QRisk 2 - to use or not to use - that is the question Essay

QRisk 2 - to use or not to use - that is the question - Essay Example 2008)). Previously few other criterias like Framingham’s criteria to assess cardiovascular risk factors and QRISK1 are used so this new model is a point of discussion that either it has some significance in the developing era or not.(Brindle, 2011). This requires collection of data from several studies which have been conducted in the recent past to compare between these models.(Hippisley-Cox, Coupland, et all. 2008). Generally, they all pointed out that using QRISk 2 is not have similar effectiveness like the traditional previous criteria as the risk factors described in this score are not single most important risk factors for development of cardiovascular diseases but they have utmost importance.(Vogel, Bernitez, 2000). RATIONALE: Cardiovascular risk factors predict 5-10 year risk of development of cardiovascular disease as well as resulting mortality and morbidity from that. (Koenig, 2003). There are few cardiac risk factors which have been defined previously like increase age, male gender, smoking status, presence of Hypertension, Hyperlipidemias, Type 2 diabetes etc. presence of all or one of these factors leads to increase tendency towards development of cardiovascular disease.(Mola, Lloyd, 2002). There are few other factors which are recently developed. These include ethnicity of the patient, presence of rheumatoid arthritis, atrial fibrillation, chronic kidney disease and treated hypertension. Data shows that they also influence future prediction of cardiovascular morbidity and mortality. (Collins, Altman, 2010). CONS OF QRISK2: By using QRISK 2, we can find out some high risk persons who are at risk of developing disease(Hayman, Kamau, 2009) It also provides benefit by treating the patients who are labeled as low risk by traditional framinghom’s criteria.(Mayor, 2010) Advantage of this system is that traditionally larger numbers of data can be included in the database. (Hippisley, Coupland, 2008) It is also the first study which uses so many factors as a risk of cardiovascular disease.(Parkes, 2010) Inclusion of ethnicity is also found to be important by some people as few diseases are more popular in a specific population (Giampaoli, Palmieri, 2004) Stroke is more common in older ones and poor countries. (Scott, 2010). QRISK system also addresses the problem of different effects on risk factors of increasing age(Vanuzzu, Pilotto, 2008) so they have introduced interaction variables between age and other risk factors to overcome this problem. (Cooney, Dudina, Graham,2009) PROS OF QRISK2: It results in superior age estimation in older age group. (Weirzbicki, 2009) QRISK over predicted the patients in only 0.4% of cases but it under predicted in 12% of cases.(Dalton, Soljak, 2011). It measures blood pressure and BMI accurately but cholesterol measurement is poor. A study shows that it measured cholesterol of only 30% people who are at risk of developing disease.(Thomas, 2011). Also there is no validation of events and everything is based on computer records. Patients are included at different times in this system. Most of the patients do not follow ten years data. This score is not validated in population other than British.(Chia, 2011). It also has another disadvantage. As it is using age as a factor for cardiovascular disease risk, it is unable to identify those who are at risk but younger. As compare to some other trials

Copper Cycle Lab Essay Example for Free

Copper Cycle Lab Essay Purpose: During this experiment, we were trying to see whether copper, after a chain of chemical reactions, will revert back to its elemental form. Procedure: First, I added nitric acid with copper in a beaker, which turned into a copper nitrate, a blue-green solution. Afterwards, I added sodium hydroxide, and my solution colored to a dark blue solution called copper hydroxide. I heated the solution to evaporate the water and I got a brownish-blackish solid called copper oxide. Once the solid appeared, I poured in sulfuric acid to it and I got copper sulfate, a bluish solution. The final step I took was to add the element zinc, which turned the solution from blue to clear, with a brown solid in the bottom of the beaker, copper. Observation: During each step, something happened. For instant, for the first step, when I added the acid to the copper, the copper disappeared and the solution turned from the clear acid color to a blue-greenish hue. In the next step, there was another chemical reaction when I added the sodium hydroxide. The whole solution turned blue when I stirred the mixture. When the time came to evaporate the solution, the liquids disappeared, leaving behind a wet, brownish solid in the middle of the beaker. When the solid was hot, it bubbled and popped until it cooled down. When all the liquids evaporated, I scraped off the solid and put it in a separate beaker. Once I put the sulfuric acid in it, the brown solids (copper oxide) slowly dissolved and turned the acid into blue. After the acid was blue, I added the metal/grey colored zinc into the solution; the solution bubbled and the zinc turned the solution clear. The zinc disappeared and in its place, copper appeared. Analysis: For each step, there was a chemical reaction, except for the part where we evaporated the water/liquefied chemicals. For each step, I was turning the copper into a compound. When an acid was added to the copper, it turned the element into a compound. When a base was added later, it merely replaced the acid with the base. Conclusion: For this experiment, I can conclude that an element/matter can never be destroyed or created. The copper cycle is evidence for the Law of Conservation of Mass, which states that an element or matter can never be created or destroyed, only changed.

Needs Assessment and Analysis Essay -- Business Research

Needs Assessment and Analysis Introduction and Overview Businesses in today's economy often face challenges that are not readily apparent until, more often than not, the costs of those challenges become critical. A businesses ability to identify the fundamentals of these challenges and act accordingly to squelch the damage that has been done while bouncing back is paramount to the businesses success. This paper will identify three key areas in identifying and repairing the critical problems that can occur. More importantly, this paper will also identify several fundamentals within the three areas. The paper will examine some sub levels of (1) analysis, (2) cost, and (3) research. Additionally, this paper will discuss the measures that several companies took in these areas to show special examples of these principles in use. Analysis Within the scope of needs assessment and analysis there are many building blocks that complete the full picture. One such block is comprised of the levels of analysis. And within the levels of analysis there are three main points. These points as reported by Goldstien (1993); McGehee and Thayer (1961); Moore and Dutton (1978); and Sleezer (1991) are (1) organization, (2) job or task, and (3) individual or person (as cited by Holton). The following paragraphs will discuss each of these three points by defining and demonstrating their context within analysis. Organization Holton (1996) suggests that the three-level approach to needs assessment suggests that assessors should start by analyzing the organization to determine what results are not occurring and should be, and what organizational factors are contributing to that condition. This could easily be interpreted as ... ...lanning, Implementation, and Control; Eighth Edition. Englewood Cliffs: Prentice-Hall, Inc. Marrelli, Anne F., Cost Analysis for Training. In Erekson, David A., Shaha, Steven H., Swenson, Craig D., (1996). Business Research Realities: Selected Readings (pp. 117-132). Needham Heights: Simon & Schuster Custom Publishing. Newsom, D., Turk, J., Kruckeberg, D., (1996). This is PR, The Realities of Public Relations, Sixth Edition. Belmont: Wadsworth Publishing Rose, M., (1999, February 5). 'New Breed of Beef' to be Test-Marketed Here. Business Journal Serving Greater Portland, 15. Page 29 Schoeppel, C.; Turning Down Manager Turnover: Financial Services Inc. In Erekson, David A., Shaha, Steven H., Swenson, Craig D., (1996). Business Research Realities: Selected Readings (pp. 257-264). Needham Heights: Simon & Schuster Custom Publishing. 10

Critical Analysis Of “Enduring Love” Essay

In â€Å"Enduring Love†, McEwan again creates a family that confronts a challenge and finds it difficult to survive. Joe and Clarissa are intellectuals living together in a well-appointed flat in a comfortable neighborhood in London. Clarissa is a professor researching Keats, and Joe is a well-known science writer with a doctorate in quantum electrodynamics who is somewhat dissatisfied with his decision to leave academia behind. Through the story utilizing the characters of Joe and Clarissa, McEwan articulates the idea humans are emotionally and intellectually evolved and are therefore less fit for survival than animals. Joe and Clarissa have figured out how to retain their individual identities within the relationship, so that they do not feel guilty that they lead separate lives, and do not become parasitic when they are together. Joe and Clarissa are aware of their individuality, and ultimately their relationship entails a defense against enmeshment, a protection of self against the encroachment of others, as a primary motivating factor. In the end it is their insistence on â€Å"me† over â€Å"us† that renders their connection vulnerable to withstand the challenge of obsession and madness from an outside source. In the novel’s celebrated opening scene, when Joe and Clarissa witness a hot air balloon in distress, Joe attempts, with several other men, to rescue the terrified boy inside the basket by pulling the balloon back to earth. The experience is undeniably traumatic. Joe’s guilt at letting go is overwhelming, and the sight of the dead body haunts him. Back at home, Joe and Clarissa comfort and support each other, cooperating in each other’s recovery by talking through the event and their feelings, and trying to work together to make meaning of it. McEwan is careful to show that their initial reaction to the trauma appears to reinforce the solidity of their relationship. It is an appropriate, mutual, and affiliative response. Clarissa recognizes Joe’s feelings and tries to help him: â€Å"‘ We’ve seen something terrible together. It won’t go away, and we have to help each other. And that means we’ll have to love each other even harder'† (McEwan 36). Moreover, Joe appreciates Clarissa’s efforts and feels delivered from his trauma by the physicality of her love: â€Å"she put her arms around my neck and brought my face close to hers. She knew I was a fool for this kind of encirclement. It made me feel that I belonged, that I was rooted and blessed† (McEwan 37). But for the reader, the event’s revelation of Joe and Clarissa’s relationship resonates on another level as well. Joe’s reflections on the nature of the cooperative effort enacted by the group of men can equally be applied to his relationship with Clarissa. He is remarkably aware, both during and after the event, of the extent to which human interaction is governed by a weighing of benefits, a balancing of pros and cons: â€Å"Selfishness†¦ is our mammalian conflict: what to give to the others and what to keep for yourself. Treading that line, keeping the others in check and being kept in check by them, is what we call morality† (McEwan 15). And, in the end, it is this constant hedging, this instinct to protect the self at the expense of risking connection with others, McEwan says, that dooms both the rescue and the relationship: â€Å"Someone said me, and then there was nothing to be gained by saying us†¦ Suddenly†¦ we were disintegrating. Suddenly the sensible choice was to look out for yourself (McEwan 15). In a sense, the extent to which Joe and Clarissa’s relationship is more of a compromise than a connection finds its expression in Joe’s astute observation about the men: â€Å"There may have been a vague communality of purpose, but we were never a team† (McEwan 11). With the metaphor of the balloon accident, McEwan implies the necessity for Joe and Clarissa to face the same choice as the rescuers – to let go and survive, or die. The audience is aware from the start of â€Å"Enduring Love† that the veneer of togetherness in this family belies a strong undercurrent of disconnection. To begin with, the reunion picnic is necessitated by the couple’s six week separation while Clarissa has pursued her own research abroad, leaving Joe home alone. Perhaps even more of a signal to the reader, however, is McEwan’s refusal to clarify the exact nature of Joe and Clarissa’s relationship. As the narrator, Joe describes his relationship with Clarissa as one of marriage: â€Å"We were seven years into a childless marriage of love† (McEwan 8). But then he refers to Clarissa not as his wife, but as his friend: ‘†Look, I’m sorry, I’m going back up to see my friend'† (28). Later, when he is talking to the widow of the balloon accident hero, he says it again: â€Å"I shook my head. There was my friend Clarissa, two farm laborers, a man called –â€Å"‘ (McEwan 122). It is significant that McEwan will not allow the consistent use of the word ‘wife’, even for the sake of convenience, and his refusal to do so comments on this couple’s lack of a formal commitment to connection. From the critical perspective and comparing to humans to animals in terms of the organizational system, Joe and Clarissa have learned to mediate conflict by focusing on the defects and failings of the partner. In a sense, McEwan implies, Joe and Clarissa’s relationship has always been about competition. In particular, Joe’s decision to give up â€Å"real science† for popular science puts him at a disadvantage with Clarissa, a promising scholar with a place at a university, who has a famous scientist as a Godfather. Moreover, their relationship is illuminated by the conflicts inherent in their chosen fields-the objectivity of science and the subjectivity of the humanities. Despite their mutual instincts for connection, and their evident love for each other, Joe and Clarissa have not, as a family, internalized a regulating dynamic by which the closure of their family can be defined and maintained. Unlike animals, Joe and Clarissa as humans are complex and evolved human beings that are reliant on comfort and habit rather than intimate dedication to each other, as evidenced by their readiness to turn the tension of the event onto their relationship rather than absorbing it together. As such they are less fir fit survival in a broad context and are vulnerable to inside and outside threats to their integrity. WORKS CITED McEwan, Ian. Enduring Love. New York: Anchor Books, 1999.

Integrative approaches to psychology and Christianity Essay

This book tells about the integrating Christianity and psychology. The author discusses integration a combining the two books of God. According to Entwistle (2004), â€Å"the book of god’s Word referred to the Bible, and the book of God’s works reflects His deeds written throughout His creation. (p. 166). † He includes five models of integration in the book which are: enemies, spies, colonialists, neutral parties, and allies as subjects of One Sovereign. The enemies model sees Christianity and psychology as enemies that need to be kept totally separate. The spies model has one discipline going into the other to take only what works for them. Psychology would enter the Christian world just to take the religious concepts that will work well with psychology. The colonialist model has one discipline colonizing or taking control and prominence over the other. Religion works with psychology as long as religion is superior to psychology. The neutral parties model has both disciplines coexisting and recognizing each other as long as they respect each others’ boundaries. Psychology recognizes that religion has good concepts to offer but it will not encroach on the religion’s domain. The allies as subjects of One Sovereign model have both disciplines working together to help people. It uses psychological and theological concepts together to gain a better understanding of the truth. According to Entwistle (2004), â€Å"God gave birth to the subject of psychology (human behavior) when he created human beings. God granted us the foundations of theology when He gave us His Word (p. 175). † The book tells us that there are two books of God: His word and His works (Entwistle, 2004). Psychology deals with God’s works and theology deals with His word. Our job as Christian counselors is to interpret both books and integrate them together so that we can use both books to help our clients. If we find something that does not make sense between both books, there is a conflict that needs to be resolved before we can use it. At this point, we need to go back and reread and study both books to see if we can find the discrepancy. Entwistle (2004) says that god gave us both books, but we have to interpret them ourselves. The problem is not with God’s books, but it is the way we interpret them. Human understanding of God’s books is based on our worldview (Entwistle, 2004). To properly integrate the two disciplines, we need to have a good understanding of both. We cannot just know theology or psychology and expect to integrate them well. We need to have a working knowledge of psychological theories and concepts as well as a working knowledge of God’s word. We need to remember, though, that our knowledge is only as good as our interpretation. God’s works have been affected by the fall into sin, and as a work of God our interpretations will be colored by the fall as well. I think this book has a lot of good ideas and concepts to it. I found it interesting to discuss the two books of God, because I had heard the term and knew what it meant, but had not really thought about what it included. I also liked the models of integration and their explanations. They were explained well enough that anyone could follow them easily. Some of the things that bothered me the most about the book and its ideas are: the idea of interpretation, the definition of integration, and where do we go from here. If we are the interpreters of God’s two books and we know that the fall and sin have colored our interpretations, how do we know if our interpretations of the books are correct? Can we interpret either book accurately? If our interpretations are wrong, can we do more harm than good to our clients? Is the definition of integration complete enough to help us know what we need to help others? When we use the current definitions of integration, do we get a complete picture of what integration means to both disciplines? With all of the models of integration, where do we go next? How do we make progress in the integration process? Can we ever integrate to a point where we can agree on most aspects of a model, or will there always be disagreement between the disciplines? These are all questions that I think are important to consider about integration. I think that integrating Christianity and psychology can benefit a Christian client by allowing us to address spiritual matters and use spiritual techniques for healing. It is important to remember that religion and psychology are both parts of God’s truth to us and can be used to help ourselves and others. When the two disciplines are integrated, we have many more options than when we use one or the other discipline separately. Finally use of both disciplines can help us reach people of faith as well as people who are not Christians, if we can use them both carefully and competently.