± 30.5

0.09

Triglyceride (mg/dL)

137.1 ± 83.5

141.2 ± 84.2

145.3 ± 87.2

0.09

ALT (U/L)

25.6 ± 11.9

25.3 ± 11.2

25.1 ± 11.1

0.69

AST (U/L)

26.0 ± 15.7

26.1 ± 10.4

27.1 ± 11.2

0.75

Hemoglobin (g/dL)

14.2 ± 1.7

14.0 ± 1.5

14.3 ± 1.9

0.45

Testosterone (ng/dL)

352.2 ± 99.5

325.5 ± 101.6

300.1 ± 145.1

0.06

BMI (kg/m2)

23.7 ± 3.4

22.7 ± 3.1

21.7 ± 3.0

0.06

*Data presented as mean ± standard deviation; †statistical analysis by Kruskal-Wallis test. Alk-p = alkaline phosphatase; LDH = lactic dehydrogenase; IP = inorganic phosphate; g-GT = g-glutamine transpeptidase; ALT = alanine aminotransferase; AST = aspartate aminotransferase; BMI = body mass index.


Discussion

Tsao et al showed that the prevalence and severity of varicoceles is inversely correlated with obesity, which indicates that obesity may result in a decreased nut- cracker effect.12 Handel et al reported that the preva- lence of varicocele decreases with increasing BMI,

and the reason for this is that increased adipose tissue decreases compression of the left renal vein and pre- vents detection due to adipose tissue in the spermatic cord.13 In the present study, patients with varicocele had a lower BMI than normal age-matched controls, but patients with grade 3 varicocele did not have a sig- nificantly lower BMI than patients with lower-grade

varicocele. The different etiology between our study and that of Tsao et al may be because patients in the previous study were young males serving in the army, which was different from our patients, but the etiol- ogy needs further evaluation.

We found that obese or overweight (BMI ≥ 25) patients might have higher serum levels of Cho and TG than normal subjects (BMI < 25). Sultan Sheriff demonstrated a marked increase in lipids, Cho and TG in the testis of varicocele patients and the etiology may have been due to non-utilization of Cho for androgen biosynthesis.14 In this study, patients with varicocele had significantly lower serum levels of Cho than patients without varicocele, but no significant difference was found for TG, which might be due to the large standard deviation (Table 1). However, there were no significant differences in Cho and TG among patients with different grades of varicocele (Table 2), and the reason needs further investigation. Obesity can mask the clinical detection of varicocele. There- fore, we used Doppler ultrasonography to confirm the diagnosis of varicocele and excluded those patients with subclinical varicocele.

Kumanov et al demonstrated that gynecomastia is negatively correlated with BMI.15 Low serum follicle- stimulating hormone and high testosterone are good prognostic factors for varicocelectomy.16 Ishikawa and Fujisawa showed that the vasodilatory effect of testosterone is decreased in high grade varicocele and they suggested that serum free testosterone will be in- creased after varicocele repair.17 Ghosh and York have reported that testosterone levels are lower and Alk-p levels are higher in the testis of varicocele-created rats.18

In our study, patients with varicocele had lower serum levels of testosterone and higher serum levels of Alk-p than patients without varicocele. In addition, patients with grade 3 varicocele had lower serum levels of testosterone and higher serum levels of Alk-p than patients with low grade varicocele. Both parameters did not reach statistical significance, and the reason might be due to a large standard deviation for testo- sterone and Alk-p levels. Therefore, the role of testo- sterone and Alk-p in patients with varicocele needs further evaluation; however, we did not measure folli- cle-stimulating hormone in this study. Our previous study showed that more free radicals might be gener- ated in varicocele veins than in the corresponding peripheral veins in patients with varicocele, because

8-hydroxy-2 -deoxyguanosine levels of leukocyte DNA in spermatic veins are higher than in the correspond- ing peripheral veins in these patients.19 Yesilli et al showed that LDH and malondialdehyde levels are greater in the sperm of infertile men with varicocele,

but the levels of LDH and malondialdehyde does not decrease after varicocelectomy.20 In the present study, serum levels of LDH were higher in patients with varic- ocele than in patients without varicocele. Further- more, higher serum levels of LDH were found in patients with high-grade varicocele than in patients with lower-grade varicocele. Neither of these findings was statistically significant. Therefore, the effect of LDH in patients with varicocele needs further evaluation.

Our findings suggest that an increase in body fat might be associated with relieving the nutcracker phe- nomenon of the superior mesenteric artery to the left renal vein. However, this study had some limitations. First, we did not compare the change in severity of varicocele in the same individual as BMI changed over time. Second, we did not use other imaging studies, such as computed tomography or magnetic resonance imaging, to demonstrate the relationship between vis- ceral fat and the region of the superior mesenteric artery, left renal vein and aorta. Third, the case numbers were small from an epidemiological view, because all of the subjects needed to have data for biochemical mark- ers, which restricted the patient numbers. Therefore, we need to include more cases in future studies.

In conclusion, patients with varicocele might have significantly lower serum levels of cholesterol than patients without varicocele. In addition, our findings support the hypothesis that patients with a greater BMI may have advantages in relieving the nutcracker phe- nomenon causing significant varicoceles, but further studies are required to clarify this issue.


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Explain the integration of the strategy into a total marketing program for the orthopedic group?

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Explain the integration of the strategy into a total marketing program for the orthopedic group?

1. An orthopedic group in Virginia has decided to conduct a survey of referral physicians. The results, which are posted on the Web site, indicate the level of satisfaction. The group has also posted comments that some of the physicians wrote on the surveys. What is this group doing in terms of attempts to recognize the customer contact process? Explain the integration of the strategy into a total marketing program for the orthopedic group?

2. Recently a surgical group in Manhattan posted a Web site that includes a page that refreshes every 10mintues and shows how close the doctors are following their “scheduled appointment” times. In terms of the value equation, what component or variable is this group trying to work on with its market?

Chapter 8:

3. A large community hospital, River Valley, has recently begun to acquire physician practices. At issue is whether to rename each acquired practice to “River Valley Associates” or to leave each name alone. What are the trade-offs River Valley should consider in this decision?

4. A company has decided to offer a health savings account plan to its employees. This new option is the first such type of coverage available in the market. Based on the factors that affect the diffusion of innovation, how might the company best accomplish the successful roll-out of this new health care coverage option?

Chapter 9: 5. Two medical organizations have recently examined their cost structures. The first group is a radiology practice with a significant investment in diagnostic imaging equipment. The second group is a single-specialty pediatric practice. The cost analysis reveals the following distribution:

Radiology Group Pediatric Group Fixed Cost 70% 20% Variable Cost 30% 80% Explain the implications of these differing cost structures of each medical group in terms of contracting with managed care organizations. 6. An ophthalmology practice is deciding whether to offer prescription eyeglasses for sale in-house. The new service would require the training and hiring of additional personnel, inventory for glasses and frames, and some minor space alterations. The utilized space in the office would be a charge allocated to the program. The costs for this new service are: Variable Costs (electricity, $80 per completed labor, supplies) pair of eyeglasses Total Fixed Cost $36,000 How much volume does the group need to break even if they charge $100 per pair of eyeglasses? If they charge $200?

: Describe the known and potential contributing factors of a disorder, including psychological, neurological, biochemical, genetic, environmental and socio-cultural factors.

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: Describe the known and potential contributing factors of a disorder, including psychological, neurological, biochemical, genetic, environmental and socio-cultural factors.

Define and describe the clinical symptoms that manifest with any disorder

2. Etiology of the disorder: Describe the known and potential contributing factors of a disorder, including psychological, neurological, biochemical, genetic, environmental and socio-cultural factors.

3. Treatment: Describe what evidence based research has shown as the most effective models of intervention in treatment of this disorder, including psychotherapy and psychopharmacological methodologies.

4. Clinical Integration: Illustrate your understanding of this disorder by providing a brief case example from your own practice or personal life that supports the research you have presented.

Public Health Obesity And Nhs Health And Social Care Essay

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When the NHS was established in 1948, one of its founding principles was that it should improve health and prevent disease as well as providing treatment for those who are ill. In November 2004, the government produces a white paper choosing health, and one of its main purposes was to improve health of the national by setting goals, putting strategies and guidelines that would have the effect of increasing the general standard of the Public health (Choosing Health 2004). Although this white paper has many strands but the one which will be looked on this assignment is obesity as a Public health issue.

This essay will start by looking the concept of health and it will look Public health and how it relates with overall care of obesity. A scenario will be used to describe the physiology of obesity’s patient and how it is affecting psycho social perspective of their life. The essay will also explain the roles of nurse in supporting individuals with health problems within the community setting as a part of inter-professional team. Government policies and frameworks in relation to patient needs will be provided. Different sources of information such as internet, books and journals to demonstrate the points will be used. Any name mentioned in this scenario has been changed in order to respect individuals’ confidentiality and comply with the code of NMC (2008).

Health has been seen as a complex concept. It means that health has different things to different people and is affected by a wide range of factors such as lifestyles, social, economic and environment such as whether people live in as a free society, what social support network are available, and how they live in terms of employment, income and housing (Simnett et al 2003). Health has two common meanings, one is negative which is the absence of disease or illness and is the meaning of health within the western scientific medical model. The other meaning of health is a state of complete physical, mental and social wellbeing, not merely the absence of disease or illness (Naidoo et al 2000). Other writer such as Seedhouse suggests that health is about improving people’s quality of life by enabling them to fulfill their own potential and empowering them so that they are capable of becoming (Simnett et al 2003). According to Ottawa Charter of November 1986, a conference primarily was response for growing expectation for new Public health movement around the world has seen health as a resource of everyday life not the objective of living (W.H.O 2000).

There are huge ranges of factors that affect health. Health can be affected by genetic, gender, lifestyle and behavior, housing, environment, food policy and many more. In Acheson report into inequalities in health on socio economic model of health, it shows the main determinants of health as layers of influence one over another. At the centre are individuals with their inbuilt genetic, age and gender related factors. Surrounding the individuals are layers of influences that in theory could be modified to allow the best possible of health. The inner layer is their personal behavior or lifestyle, with factors such as smoking and drinking habits, and physical activities with the potential to promote or damage health. Individuals are seldom alone; they interact with friends, relatives and community and come under social and community influence. This model emphasizes interaction between these layers. The model has been used to guide research for example it shows that the social environmental people live is related to their health behavior, patterns of eating, drinking, smoking and physical activities. The model also demonstrates the various interventions on attempting to change individuals’ risks by encouraging people give up smoking and change diet (Acheson 1998).

Obesity is a condition which weight gain has reached a point where it causes a significant risk of health (NICE 2006). World Health Organization defined obesity as abnormal or excessive fat increase that may impair health; this means BMI (Body Mass Index) is equal to or more than 30. (BMI is defined as the weight in kilograms divided by the square of the height in meters) World Health Organization indicated that, globally approximately 400 adults and 20 million children under the age of 5 were obese on 2005 and by 2015 the number will reach more than 700 million. Obesity is one of the most Public Health challenges of the 21st century in the world and is already responsible for 2 to 8% of the health cost and 10 to 13% of deaths indifferent parts of the region. Obesity is also a major contributor to the global burden of chronic disease and disability (WHO 2010). Public health is a social and political concept aimed at the improving health, prolonging and improving quality of life of the population through promotion, prevention of disease and other forms of interventions (Acheson Report 1988).

According to the Department of Health guidance of March 2006, obesity is one of the biggest public health issues facing England. Estimates suggest that more than twelve millions adults and one million children will be obese by 2010 if no action is taken (NICE 2006). Obesity has grown up almost by 400% in the last twenty five years and it will entail levels of sickness that will put huge pressure on the health services (The House of Common 2004). According to the government study of 2007, half of the population could be obese within 25. Obesity has a substantial human cost by contributing to the start of the disease and premature mortality and it has serious financial consequences for the National Health Service (NAO 2001). It suggests the cost of epidemic, in terms of health care provision could reach 45 billion a year by 2050 (BBC 2007). There is also a cost to society and economic mostly on sickness absences which reduce productivity (DOH 2010).

The cause of Obesity is complex, and can be grouped into different areas. Individual’s genes may play an important part in influencing metabolism and the amount of fat tissues in the body. Genes could also affect individual’s behavior, inclining individual towards lifestyle choices that may increase the risks of obesity. The risks of excess weight also can be contributed by the pattern of growth during early life. The growth of the baby’s rate in the womb, following the birth is the part determined by parent’s factors especially with regards to mother’s diet and how she feed the baby (DOH 2008). The availability of more variety, cheaper and testes processed food with bigger size portion has also contributed obesity. More people are eating pre package food, fast food and soft drinks which are regularly high in calories, salt, fat and sugar. These foods are heavily advertised especially to children (Cancer Research UK 2009). The modern physical environment has contributed to increasingly inactive lifestyle over the past fifty years because of changing in work and shopping patterns from local to distant that has results people dependence on motorized transport. Other factor is UK has changed from an industrial to a service based-economic therefore fewer jobs are now requiring physical work. Obesity has also been contributed by poor urban planning where pedestrians and cyclists have lower priorities than for motor vehicle. Most people now spend less time on active games and more time in sitting at the computer, watching TV and playing video games. Our exercise, eating and drinking habits also are greatly influenced social and psychological factors (DOH 2008).

This example relate to an obese and a type two diabetes patient whom has been referred to District Nurse by a General Practitioner following her health condition. Her name is Maria, sixty two years old and she lives alone in a one bedroom flat. Maria is hardly walks because of her condition; she spends more time sitting in a chair and sleeping on her bed. She depends on Carer for her personal hygiene and preparing meals. A District Nurse visits her twice a day to administer insulin. Maria sometimes looks to be confused. She has been advised several times by Dietician and District nurse on her habits of eating unhealthy food, but she says she is not bothering and she does not feel sorry with her condition. Maria background shows that her father was obese and a diabetic, he dead from heart failure.

Obesity is a central player of pathophysiology of diabetes mellitus and insulin resistance. It is a major contributor to the metabolic dysfunction involving lipid and glucose. It influences organ dysfunction involving liver, endocrine, pulmonary and reproductive functions. It also increases the chances of myocardial infarction (Redinger 2007). Diabetes can cause heart disease, amputation, kidney failure and more death than cancer (Diabetes UK 2080). The case study shows that Maria father had died from heart disease.

People like Maria needs support to improve their health. The support could be treatment, a promotion activity, or a care services. According to the Ottawa Charter, health promotion is a strategy that aims to integrate skills and community development and to create supportive environments for health, make efforts to build healthy public policy and look at re orienting health services (WHO 1986). The Jakarta declaration on leading health promotion into the 21st century confirms that this strategy and action areas are relevant to all countries including cities, municipalities, local communities, schools, workplaces and healthcare services. The declaration identifies priorities on promoting health social responsibility, expand health promotion partnership, empower the individual and expand community capacity and secure health promotion infrastructure (WHO 1998). The WHO global strategy on diet, physical activities and health urged all the stake holders to take action to support healthy diets and physical activity global, regional, and local levels to reduce the prevalence of chronic disease and their common risk factors, primarily unhealthy diet and physical activities (WHO 2010).

In 1999, the UK government document Our Health Nation, has identified a three way partnership for a better health. The government, local communities and individual have to work together in partnership to improve our health. Partners include the government, health authorities, local authorities, business, voluntary bodies and individuals (DOH 1999).

Locally, Community care means to provide the right level of intervention and support to people and enable to achieve maximum independence and control over their own lives (Titterton 1994). The Acheson report on Public health, it defined public health as the science and art of preventing disease, prolonging life and promoting health the organized effort of society (Naidoo et al 2000). NHS original goals of providing a comprehensive health service, improving physical and mental health and to prevent, diagnose and treat illness is much in common with the health promotion. Use of the health services is universal so that everyone at some point in their lives comes into contact with the health service providers. Primary health care is the first level of contact of individuals and community with the national health system bringing health care as close as possible to where people live (MacDonald 1993). Primary health care provides a setting where health promotion at primary, secondary and tertiary levels takes place (Naidoo et al 2000). The primary prevention is to delay or prevent the beginning of disease. Joyce treatment of diabetes would have started at this point by screening and advising on changing diet and her lifestyle (SIGN 2007). The secondary and tertiary prevention is sought to reduce the occurrence of relapses and the establishment of chronic conditions through example, effective rehabilitation (WHO 1998). At secondary stage patients are vulnerable and require regular monitoring such as weight monitoring, signs of deterioration, etc.

One of the aims of the district nurses in the community is to improve health of the population by reducing obesity and increase the awareness of the positive healthy behaviors in community. Nurses delivering public health by influencing public policy and health promotion and are working to create the opportunity for people to live positive healthy lives (RCN 2007). The first visit of District nurse to Maria’s home was to assess the needs and prepare a care plan. The plan will include advice and educate on health eating and blood sugar management. District nurse visits will include administering of insulin depend on how serious the diabetes is. Because Maria spends more time sitting, the chance of developing pressure sore and leg ulcer is higher, a District nurse will advice Maria on how to avoid possible break of skin. The district nurse will refer Maria to dietician for advice on Maria’s diet, physiotherapist to help her on physical problems and occupational therapist who will work to improve her ability to perform daily tasks. A district nurse will do referral to social service if required. The general practitioner will be involve in the care of Maria on prescribing insulin and losing weight medicine such as orlistat which works by blocking the action of enzymes that is used to digest fat ( NHS choices 2010).

On the government side, Department of Health is responsible for policy on public health aspects of diet, nutrition and physical activities. It ensure that public and others have the information they need to improve health. It sets national priorities to improve health and reduce health inequalities. It also commissions research on the effectiveness of interventions. Department of Health works together with the Department for Education on promoting education and health school also encourage young people to be active by participating in sports within and beyond school. Schools provide a healthy diet and education and nutrition so that young people can eat a balanced nutrition diet. Department of health also works with other department such as the Department the culture, media and sports to promoting walking and cycling, facilitate active leisure and to improve quality of life for sporting activities so that more people to participate in sports( NAO 2001).

Many people like Maria do not even know that obesity as a problem because they have no access to health information services or support for individuals need’s for information is sometimes underestimated. It could be even health practitioners do not use their skills to promote health of individuals. Health professionals need to work face to face to with individuals so that to provide advising and persuading them to make them change their lifestyles. Accurate and appropriate information about people’s health should be provided and what social and behavior factors can affect their health. People should be made aware of important of health benefits associated with active lifestyle for examples, improve their self efficacy and confidence and enhanced their social opportunity. They should be aware that food high in fat, sugar and salt are not necessary and should be avoided or eaten in minimum (SIGN 2010).

To summing up, obesity is possibly dominating the public health issue in UK today and its effect can not be seen as an individual but is a society a whole. Communities, individuals and other groups need to work together in tackling obesity epidemic and work together in promoting health and well being.

A review of the U.S. economy and its impact on transportation and logistics management with an emphasis on military transportation and logistics management.

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Logistics:  A review of the U.S. economy and its impact on transportation and logistics management with an emphasis on military transportation and logistics management.

Instructions: This week (week 1) you will choose your topic and submit your proposed Problem Statement for your research paper as well as an outline.
The Outline will consist of 4-5 pages. The Title Page and Reference Page are not included in the page count. The paper/outline describes your final research project. Each major section within your final project should be covered in this paper. The Project Outline must be in narrative form, and be descriptive enough that explains each element of your project. The use of graphics and charts is highly encouraged.

The Final Research Project will be 20-25 pages and due in week 8. The project must include a title page, table of contents, abstract, and a reference page. The project will demonstrate the knowledge acquired through course work completed to date. The project is an application of this knowledge and requires the student to analyze and interpret the topic of interest. The use of graphics and charts is highly encouraged.
This report must be original work. This report cannot include papers submitted in previous courses.

Organization should be as follows:
APA cover page
Abstract (1/2- 1 page)
2. Introduction to the topic, problem or thesis statement
3. Literature Review Background Research on the topic
4. Discussion of your ideas on the topic and problem
5. Discussion of new solution(s) to the problem
6. Conclusion
Looking Ahead
The final paper must have the following key sections, clearly identified, though they can be titled creatively to reflect your question and interests:
I. An introduction that states the problem and why your topic is important.
The research question, clearly and concisely stated as a question. What do you hope to answer with this research? This section should also include definition of terms.
II. Literature Review – background research on this topic
III. The results/ discussions, describes what you have learned that helps answer the research question. What are you ideas about this topic?
IV. The discussion of potential new solutions.
V. The conclusion, which summarizes the key points of the paper and suggests further research needed on this topic.
VI. A list of references in APA format.

Topics for the course project include but are not limited to:
1) The convergence of transportation congestion and transportation security at a U.S. seaport.
2) A review of past Transportation legislation while developing a new proposal to address past weaknesses and omissions.
3) The transitioning of the Defense Transportation System toward complementing best practices in supply chain management efficiently and securely.
4) A review of the U.S. economy and its impact on transportation and logistics management.
5) Identify new challenges within transportation and logistics management and develop viable solutions to these challenges.
6) Identify an emerging concept such as reverse logistics, green logistics, etc. and analyze its impact on the future of transportation and logistics management.
7) Other topics will be considered.