Qualities of a Successful leader

Qualities of a Successful leader Introduction Management is concerned with human beings whose behaviour is highly unpredictable. An individual or a group of people who accept responsibility to run an organisation and direct its activities are called management. The importance of management in business is universally accepted. It acts as a driving force in business. Modern business is highly competitive and needs efficient and capable management. According to Peter Drucker (2007), management is a multi-purpose organ that manages business and manages managers and manages workers and work. Manager A manager is a person tasked with overseeing employees to ensure that they carry out their assigned duties. (www.wisegeek.com) Qualities of a Successful leader Leadership Qualities Personal Traits Managerial Traits Self-confidence, initiative innovative, emotional maturity, intelligence, decisiveness, vision foresight, acceptance of responsibility. Knowledge of human skill, administrative ability, technical knowledge, ability to deal with people, ability to judge and decide quickly. (Appleby.R, 1969) Leadership Leadership is followership. Leadership is not a quality which is in born. Its a quality which can be developed from within. Leadership is a strategy used, by which a manager influences the employees to achieve the tasks and objectives and keep the organization together and focused to strive hard towards its goals. Leadership is often a dynamic activity concerned with changing attitude. They are more inspirational and involve more emotional input than management. (www.skagitwatershed.org). According to Koontz ODonnell, â€Å"leadership is the ability of a manager to induce subordinate to work with confidence and zeal. (Kale.N, 2006) Discussion: Styles of leadership and motivation, which can be used by a Manager. There are 4 basic styles of leadership. Autocratic Bureaucratic Laissez-faire Democratic But the styles which are mainly and widely used in most of the organisations are as follows: Autocratic style: This is a method which takes place in most of the organisations. In this style the manager keeps control over everything. They give orders and draw lines. There is a strong supervision on the employees. Employees do not get an opportunity to discuss or give their suggestions or inputs. They have to follow the instructions given. In this method the motivation is either encouraged by rewards or punishments. This style has been criticized from past many years. The most important drawback of this style is that it has always been a higher staff turnover and staff not turning up to work with an excuse of illness. (Gaynor. G, 2004). This leadership style falls under theory x by Douglas Mc gregor. For example: This is sometimes being observed in the hotel industry. Where the manager sets up the rules, orders and staff has to follow them without any discussions or opinions. Characteristics Managers mostly depend on threats and punishments to get the work done from their subordinates. Most important factor that there is no trust on the employees. Employees do not play any role in the management decision and discussions. Situation 1: The new staff has just joined the front office department in a 4 star hotel. She has worked before in many hotels with different types of systems. The systems used in this hotel are new for her. She is completely new and untrained so she needs to be trained on the systems. As she is new to the company, the service standards are purely different then what she has seen in the past, so she needs to be under detailed supervision, for that she needs to follow instructions orders. The hotel is really busy place and they are also understaffed. If she makes a mistake, there is no time to sort out the issue on the spot. The management has just changed before she joined the hotel so everything before was poorly managed. So she has to follow up the orders there is no time for discussions or suggestions. She has to deliver the best performance under the instructions of the manager. This clearly shows that in the situation mentioned above, the manager needs to use an Autocratic style of leaders hip. Democratic style: Democratic leadership is also called as participative leadership. This is a strategy where the subordinates or staffs can actually participate in the discussions and decisions. Everything is done systematically in this leadership style. The manager will meet the employees, inform them about the issues emerging that might affect their work or the organisation and then shares the information in order to make decisions and to decide who will sort out the problems and with what responsibilities. (Surridge.M 2004). This leadership style falls under theory y by Douglas Mc gregor. For example: Many giant corporate companies who are into retailing and car industry would follow this style. Where there is a trust between higher management and the subordinates in regards to suggestions and decision making and planning. Characteristics The manager will develop a strategy, a plan to support the employees to review and improve their performance. The manager will actually work hand-in-hand with employees to achieve the goals and objectives. Manager encourages the staffs to grow up in their work performance and inspire them towards the promotion. Situation 2: BMW is a giant car manufacturing company. It has a good reputation in building its luxury cars. They have strived hard to gain their customer satisfaction. Within one of their plant in UK, the business is going well. They are proper staffed. Also the production manager of that plant is keen on discussing/meeting every week with the employees of all the departments and would like to get suggestions and opinions from all the subordinates regarding any current issues, problems and solving them. The manager discusses the performance of each every employee to give them a review of their work to support them to bring themselves to success. He creates an environment of building a team and participation where everyone gets involved equally in every situation faced by the company. This shows that the manager does trust his employees do achieve their objectives. In this situation the manager would use a Democratic style of leadership. Motivation Motivation is an art of getting things done willingly from others. The term motivation is derived from Latin word ‘movere which means to move. Motivating means encouraging people to take more initiative and interest in the work assigned. Motivation is the inner psychological forces in an individual which induce him or her to act or not in a particular way. The creation of the desire and willingness to perform the job efficiently is what is generally known as motivation. (Ahmed. M, 2006) â€Å"Motivation means, a process of stimulating people to action to accomplish the desired goal†. (W.G.Scot) Who needs Motivation Individuals who are just performing their routine work without any new ideas or bringing initiatives in their work. Those people who just do their work and count minutes to end their shifts. These kind of people need motivation and inspiration. Types of Motivation Intrinsic motivation: People who are naturally motivated by having a desire to participate to participate and face new experiences. These people do not rely on rewards or benefits for their performance. They develop their motivation by self-developing their qualities for any kind of challenging work. (www.giftedkids.about.com) Extrinsic motivation: These people need motivation from outside, externally. This includes encouraging the employees artificially, like: offering bonus, compensations, benefits and pay rise. Instead of being eager to grasp the tough situations. These individuals get motivated by only manually assigning them the challenging projects. (www.giftedkids.about.com) MOTIVATION INTRENSIC EXTRINSIC Theories of Motivation The eminent psychologist Douglas McGregor has called the theory of motivation as Theory x and Theory y. the traditional approach to management is as explained as theory x and professional approach is explained as theory y. the theory is explained into two sets of employees based on the perception of human nature. (Kale. N, 2006) Theory x is static, rigid, conservative and pessimistic. Theory y is optimistic, dynamic, flexible and progressive. More importance is given to external control imposed by the superior on the subordinate in theory x. according to the theory y people are basically positive in their approach. As pointed by D. McGregor that managers need not follow only one theory for motivating subordinates. They can use both the theories depending on the situation. Theory y is more democratic and is also suitable to present trends in the business world. Whereas Abraham Maslows theory of motivation has identified five sets of human needs arranged in a hierarchy of their importance and priority. Security/ safety needs Social needs Esteem needs Self-actualization needs Hence both the theories are linked with each other and have limitations and as we see McGregors theory is somewhere based on the assumptions made by Maslows hierarchy of needs. The lower tier showed as theory x and the higher tier is showed as theory y. Maslows theory has certain criticisms like; Its based on human needs only It fails to refer the other motivating factors like expectations and experience. Peak experiences Self-actualization Psychological needs Safety needs Basic needs Maslows hierarchy theory of needs (Prabhu. V, 2005) Thus Maslows theory is an empirical theory. Its more philosophical then scientific. Whereas McGregor has discarded the assumptions of classical school of thought. He has rightly given his preference for theory y that facilitates building and development of an organization. References www.jstor.org/pss/254978 (scott motivation) (Edition 2 the essential drucker by Butterworth- Heinemann)

Prevalence of Coronary Heart Disease in India

Prevalence of Coronary Heart Disease in India Introduction According to WHO (2007) coronary heart disease (CHD) (including Myocardial ischemia) is the most common cause of death in the world and the biggest cause of premature death in modern and industrialised countries (Lopez et al., 2006; Lindsay and Gaw, 2004). In 2001, ischemic heart disease accounted for 7.1 million deaths worldwide among which 5.7 million (80%) deaths were in developing and underdeveloped countries (Lopez et al., 2006). Although geographical variations such as ethnic origin and social class influence the CHD mortality rates (Lindsay and Gaw, 2004), coronary heart disease remains common globally despite the development of a range of treatments (Brister et al., 2007). There is evidence that ethnicity is an important factor for coronary heart disease (Gupta et al., 2002; Brister et al., 2007) and a number of studies have suggested that there is increased incidence in coronary artery disease in South Asians (people originating from India, Pakistan, Bangladesh and Sri Lanka) when compared to the white population (Brister et al., 2007). South Asian people also have a greater risk of coronary heart disease than others from developed countries (Mohan et al., 2001; Joshi et al., 2007). In 2002 India had the highest number of deaths over 1.5 million due to coronary heart disease (Reddy et al., 2004). By 2010, it is expected that 66% of the worlds heart disease is likely to occur in India (Ghaffar, 2004). Therefore, this dissertation will focus on the prevalence of CHD in India and the impact of life style in the aetiology of CHD. There is wide range of evidence regarding the incidence and prevalence of coronary artery disease (CAD) in India (Reddy, 2004; Kasliwal et al., 2006; Patel et al., 2006; Brister et al., 2007), including Indian, British and Singaporean journal articles. This dissertation is broken down into three parts: the first discusses the topic in relation to the existing literature on the prevalence of CHD in India; the second part is a critical appraisal of the risk factors and the impact of life style of CHD in Indians; While the third presents the management of CHD, and includes a discussion of the nursing implications and future research into this area. Background THE DISEASE ASPECT- CORONARY HEART DISEAS/CORONARY ARTERY DISEASE Definitions Coronary heart disease â€Å"CHD covers a spectrum of disease such as angina, acute coronary syndrome, myocardial ischemia, ischemic cardiomyopathy, chronic heart failure and a proportion case of sudden cardiac death† (Lindsay and Gaw, 2004 pg no. 1). Acute coronary syndrome This is the clinical entity of myocardial ischemia and myocardial infarction. Myocardial Infarction â€Å"it is a condition that results from diminished oxygen supply coupled with inadequate removal of metabolites because of reduced perfusion to the heart muscle† (Woods et al., 2005 pg no. 541) Angina â€Å"A condition characterised by chest pain or discomfort from myocardial ischemia† (Woods et al., 2005 pg no. 541) Overview of Coronary Artery Disease CHD is the major cause of death in most countries and is considered almost to be an epidemic in western countries (Lippincott, 2003). In Britain it accounts for one in three deaths in men and one in four deaths in women, while 5,000,000 deaths annually are seen in US (Forfar and Gribbon, 2000). It is estimated that more than 80% of patients who develop clinically significant coronary artery disease (CAD), and more than 95% of those who experience a fatal CAD event have at least one major cardiac risk factor (Greenland and Klein, 2007). CHD is more prevalent in males, whites and the middle-aged, as well as elderly people. More than 50% of males age 60 or older show signs of coronary artery disease on autopsy. The peak incidence of clinical symptoms in females is between ages 60 and 70 (Lippincott, 2003). There is a marked difference in death rates due to coronary disease between countries: for example, a 10-fold greater age-standardized death rate for men aged 35 to 74 years in Scotland compared with Japan. Within Europe, a threefold difference in death rates and disease incidence can be seen with Finland and the United Kingdom higher than Italy, France, and Spain (Forfar and Gribbon, 2000). There are also marked contrasts in coronary disease mortality trends between developed and developing countries. In the United States, Western Europe, and Australia, mortality has been falling between 15 and 50 per cent for at least 20 years (Lippincott, 2003). In contrast, rates continue to rise in Eastern Europe, including Poland, Hungary, Bulgaria, and the Czech Republic. The fall could be due to a fall in disease incidence or case fatality rates, or both. Although the management of acute myocardial infarction in particular has improved over this time, with case fatality rates halved, there ha s also been an increased awareness of risk factor avoidance (Forfar and Gribbon, 2000). The Disease aspect Coronary arteries bring blood and oxygen to nourish the heart. The heart pumps deoxygenated blood to the lungs, where it receives oxygen before it is pumped to the whole body. Because the heart is a muscle, it needs a continuous source of oxygenated blood to function. Causes and symptoms CHD is usually caused by atherosclerosis. Cholesterol and other fatty substances accumulate on the inner wall of the arteries, which in turn attracts fibrous tissue, blood components, and calcium to the inner walls of the arteries which then hardens into artery-clogging plaques (Woods et al., 2003). Atherosclerotic plaques often form blood clots that also can block the coronary arteries (coronary thrombosis). Congenital defects and muscle spasms can also block blood flow. Recent research indicates that infection from organisms such as the chlamydia bacteria may also be responsible for some cases of coronary artery disease (Warrel, 2003). A number of major contributing factors increase the risk of developing coronary artery disease. Some of these can be changed and some cannot. People with more risk factors are more likely to develop coronary artery disease. Major risk factors Major risk factors are those factors that lead to CHD. They are mainly classified into two groups: non-modifiable and modifiable (Lippincott, 2003). Those that cannot be changed are the non-modifiable risk factors such as: Heredity if a persons parents have coronary artery disease he/she is more likely to develop it. Sex Men are more likely to have heart attacks than women and to have them at a younger age. Age Men 45 years of age and older and women 55 years of age and older are more likely to have coronary artery disease. However now-a-days, coronary disease may occasionally strike a person in their 30s (Lippincott, 2003). Major risk factors that can be changed (modifiable risk factors) are: Smoking Smoking increases the chance of developing CHD and the chance of dying from it. High cholesterol Dietary sources of cholesterol are meat, eggs, and other animal products. There are other factors also that increase the cholesterol level such as age, sex, heredity, and diet affect ones blood cholesterol. Total blood cholesterol is considered high when it is above 240 mg/dL and borderline at 200-239 mg/dL. High blood pressure High blood pressure makes the heart work harder, also increases the risk of heart attack, stroke, kidney failure, and congestive heart failure. A blood pressure of 140 over 90 or above is considered high. Lack of physical activity Lack of exercise increases the risk of coronary artery disease. Even modest physical activity, like walking, is beneficial if done regularly (Lippincott, 2003). Diabetes mellitus the risk of developing coronary artery disease is seriously increased in diabetics. More than 80% of diabetics die of some type of heart or blood vessel disease. Chest pain (angina) is the main symptom of coronary heart disease but it is not always present. Other symptoms include shortness of breath, and chest heaviness, tightness, pain, a burning sensation, squeezing, or pressure either behind the breastbone or in the arms, neck, or jaws (Lindsay and Gaw, 2004). Many people have no symptoms of coronary artery disease before having a heart attack: according to the American Heart Association 63% of women and 48% of men who died suddenly of coronary artery disease had no previous symptoms of the disease (Woods et al., 2001). THE COUNTRY PROFILE INDIA The country India India, situated in the South Asian region, is the seventh largest, and the second most populous, country in the world with a population of 1.103 billion (United Nations Population Division, 2005) in 32 states and union territories covering about four thousand towns and cities and about six lakhs villages (Nag and Sengupta, 1992). The population distribution is 71% rural and 29% urban (United Nation Population Division, 2005). Initially, India was a rural economy that subsequently participated in the industrial revolution with the help of colonial rule. After independence in 1947, the country followed socialist policies and hence large-scale infrastructure and industry development was carried out through the public sector. By the early 1990s, the Indian economy was opened up through liberalization and is now on the road to privatization through disinvestment policies. However, the economic growth in India during the 1990s as a result of the 1991 economic reforms has also seen an increase in poverty and a radical transformation in the well-being of the bottom half of the population (Rajeshwari et al., 2005). The consequences of these economic and social changes have led to an epidemiological transition (Joshi et al., 2006). An epidemiological transition is a focus on the complex changes in the patterns between the health and disease and the interaction between them and various other factors such as demograp hic, economic and determinants with their consequences (Omran, 2005). The urban population has increased by 4.5 times during 1951-2001 (WHO, 2000). The life expectancy from birth for males is 62 and females 64 (WHO, 2008). While the crude mortality rate is decreasing the percentage of children under 15 is declining (WHO, 2007). Total expenditure on health per capita (Intl $, 2006): 109. Total expenditure on health as % of GDP (2006): 4.9 (WHO, 2008). The leading cause of mortality after death during childbirth is cardiovascular disease, accounting for 188 deaths per 100,000 population (WHO, 2005). The health care system of India is overseen by two different bodies: The Department of Health Family Welfare. The Department of AYUSH (Ayurvedic, Unani, Siddha and Homeopathic Medicines). Each state has a Ministry of Health Family Welfare although their organization differs from state to state. Generally, there is a Directorate of Health Services providing technical assistance. Some states have a separate Directorate of Medical Education Research, and some have a separate Director of Ayurveda or Director of Homeopathy (WHO, 2007). In rural areas, Community Health Centres serve estimated populations of 100,000 and provide speciality services in general medicine, paediatrics, surgery and obstetrics gynaecology. However, there is still a shortfall in the number of community health centres in the rural areas of India. A Primary Health Centre (PHC) covers around 30,000 people (20,000 in hilly, desert or difficult terrain) and is staffed by a medical officer, and one male and one female health assistant along with supporting staff. A sub-centre serves around 5,000 people (3000 in difficult terrain) and is supported by one male and one female multipurpose health worker. T hese workers and health assistants have different designations in different states. Playing an equally important role in curative and preventive care in urban areas is the private sector. A large number of private practitioners exist and there are many large and small hospitals and nursing homes along with a large number of voluntary organizations providing health care (Bhat, 1993). Chapter One: Literature Review Aims The aim of this review is To analyze the prevalence of CHD in India To analyze the mortality rates related to CHD To understand the aetiology of CHD in India This review will also include a comparison study of the prevalence of coronary heart disease among migrant Indians and the natives of the particular migrant destination countries. Reason for the selection of the topic CHD remains the largest cause of death worldwide. Mortality rates from cardiovascular disease have been known to increase from five-fold to ten-fold around the world (National Institute of Health, National Heart, Lung and Blood Institute, 2000). A World Health Organisation (WHO) Multinational monitoring of trends and determinants in cardiovascular disease (MONICA) study analysed the event rates of CHD among 38 populations between the age group 35-64years, and found variations in CHD prevalence and mortality rates among different ethnic groups (Tunstall-Pedoe et al., 1994). India is a developing country which is seeing an increased rise and prevalence of CHD (Reddy, 2004). While the incidence of coronary artery disease (CAD) has decreased by 50% over the past 30 years in developed countries, in India it has doubled (Kasliwal et al., 2006). Prevalence is an epidemiological measure to determine a how commonly disease or condition occurs in a population, whereas incidence is another epidemiological measure that measures the rate of occurrences of new case of a disease or condition (Le and Boen, 1995). The prevalence of CHD is seen mostly from the age of 35 years and over (Kasliwal et al., 2006). CHD is the second leading cause of mortality in Indians (Patel et al., 2006). Joshi et al., (2006) conducted a survey in the rural areas of Andhra Pradesh, India, the results of which suggested that vascular diseases (including ischemic heart disease and stroke which accounts for 32%) are the main cause of mortality in India when compared to other chronic conditions such as infectious and parasitic diseases, tuberculosis, intestinal conditions, HIV, neoplasm and diseases of the respiratory system. However, CHD mortality rates have decreased in by 50% in most industrialised countries since 1970s (Unal et al., 2004). In United States the decline was seen during the 1980s (US Department of Health and Human Services, 2000), while in the United Kingdom the decline saw a slower pace (British Heart Foundation, 2003). In the United Kingdom the death rates fell by half in the 55-64 age group and slightly less than 40% in men aged 35-44. In women death rates fell by half and a third in those aged 55-64 years and 35-44 respectively (British Heart Foundation- BHF, 2004). However, even though the mortality rates from CHD have fallen it does not suggest that the prevalence has also fallen. The reasons for the decline are not clearly understood but some hypothesise that a reduction in smoking; management for lipid and blood pressure control; modern care for acute coronary syndrome; and secondary prevention has contributed (Luepker, 2008). The increased incidence of CHD has led to the increase in number of Coronary Artery Bypass Grafts (CABG) and other cardiac surgeries. It is estimated that 25,000 CABG surgeries are carried every year in India (World Health Organisation Statistical Information System, 2003). Hence, it could be noted that in a highly populous country like India with its increased prevalence of CHD that the estimated CABG surgeries reaching to the public is actually very few. Therefore, there could be considerable gap between the public need and treatment. Therefore, the reason for this thesis is to help us understand that there is high prevalence in CHD in the Indian population; the specific reasons for this increased epidemic; and how can it be managed so the population can remain healthy. Search strategy The literature was searched with the specific intention of examining the most up-to-date data concerning the prevalence of CAD in India. The search was performed by accessing specialised scientific medical and nursing databases carrying articles regarding the specified subject area (Craig and Smyth, 2002). The databases accessed included the Cumulative Index of Nursing and Allied Healthcare Literature (CINAHL), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and MEDLINE and EMBASE using the Ovid SP interface. The keywords used for the search were: coronary artery disease, ischemic heart disease, and coronary heart disease, South Asians, prevalence, mortality rate, British white, Caucasians and India. The Boolean term AND was used simultaneously. The date range of the studies targeted was set between 1991 and 2009; and was chosen so the most recent evidence could be drawn on, although articles outside this date limit were also incorporated into the search so as to be able to compare whether there have been any changes in the literature over time. To focus the search more strategically the following inclusion and exclusion criteria below were applied. Inclusion and exclusion criteria used to narrow the search The inclusion criteria include prevalence of CHD in both rural and urban areas in order to compare the prevalence of CHD, the date range was set from 1991-2009 so that the recent evidence could be drawn on. The other inclusion criterions were British Indians, American Indians, migrant Indians and South Asians. The patient age group considered was from 35 years over as this matches the known incidences of coronary artery diseases (Kasliwal et al., 2006). The exclusion criteria were other cardiovascular studies such as peripheral artery disease since the literature review focussed on CAD only. Search Results Initially the search revealed 78 potentially relevant papers; however 48 did not contain data pertinent to the inclusion criteria or were not credible sources. The 30 papers that were used for the review included both qualitative and quantitative studies. They included a wide range of international literature to allow a comparison of the prevalence of CHD between British Indians and British whites. The literature that provided evidence from the Indian health care system were all medical journal articles by authors such as Bhardwaj, 2009; Mandal et al., 2008; Kamili et al., 2007; Chow et al., 2006; Patel et al., 2006; Kuppaswamy and Gupta, 2005; Patel et al., 2005; Sharma and Ganguly, 2005; Ward et al., 2005; Indrayan, 2004; Pinto et al., 2004; Gupta et al., 2003; Gupta and Rastogi, 2003; Gupta et al., 2002; Singh et al., 1997; Gupta et al.s 1997; Dhawan, et al 1996; Gupta et al., 1995; Gupta et al., 1993; Kutty et al. 1992. Journals from UK include Zaman et al., 2008; Whincup et al., 2002; Bhopal et al., 1999; Cappuccio et al., 1997; and Journal from Singapore are Mak et al., 2004; Tai and Tan, 2004; Kam et al 2002; Lee et al., 2001. From the analysis of the above literature the following themes were formulated The prevalence of CHD in the mother country, India, both in rural and urban areas. The reasons for the increase in CHD in India. A comparison of CHD prevalence and mortality rate between British Indians and British whites. Credibility of the Literature In order establish the evidence of increased prevalence of CHD in India it is necessary to analyse a wide range of literature. To assess the credibility and reliability of the evidence, the strengths and limitations of the texts were identified. Systematic reviews were used to determine the strength of the evidence. In the hierarchy of evidence, systemic reviews are considered the golden standard. This is because systemic reviews draw on â€Å"Statistical procedure[s] for combining data from a number of studies and investigations in order to analyse the therapeutic effectiveness of specific treatment or interventions.† (Helewa Walker, 2000, p.111). There was only one systematic review available for this literature review (Bhopal et al., 2000). This research paper has a clear search strategy stated, limits, and selection criteria. The search was limited to English research papers, however one exception was that only published studies reporting original comparative data were included. Unpublished studies and studies only reported as abstracts were not included, which ensures rigour in the analysis of the data by having a complete recount of the different studies; this also ensures that the studies had gone through an evaluation committee before being published. The conclusions reached in the systematic reviews support the conclusions reached across the other literature sourced (Mandal et al., 2008; Gupta et al.,1997). Observational studies are considered a good source of evidence, and are similar to Randomized Controlled Trials (RCTs) in terms of effectiveness, appropriateness, and feasibility of the evidence (Craig Smith, 2002). The studies examined as part of this essay also described the setting, location, and relevant dates, including periods of recruitment, exposure, follow-up, and data collection, thereby increasing their robustness (STROBE checklist, 2008). There was one observational study that mentioned its location, time period and setting, and therefore provided credible evidence for the literature review (Wilkinson, 1996). Most of the studies analysed for the literature review were population based surveys, while some studies were clearly addressed and statistically analysed (Mandal et al., 2008; Zaman et al., 2008; Chow et al., 2006; Patel et al., 2005; Mak et al., 2003; Whincup et al., 2002; Lee et al., 2001; Bhopal et al., 1999; Cappuccio et al., 1997, Gupta et al., 1997; Singh et al., 1997; Kutty et al., 1992) ethical issues were mentioned (Cappuccio et al., 1997; Kutty et al., 1992). Some studies however did not explain their statistical analysis (Bhardwaj, 2009; Pinto et al., 2004), and without knowing the specific characteristics of the statistical analysis, the studies cannot be replicated as evidence in this literature review. In regard to qualitative research, a great deal of debate is still going on regarding how to assess the quality of such work (Sandelowski, 1986). In particular, researchers suggest that it is difficult to develop a single benchmark against which the true value of claims can be judged (Craig Smith, 2002). Even though qualitative studies are not considered excellent or even good sources of evidence, based on evidence-based hierarchy, they can address questions that cannot be answered using other experimental methods (Green Britten, 1998). One qualitative study in the literature was used to examine and compare the illness beliefs of South Asian and European patients with coronary heart disease (CHD) about causal attributions and lifestyle change. The method of sampling and data analysis was appropriate. Although the reviews of the literature accessed for this literature review did not prove as rigorous as other sources of evidence, because they did not draw on empirical data, they were used to support the findings of other more robust forms of evidence, which were generated from systematic reviews, observational studies and survey. Reviews of the literature carried out by Goyal and Yusuf, 2006; Kuppaswamy and Gupta, 2005; Sharma and Ganguly, 2005; Tai and Tan, 2004; Barakat et al., 2003; Yusuf et al., 2001; Reddy et al., 1998 provided evidence, however the paper fails to present a search analysis. Evaluation of key studies The prevalence of CHD in India Coronary heart disease has emerged as an epidemic in India (Gupta and Rastogi, 2003). According to the National Commission and Macroeconomics and Health, Government of India the total number of CHD patients in India by the end of the century was around 30 million (5.3% ) of the adult population; this is forecast to increase to up to 60 million cases (7.6%) by the year 2015 (Indrayan, 2004). Although there are various comparative studies showing the burden of cardiovascular disease among Indian immigrants in Western countries, there has been less attention paid to CHD in India itself (Goyal and Yusuf, 2006, Reddy et al., 2004, Yusuf et al., 2001, Anand et al., 2000). Hence, this section of the literature review will focus on the prevalence of CHD in India. In developed countries, there are no rural-urban differences in the prevalence of CHD (Feinleib, 1995). However in India there is marked difference between the prevalence of CHD in the rural and urban areas with surveys showing that the prevalence rate of CHD in urban areas is about double that rural areas (Gupta et al., 2006; Reddy, 1998; Singh et al., 1996; Singh et al., 1997). Studies have been done in various states of India of the prevalence of CHD in the country. For example, Mandal et al., (2008) conducted a cross-sectional survey among the urban population of Siliguri in West Bengal, from a random sample population aged greater than or equal 40 years, to determine the prevalence of ischemic heart disease and the associated risk factors. The results showed that 11.6% had ischemic heart disease (IHD) and 47.2% had hypertension. Males had a higher (13.5%) prevalence of IHD than females (9.4%). About 5% of the patients had asymptomatic IHD. However, this study had a small sample size, which could limit the generalisability of the findings and is limited by the fact that other risk factors like diabetes and lipids were not included. On the other hand, Kutty et al. (1992) conducted a survey among the rural population of Thiruvananthapuram district in Kerala state, to analyse the prevalence of some indicators of coronary heart disease. The indicators included in the study were ECG changes and well-known risk factors such as obesity, hypertension, smoking and diabetes. From the above criteria it was found that rural Thiruvananthapuram has a lower prevalence of coronary heart disease when compared to urban centres like Delhi. However there were drawbacks to this study too, such as the fact that people were sampled on the basis of household list from the panchayat office (panchayat is south Asian rural political system) so anyone who did not belong to the house list in the panchayat was not included in the study. This could have caused a limitation in the generalisability of the results as there was bias in sampling technique. Similarly, Singh et al., (1997) conducted a cross- sectional survey in two villages in Northern India, which showed a significantly higher and increased prevalence of CHD in urban areas compared to rural areas. Reddy also (1998) conducted a cross-sectional survey which found the prevalence rate of CHD as being 6% in the rural areas of Haryana, India. Another study conducted was in the rural areas of Northern India in Himachal Pradesh which showed a CHD rate of 4.06% among the whole rural population in the age group between 50-59 years with a slightly higher incidence in men than women (Bhardwaj, 2009). However these research papers failed to set out their statistical analysis or research analysis, meaning that the reliability of the papers cannot be measured. Nonetheless, it can be noted that the prevalence of CHD was lower in the rural areas and also that the prevalence rates varied in different states of India. Chow et al., (2006) conducted a survey in the rural areas of Andhra Pradesh to investigate the prevalence of cardiovascular disease and levels of managing the major risk factors. Their results showed that cardiovascular disease is highly prevalent and the community knowledge about cardiovascular disease is quite good. However, the results also pointed out that even though people have the knowledge, their management for risk factors remains suboptimal. Hence it could be suggested that even though the people had good awareness regarding CHD the care provided for them was insufficient. Additionally there were a number of studies done to determine the increase in CHD prevalence in urban areas compared to rural areas of India (Pinto et al., 2004; Gupta et al., 2002; Gupta et al., 1995). However there are limitations to these studies, including such factors as: small and variable samples, low response rates, inappropriate diagnostic criteria, non-specific electrocardiographic changes, a lack of standardization, or incomplete results. Gupta et al.s (1997) survey in a rural area (Rajasthan) found that even though the prevalence of CHD was lower in the rural areas, it had nevertheless increased (to 3.4% in males and 3.7% in females) when compared to previous studies. The study was carried out with a detailed questionnaire prepared according to guidelines from the World Health Organization (WHO) the United States Public Health Service and a based on a review of previous Indian studies. The Performa elicited: family history of hypertension and CHD; social factors such as education, housing, type of job, stressful life events, depression, participation in religious prayer and yoga; along with conventional risk factors such as smoking, alcohol intake, amount of physical activity, diabetes, and hypertension. Blood pressure measurements and a 12 lead ECG using proper standardization were performed on all participants. Earlier studies from India used different criteria and showed higher CHD prevalence. When the diagnostic criteria in the present study are extended to include past documentation, response to WHO-Rose Questionnaire and ST-T wave changes in ECG as done in previous studies, the prevalence rises to a rate higher than those found in previous Indian rural studies. However, the results cannot be validated. For example, some of the previous studies from India included ECG criteria as the presence of left bundle branch block, complete heart block and presence of ST segment and T wave changes while some studies suggest that these findings are not reliable enough to diagnose CHD, especially so in females where ST-T changes may be non-specific (Reddy et al., 1996; Gupta et al., 1993). That said, it is clear evidence that there is still an increasing prevalence of CHD in India. Heart diseases are also occurring in Indians 5 to 10 years earlier than in other populations around the world (Dhawan, et al 1996). According to the INTERHEART study, the median age for first presentation of acute Myocardial Infarction (MI) in the South Asian (Bangladesh, India, Nepal, Pakistan, Sri Lanka) population is 53 years, whereas that in Western Europe, China and Hong Kong is 63 years, with more men than women affected (Yusuf et al 2004) (the INTERHEART study was a standardized case-control study that screened all patients admitted to the coronary care unit or equivalent cardiology ward for a first MI at 262 participating centres in 52 countries throughout the world). Epidemiological studies have shown that immigrant Indians share a significantly higher incidence of CHD than the native populations (Enas et al., 2005; Gupta et al., 2002). The first evidence of this was found in a 1959 study among expatriate Indians in Singapore (Kuppaswamy and Gupta, 2005). Similarly many studies have been done in various other countries to corroborate these findings (McKeigue, 1991; Enas et al., 2005). However, in the UK it is only recently that the importance of ethnicity and disparities in regard to CHD has been realised (British Heart Foundation, 2004). Several studies have reported that there is increased prevalence of CHD in British Indians when compared to British Whites (McKeigue, 1991; Bhopal et al., 1999; Enas et al., 2005). Hence, the review of the literature clearly shows the prevalence of CHD among the urban and rural populations in In

Eastman Chemical :: essays research papers

Eastman Chemical Company located in Kingsport, Tennessee is in an industry that produces basic and immediate chemicals, specialty chemicals, agricultural chemicals, petrochemicals, plastics and fibers, and paints and coatings. Eastman also manufactures over 1200 chemicals, fibers and plastics; as well as being the largest supplier of polyester plastics. Currently Eastman employs over 15,000 people in 30 countries with manufacturing sites tactically located in 17 countries, with Asia Pacific Region Office being one of their key offices.   Ã‚  Ã‚  Ã‚  Ã‚  Eastman is known in the chemical industry as a world leader in the e-business. They are the first chemical company to provide their customers with e-business, which allowed them to do business in a much easier and efficient manner. Eastman e-business specializes in an online storefront and transactional Customer Centra; Web-enable auctions; alliances and investments in digital business, along with system-to-system ERP connections. The main focus of Eastman’s e-business was:   Ã‚  Ã‚  Ã‚  Ã‚  1. Creating customer-centric solutions   Ã‚  Ã‚  Ã‚  Ã‚  2. Portfolio of option, along with providing solutions for customers via electronic means   Ã‚  Ã‚  Ã‚  Ã‚  3. Invest in technologies/capabilities that bring value to customers   Ã‚  Ã‚  Ã‚  Ã‚  4. Be externally focused   Ã‚  Ã‚  Ã‚  Ã‚  5. Form partnerships   Ã‚  Ã‚  Ã‚  Ã‚  6. Build an e-brand, which attract customers, suppliers and technology partners   Ã‚  Ã‚  Ã‚  Ã‚  7. Leverage its intellectual capital, industry knowledge, network of contacts, credibility, brand and customer base   Ã‚  Ã‚  Ã‚  Ã‚  By implementing the e-business, Eastman’s customers were able to view products, check status of orders, access certificates of analysis, material safety data sheets, etc. The only problem Eastman originally saw with the e-business model which they have worked so hard to implement was that only 22 of the companies, which they do business with, are connected. And it’s very important to get all the companies connected into their infrastructure, which will provide all their customers with the seven foundational principles.   Ã‚  Ã‚  Ã‚  Ã‚  Knowing the importance of getting the industry knowledgeable and connected to the e-business, Craig Knight, the Asia Pacific Digital Business and Customer Service Manager of Eastman Asia Division was tasked to sell the Eastman’s philosophy. Knight made a two-week trip to Tokyo, Shanghai, and Malaysia to sell Eastman’s integrated electronic supply chain, known as the Integrated System Solution (ISS), to business partners in the industry. He was able to sell Nagase & Co., Ltd, a company in Japan on the ISS, but they had some concerns regarding the system. Knight truly understood their concerns, and made every effort to ease the process by providing the long-term benefits of the ISS to Nagase & Co., Ltd and other business partners.   Ã‚  Ã‚  Ã‚  Ã‚  According to George Eastman, â€Å"business as usual can put you out of business†.

The Thirty Years War Essay -- History, War

The section of documents, numbering nineteen to twenty three, consist of many different accounts ranging from of a portion of the â€Å"Swedish rule of war†, a theologian’s take on peace, the assassination of General Wallenstein, an account of battle and even a Cardinal’s warning. These documents vary in years from 1632-1634, drawing a close to the middle segment of the Thirty Years War. These articles illustrate not only events such as a General’s murder, Swedish defeat or French apprehension, they also show a growing desire for peace and political well-being contrasted with serious religious sentiment. At this stage in history Sweden is now involved with many allying to protect German liberties. The balance of power in Europe, always a delicate manner, was naturally threatened by the war, kingdoms such as France watched closely to protect their own states. It is through the coupling of this time of history with the documents listed here that one ca n see an intricate web of motives, including ones from political success and dominance to religious purity, all under the blanket of a â€Å"religious war†. This leads the audience to ask and judge where Europeans’s opinion and ideas stand considering the war as the unique solution to war loomed ahead. To investigate these different motives three out of the five mentioned documents will be closely analyzed, beginning with document twenty. Entitled â€Å"Memorandum of Hoe von Hoenegg† this article was written in Dresden, Germany by Lutheran Theologian Matthias Hoe von Hoenegg. It is his answer to the Elector of Saxony’s question on the religious consequences of peace. Just before this, the Heilbronn League formed, coming under Sweden and France to fight against imperialist forces. Yet, Sa... ... only one question: how, how would France take these next steps for their national interests. Richelieu ends his letter with this heed, â€Å"but that if, in order to remedy the present evil, one fails to make an extraordinary expenditure now, it will be necessary to make one in the future—through it would then not produce any result, nor prevent our ruin† (152). French involvement is for the protection of the nation, and it would seem this sentiment alone. The above documents seem to be the opinions and views of particular people throughout this tumultuous time. They show two motives: religious and political. What remains is to decipher if this theme is of value and if so, what value does it have and what can it tell historians about the war, as well as the approaching treaty that would come to rule European ideas on religion and government for decades to come.

Reading Books Essay

Reading a book is one of the best forms of entertainment a person can have. Books can take you places to a time and lifestyle that you will never visit or experience. I remember the old show called â€Å"Reading Rainbow† and it lyrics were gave a very interesting take on books they went like this: â€Å"I can twice as high take a look, it’s in a book A Reading Rainbow, I can go anywhere, Friends to know and ways to grow, Reading Rainbow, I can be anything take a look it’s in a book.† Those lyrics are so true. Reading a book you can read about how life was in the 1700’s up until our generation today. I could be a detective who solves a famous mystery or I could be the killer trying to get away. I can learn to speak another language. There are so many things and topics in reading a book that can change your appearance, your political viewpoints, and change your attitude. Some say that books might become obsolete because movies are made from these books and you can watch the movies in two hours. Watching the movies a person feels that you can get the plot and conclusion of the book in two hours. This is true but for example if it is true life story the movie are going to change some parts of the books to make it more enjoyable, whereas the book is going to give you every detail the author wants you to have. Books gives people a conversation piece just like a movie but the only difference is books can join the world. Movies can’t be seen in some countries but a book can be read. So like the Reading Rainbow says â€Å"take a look it’s in a book†. So in conclusion reading a book is the best form of entertainment. Stephanie C. Williams November 20, 2010

Helping Your Child Recover from Sexual Abuse

From a parent point of view I ask the question of how you help your child heal from sexual abuse. I have chosen this because I am a parent that is going through trying to help my child heal from her abuse. As I research the Ashford library, Pro Quest, Goggle, and information from the Women’s Center of Houston. I have found that parents play an important role in helping our children recover from sexual abuse. Just as helping those with school work, trying to tie their shoes, picking out their clothes for the day, or even helping them be successful in the future. It’s our duty as parents to give them support, belief, and protection when they have been through a shocking experience. How do you help your child heal from sexual abuse? Caren Adams and Jennifer Fay, University of Washington Press, 1987, ask the same question. Put yourself in parent’s shoes that are going or has been through what we fear each and everyday. Can you wonder how it feel if your child comes to you and says â€Å"it has happen to me†? What do you do after the shocking news? The nightmare of coping with the sexual abuse of your child begins. Will your child get over it? Will your child grow up to be an offender? What do you do in the days to come? Will this affect your child’s life? Parents of child victims are all over the world are asking this question right now. Hundreds of children are being sexual abuse every year. America reports that every 1 in 4 girls will be sexually abused by thee age of 18, and 1 out of 8 boys will be also. There are many different types of abuse that can occur, but the single most traumatizing type is sexual abuse. Sexual abuse is unwanted sexual activity forced on a person by another through coercion or threats. Now no one wants their child to go through a traumatic experience growing up. So when something like this happens to your child the question still stands. How do you help your child heal from sexual abuse? This question may be hard to answer if you never been in this situation before. I didn’t know how to go about to even find ways on healing for my daughter. Her sexual abuse happen when she was 14 year old. I’ve called several hotlines to speak to social workers, of the Child Assessment Center. I just need the first step in talking to someone about my situation in getting some help for my daughter. The social worker was kind enough to tell me that she might need to go to counseling before it gets too late in the future. Counseling for children and teens that has been sexual abuse is good this will help your child to be able to talk about the abuse that he or she has experienced. It really starts from the beginning, when the first thing you need to do is separate your natural reaction to the horrible news from the disbelief of your child. Feeling of disbelief is called denial, and most of the time they wish that all of this is a bad dream. Children hide their feeling from parents and other people around them. Our role is to support our child/children in recovery through reassurance, safety, and love. A parent of a victim of sexual abuse told me that in order to heal from the pain and hurt. â€Å"We need to find a position of recover first†. From that note I realize that it take parents to be able to heal themselves as well, so that they can help their children heal. We must tell our child/children that we believe them, we love them, I’m sorry that this happen to you, It wasn’t your fault; I will be there to take care of you. The subject on helping your child heal from sexual abuse is important because our children are our future. There is life after the abuse. The victims can become what ever they desire to be in the future and put the hurt in the past. This will allow the healing to take over the world and be successful adults.

How ICT requirements are met in an organisation Essay

Report B: How ICT requirements are met in an organisation Before Haden was introduced ICT, everything was done by hand. This took longer and was not a reliable method of processing information. Haden has many departments and altogether they have many computers. I am going to only analyse one of those departments because doing the whole building with the number of computers will be ridiculous. The department I will be analysing is the Fraud department. This department deals with all the people committing benefit fraud. They work with the police to get those people in court. The Fraud department found it hard to cope without computers. When the computers were introduced everything was easy. Everything needed ICT. In the Fraud department there are 45 computers. Here are the specifications of the hardware. Hardware – Input devices Keyboard- There is 40 standard QWERTY keyboards and 5 ergonomic keyboards. Ergonomic keyboards are QWERTY but the layout is different. The keyboards connect by PS/2 port. Mice- There is 45 standard mice. These come as default on all the computers. The mice connect also connect through PS/2 port. Digital Cameras- These cameras are devices that can take photos or moving images (films) and transfer them on to a PC. The images are JPEG, GIF, UGA, UFO or PSO. There are a total of 4 cameras in the department. The digital cameras connect to the via USB port. Scanners- There is 2 scanners in the department and they also transfer images to the computer. They work like photocopier but can transfer the images to a PC. This device also connects through USB port. Web Cams- The web cams are used to project moving images on to the internet. Only 7 computers have these and they are only used for handling confidential documents. The web cams connect to the computers by the USB port. The web cams are used for personal use. Well, that’s what I think! An input device is something that transfers raw data into a computer for it to be processed. These can include images and evidence from fraud suspects. Output devices Monitors- There is 45 monitors. 5 flat screen monitors, also know as LCD (liquid crystal display) screens and the rest are standard default monitors which are CRT (cathode ray tube) monitors. The monitors connect through the serial port. Colour printer- The colour printers are used to print documents with Haden’s header on them. The colour makes it more professional. The printers connect through the LPT or parallel port. These are the main output devices. They take raw information/data and give it back to us processed. Every computer has many different specifications inside and outside. The computers are all the same so it will be easy to describe them. Below are the specifications. Compaq Deskpro 40 GB Hard drive CD/CD-RW Drive Floppy Drive Zip Drive 512 mb DDR RAM 64 mb DDR Geforce 4 graphics card Creative soundcard Ethernet Card Modem port 4 USB 2. 0 ports 2 serial ports 2 LPT/parallel ports 2 Fire wire ports 2 PS/2 ports 1 game pad port 1 Network port The hard drives are big so that a lot of data can be stored. But there is a downfall to that. It is easier for files to get lost and the file security is not great. The RAM is a ridiculously large. It seems like the computers are made to play games and not do work. This also applies for the graphics card. It also has a large card memory. Most of it is wasted because it is not being used. The department can save a lot of money they had computers which are a bit lower on the specifications. (RAM, Graphics card etc) As all the computers are same, it is easy for me to describe only one of the computers specifications because they have the same specifications like the other computers in the department. There is a large server for the department. The server is very fast and quick. Below are the server specifications. Intel Pentium 4 M 3. 0 GHz processor memory 1024 mb DDR RAM 120 GB Hard drive Tape drive CD/CD-RW Drive Floppy Drive All the computers are Compaq brand. They are reliable and safe to use. Software The computers have different software installed on their hard drives. The computers are new. They have Microsoft Office 2002 installed on their hard drive. They also have other programs like anti-virus. Microsoft Word- This is the default word processing application. It is easy to use and it has many features like recording macros and inserting pictures. Microsoft Excel- This application is installed on the system but it is not used often. It may be used to do calculations for wages and salaries. I am not very sure what it is used for in this department. Microsoft Access- This application is not used. Database- Haden have there own database. It is very complicated to use their database. It comes up as a black screen with white writing. Almost like MS-DOS on old computers. The database holds information of people that have benefits and that commit fraud. You have to be trained to use the database because it is so complicated. This is what I think are in the databases: Name, address, post code, county, age, gender, contact details, national insurance number etc. Outlook Express- Easy to use and is fast for sending and receiving information. The e-mail is not for personal use. The companies boss can other employees can read the personal e-mails. Information is not confidential so it is a great and fast method of transferring data. Internet Explorer is used to surf the web for web related fraud. The internet has a special tracking device that seeks out people using other people’s insurance numbers and other details to get money. Intranet- All the computers are linked to an intranet. The intranet is a small network that only the company personnel can enter. No one from the outside, like me, can enter the intranet. Some of the files are password protected and only those who have the password can enter. Others are common files that everyone linked to the intranet can access. All personnel have their own password. They also have a card key that is used to enter the PC otherwise they do not have access. Norton System works is an antivirus application. All the computers have this software to protect against viruses. There is however a disadvantage. There is no internet firewall. Although one will be installed soon, the security is at risk and therefore hackers can enter easily. Evidence Eliminator is an application that is used to destroy unwanted fraud evidence from the Fraud departments’ computers. The evidence will no longer be available for hackers. Evaluation Haden’s use of ICT is excellent. They are faster now than before computers were introduced. The department of Fraud has found that using ICT is a must for them. Most of it is writing up databases. They have improved in using their own database that has outstanding security due to it being hard to use. There are several advantages and disadvantages. The main one is that the computers can get out of date and will require fixing all the time. Another disadvantage is in the Fraud computers the security is not that good. Hackers can attack it easily. The evidence eliminator application will have to be used several times because there is no firewall and hacker can attack any time. The Fraud department has to step up its security to insure that it is safe to transfer files through the networks. Overall, the organisation has improved in keeping things up to date. The security has to improve for the internet, other than that; the company is sophisticated and well improved.