The Negative Effects of Divorce on Children

â€Å"So many persons think divorce a panacea for every ill, find out, when they try it, that the remedy is worse than the disease† (Qtd in Harper 192). Divorce in any situation tears a child apart, tossing them from one house to another, limiting the time spent with their parents, and confusing them. There arent very many reasons that would show to be more beneficial for the parent to leave than to stay and keep their marriage. Usually its better for the children if their parents work through their differences rather than get a divorce. To anyone, divorce is a horrible word.There is no way to make the word sound better or make it less painful. According to the Webster’s Dictionary, divorce is â€Å"the legal dissolution of marriage or the termination of an existing relationship or union† (Webster’s 370). This definition makes it seem formal and doesnt show the feeling that people have when the word is mentioned. To most children, divorce is much more than a legal dissolution; it is their whole world being torn apart and thrown on the ground in pieces. One of the biggest problems that divorce imposes on children is the decision of who they should live with.Usually parents divorce when children are small and the children have no say in where they go. Since the child cant choose, this usually leads to custody battles that end in split custody or joint custody. Whatever the choice turns out to be, either one of them will be detrimental to the child. When split custody is decided, it forces either the child or the court to choose which parent to live with and which one is in the childs best interest. It limits the time the child spends with both parenta. When the child only lives with one parent, the relationship with the other parent can be severely damaged.According to the National Survey of Children, close to half of all children with divorced parents have not seen their nonresidential parent in the past year, and only one in six had weekly contact (Whitehead 2). Since the children don’t see both their parents often, the parent that the child lives is usually thought of as strict and â€Å"no fun† because that parent is always there and is always responsible for disciplining the child. This can damage and cause social problems with the child. The nonresidential parent is usually viewed as the fun, exciting one that the child wants to be with.This parent usually tries to give the child presents, and money almost like they are using it in an attempt to â€Å"buy† the child’s love. The child doesnt usually feel the love and security of having a close family, since they are constantly moving from house to house. Because of the constant movement, the child doesnt usually receive quality time from either parent, and it makes it more difficult to feel loved. Joint custody, on the other hand, proves to be even less successful (Zinmeister 29). This type of custody is now allowed in half of the states in the US, although, joint custody is very unusual because of the extreme complications.In California, where divorce is more common than anywhere else, only eighteen percent of divorced couples have joint custody. Even when the divorced parents maintain regular contact with their children, truly cooperative child rearing is rare (Zinmeister 29). Research shows, that the parents have no communication or mutual reinforcement; this usually leads to very unhealthy relationships with their children. Joint custody is even worse on a child because there is even more movement involved. With split custody, the child goes to the nonresidential parent’s house on a certain schedule.In joint custody, however, the child is constantly moves back and forth between houses, causing an even larger lack of time between parent and their child. The custody battle can be damaging, but the divorce of a child’s parents can also confuse the child, suggesting that it is better for parent s to stay together. The child does not really know what commitment really means. Since these children see their parents breaking vows without a second thought, they start to think that whats right for the parents must be the right thing for them to do too.Children are basically shown that they dont have to work out their problems as long as they can run away. This is one reason that today, when someone makes a promise, there is really no promise of whether it will happen or not. According to The Effects of Divorce on Children, an article written by J. Lynn Rhodes, young adults whose parents have divorced previously are likely to have social problems and trouble forming and maintaining intimate relationships (Effects 1). The value of a person’s â€Å"word† has lessened.Partly because of bad examples parents are setting for their children when they get a divorce. Generally, its better for children to suffer a bad marriage than to cope with divorce. According to Universit y of Michigan psychologist and divorce expert Neil Kalter, the misery of an unhappy marriage is less significant than the changes after a divorce. The children would rather their parents keep fighting and not get divorced (Marriage 64). Although it doesnt seem logical, it shows that children want their parents to be together no matter what the cost.The alternative to most divorces is not life in a war zone (Zinmeister 30). In the most of the number of divorces there is no problem or issue that could ruin a person’s childhood. These divorces almost always make the child worse off and create many unnecessary problems for the child. If parents would concentrate harder on working their problems out rather than their own personal happiness, the children would be better off. Divorce, however, isnt always a terrible thing. In a few situations it is for the best.The two situations that can prove beneficial for a person to get a divorce are abusive relationships and adultery. When one parent is abusive, whether verbal, physical, or sexual, to the children, it is more beneficial to the child if the parent leaves (Huffman 4). Also, if one parent is physically abusing the other, the marriage should be ended. If a child watches their parent get beaten their entire life, they could think that its okay to act that way to other people or they can begin to hate the parent for staying.Also, when a spouse is committing adultery, divorce is definitly an option. When one spouse is faced with the affairs and still wont stop having them, the Bible gives the option of divorce. In Matthew 19:8-9 it says, â€Å"Moses permitted you to divorce your wives because your hearts were hard. But it was not this way from the beginning. I tell you that anyone who divorces his wife, except for marital unfaithfulness, and marries another woman commits adultery† (Huffman 9). Even under these ircumstances, Jesus permitted divorce, but he didnt encourage it. It generally shows to be more beneficial for a child if their parents stay in an imperfect marriage rather than getting a divorce. The things that are involved with a divorce severely damage a child. The child lacks a â€Å"sense of belonging† and becomes very confused. Therefore, when a person gets married, they need to think long and hard to make sure that it is the right choice for them and for possible children that they may have one day.The person needs to make sure that they dont settle for the person they can live with; they need to wait for the person that they cannot live without. As Jesus says in Mark 10:5-9: It was because your hearts were hard that Moses wrote you this law. But at the beginning of creation God made them male and female. For this reason a man will leave his father and mother and be united to his wife, and the two will become one flesh. So they are no longer two but one. Therefore what God hath joined together, let no man put asunder (Huffman 1). Works Cited Harper Book of American Quotations, New York, Harper and Row, 1988, p.192. Huffman, John. â€Å"The Raw Reality of Divorce.† Http://www.christiandigest.com/divorce.html. (19 November 1998). Marriage and Divorce, California, Greenhaven Press, Inc., 1997, p.64. Rhodes, J. Lynn. â€Å"The Effects of Divorce on Children.† http://www.lrhodes.com/divorce.html. 1997. â€Å"Through the eyes of a child.† Http://www.divorceonline.com (20 November 1998). Webster’s Ninth New Collegiate Dictionary, Massachusetts, Merriam-Webster, Inc., 1984, p.370. Whitehead, Barbara. â€Å"Coming Apart.† http://www.divorceonline.com (20 November 1998). Zinmeister, Karl. â€Å"Divorce’s Toll on Children.† Current Magazine, April 1997: 29-30.

Firoozeh Dumas Essay

â€Å"To deny someone and education is not just a crime but a sin, because you are denying that person the opportunity to realize who he or she is meant to be. † This quote represents Firoozeh Dumas’s view on learning and becoming the person that she is today. Through her hardships, struggles, good times and the bad times, she has matured and learned a great deal. In the autobiography Funny in Farsi by Firoozeh Dumas, the themes or clashing cultures, new environments, and learning through experience comes into play. The story begins as Firoozeh moves with her family to the United States in 1972, as a seven-year-old. From the moment her airplane lands, she starts to see differences; not only in the geography of the land and the appearance of the people, but the look of the whole place. She is used to bustling cities in Iran, crowded with enthusiastic workers, shoppers, and people socializing. In contrast, her new neighborhood in America seemed fairly unexciting; she describes it as uniformed houses, all the lawns in perfect order, as if everything was constantly being maintained to achieve the ideal look. But little did she know that this was only the beginning of differences. Entering a new school would open a whole other orbit of biculturalism. As she enters school, she sees everyone; completely different looking from her, and all of them fluent in English. Curious classmates peered around her desk, examining her from head to toe trying to figure out who she is; what type of creature she is and where she comes from. To make things even worse, Firoozeh’s mother decides to attend school with her, to learn proper English. This leads to ultimate humiliation for Firoozeh. Not only is she an immigrant student, but an immigrant student with her mother in elementary school with her. Students constantly ask her where she comes from, as if she’s an alien of some sort. She slowly learns to respond by saying â€Å"You know, the country where Persian cats come from. † She hopes to one day learn English properly so she can fit in and communicate with her fellow students. Her first day is completely confusing as she tries to embrace all that is happening around her. On the way home, the bus driver drops Firoozeh and her mother a few blocks away from their house. Not so familiar with the location, they get further confused and can’t recognize their own home. To them, the homes all look alike, and can’t distinguish their own from the rest. These incidents represent the difficulties that Firoozeh goes through in her first couple of months in America. However, after a couple of months time, she learns more and more about the American culture and believes she is on her way to â€Å"Americanization. † During summer vacation, the family celebrates their first year completed in America by voyaging to Disneyland. Being a child, Firoozeh is completely star-struck and amazed by the tiny world created for the sole purpose of entertaining people. All her favorite Disney characters that she had only heard the names of in Iran were now walking amongst her in real life! Firoozeh wasn’t the only one who enjoyed herself. Her father Kauzem described Walt Disney as a â€Å"†¦ genius, a man whose vision allowed everyone, regardless of age, to relive the wonderment of childhood. † (p. 17) Their lives in America seemed to be improving, until the Iranian Revolution ten years later. Firoozeh, now a seventeen year old, was again suffering from racism everywhere she went. People were now staring at her again, questioning her and calling her a terrorist, just because of what was happening in her country. The pain of not fitting in was now something she became accustomed to, and she decided to overcome it by further educating herself. She was thankful to have the opportunity to be educated, and she wanted to take advantage of her chance. Firoozeh spent high school learning French, until she got fluent in it. She was offered an opportunity to travel to Paris for two months because of her immense skill and fluency at the language. There, she again faces racism, where she is interviewed and labeled as a seventeen-year-old spy. She begins to ignore the racism around her, and advances in her studies. From education, she learns who she really is. The strength is now ingrained in her and she knows who she is: a young Iranian woman who has succeeded through many hardships. Nothing can stop her from learning, the main factor that helped her develop her personality. The main conflict she faces over and over again throughout the story is intense racism and not being able to fit in with every other American. By end, she realizes that by using education she can overcome all her struggles. Firoozeh Dumas ends up marrying a Frenchman who she meets in college, and they both live happily together. She realizes that her own encouragement and drive to study has brought her all the way to college, and finds her a perfect partner. As she said before, education is what helps a person realize what they are meant to be. In my opinion, the character goes through many hardships; and just as things begin to turn up, she again falls into another political conflict because of the Iranian Revolution. With these multiple problems she has to face, she realizes that one key factor can help her survive through it all: education. She knew that as long as she kept studying and taking advantage of the right of education, she will succeed; and she did. I think she dealt with her hardships perfectly and came out extremely strong at the end. This book is an ideal representation of an immigrant girl coming from Iran. It shows the perfect perspective of what someone like Firoozeh might think, and the problems they will face. It gives an opportunity for the reader to advance their knowledge on a new culture, to see an Iranian immigrant’s point of view. By adding some humor in the story, it becomes even more entertaining and interesting to learn about Firoozeh’s struggles. This book has given me an increased amount of respect for people who come from a different country. Firoozeh’s education helped her go extremely far and be successful in life, and I hope the same will happen to me because I’m blessed with the right of education that Firoozeh describes.

Compare and contrast arguments for and against belief in life after death Essay

) Compare and contrast arguments for and against belief in life after death (20 marks). 26/01/03 One initial problem with studying the belief in life after death is that there are a vast number of theories stating what they believe ‘life after death’ actually is. Therefore in order to effectively ascertain arguments for and against this idea, it is necessary to deal with each individual theory separately. Plato’s theory of dualism1 argues that it is the mind that determines our personality and that the body is an outer shelf for the real self. The body is contingent and therefore destined for decay but the mind is associated with the higher realities such as truth, goodness and justice and is immortal. Plato believed that the soul continues after death. Plato said that there was a perfect idea/form for everything in existence. The idea of the thing is prior to the individual instance of it and so it must be more real. Ideas are not physical things so they must belong to a spiritual realm of reality, which is more real than the material realm. According to Plato the telos2 of the body is to be in the physical world and receive sense-impressions whereas the telos of the soul is to travel into the realm of heavenly ideas and understand them. Before our immortal souls became imprisoned in our bodies they were acquainted with these heavenly ideas and so our soul wants to break free of our bodies and spend eternity in contemplation of the true, the beautiful and the good. In this realm the thinking being would survive without the physical body, the body would not survive death, but the soul – the real essence of the person would continue. Plato terms this ‘soul’ as our personality identity. According to Davies, although the arguments may seem ingenious, in actual fact they are severely misguided. Things may have opposites, but it does not follow that if something comes to be, there is something which is its opposite from which it comes. Nor does it follow that if something ceases to be, something comes to be which is opposite to something existing earlier. Davies adds that Plato’s second argument does not work because it mistakenly assumes that if all who have lived come to be dead, it follows that everyone has come to be dead. It is true that someone who has gone to sleep has not awoken but it is not true that nobody is awake.3 Aristotle developed a similar theory of dualism for life after death, he considered the ‘soul’ to be the part of the body that gives it life. It is what turns the physical form into a living organism of its particular type. Therefore a human will have a human soul. Aristotle defines the body and soul as being inseparable. The soul develops the person’s skills, character or temper, but it cannot survive death. When the body dies, the soul ceases to exist, as they are one. This would appear to be materialistic at first but Aristotle believed that the body and soul were different. Human beings have a soul or self that is capable of intellectual life. Only humans can reflect on feelings and sensations and grasp ‘universals’. In this way we come to understand eternal truths and in doing so we move on to achieve a higher level of existence. It seems evident here that Aristotle’s argument is guilty of confusing spiritual fulfilment that occurs on an entirely physical level, involving emotions and cognitions with life after death and so it seems we must reject his argument. Bernard Williams raised concerns that the separation of body and mind raises questions for discussion. Williams argues that memories are not a good guide to identity. Memories and personality can be fabricated and personal identity cannot be proved through mental activity alone. He believed that identity comes from physical characteristics as well. Personal identity depends on the way in which we recognise each other and without our bodies we cannot be fully identified. However, one could counter this by saying that the recognition of each other is irrelevant as it is more the manner within which we recognise ourselves that is important. Furthermore, Williams speaks of recognition on an entirely materialistic level as it is merely the physical person they are identifying. Given that one might say that we make judgements through the form of our physical selves and not our souls to recognise something non-physical by this means does not seem rational. Williams also highlights the causal affects between body and mind. For example the use of alcohol and drugs affects cognitions and changes personality.4 We can argue against this by distinguishing between the mind – a non-physical entity, and the brain – a physical entity by which the mind operates. Modern science has shown links between the mind and the brain. Surgeons are now capable of splitting the brain and effectively creating two minds. It is possible to argue that dualism was only invented as a philosophy as a means of explaining what, at that time science could not understand. Finally there is the argument that if the mind is a non-physical object how can it cause anything to happen in the purely materialist realm of the world. Arguments have been put forward to counter this – some philosophers for example have highlighted parts of the brain by which they believe the mind connects to the physical realm. However, modern science has once again defeated this argument and shown how they serve other purposes. It seems that the argument was little more than unfounded opinion and guesswork. Rene Descartes is also greatly associated with dualistic arguments for life after death. He states that if human beings are not to be identified with their bodies, then the view that they can survive death seems a plausible one. We normally think of death as the end of a persons bodily life. But if people are distinct from their bodies, then the fact that their bodies die does not entail that they die. Another modern advocate of a distinction between persons and their bodies is Richard Swinburne. According to him it is coherent that a person can exist without a body. Swinburne asserts that if X (the body) can be without Y (the mind), then X and Y are distinct. Since I can be without my body, it follows, says Swinburne, that I am not my body. Through Descartes’ and Swinburne’s arguments it becomes entirely possible to attack the premise of a dualistic interpretation of life after death by attacking the premise of dualism itself. On the other hand, although our language seems to involve subscribing to a distinction between body and mind this does not show that they are separate things. Furthermore we often talk about ourselves as being distinct from our minds also, so it seems this argument does not work. There are a number of arguments, however, which work in favour of this approach. For one thing, there is the fact that we often naturally talk about our real selves as though they were distinct from our bodies. Another factor is that we also have privileged access to many of our thoughts. We can think about something without displaying that fact by our bodily behaviour. However what does the fact that we have privileged access to many of our thoughts actually tell us. It certainly does not mean that only I can know what I am thinking as it is entirely possible for someone else to know what you are thinking by an observational analysis of your physical responses and even for them to be thinking the same thing at the same time. Unfortunately this counter-argument does not work either as although it is entirely possible for someone to work out roughly what you are thinking, they will never be 100% accurate, nor will they ever be able to think with the perceptions, cognitions and interpretations which you do. Another argument put forward by Descartes to uphold dualism is his statement: â€Å"I know I exist†. He also states that he can say that he is essentially a thinking thing. Therefore this perception of the physical seems to imply that there is something else apart from the body with regard to being a human.5 However in this case it is possible to argue that appearance may be deceptive, as sometimes our senses can be mistaken regarding the physical world. Why should we be an exception? For example a drunk man may perceive himself to be sober when actually this is not the case. However, we may point out that this analogy is at fault because if a man is drunk then his perception and mind have been distorted by alcohol and has little to do with appearance as the appearance which has been perceived is not a truthful one. Unfortunately this line of argument seems to fail when we ask why should drunkenness be any different to other distortions of perception which may occur naturally without our awareness. In fairness, it is not. Furthermore, Immanuel Kant would argue with Descartes over this issue stating that – the human mind imposes order on our experiences and in reality we do not know with certainty the source of the sensations that the mind organises. An alternative to dualism is materialism or behaviourism, which is the view that so called mental events are really physical events occurring to physical objects. Emotion for instance is just the interacting of chemicals in our physical body. Gilbert Ryle (1949) dismissed dualism as a theory about ‘a ghost in a machine’. That is the ghost of the mind inside the machine of the body. Ryle called the notion that the body and mind are separate entities calling it a category mistake. He uses the analogy of an overseas visitor who is shown around a collegiate university town and sees the college, libraries, and so forth, only at the end of it to ask â€Å"but where is the university†. Failing to appreciate that the university is not something separate from its constituent parts; failing to see the ‘wood for the trees’ as some may say†¦ Ryle advocated something known as philosophical behaviourism – all mental events are really physical events interpreted in a mental way. Thus our mind is not a separate entity but just a term meaning what we do with our physical bodies. Some critics have suggested that this does not explain all mental behaviour. If we are for example wishing for something, this does not mean we are behaving in a particular way. You could counter this by saying that the number of subconscious thoughts we have are numerous, and they often can manifest themselves through behaviour without our knowledge, who is to say that conscious thoughts are any different. In fact it seems highly likely that they are not. Ryle’s behaviourist theory can be assigned to a mode of thought known as materialism. There are two forms of this – hard materialism and soft materialism. Hard materialism refers to a mode of thought that does not accept that an individuals characteristics are anything more than physical ones. Any idea of consciousness is nothing more than brain activity. The mind cannot be separated from the body. When the body dies, then so does the brain. Soft materialists do not accept that all characteristics are physical ones. Consciousness is more than just a brain process. The mind and body are related to and do not act independently of each other, but the body often displays inner emotions. A physical symptom may be caused by something that is troubling the mind. There is nothing that we can do independent of our bodies and therefore our personal identity must involve our bodies. They believe that when the physical body dies, so does the mind. These views seem particularly strong as to oppose them would be to suggest that there are bodiless people capable of being defined as human beings, when surely having a body is part of the definition of being human. Not all materialists accept that death is the end, instead, some believe that there is life after death. As the physical body cannot be separated from the ‘soul’ (mind), there is only one way this could happen and that is if the whole body continues after death. The survival would have to involve the resurrection of the body. This belief is known as re-creation theory and is held by Christians. One flaw with this theory is that if we survive as both body and mind, then what state is the body in – are we old/young, sick/healthy etc. The question ultimately refers to the identification of the ‘self’ and who we really are. If a person was born with a terminal illness it would not seem just for them to be resurrected as a person with such an astounding deficiency, yet would they not so, it would not be truly them. The only plausible way around this would be to resort to a dualist style of argument separating the body from the soul. Unfortunately however this is not cohesive with creation theory. The theory also does not take into account personal development, if we are resurrected as a younger person of ourselves then it ignores part of what it is to be human – the ability to develop and change in order to achieve self-actualisation. The development of the self is not compatible with the arguments stationary grounding. Therefore it would seem necessary that we be resurrected in the form that we were just before we died. Yet if the person had contracted a painful illness or indeed was in a coma then this would seem non-sensical. The reason for this being that if (as in this world) suffering and pain is random and universal then the whole point of an afterlife (to reward and punish) is negated. Furthermore if a person were to be ‘cured’ as it were, then they would have had a very real aspect of their character and development removed from them (as undoubtedly the ailment would have changed them as a person, however small the change) and so it would not be the actual person that was carried on. John Hick would counter-argue and state that it would be entirely plausible that the dead could exist after death as themselves, if an exact replica of them were to appear. This replica could be identified as being the same person who had died, and therefore, according to Hick, would be the same person. If this replica will be complete with all the characteristics and memories of the individual then it would be the same person re-created. It is possible to counter-argue this point and ask the question: Would this replica not merely be an exact copy of ourselves but not really us. The individual atoms of which we are composed would differ to those of our copy. We are contingent beings and given that there must be some gap in time in between us ceasing to be and our replica coming to be, then surely it cannot be the same person. Hindu and Buddhist traditions hold the view that we have lived many lives before and that on death we will be reborn again. The condition of our present lives are believed to be a direct consequence of our previous lives. According to Verdic tradition, there is an ultimate reality – Brahman. Everything else is maya – a temporary and finite illusion. Within maya there is a limitless number of souls who all seek union with Brahman. The theory of karma and rebirth is concerned with the soul’s journey from illusion to reality6. The soul continues from life to life, being reincarnated, until it finds the eternal truth; after this the soul is not reborn any more and is united with Brahman. Thus when an individual dies, their mental aspects live on and the next birth is determined by how good or bad their karma was in the last life. Evidence frequently cited for this is the fact that many people seem able to remember fragments of their previous lives, sometime under hypnotic regression. However, although evidence for recall can sometimes be damning, why would it seem to suggest evidence for reincarnation, it could be interpreted as a number of things. Possibly, you could argue that we are all merely cells in one great organism and that these people have just happened to find interconnections between cells. If we removed the cultural-related feasibility of reincarnation then this argument would appear no less likely. In addition, it is possible that there is a rational explanation for this apparent ‘recall’. Firstly, the individual might simply be recalling information gained in childhood and attributing it to a past life. Secondly there could be a ‘cultural’ gene that passes down information from our ancestors. Or thirdly, that some memories may result from psychological problems and be manifested as memories of earlier lives when in fact they are suppressed events from this life. These three explanations seem relatively weak and unable to explain the multitude of ‘regressions’ which have taken place. David Hume would call into validity the nature of the people who make and verify these claims, stating that either they are religious and seek to prove their beliefs to be true, or are mentally unbalanced and cannot be relied upon to make accurate claims. Furthermore, hypnosis is a very unreliable source of evidence. Numerous psychologists have conducted studies showing that not only are only 33% of the population susceptible to in-depth hypnosis, with 33% being not at all susceptible, but also that false memory syndrome can occur quite regularly under hypnosis, where the patient wrongly ‘remembers’ an event to have occurred even though it actually has not.7 Although this argument does successfully call into doubt the reliability of hypnosis, the majority of other physical explanations seem relatively weak and fail to affectively account for something – which in all fairness we cannot explain. Yet the fact that we cannot remember why we know something should not provide proof that we have had previous lives, moreover that there are things which we know that transcend our sensory experiences. Philosophically, however, there are problems with this style of argument. Human beings seem to require three things to make up their individuality – body, memory and psychological patterns (personal identity). If we apply these to reincarnation, when we are reborn, continuity is lost. If we cannot remember our previous lives then our memory is lost. With only psychological pattern remaining it would be impossible to determine if one person is the rebirth of another since, unless they displayed identical characteristics, all we could say is that reincarnated people are ‘similar’ to those who went before. Therefore given that reincarnation argues not for life after death, just for life per se, it seems irrelevant to discuss the strengths and weaknesses of its arguments. Another argument for life after death arises through ‘spiritualism’ and communications between the spirit world and the living is regarded as evidence of life after death. Many ‘mediums’ have passed on messages from departed spirits that contain accurate information which was previously unknown to the medium. However, investigations of a number of mediums have proved that they are frauds. Others appear to be genuine and are able to demonstrate that something extraordinary is happening when they pass on messages. This could be communication with departed spirits or some form of telepathic access to the minds of the living. Once again however, the question is introduced as to whether we can trust the testimony of another human being without actually witnessing the occurrence for ourselves. Given the frequency of unexplainable occurrences such as these they do seem be a reasonable argument for life after death. There have been a number of ‘sightings’ of dead people, which also constitute as arguments for life after death. Dr Deepak Chopra stated that bodies are comprised of energy. They may appear to be solid, but the truth is that they are in reality just an impulse of energy. When an individual dies, the energy field may retain his/her image and may be perceived as a ‘ghost’. He considered the ghost to be an individual’s consciousness manifesting itself through the remaining energy. However there are a number of explanations for the phenomenon including hoaxes or elaborate tricks, which could convince people they had seen a ghost whereas in actuality they had not. Secondly there is the ‘stone tape’ theory which suggests that just as a magnetic tape is able to record events and play them back, in certain conditions, stones will record events and ‘play them back’ when the same conditions are present. Finally there is the fact that ghosts could be the result of a case of mistaken identity, or the power of suggestion could lead to the mistaken belief that a ghost had been sighted. The ‘stone tape theory’ is quite ludicrous as it takes upon a scientific argument to prove a theory when the main differentiation between science and philosophy is empirical verification. In this case there is no evidence to support the theory. Aside from this theory, the other two seem quite believable in that they are quite feasible and explain the frequency and variety of times such an occurrence has taken place. Furthermore, the fact that a bundle of energy continues to exist, showing something that once did exist does not mean that life after death exists. Indeed if the energy is little more than a reflection of what once was, it fails as an argument intended to prove what know is. In addition can a bundle of energy really be constituted as ‘living’, if not then once again the argument is invalid. The argument of near-death experiences also puts forward an argument for life after death. Dr. Raymond Moody has studied many cases of people who had, to all intents and purposes died (during a surgical operation) and subsequently been resuscitated. Many claimed similar experiences – floating out of their bodies, travelling down a tunnel where they emerged into a world of light. However, these accounts have problems. Firstly, these accounts may be merely the result of people dreaming or experiencing some subconscious phenomena. Given the clarity of these dreams the first account seems unlikely, the second more plausible yet still is devoid of scientific evidence to support. Some have suggested that a lack of oxygen to the brain resulted in this hallucination. The main problem once again is verification in that it is impossible for us to experience the phenomena ourselves and judge its reliability accordingly. In addition, the types of experiences are often largely dependent on culture and society and so whether or not they are genuine or merely a manifestation of what the person may expect to see, or in the case of non-believers, expects not to see. One can counter-argue this however by saying that God may not actually be a fixed being but more of an interpersonal one varying from person to person and so the culture argument may not be relevant. The arguments discussed here are numerous, but generally do not hold a great deal of weight. The philosophical arguments are flawed and in places not logical, and the empirical arguments are generally unverifiable. However, given the sheer number of empirical arguments and the fact that some of them (near death experiences and regression to previous lives for example) are apparently otherwise unexplainable – we must realise that it is highly plausible if not possible that life after death does occur in some form or another. Bibliography: Religious studies, by Sarah K. Tyler and Gordon Reid. Philosophy of religion for A level by Neil Lockyer, Anne Jordan and Edwin Tate. An introduction to the philosophy of religion, by Brian Davies. The puzzle of God by Peter Vardy Religious Education notes from R.S. conference 1 â€Å"Any view that postulates two kinds of thing in some domain is dualist; contrasting views according to which there is only one kind of thing are monistic† – Simon Blackburn Oxford Dictionary of philosophy pg 248 2 Greek word meaning ‘purpose’ 3 The Puzzle of God – Peter Vardy 4 The puzzle of God – Peter Vardy 5 Religious Education notes from R.S. conference 6 Also known as a state of ‘Nirvana’. 7 The puzzle of God – Peter Vardy

The Methods of Selection in the Recruitment Process Assignment

The Methods of Selection in the Recruitment Process - Assignment Example If the organization does not come to terms with these methods of selection, it hires other companies which search for the required talent. However, what is needed here is an understanding that shall reach upon the premise of hiring people who are skilled enough to deliver the goods as and when required. Recruitment process is important to understand within an organization because it is the basis of resource provision that employers look forward to having (Bierman, 2002). The recruitment process paves the way for the growth and development domains of an organization since it finds the ways and means through which success will be deciphered in a proper way. What is even more significant is the way under which the human resources management department deals with the process of recruitment that shall only make the entire process understandable to the publics who are outside the domains of the organization (Noe, 2009). These publics would want to know what kind of recruitment strategies a re in place within the organization and where the hiring regimes are coming into full action. Since these publics have a fair amount of say within the working methodologies, it is only natural to think of the discussion of stakeholders because these stakeholders have one or the other stake within the organization. Either the shares are being looked after by these stakeholders or they have invested a fair bit under the aegis of the organization (Laser, 1994). The need is to realize where the stakeholders deem the company in a positive way and what kind of optimism they have in mind regarding the chosen organization. In the same light, the organizational discourse must find a way through which the recruitment processes are handled in an ethical and moral way. If the hiring and firing domains are settled properly by the selection methodologies which are in place, then this should mean that the organization is doing something right for the new hires. This would be translated in the form of people joining its fore and aspiring to become a part of it in the coming times as well (Mckinney, 1991). However, many organizations are not well equipped to tackle all these issues and end up being at the receiving end of the public wrath for a number of reasons. The recruitment processes within China and the United Kingdom are important to understand because it outlines the basis of properly utilizing the resources within the domains of an organization. If the recruitment process manifests time delays and similar issues, then it would mean that there are serious problems that exist within the fore of hiring individuals within an organizational setting. Therefore the role of the human resources management department

Personal Statement for Postgraduate Study Applications Essay

Personal Statement for Postgraduate Study Applications - Essay Example Nevertheless, it allowed me to define what career I would like to choose. My graduate education showed me the importance of organization in business sphere that is why I choose business management as a possible career. Management is getting things done through other people (Caroselli, 1). As for me, good organization is crucial for getting positive results in any sphere of business. A good manager is a person, who can plan, control, motivate and reward the employees. I feel I need the education that would give me those skills. Another sphere, which makes me interested, is economic and finance. I feel that this course should help me to enhance my knowledge in the peculiarities of financial management of the company. I've always felt the importance of acquiring skills in money management. I hope this course can teach me the mechanics of financial functioning of the company, and provide knowledge on the mechanisms of getting profits and minimizing losses. In addition, I've always been interest in global economics. I hope that an advanced course in economic and finance may grant me deeper insight into this issue. For me working with schedules and deadlines is the most challenging issue.

The glass ceiling Essay Example | Topics and Well Written Essays - 250 words

The glass ceiling - Essay Example ceived superiority of men in administrative and leadership roles, diminishment of women’s voices in decision-making situations and valuation of perceived ‘masculine’ traits, such as, aggression and dominance over perceived ‘feminine’ traits like understanding and patients, especially in highly competitive and political environments. The glass ceiling has a variety of effects on women. The first and most obvious is to subtly exclude them from reaching top positions in their fields. While a few women do make it into upper management or leadership roles in their fields, the vast majority of most professions, and especially the highest echelons of those professions, remain dominated by men. This process can also create a significant negative impact on a woman’s personal life. Most obviously, professional stalling that occurs when women hit the glass ceiling and are no longer able to advance creates significant emotional problems, such as, professional frustration and decreased self-worth. Women are often made to make lose-lose choices, for instance, having to decide between having a child, and thus loosing time, energy and prestige at work, or focusing on their careers and losing out on family opportunities – choices men are never forced to make. (For question three, maybe focus on things such as the fact that you can use traditionally feminine traits to be an excellent psychologist, you can side-step traditional hierarchies that exist in other professions, and publish work in a merit-based fashion to achieve prestige without needing to go through patriarchal

Please choose the relevant title for my report Essay

Please choose the relevant title for my report - Essay Example Total quality management refers to designing an organizational environment where there is continuous improvement and delivery of high quality products to customers. Total quality management methods are strongly associated with techniques utilized during quality control. Quality is all about achieving superior degree of excellence. It is dependent on wide range of factors such as grade of service or product, safety, reliability, customer’s perception and consistency. There are various definitions of quality like conformance to specifications, fitness for usage, value for price, psychological criteria and supporting services. Dimensions of quality usually vary across service and manufacturing organizations (Tamimi and Sebastianelli, 2008). Service organizations exhibit higher quality level through consistency, atmosphere, friendliness, responsiveness, tangible factors and promptness. On the other hand, manufacturing firms possesses quality dimensions in the form of specification conformance, durability, performance, features, serviceability and reliability. The quality term has sustained since many years but there are changes incorporated within its definition. In business organizations, the quality concept was drastically altered during 1970s. The time frame between 1970 and 1980 resulted into US industries losing their market share due to intense foreign competition. Honda and Toyota supposedly became the largest players in automobile industry. Manufacturing firms during time period of 1970.

Cash and Stock Control Research Paper Example | Topics and Well Written Essays - 2000 words

Cash and Stock Control - Research Paper Example Product descriptions taken New Item Data entry form for entering New items taken in from suppliers Products table using VLOOKUP function Update Stock Update the stock levels of products procured in the "Product Table" Print Print preview of sheet Deliveries Data base of Main Page Return to Main Page Customers containing their names and addresses Add Customer Data form for entering customer data Sales invoice Table of up to 5 Main Page Return to Main Page products sold to a customer (using VLOOKUP function) Add item Data form for entering products sold (Product ID and Quantity), other data are given by the VLOOKUP function Update Stock Update the stock levels of products procured in the "Product Table" Print Print preview of sheet B. Print outs of various screens and tables 1. Main Page 2. Product Table 2.a. Sort by Product ID 2.b. Sort by Product Type 2.c. Re-Order List 2.d. Print preview of Product Table 2.e. Add new product 3. Order form 4. Goods In 5. Deliveries 6. Sales Invoice 6.a. Sales Invoice Screen before Updating Sock 6. b. Product Table before Updating Stock The second row of data (product ID 0002) is one of the stocks affected by the update from sales invoice table. Before the update its stock is at 23, 2 below the re-order level of 25, re-order stock is 2, invoice is 1, and Re-order value is 190. 6. c. Product Table after Update After the update, the stock volume is reduced by 1, re-order stock is 3 and its re-order value increased to 285. C. User Manual You should have at least MS Excel 2003 installed in your computer with the security level reduced to low level, or else the macros are disabled and cannot operate at higher security levels. You should also have an antivirus program installed in your... You should have at least MS Excel 2003 installed in your computer with the security level reduced to low level, or else the macros are disabled and cannot operate at higher security levels. You should also have an antivirus program installed in your computer. A print button is included in all sheets so you can preview or have hard copy of the transaction made. A VLookup function (vertical look-up function) is used on the product table to help "automate" the entry of product type and descriptions in the other sheets, so the user may not need to re-enter these information. Data can be entered directly on the spreadsheet or by using the data form entry button provided.

Public Anger And The Occupy Wall Street Essay Example | Topics and Well Written Essays - 500 words

Public Anger And The Occupy Wall Street - Essay Example The idea was obviously to goad and move the government and to convince them that people the limit of patience of a docile public has been reached (Moynihan, 17 March 2012). The OWS movement was a continuation of the anger felt by a frustrated public across the world. This was seen in the Tahrir square of Egypt, the Arab Spring movement of Saudi Arabia, protests in the UK, Spain, Greece, India, Pakistan, Libya, and many other nations. In many places, these movements have succeeded in bringing in some level of change. In Egypt, the President Mr. Mubarak was forced to resign, in the Middle East, changes were brought in the manner in which people were governed, in Greece, the government was forced to change its stance on the Euro. In a way, such movements have brought in changes though not to the extent those were planned. These mass-based movements can be traced to Mahatma Gandhi who used non-violent protests to throw out the British from India. China had the Tiananmen Square protests that ended in a massacre. Such movements become successful when there is a mass-based movement and more people in different cities join the movement. Zit must be a movement by the masses and not by a few. Some discipline, leadership and an agenda are needed else the movement becomes anarchy and lewd acts, violence and anti-social elements take over the movement. It is interesting to see how the common person on the street is affected. When such protestors block roads and they do not allow traffic to pass, people cannot go to work, to school, and the ill cannot go to the hospitals and so on. When traffic is blocked, the government machinery grinds to a halt. Police can be called in but they can do little when the number of protestors is in thousands.

Systematic Comparison between Traditional and Agile Methods Essay

Systematic Comparison between Traditional and Agile Methods - Essay Example Some do not go through all the stages while others may pass through one stage more than once. The Traditional approach involves designing a detailed plan before the start of the project and strictly adhering to it. Therefore, the whole project is clear to the developers before it is started. Agile project management is a collaborative approach in which all the team members are involved in the project. It involves an iterative process in which managers facilitate the working of the team and it requires regular adaptation to changing situations. The project plan is flexible and is not developed at the beginning of the project. Instead, it is developed throughout the project. The end result of the project is not predictable. This discussion explores the comparison between traditional and agile project management approaches. Traditional Project Management Approaches The traditional approach to project management consists of five components namely initiation, planning, execution, monitori ng and control, closure. Some traditional project management methods include linear and incremental project management lifecycle. Linear project management lifecycle does not allow any changes in the project plan. ... Scheduling the whole project before starting it gives the team a clear picture of what is expected to be done and who is responsible for each task. Moreover, details about the resources necessary for the completion of the project are known from the beginning. This approach does not require people with a lot of skills and supervision is not necessary as all the project details are written down. Co-location of team members is not necessary as each person has details of the part he/she is expected to play. It also has disadvantages. This model does not allow for changes. It is also very costly. It does not produce deliverables until in the late stages of the project. In addition, preparing a complete plan beforehand is time wasting. The process is rigid and there is no going back to make changes. This model is focused on the timely completion of the project within the available budget but not on client value (Wysocki 2011). Incremental project management life cycle consists of several d ependent increments, each with the lifecycle components of execution, monitoring, and project closure. These increments are accomplished in a prearranged sequence. The characteristics of the incremental project management lifecycle method are similar to those of the linear approach. The deliverables in this model are released against a schedule that is more aggressive. Advantages include the following: The business value is produced early and not at the end of the project like in linear approach. This model can allow for some changes in the scope of the project. It focuses on the client value more than the linear approach. It also facilitates the scheduling of few resources better. Some disadvantages include the following: Team members can be lost in between increments. It

Website Improvement of www.easycar.com Essay Example | Topics and Well Written Essays - 500 words

Website Improvement of www.easycar.com - Essay Example From vans to luxury cars the online car rental operates in 60 different countries. The website can be more colorful and trendy, a darker color would suit the website much more rather than orange for example a combination of black with maroon. The website is difficult to access through slower internet connections because it’s resource heavy. Another point that would make a negative impact on the viewer is the clustered written material present on the web pages, a simple solution is to divide the content on more web pages. Another more feasible, interactive and innovative way would be to study the type of customers that are generating the most traffic on the website and then make a home page that gives the user an option to select his or her type and then the selected option would lead the viewer to his desired web page. This would not only lighten the resource weight but would also make the website matter specific making the website much easier to use. The book now and pay late r is a very innovative offer that is being given to the user hence it should be promoted in a better and more effective way, a separate web page can be assigned to this section. The category of prestige cars can be further divided into SUVs, sports and luxury cars, making the website more specific in terms of car selection. The prestige car section should have more details and attributes of the cars available mainly because of two reasons. Firstly the cars are expensive and it would be much better that a customer selects exactly what he or she wants, secondly the car specifics and attributes would invite more people to view the website. All this would eventually result in improving customer satisfaction. Another new feature that would make the website more interactive and innovative can be added by the name of car comparison. This would not only enable the user to compare cars to help him or her in analyzing the cars more effectively

Honda vs Toyota Essay Example for Free

Honda vs Toyota Essay The Honda Company was founded by Soichiro Honda . Soichiro Honda was a racer, a businessman, and a manufacturer. But most of all he was a dreamer. He dreamed of a better way of making piston rings, founded a small company, and began production. He dreamed of giving people everywhere an economical form of transportation, and began producing small motorcycles, including one built in 1949 called the D-Type Dream. Soichiro Honda started Honda Motor Company in 1948, at the age of 41. Honda of America Mfg. has been committed to building quality products for their customers and quality communities where their associates live and work. Their Fundamental Beliefs are Respect for the Individual and The Three Joys. The three joys are Joy of Buying, The Joy of Selling and The Joy of Creating  which express Hondas belief and desire that each person working in, or coming into contact with the company, directly or through or products, should share a sense of joy through that experience. Hondas company principle is Maintaining a global viewpoint, we are dedicated to supplying products of the highest quality, yet at a reasonable price, for worldwide customer satisfaction. Honda Management Policies are Proceed always with ambition and youthfulness, Respect sound theory, develop fresh ideas and make the most effective use of time. Also Enjoy your work, and encourage open communications, Strive constantly for a harmonious flow of work, Be ever mindful of the value of research and endeavor. Honda follows a philosophy they call â€Å"The Racing Spirit†. This philosophy is summarized by Seek the Challenge, Being ready on Time, Teamwork, Quick Response, and Winner Takes All. Honda seeks to minimize waste throughout the entire manufacturing process. This starts with designing production processes, parts logistics, energy management systems and other operations in ways to reduce their impact on the environment. Improving the energy efficiency of Honda factories is the single biggest focus to reduce the environmental impact of its manufacturing operations. As a result, Honda plants are leaders in reducing CO2  and other greenhouse gases. Honda views solid waste generated in their factories as the inefficient use of raw materials. From this perspective, Honda has established a waste management hierarchy at its manufacturing operations with the ideal of producing no downstream waste. The Toyoda Automatic Loom company was founded by Sakichi Toyoda, a prolific inventor, based on his groundbreaking designs. Toyota has a Production System which is steeped in the philosophy of the complete elimination of all waste imbuing all aspects of production in pursuit of the most efficient methods. Toyota Motor Corporations vehicle production system is a way of making things that is sometimes referred to as a lean manufacturing system or a Just-in-Time system, and has come to be well known and studied worldwide. This production control system has been established based on many years of continuous improvements. Based on the basic philosophies of jidoka and Just-in-Time, the TPS can efficiently and quickly produce vehicles of sound quality, one at a time, that fully satisfy customer requirements. The concept of jidoka is Highlighting or visualization of problems which is basically the idea that quality must be built in during the manufacturing process. The Just-In-Time concept is basically productivity improvement which means making only what is needed, when it is needed, and in the amount needed. Toyota has seven guiding principles. The first principle is honor the language and spirit of the law of every nation and undertakes open and fair business activities to be a good corporate citizen of the world. The second principle is respect the culture and customs of every nation and contribute to economic and social development through corporate activities in their respective communities. The third principle is Dedicate our business to providing clean and safe products and to enhancing the quality of life everywhere through all of our activities. the forth principle is Create and develop advanced technologies and provide outstanding products and services that fulfill the needs of customers worldwide. The fifth principle is Foster a corporate culture that enhances both individual creativity and the value of teamwork, while honoring mutual trust and respect between labor and management. The sixth principle is pursue growth through harmony with the global community via innovative management. The last principle is Work with business partners in research and manufacture to achieve stable, long-term growth and mutual benefits, while keeping ourselves open to new partnerships. Toyotas has for Action Guidelines. The first guideline is take on the challenge of achieving zero emissions at all stages. The second guideline is Business partners are partners in creating a better environment, Cooperate with associated companies. The third guideline is As a member of society actively participate in social actions. The last guideline is toward better understanding actively disclose information and promote environmental awareness. The four basic policies are contribution toward a prosperous 21st century society, pursue all possible environmental technologies, develop a voluntary improvement plan, and build close and cooperative relationships with a wide spectrum of individuals and organizations

Comparison of Electroconvulsive Therapy and Antidepressants

Comparison of Electroconvulsive Therapy and Antidepressants Brief 101151 INTRODUCTION Depression is one of the more common forms of mental illness. It has been estimated that approximately 9.5% of the population will suffer with depression at any one time (Robins and Regier 1990) and that 17% of people will suffer with depression at some point in their life (Blazer et al 1994). Defining depression is not a straight forward task. This is due to the fact that it can range from normal unhappiness through persistent and pervasive ways of feeling and thinking to psychosis (Hale 1997). Having said this, a number of different features which can be associated with depression have been identified by Hale (1997): Persistent low mood Loss of interest and enjoyment Reduced energy and diminished activity Poor concentration and attention Low self esteem and low confidence Ideas of guilt and unworthiness Bleak pessimistic views of the future Ideas or acts of self harm or suicide Disturbed sleep Diminished appetite It is also possible to distinguish between three major types of depression. The first form of depression is Dysthymia which involves long-term chronic depressive symptoms which do not necessarily disable the individual. The second form is Bipolar Disorder which involves the patient experiencing periods of mania and depression through cycles of mood change. The third and final category concerns Major Depression. The symptoms involved with this mental illness combine to ensure that it is difficult for the patient to work, study or to enjoy activities as well as them having difficulties regarding eating and sleeping patterns. It is this third and most serious form of depression which will be the focus of the following discussion. TREATMENT OF SEVERE DEPRESSION A number of different approaches to the treatment of depression have been taken which are based on a range of theoretical perspectives. These include approaches such as Cognitive Behavioural Therapy, Psychoanalysis and those based on increasing exercise levels. However, perhaps the most common treatment for depression involves the use of antidepressant drugs (American Psychiatric Association 1993) These include medications such as Tricyclic (which is cheap and effective but does have side effects which limit compliance), Selective Serotonin Up-Take Inhibitors (which has fewer side effects but less effective for disturbed sleep) and Monoamine (which, in rare cases, can be fatal when mixed with certain foods) Although antidepressants can be effective, research has indicated that they may not be the optimal solution. For example, Thomas et al (1982) conducted a study involving 115 participants who were randomly allocated to receive either a combination of antidepressants or a placebo. T he medication was found to have a significant effect but non-compliance was identified as a significant problem. It has been estimated that non-compliance regarding antidepressant drugs is between 20 and 59% (Johnson 1973 and Thomas et al 1982). Further research has also reported that patients who are suffering with depression are still at a significant risk of relapse or recurring symptoms even when they have been adhering to their medication programme for a long period of time (Grunhaus et al 1990). It may also be the case that medication is not suitable for all forms of depression. For example, Hale (1997) suggested that antidepressants may not be effective for psychotic depression. Therefore, as a result of the potential drawbacks of non-compliance, relapse and not being effective for all forms of depression, efforts have been made to identify other approaches for the treatment of severe depression. One of the most controversial treatment approaches is Electroconvulsive Therapy (ECT). It was first used in 1938 by Cerletti and Bini (Linington and Harris 1988). It involves sending an electrical current through the patient’s brain with the aim of stimulating the release of neurotransmitters which will ultimately improve the patient’s mood. ECT has obtained a somewhat negative reputation due to stories of bitten tongues and fractured bones and it is often seen as a form of punishment rather than treatment. However, reviews of its application have demonstrated that ECT does have significant benefits compared to simulated ECT, when all procedures are followed without an electrical current actually being given (The UK ECT Review Group 2003). Whenever one is making decisions regarding the use of any given treatments, one must consider the body of scientific evidence which has assessed the treatment’s efficacy and effectiveness. The following review will aim to consi der the research which has assessed the efficacy and effectiveness of ECT as a treatment for severe depression in order to determine its effectiveness with reference to the use of antidepressants. RESEARCH QUESTION Thus, the following review will aim to answer the question ‘Is ECT an effective treatment compared with antidepressants in cases of severe depression’. The methodology which was employed within this research will now be outlined. LITERATURE SEARCH A systematic review aims to integrate existing information from a comprehensive range of sources, utilising a scientific replicable approach, which gives a balanced view, hence minimising bias. It can also be stated that systematic reviews provide a means of integrating valid information from the research literature to provide a basis for rational decision making concerning the provision of healthcare. 2.1 SOURCES OF DATA The methodology employed within the research involved obtaining data from three key sources: Computerised searches, Manual searches, and the Internet. Each of these data sources will now be considered in more detail. 2.11 COMPUTERISED SEARCHES The methods used in this research will include a detailed computerised literature search. Multiple databases, both online and CD–Rom will be accessed to retrieve literature because they cite the majority of relevant texts. The computerised bibliographic databases are:- MEDLINE EMBASE CINAHL PSYCHINFO Biological Abstracts Cochrane SIGLE However because articles may not be correctly indexed within the computerised databases, other strategies will be applied in order to achieve a comprehensive search. 2.1.2 MANUAL SEARCHES A manual search will be performed to ensure that all relevant literature is accessed. The manual searches will include:- Books relevant to the topics from university libraries and web sites Inverse searching- by locating index terms of relevant journal articles and texts Systematically searching reference lists and bibliographies of relevant journal articles and texts 2.1.3 THE INTERNET The internet will provide a global perspective of the research topic and a searchable database of Internet files collected by a computer. Sites accessed will include:- Department of Health National Institute of Clinical Excellence English National Board of Nursing, Midwifery and Health Visiting Google British Medical Journal 2.2 IDENTIFICATION OF KEY WORDS A set of key words will be used within the literature search. Elements of the research question will be used to provide the search terms. Therefore, the words Electroconvulsive Therapy, Antidepressants, Depression, Effectiveness and Evaluation will all be used. 2.3 INCLUSION AND EXCLUSION CRITERIA To ensure that the more relevant research studies are identified, a set of inclusion and exclusion criteria will be utilised. In order to be included in this research the studies will need to relate to the evaluation of Electroconvulsive Therapy and relate to the treatment of depression. Furthermore, studies will be excluded if they are published before 1975 or if they are not available in English. DISCUSSION This review has identified literature which has focussed on assessing the effectiveness of ECT in comparison to antidepressants regarding the treatment of severe depression. In order to structure the discussion, the research will be analysed with reference to the benefits of ECT regarding relapse, patients who are drug-resistant and those with severe depression in particular. The potential drawbacks of ECT will then be briefly considered before overall conclusions are drawn regarding the research question. 3.1 RELAPSE Studies were located which highlighted the benefits of ECT regarding the reduction of relapse. For instance, Petrides et al (1994) reviewed the case histories of 33 patients who had been diagnosed with long term depression. A set of 21 patients were included in the study as a one year follow up report was available for analysis. Each of the participating patients had been taking antidepressants for a significant length of time but were still experiencing relapses of depression. After the delivery of ECT it was reported that the number of patients with depression who suffered relapses fell from a normal rate of 50% to 33% at the one year follow up. For the patients with delusional depression in particular, the relapse figure fell from a normal rate of 95% to 42%. Based on this research it would appear that ECT can be more effective than antidepressants in terms of reducing relapse rates. A more recent and relevant study was conducted by Gagne et al (2000) which also involved the retrospective reviewing of patients’ notes. Two groups of 29 matched participants were identified. The first group had only been taking antidepressants were as the second group had antidepressants along with ECT. At the two year follow up stage the relapse rates for those who had ECT was 52% compared to the 93% associated with those who only had medication. At the five year follow up stage, the relapse rate for the drug-only group had fallen slightly to 73% where as the ECT group had fallen dramatically to just 18%. The average survival rate of the ECT group was 6.9 years which was significantly longer than the 2.7 years for the drug-only group. Therefore the research considered in this section would lead one to conclude that ECT can be more effective than antidepressants alone in terms of reducing relapse rates. Having said this, it should be noted that these research projects involve d combining ECT with antidepressants rather than replacing them entirely. 3.2 MEDICATION RESISTANT PATIENTS Although antidepressants are effective for many patients with depression, there are some groups for whom it is less effective. Rabheru and Persad (1997) reviewed the literature which focused on assessing the effectiveness of ECT for patients who were found to be resistant to antidepressant medication. They found that the research evidence indicated that ECT could have significant benefits for medication resistant patients. These benefits were particularly relevant for elderly patients with depression. An important point to make here, however, was demonstrated by research conducted by Prudic et al (1996). They reported that the effectiveness of ECT may decline as the time for which the patient has suffered with severe depression increases. Therefore, the approach of using ECT when the patient has been found to be resistant to antidepressants may not be the optimal approach as the possible benefits of ECT may have been reduced. Therefore, this section has demonstrated that ECT could be beneficial for patients who have severe depression and have not been significantly helped by the use of antidepressants. However, it is important to note that the use of ECT may decline over time. 3.3 PATIENTS WITH SEVERE DEPRESSION Further research has indicated that ECT may well have particular benefits over antidepressants with regards to patients who have severe depression. Sobin et al (1996) conducted research to evaluate the effectiveness of ECT for patients with a range of levels of depression. They reported that 70% of the participants responded significantly as a result of the ECT and that significant improvements were made by those who had severe depression. Other research has also leant support for the assertion that ECT is particularly beneficial for patients with severe depressive symptoms, mood congruent delusions and those who are at prominent risk of committing suicide (Martin 1989, Schatzberg 1992, Persad 1990, Philibert et al 1995 and Fink et al 1996). It appears that the attributes of ECT are particularly suited to the treatment of people with severe depression. It may be that the more severe a person’s depressive symptoms are, the more drastic and severe the treatment approaches need t o be for them to be effective. CONCLUSIONS This review has considered research which has investigated whether ECT is effective in treating severe depression when compared to antidepressant drugs. Based on this research it can be concluded that ECT, when combined with antidepressants, does appear to significantly reduce patients’ relapse rates. It can also be said that the evidence supports the view that ECT can be effective for patients who have been found to be resistant to antidepressants. The third and final conclusion is that ECT appears to be particularly suited to patients with the more severe forms of depression. Having said this, some criticisms need to be acknowledged regarding this body of research. For instance, Rose et al (2003) highlighted three major drawbacks. Firstly 1 in 3 patients who are given ECT report persistent memory loss. Secondly, the research studies conducted by clinicians in this area report more positive results than those conducted by consumer agencies. This may be due to the selection of participants or the focus of the research questions. The third and final drawback outlined by Rose et al (2003) is that the studies which support ECT rarely assess the long term effects or cognitive functioning and the majority of them were conducted many years ago using small samples. The research is also limited because it mainly uses case studies (Thienhaus et al 1990), naturalistic studies (Aronson et al 1987) or retrospective reviews of patient notes (Stiebel 1995). Few randomly controlled trials were highlighted by this literature search. Such criticisms must be kept in mind when considering the effectiveness of ECT in comparison to antidepressants for treating severe depression. 5.0 IMPLICATIONS FOR PRACTICE Guidelines produced by the National Institute of Clinical Excellence, based on a review of Department of Health and Cochrane database research, recommends that ECT be used for rapid and short term improvements for patients with severe depression or who are at significant risk of suicide (Tharyan and Adams 2003). However, as highlighted by the Royal College of Psychiatrists (2003) in their response to these guidelines, the use of ECT may have a wider scope than this approach would suggest and the guidelines may ensure that patients who may benefit from ECT are not given the treatment. Further research in this area will provide a basis upon which to test the appropriateness of these guidelines and the current use of ECT. It would appear that ECT can have significant benefits for patients with severe depression but that more efforts need to be made to tackle the negative impressions which may be associated with this treatment such that it can become a more accepted approach. The main im plication of this review for practice is that ECT appears to have a significant role to play in the treatment of severe depression but that it is likely to be alongside the use of antidepressants rather than instead of them. This strategy will enable the most comprehensive treatment programme to be delivered to the patients and ensure that their chances of a full recovery are maximised. REFERENCES American Psychiatric Association (1993). Practice guidelines for major depressive disorder in adults. American Journal of Psychiatry; 150(suppl): 4. Aronson TA, Shukla S, and Hoff A: (1987) Continuation therapy after ECT for delusional depression: a naturalistic study of prophylactic treatments and relapse. Convulsive Therapy; 3:251–259[Medline] Blazer DG, Kessler RC, McGonagle KA, and (1994) Swartz MS. The prevalence and distribution of major depression in a national community sample: the national comorbidity survey. American Journal of Psychiatry;151:979-6. Gagne, G. G., Furman, M. J., Carpenter, L. L. and Price, L. H. (2000) Efficacy of continuation ECT and antidepressant drugs compared to antidepressants alone in depressed patients. American Journal of Psychiatry, 157, 1960-1963 Grunhaus L, Pande AC, and Haskett RF (1990) Full and abbreviated courses of maintenance electroconvulsive therapy. Convulsive Therapy; 6:130–138 Johnson DAW. (1973) Treatment of depression in general practice. British Medical Journal; ii: 18-20. Linington, A. and Harris, B. (1988) Fifty years of electro-convulsive therapy. British Medical Journal, 297, 1354-1355 Martin BA (1989) Electroconvulsive therapy for depression in general psychiatric practice. Psychiatric Journal of the University of Ottawa; 14:413–417 National Institute for Clinical Excellence (2003). Guidance on the use of electroconvulsive therapy. London: NICE, 2003. www.nice.org.uk/pdf/59ectfullguidance.pdf (accessed 9 Jun 2003). Persad E: (1990) Electroconvulsive therapy in depression. Canadian Journal of Psychiatry; 35:175–182[Medline] Petrides G, Dhossche D, Fink M, and Francis A: (1994) Continuation ECT: relapse prevention in affective disorders. Convulsive Therapy; 10:189–194 Philibert RA, Richards L, Lynch CF, and Winokur G: (1995) Effect of ECT on mortality and clinical outcome in geriatric unipolar depression. Journal of Clinical Psychiatry; 56:390–394[Medline] Prudic J, Haskett RF, Mulsant B, Malone KM, Pettinati HM, Stephens S, et al. (1996) Resistance to antidepressant medication and short-term clinical response to ECT. American Journal of Psychiatry;153:985-92. Rabheru K, and Persad E: (1997) A review of continuation and maintenance electroconvulsive therapy. Canadian Journal of Psychiatry; 42:476–484 Robins LN, Regier DA (Eds) (1990). Psychiatric Disorders in America, The Epidemiologic Catchment Area Study,; New York: The Free Press. Rose D, Wykes T, Leese M, Bindman J, and Fleischmann P. (2003) Patients perspectives on electroconvulsive therapy: systematic review. British Medical Journal;326: 1363-5.[Abstract/Free FullText] Sackeim HA (1994) Continuation therapy following ECT: directions for future research. Psychopharmacology Bulletin; 30:501–521 Schatzberg AF: (1992) Recent developments in the acute somatic treatment of major depression. Journal of Clinical Psychiatry; 53(Mar suppl):20–25 Sobin C, Prudic J, Devanand DP, Nobler MS, and Sackeim HA. (1996) Who responds to electroconvulsive therapy? British Journal of Psychiatry;169:322-8. Stiebel VG: (1995) Maintenance electroconvulsive therapy for chronically mentally ill patients: a case series. Psychiatric Service; 46:265–268 Tharyan P, and Adams` `C`E (2003) Electroconvulsive therapy for schizophrenia. Cochrane Schizophrenia Group. Cochrane Database Systematic Review;(1): CD000076 The UK ECT Review Group (2003) . Electroconvulsive therapy: systematic review and meta-analysis of efficacy and safety in depressive disorders. Lancet;361: 799-808 Thienhaus OJ, Margletta S, and Bennett JA: (1990) A study of the clinical efficacy of maintenance ECT. Journal of Clinical Psychiatry; 51:141–144 Thompson J, Rankin H, Ashcroft GW, Yates CM, McQueen JK, and Cummings SW. (1982) The treatment of depression in general practice: a comparison of L-tryptophan, amitriptyline and a combination of L-tryptophan and amitriptyline with placebo. Psychological Medicine; 12: 741-751[Medline].

Strategies for the Dietary Control of Diabetes

Strategies for the Dietary Control of Diabetes A survey of the recent strategies for the dietary control of diabetes in the Middle East INTRODUCTION Significant changes in the political and socio-economic climates have been the hallmark of the last decade in the many of the countries in the Middle East especially those located in the territories of the Arabian Gulf. These changes have impacted in no small way on the demographics of the affected countries. Notable are the obvious shifts in age distribution and a perceptible increase in healthy life expectancy. Furthermore, there have been alterations in the conventional lifestyles of the people living in these countries perhaps due largely to westernization, rapid urbanization and industrialization (Abdella et al 1995). It is also worth mentioning that disease types, trends and or their prevalence have also changed dramatically. Prominent among these is diabetes. Diabetes – delineation The incidence and prevalence of diabetes have consistently increased in the last 20 years; these changes have paralleled environmental transformation as well as the adjustments to changes above mentioned (Abdella et al 1995; Zimmet et al 1977). The current projection of the World Health Organisation (WHO 2007) indicates that there will be further increases in the prevalence of diabetes in the Middle East. A working committee of the WHO on diabetes defined the disease as ‘a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both; the effects being long-term damage, dysfunction and failure of various organs’ (Alberti and Zimmet 1998). Diabetes is caused by a lack of the hormone insulin, which is produced by the ÃŽ ²-islet cells of the pancreas. Glucose is the primary energy source for all cells and is provided by digest ion of carbohydrates from the diet. Insulin enhances the body cells’ uptake of glucose from blood plasma. Hence, defects in insulin secretion, insulin action, or, most commonly, both leads to decreased uptake of glucose by the cells and an increase in blood glucose levels. Sustained increases in blood glucose level will lead to the excretion of glucose in the urine when such increases exceed the renal threshold of the molecule. This in turn leads to the typical symptoms of diabetes: excessive production of urine (polyuria) and extreme thirst (polydipsia). Fatty acids from fat stores are metabolized as an alternative energy source when the body senses a lack of glucose, the result is weight loss and fatigue other common symptoms of diabetes (Maitra and Abbas 2004). The clinical profile of diabetes varies minimally between the countries of the Middle East. In Kuwait for example, because of the marked disparity between individuals in their age of diabetes onset, mode of present ation, and the degree of obesity, the clinical profile of the disease is heterogeneous (Abdella et al 1995). Diabetes mellitus is not a single disease entity, but rather a group of metabolic disorders sharing the common underlying feature of hyperglycemia. Type 1 (early-onset diabetes or insulin-dependent diabetes (IDDM) and Type 2 (maturity-onset diabetes or non-insulin-dependent diabetes (NIDDM) diabetes are well known types and are characterized by the different metabolic processes of the disease (Alberti and Zimmet, 1998). Type 2 accounts for about 80% of the disease worldwide. The chronic hyperglycemia and attendant metabolic dysregulation may be associated with secondary damage in multiple organ systems, especially the kidneys, eyes, nerves, and blood vessels (Maitra and Abbas 2004). The Role of Diet in the Management of Diabetes Nutritional therapy is an integral part of the management of diabetes and plays a vital role in helping people with diabetes achieve and maintain optimal blood glucose level (United Kingdom (UK) Prospective Diabetes Study Group (UKPDS), 1990; Delahanty, 1998). The nutritional management of patients is based on evidence-based principles and recommendations for the treatment and prevention of diabetes and related complications (American Diabetes Association, 2002). These recommendations are based on evidence published in the international literature and from consensus and expert opinion as required (Ha and Lean, 1998). The benefit of tight control of both blood glucose and blood pressure in people with type 1 and type 2 diabetes has been demonstrated in several well controlled randomized large-scale studies (Diabetes Control and Complications Trial Research Group, 1993; UKPDS 1998a,1998b). Generally, the objectives of strategies for the dietary control of diabetes are complementary to the aims of medical treatment. Dyson (2002) reported that these includes but not limited to the following: Maintaining blood glucose within predetermined target range Minimizing the risk of hypoglycaemia for those patients taking insulin or oral hypoglycaemic agents Achieving weight loss in the obese patient Reducing the risk of long-term complications of diabetes Maintaining blood pressure and lipid levels within predetermined target ranges Improving and maintaining suitable quality of life. (Dyson 2002) Rationale for the project Contemporary management of diabetes places emphasis on the individual patient’s responsibility for diabetes control of blood sugars and of food consumption. The concept of self-care with regard to a recommended diet is thus considered important in order for patients to maintain normoglycaemia and reduce or prevent diabetes-related complications (Rubin and Peyrot, 1992; Rubin et al, 1997). The diabetic patient is expected to monitor his/her carbohydrate metabolism, energy expenditure and the effects of insulin or recommended medicaments on blood pressure and sugar levels. This inevitably demands a level of understanding about diabetes and of the effect of diet on the progression and or management of the disease. This survey will explore the individual patients’ approach to control or support the pharmacotherapeutic management of his/her diabetes using diet. The study will shed light on diabetic patient’s adherence to guideline dietary recommendations in the Middle East or on novel dietary strategies for the control of the disease. The results of this study is essential to health policies makers in the region and pivotal for governmental strategies to minimize the burden of the diabetic epidemics in the Middle East. Using Kuwait as First Port of Call for the Middle East Diabetes Diet Study (MEDDS) The middle east comprise a large region that covers parts of northern Africa, southwestern Asia, and south eastern Europe consisting of Bahrain, Cyprus, Egypt, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Sudan, Syria, Turkey, United Arab Emirates, and Yemen. The ‘Middle East Diabetes Diet Study’ (MEDDS) will focus on Kuwait in its first phase. Implementation of the study in other countries of the Middle East will stem from its success in Kuwait following appropriate modifications to adapt the study tools to the settings and subjects of these countries. Description of First Target site: Kuwait is a relatively small country, (17, 818 km2 in surface area) and is situated in the North Eastern part of the Arabian Peninsula. Kuwait shares the north and west borders with Iraq, is bordered on the south by Saudi Arabia and on the east by the Arabian Gulf. Total population of Kuwait in 2005 was 2, 867, 000 and over 88% of these were aged 15 and over; percent Urban population out of total population was 100% during the same period (WHO 2007). The prevalence of diabetes in Kuwait was 104,000 in 2000 and the projection for the year 2030 is 319,000; this will amount to about 44% of the projected total population (WHO 2007). AIM AND OBJECTIVES Aim: The aim of this proposal is to develop a plan for the conduct of a cross-sectional survey of the recent ( Objectives: To purposely select a panel of experienced diabetes practitioners/clinicians to conceive questions assessing patients’ knowledge of their diabetes and the effects of their food types and feeding pattern on glycaemia and blood pressure control (in 11 main domains) To develop and validate a diabetes-diet questionnaire tool for the study To implement the diabetes-diet instrument during a face to face semi-structured interview designed to further explore recent dietary strategies for the control of diabetes To administer a 7-day diet dairy to respondents. Repeat the survey in other countries of the Middle East METHODOLOGY Development of Study Instruments An initial list of 11 patient’s knowledge domains as shown below will be used: Basic knowledge about diabetes Knowledge of patient’s own current management if involving pharmacotherapy Consumption of olives, fruits and vegetables, nuts and cereals in recent times. The intake of legumes in cooked foods in the last 5 years Recent intake of dairy and meat products. Consumption of alcohol/wine in the last 5 years Knowledge of other food types consumed recently Knowledge of feeding pattern in recent times Knowledge of occurrences of diabetes complications and or hospitalisations in the last 5 years Knowledge of the effect of food types and pattern of intake on control of blood pressure in the last 5 years Knowledge of the effect of food types and pattern of intake on the control of blood glucose in the last 5 years Under each domain, important points regarding each topic will be identified. To ensure content validity, a panel of 10 senior practitioners in the area of diabetes management will be identified and asked to participate in diabetes-diet (MEDDS) instrument development phase (Kline 1986; Streiner and Norman 1989). The expert reviewers will include 2 pharmacists involved in care of diabetes patients, 3 diabetes staff nurses, 3 diabetes specialist dietitians and 2 consultants in the area of diabetes. These will be identified based on their records of diabetes patient care experiences and on their knowledge of the factors impacting on the progression of the disease. The diabetes-diet (MEDDS) instrument’s content experts will rate each of the topic domains and indicate the percentage weight of each domain within the entire study tool. Between 6 and 12 multiple-choice questions will be created for each domain, with a focus on information ranked by the experts as most important for the objectives of the study. The multiple-choice question format is chosen because it is easy to administer and it will be easy to psychometrically validate the ensuing instrument (Kline 1986). Each multiple choice question will have 4 possible responses, namely one correct answer and 3 distracters. However, in order to fully capture any emerging theme, respondents will be allowed time to comment freely on the questions and the multiple choices in a semi-structured interview. These will then be transcribed for analysis. Existing questions from previous studies may be harnessed and modified by the panel. The expert panel will also rank the questions within the domain in descending order based on its relative importance to patients’ diabetes diet requirement/knowledge. After the initial item bank is compiled, the expert panel members will be asked to rank the overall quality of each item on a scale of 1 to 5 (1 = poor, 5 = excellent) in terms of how well it tested each information point. These rankings will be used to eliminate questions and create a 20-30 item pilot instrument. An item bank will be developed based on this information. Questions will be written at 7th grade reading level as determined by the Flesch/Flesch-Kincaid Readability Tests calculated from Dave Taylor and Intuitive systems (2007). Respondents will also be asked to fill a 7-day diet diary. Inclusion criteria Adult volunteers aged 18-85, living in the study site with not less than 3 years diagnosis of type 1 or type 2 diabetes. Since retinal and vascular problems associated with diabetes mellitus are common, attempts will be made to administer the tools also in carers of blind diabetic patients. Exclusion criteria Anyone diagnosed with a mental illness as it may be difficult to determine the truthfulness of information collected from these patients. Patients who are deaf; this is because a researcher and the interviewee would need to be proficient in sign language for any meaningful interview to take palce Data-collection tools Three data-collection tools will eventually be used; (1) the diabetes diet questionnaire (MEDDS tool), (2) a semi-structured interview using validated questions developed by the experts group and (3) a health diary. The interview and diet questionnaire will be the main data source. The semi-structured interview will last for 20 -30 minutes and will be conducted to further explore dietary trends for the control of diabetes in the last 5 years; this will be done at any location convenient for the respondents. The MEDDS questionnaire will be self or researcher administered during the face-to-face interview. A team of 8 interviewers will be trained by the researchers for 4 days before the start of data collection. The questionnaire will be translated into the local language of the study site. The study tools will be pre-tested for about 1 week in diabetes patients across age and sex variables of the target diabetic cohort as shown by Abdella et al (1995) for diabetic Kuwaiti. Larger scal e administration of the instrument will be for 6 months following the pre-test period. Study population Based on the household registry linked to databases of diabetes organisations in Kuwait, the survey will stratify the area of Kuwait into seven strata according to the degree of urbanization, geographic location, and administrative boundaries. Townships or districts will be selected from each stratum with the selection probability being proportional to its size. Sample selection will involve the use of multi-stage cluster random sampling procedure at the district level to select sub districts and zones from where the study sample could be drawn. In each district, the area will be sub-divided into sub districts from which 3 zones will be selected based on population size. Within the selected zones, households will be randomly numbered, and houses assigned ‘even numbers’ will be selected into the final sample. . Instrument Administration Diabetes patients or their carer (as may be necessary) will be identified for face-to-face semi-structured interview, the administration of the diet questionnaire and the filling of a diet diary in the final sample population. Knowledge of dietary recommendations for the management of their diabetes will be investigated; types of food as well as feeding pattern in the last 5 years will be evaluated for each diabetes type. Answers will also be sought to questions that will provide insight into patients recent general daily energy intake and expenditure; daily amount of carbohydrate and protein in the diet, control of blood pressure and glucose levels in the last 5 years. Respondents will also provide insights into changes in local custom for dietary control of diabetes. Following the interview and administration of the diet questionnaire, each participant will be given a 7-day diet diary to complete after each meal or at the end of each day. It will be explained that the diet diary sh ould contain food types and time of eating and all dietary tactics taken to maintain normal blood glucose level (4–7 mmol/litre). The diet diary will further explore the truthfulness of information provided in the interview/ questionnaire as well as shed light on how the respondents have presented their recent self-care dietary strategies for the control of their diabetes. The Use of Interpreters Linguistic competency is central to cross-cultural studies and problems that may arise due to the researchers not understanding the local language could be overcome by the use of an interpreter (Davies, 1999). It may also be reassuring for the respondents to see someone with whom they share the same culture and language during the interview periods (Freed, 1988). Interpreters will either provide verbatim translation during the face to face interview or conduct the interview independently following adequate training (Baker, 1981). Psychometric Analysis of the Questionnaire for the Dietary Control of Diabetes Ensuring content and construct validity are appropriate methods to develop a knowledge instrument. Questionnaire validity is ideally established by comparing the new instrument being developed with an established recognized standard. There are no such standard for the target patients of this study. Reliability is also a vital attribute of a sound knowledge instrument. The diabetes-diet (MEDDS) instrument will be said to be reliable when scores are consistent over time within a site or as implementation moves from one site/country to another. The variability of the instrument’s results should in this case be due to true differences among the individuals patients that will be enrolled into the study (Streiner and Norman 1989). Content Validity Content validity refers to the extent to which a set of items reflects the intended content domain (De vellis 1991). A systematic approach to identifying important domains and developing specific items based on consultations amongst experienced practitioners in the management of diabetic patients will ensure the content validity of the ‘Middle East Diabetes Diet Survey’ (MEDDS) instrument’. This method follows those employed by Zeolla et al (2006) in determining patients’ knowledge of the management of their disease. Construct Validity Construct validity determines the instrument’s ability to function for its intended purpose (Kline 1986). The ‘contrasted group’ method will be used in this study to determine the construct validity of the MEDDS tool (Kline 1986). Reliability of the Diet Questionnaire A proportion of the diabetic patients recruited into the study will be followed-up after 4 months and urged to complete the diet questionnaire only. The time elapse is considered sufficient to reduce the impact of recall (Streiner and Norman 1989). A correlation coefficient will be calculated between the test scores from each administration. A coefficient of 0.80 or higher is considered acceptable for demonstrating test–retest reliability (Streiner and Norman 1989). Hypothesis for Construct Validity If the MEDDS instrument is a valid tool to assess the recent approaches for the dietary control of diabetes, patients managed for diabetes, should be more knowledgeable and achieve significantly higher scores than those not diagnosed or managed for the disease. To confirm this hypothesis, the response of diabetic patients to the final instrument will be compared with responses of age-matched subjects without diabetes in the same setting. Construct validity would be confirmed if the mean generated score for diabetic subjects were significantly higher than those not diagnosed or managed for diabetes. . Statistical and Data Analysis Statistical analyses will be by SPSS version 14. The results of the pre-test will be excluded from the analysis. Student’s t-test will be used to compare the differences in mean scores of patients managed and not managed for diabetes. Using chi-square (à ¯Ã‚ Ã‚ £2), demographics characteristics will be compared between patients managed and not managed for diabetes. Pearson’s correlation coefficient will be used for the test–retest reliability analysis. Descriptive statistics will be used to report patient demographics. The interview transcripts and the health diaries will be deliberated upon on more than one occasion to fully understand patients’ self care approach and identify individual patient’s dietary care strategies. Themes emerging from the interview will then be compared with dietary patterns observed in the 7-day diet diary and the diet questionnaire. Following a detailed analysis of the results of all 3 tools, perceptions of respondentsà ¢â‚¬â„¢ conformity to recommended dietary regimen or their general philosophy/strategy of managing diabetes with diet will be reached. ETHICAL CONSIDERATION The study qualitative paradigm protocol will be submitted for review and approval by the local ethics committee for the study region. A covering letter describing the goals of the study will be provided to patients agreeing to participate. The purpose of the study will be very carefully explained to the respondents and their consent will be individually obtained before the study tools are administered. Each participant will also complete a brief demographic questionnaire. In cases of identified illiteracy, the information contained in the form will be read by the study interpreter and informed consent sought. All respondents will assured of anonymity, confidentiality and that they could withdraw from participation in the study at any time. EXPECTED OUTPUT Interventions to prevent diabetes in the Middle East should include culturally appropriate and effective ways to improve the nutritional adequacy of the diet in line with international guidelines for the dietary control of diabetes. The result of the study will indicate the knowledge gaps if any in the study population. Tight glycaemia control associated with certain food types and feeding strategies identified in the study may become basis for its recommendation and use in other parts of the world for the control of the worldwide diabetes epidemic. References Abdella Nabila A., Moustafa M. Khogalib, Amani D. Salman’, Shaker A. Ghuneimi†, Jasbir S. Bajajd (1995) Pattern of non-insulin dependent diabetes mellitus in Kuwait Diabetes Research and Clinical Practice 29.1 29-136 Alberti, K.G. Zimmet, P. Z. (1998) Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1:Diagnosis and classification of diabetes mellitus, provisional report of a WHO commission. Diabetic Medicine, 15, 539^553. American Diabetes Association (2002) Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 25: S50–S60 Baker N (1981) Social work through an interpreter. Soc Work 26:391–97 Dave Taylor and Intuitive system (2007) [Internet] [Accessed 21st April 2007] http://www.readability.info/ Davies CA (1999) Reflexive Ethnography: A Guide to Researching Selves and Others. Routledge, London Delahanty LM (1998) Clinical significance of medical nutrition therapy in achieving diabetes outcomes and the importance of process. J Am Diet Assoc 98: 28–30 Devellis RF (1991). Scale development: theory and applications. Newbury Park, CA: Sage Publications. Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of longterm complications in insulin-dependent diabetes mellitus. N Engl J Med 329: 977–86 Dyson Pamela (2002) Nutrition and diabetes control: advice for non-dietitians British Journal of Community Nursing Vol 7, No 8. 414-419 Freed AO (1988) Interviewing through an intrepreter. Soc Work 33(4): 315–97 Ha TKK, Lean MEJ (1998) Recommendations for the nutritional management of patients with diabetes mellitus. Eur J Clin Nutr 52: 467–81 Kline P. (1986) A handbook of test construction: introduction to psychometric design. New York: Methuen Co. Maitra A and Abbas A.K (2004). The endocrine system. In: Robbin’s and Cotran Pathologic Basis of Disease (edited by V. Kumar, A.K. Abbas N. Fausto). Pp. 1189-1207, 7th edn. Philadelphia, PA: Elsevier Saunders Company. Streiner DL, Norman GR. (1989) Health measurement scales: a practical guide to their development and use. New York: Oxford University Press. UKPDS (1998a) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes: UKPDS 33. Lancet 352: 837–53 UKPDS (1998b) Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 317: 703–13 UKPDS (1990) Response of fasting plasma glucose to diet therapy in newly presenting type II diabetic patients: UKPDS 7. Metabolism 39: 905–12 WHO (2007) [Internet] Available: http://www.who.int/diabetes/facts/world_figures/en/ Accessed 21st April 2007 Zeolla M. M., Michael R Brodeur, Angela Dominelli, Stuart T Haines, and Nicole D Allie (2006). Development and Validation of an Instrument to Determine Patient Knowledge: The Oral Anticoagulation Knowledge Test Ann Pharmacother 40:633-8. Zimmet, P., Taft, P., Guinea, A., Guthrie, W. and Tchoma, L. (1977) The high prevalence of diabetes mellitus on a central Pacific island. Diabetologia 13, 111-115.