A Review of the Dr. Seuss Classic, The Lorax

A Review of the Dr. Seuss Classic, The Lorax Since The Lorax, a picture book by Dr. Seuss, was first published in 1971, it has become a classic. For many children, the Lorax character has come to symbolize concern for the environment. However, the story has been somewhat controversial, with some adults embracing it and others seeing it as anti-capitalist propaganda. The story is more serious than most Dr. Seuss books and the moral more direct, but his wonderful zany illustrations, use of rhyme and made-up words and unique characters lighten the story and make it appealing to children 6 and older. The Story A little boy who wants to learn about the Lorax explains to the reader that the only way to find out about the Lorax is to go to the old Once-lers home and give him ...fifteen cents/and a nail/and the shell of a great grandfather snail... to tell the story. The Once-ler tells the boy it all began long ago when there was an abundance of brightly colored Truffula trees and no pollution. The Once-ler concentrated on expanding his business, adding to the factory, shipping more and more fruit and making more and more money. In telling the story to the little boy, the Once-ler assured him, I meant no harm. I most truly did not. / But I had to grow bigger. So bigger I got. The Lorax, a creature who speaks on behalf of the trees, appears to complain about the pollution from the factory. The smoke was so bad that the Swomee-Swans could no longer sing. The Lorax sent them off to escape the smog. The Lorax also angrily pointed out that all of the byproducts from the factory were polluting the pond and he also took the Humming-Fish away. The Once-ler had grown tired of the Loraxs complaints and angrily yelled at him that the factory was going to get bigger and bigger. But just then, they heard a loud sound. It was the sound of the very last Truffula tree falling. With no more Truffula trees available, the factory closed. All the Once-lers relatives left. The Lorax left. What remained was the Once-ler, an empty factory and pollution. The Lorax disappeared, leaving only a small piece of rocks, with the one word...UNLESS. For years, the Once-ler wondered and worried about what that meant. Now he tells the young boy he understands. UNLESS someone like you cares a whole awful lot, nothing is going to get better. Its not. The Once-ler then throws the very last Truffula tree seed down to the boy and tells him hes in charge. He needs to plant the seed and protect it. Then, maybe the Lorax and the other animals will return. Impact What makes The Lorax so effective is the combination of a step-by-step look at cause and effect: how unfettered greed can destroy the environment, followed by an emphasis on positive change through individual responsibility. The storys end emphasizes the impact one person, no matter how young, can have. While the rhyming text and entertaining illustrations keep the book from being too heavy, Dr. Seuss definitely gets his point across. Because of this, the book is frequently used in elementary and middle school classrooms. Dr. Seuss Dr. Seuss was the most prominent of several pseudonyms that Theodor Seuss Geisel used for his childrens books. For an overview of some of his most well-known books, see.

The Wimpy Kid Movie Diary Book Summary

The Wimpy Kid Movie Diary Book Summary The Wimpy Kid Movie Diary is an illustrated account of the making of the movie by series author. Jeff Kinney provides a behind the scenes look at the casting and making of the Diary of a Wimpy Kid movie, as well as its relationship to the Diary of a Wimpy Kid book, the first book in the series. Highlights Kinney then recounts the differing viewpoints of Hollywood executives on what the movie should be like, the initial drafts of the script and the hiring of the director. He describes the search for the perfect young actors to portray Greg and his friend Rowley and their screen test. Kinney includes sketches and essays by the young actors about the character each was to portray, which provide insight as to what they thought about their characters. Author Jeff Kinney and His Books Diary of a Wimpy KidDiary of a Wimpy Kid: Rodrick RulesDiary of a Wimpy Kid: Dog DaysDiary of a Wimpy Kid: The Ugly TruthDiary of a Wimpy Kid: Cabin FeverDiary of a Wimpy Kid: Do-It-Yourself Book

Should professors be allowed to advocate their views on political or Essay

Should professors be allowed to advocate their views on political or social issues in the classroom - Essay Example This article would further give an overview about this topic and would clarify the position of professors educating their students rather then indoctrinating them. (Erin 2007) Indoctrination is a word commonly used by the critics of the professors. This word here means that the knowledge which is being given by the professors should not be one sided or unquestionable. It is unto the students to decide as to what knowledge is right and what is not. Thus the students are required to put forward their own views when the professors are teaching. However the criticism by different organizations about the professors has been counterattacked by the professors. These different organizations have urged the professors to bring in any other subject of study which is not relating to their course material. Anything which is related to the other course of study is not to be guide lined by the professor in the class. However the professors in response to his statement have said that every thing which is being stated in the class and is not in the course material has significant importance. And as in Michael Berube describes in his words that he teaches in his class on d ifferent subjects which are not even in mentioned in the course material. However he counters this action by telling that he can co-relate the topics on which he is teaching to the course materials.

How to Support Biligualism in Early Childhood by Victoria Rodriguez Essay

How to Support Biligualism in Early Childhood by Victoria Rodriguez - Essay Example Finally the article answers important questions and addresses various issues that may arise with the parents or the teachers. I believe that apart from few lines where there is a hint of bias and faulty reasoning, the article is very well written. In these lines, the author makes use of faulty reasoning. One such place is when, with respect to the teachers and administrators, the author mentions ‘This cannot be done without ongoing and in-depth professional development’. I disagree with this point since professional development and experience is not the only thing that matters and it should not be the only criteria. Since this is children that are being dealt with, the criteria should be that the person should not only have an adequate command on both the languages but also be frank, responsible and dedicated no matter whether the person has any professional training or not. Apart from these lines, the whole article is very informative and pleasant to

Information Systems Management in E-Government Essay

Information Systems Management in E-Government - Essay Example For example, the National Health Service (NHS) aims to have â€Å"access to a far wider, and more detailed suite of digital mapping† (The Health and Social Care Information Centre, 2011). Further, according to HM Government and Ordnance Survey (2011), the initiative of Public Sector Mapping Agreement (PMSA) is targeted to create â€Å"a common location data framework for joining up policy and providing services† and achieve â€Å"better planning to meet e-governance targets and initiatives†. Moreover, there are the Local Government Authorities (LGAs) which are to be extensively inter-networked with the help of ICT integration (The Audit Commission, 2002). 2. Can these targets be achieved? The targets cannot be achieved until it is understood that governance in UK is done through different organisations; hence e-governance will call for extensive coordination of various electronic data and processes. 3. What are the types of problems that are being encountered? Th e inability of the local authorities to sufficiently specify their requirements is a serious problem. â€Å"Around one fifth of authorities (are) reporting that they found it difficult or fairly difficult to specify their requirements in e-government contracts.† (Office of the Deputy Prime Minister et al, 2003, p. 30) Lack of understanding of e-governance is another type of problem. Moreover, there are â€Å"a number of accounts of technologies that were delivered late, mis-specified, failed to provide the required functionality and were slow or costly† (Office of the Deputy Prime Minister et al, 2003, p. 16). 4. What are some of the problems involved in private and public IT projects? Wrong selection of technologies is a major problem. In private sector, scarcity of understanding and process education continues to be a debacle (Kelle & Akbulut, 2005; Jankowicz, 2000). Moreover, lack of political will and socio-technical policy framework may lead to serious concerns in public sector IT projects (Bellamy & Taylor, 1998). 5. What is the impact of technology on business? Technology is designed to simplify the business processes and provide decision support. In the business of e-governance, public interactions through advanced technology interfaces would provide greater participation and understanding. (Guo, Fang, & Winston, 2006) 6. What are some of the real world problems of large IT projects? Software programming error or inadequacy can be a major risk for large IT projects. For example, the Department of Communities and Local Government (DCLG) has revealed concerns about creating optimum software for the purpose of digital mapping and related data analysis (The Health and Social Care Information Centre, 2011). Technological integration in the context of â€Å"change management† is another significant problem, as we have seen in the case of Groupware Technologies (Orlikowski & Hofman, 1997, p. 11). Inter-organisational exchange of critical electronic data is another run time problem in large IT projects. (Bigdeli, Kamal, & deCesare, 2011) Section 2: Analysis 1. How can the technologies used in UK E-Government be expanded and developed? The technologies which are being utilized for the purpose of creating a common platform for UK E-Government are organised inside the Electronic Government Interoperability Framework (eGIF) (Cabinet Office, Office of the E-Envoy, 2001). In expanding this system, we need â€Å"a comprehensive framework to examine the factors affecting

Literature Review: Smoking And Coronary Artery Disease

Literature Review: Smoking And Coronary Artery Disease Cigarette smoking highly boosts the risk of coronary artery disease (CAD), and the associated risk is particularly high in subjects with diabetes mellitus (DM) (Mà ¼hlhauser, 1994). The prevalence of smoking worldwide is one and quarter billion adult smokers, 10% of them reside within South East Asian countries. Smoking prevalence in these countries is a range from 12.6% to 40% in Singapore and Laos, respectively. Malaysia is recording 21% adult current smokers (Southeast Asia Tobacco Control Alliance (SEATCA), 2008). Cigarette smoking is estimated to cause more than five million deaths, making it the leading cause of preventable mortality worldwide (Peto et al., 1996). Atherosclerotic cardiovascular disease, chronic obstructive pulmonary disease (COPD) and lung cancer consider the three relevant causes of smoking related mortality (Centers for Disease Control Prevention, 2008). It has well known that cigarette smoking increases the risk of microvascular complications in DM (ie, nep hropathy, retinopathy, and neuropathy) probably by its metabolic effects (worsening diabetes control and insulin resistance) in combination with increased inflammation and endothelial dysfunction. It appears to be stronger in type 1 diabetic patients, while the enhanced risk for macrovascular complications, coronary heart disease (CHD), stroke, and peripheral vascular disease, is most pronounced in type 2 diabetic patients (Eliasson, 2003, Haire-Joshu et al., 1999, Solberg et al., 2004). Smoking cessation can safely and cost effectively be recommended for all patients, and it is a gold standard against which other preventive behaviors should be evaluated. Stopping smoking at any age has a considerable impact on improving life expectancy, reducing morbidity and reducing health care costs associated with treating smoking related conditions (Asaria et al., 2007, Ward, 2008), but effective strategies are lacking cessation support (Everett and Kessler, 1997). There are several treatment interventions have been identified as essential to achieve cessation. These interventions include brief counseling by multiple health care providers, use of individual or group counseling strategies, and use of pharmacotherapy (Haire-Joshu et al., 1999). Smoking cessation medicines are among the most cost-effective disease prevention interventions available (Fiore, 2000). There are several types of them assist in smoking cessation are available. (Wu et al., 2006). The 2008 update to Treating Tobacco Use and Dependence, a Public Health Service-sponsored Clinical Practice Guideline Panel identified seven first-line (FDA-approved) medications (bupropion SR, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch, and varenicline) and two second-line (non-FDA-approved for tobacco use treatment) medications (clonidine and nortriptyline) as being effective for treating smokers (Fiore et al., 2008). The most commonly used formulation is nicotine replacement therapy (NRT). It reduces motivation to smoke and many of physiological and psychomotor withdrawal symptoms usually experienced during an attempt to quit smoking, and therefore, may increase the likelihood of remaining abstinent (Gourlay and McNeil, 1990, W est and Shiffman, 2001). NRT is currently recommended as a safe intervention to general populations and higher-risk groups, including pregnant and breastfeeding women, adolescents, and smokers with cardiovascular disease (National Institute for Health and Clinical Excellence (NICE), 2008). Systematic reviews show that all forms of NRT have been proven to be effective (Fiore et al., 2008) and it increase quit rate one and a half to two fold in comparison with placebo. There are many studies provide good evidence that smoking cessation pharmacotherapy enhance the success of quit smoking attempt (Cahill et al., 2008, Fiore et al., 2008, Hughes et al., 2007, Stead et al., 2008). Unfortunately, there are insufficient evidences to recommend one delivery system over another. Literature review This review will cover the aims of this research. Globally, it was estimated that there are about 1.3 billion smokers, half of whom will die from smoking-related diseases (Shafey et al., 2009). While in Malaysia, the Third National Health and Morbidity Survey has reported some decline in smoking statistics among general population (18 years and above) in Malaysia with an overall smoking rate of 21.5%; male and female smoking rates of 46.4% and 1.6%, respectively (Ministry of Health, 2006). To our knowledge, there is limited information about the prevalence of smoking among diabetes mellitus patients, but it seems to be mirror to general population, at least for young adults. Findings from the national Behavioral Risk Factor Surveillance System show that the prevalence of smoking in young adults with diabetes mellitus is similar to the prevalence in the general population (Ford et al., 2004). Other study in the United States found the age-adjusted prevalence of smoking was 27.3% and 2 5.9% among people with and without diabetes, respectively. The prevalence of smoking did not differ significantly between participants in both groups when they were stratified by age, sex, race, or education (Ford et al., 1994). Few studies examined the prevalence of tobacco use with diabetic patients, information that is critical for targeting prevention efforts. There is no estimated prevalence for smoking in diabetes mellitus patients in Malaysia. Few studies was conducted about the knowledge and awareness of diabetic patients towards smoking cessation and its pharmacotherapies. There is a survey done in the United Kingdom to investigate awareness of pharmacotherapeutic aids to smoking cessation in diabetic cigarette smokers. A structured questionnaire-based interview was held by research nurse individually with current smokers in a private room. Of 597 diabetic patients attending a routine clinic, one hundred diabetic patients were current smokers. The majority of them were type 2 diabetic patients (96%). There were 66% and 54% had heard about NRT and bupropion, respectively. Those who had heard about NRT, only 49% considered it safe with diabetes, while who knew of bupropion 39% thought it unsafe in diabetic patients. Approximately 84% were aware of the UK National Health Service (NHS) quit line, but only 8% had used it. The authors conclude that this subpopulation has poor knowledge and awareness of NRT and bupropion as aid s to quit smoking (Gill et al., 2005). A qualitative study done in the United States, aimed to investigate beliefs about cigarette smoking and smoking cessation among Urban African Americans with Type 2 Diabetes. Focus groups and a short survey were used to assess cigarette use patterns, perceived smoking health effects, preferences for treatment, and attitudes toward smoking cessation among this subpopulation. Twenty five participants were included in this study. The mean age was (SD) 48.5 years ( ±10.23), 60% female, smoked 20.9( ±12.54) cigarettes per day. Regarding the beliefs and knowledge about smoking and diabetes, Participants believed that smoking increased their risk for all health outcomes, though there was not a clear understanding of how. Furthermore, they believed smoking decreased their appetite and quitting smoking makes you gain weight, and that it would negatively affect diabetes. Regarding beliefs and opinions about stopping most participants desired to quit and believed it was important t o quit, but were not motivated to quit or confident they could achieve cessation (Janet L. Thomas et al., 2009). Another study established in the United States, aimed to assess what smokers believe about the health risks of smoking and the effects of smoking filtered and low-tar cigarettes, as well as their awareness of and interest in trying so-called reduced risk tobacco products and nicotine medications. It was conducted between May and September 2001. They gathered data on demographic characteristics, tobacco use behaviors, awareness and use of nicotine medications, beliefs about the health risks of smoking, content of smoke and design features of cigarettes, and the safety and efficacy of nicotine medications. The findings of this study showed a substantial percentage of respondents either answered incorrectly or responded dont know to questions about health risks of smoking (39%), content of cigarette smoke (53%), safety of nicotine (52%), low-tar cigarettes and filtered cigarettes (65%), additives in cigarettes (56%), and nicotine medications (56%). The smokers characteristics most commo nly associated with misleading information when all six indices were combined into a summary index were as follows: those aged 45 years or older, smokers of ultra-light cigarettes, smokers who believe they will stop smoking before they experience a serious health problem caused by smoking, smokers who have never used a stop-smoking medication, and smokers with a lower education level. Those who believed they would stop smoking in the next year were more knowledgeable about smoking. The authors conclude that smokers are misinformed about many aspects of the cigarettes they smoke and stop smoking medications (Cummings et al., 2004). Unfortunately, there is a dearth of information on the efficacy of smoking cessation pharmacotherapies in diabetic patients because large-scale studies involving this group do not report results separately for them. Additionally, there are few direct head to head comparison studies among them in this subgroup population. In an open-label, randomized trial conducted in Belgium, France, the Netherlands, the United Kingdom, and the United States, compared varenicline with transdermal NRT for smoking cessation. Participants were randomized to receive either 12 weeks of varenicline or 10 weeks of transdermal NRT (Aubin et al., 2008). The primary end point was continuous abstinence rate (CAR) during the last 4 weeks of each treatment. Secondary end points were CARs from the last 4 weeks of treatment through weeks 24 and 52 and the 7-day point prevalence of abstinence assessed at the end of treatment, week 24, and week 52. The Minnesota Nicotine Withdrawal Scale (MNWS) and The modified Cigarette Evaluation Questionnaire (mCEQ) measures of craving, withdrawal, and smoking satisfaction were assessed at baseline and at each weekly visit through week 7 (or at early termination). Data were analyzed in both the prespecified primary analysis population (all randomized participants who received at least 1 dose of study drug: 376 varenicline, 370 NRT) and the all-randomized population (378 varenicline, 379 NRT). CARs were significantly higher in the last 4 weeks of treatment of varenicline group compared with NRT group (55.6% vs 42.2%, respectively; Odds ratio (OR) = 1.76; 95% CI, 1.31-2.36; P < 0.001). At week 24, there was no significant difference in CARs (32.2% and 26.6%; OR = 1.33; 95% CI, 0.97- 1.82). At week 52, CARs were not significantly higher for varenicline over to NRT in the primary analysis population, although the difference in CARs remain significant through week 52 in all-randomized population analysis (25.9% vs. 19.8%; OR = 1.44; 95% CI, 1.02-2.03; P = 0.04). The 7-day point prevalence of abstinence at week 12 was significantly higher for varenicline compared with NRT (62.0% vs 47.0%, respectively; OR = 1.71; 95% CI, 1.27-2.30; P < 0.001). The d ifferences in 7-day point prevalence of abstinence were not significant at week 24 or week 52. For weeks 1 through 7, the average scores of MNWS and mCEQ for cravings, withdrawal symptoms, and the reinforcing effects of smoking were significantly lower with varenicline compared with NRT (all population analysis, P à ¢Ã¢â‚¬ °Ã‚ ¤ 0.001). Varenicline group had significantly lower MNWS subscale scores for negative affect and restlessness compared with NRT (both, P < 0.001); there was no difference between varenicline and NRT in the subscale scores for increased appetite or insomnia. A guideline Treating Tobacco Use and Dependence: 2008 Update is a product of the Tobacco Use and Dependence Guideline Panel. This guideline contains strategies and recommendations designed to assist clinicians; tobacco dependence treatment specialists; and health care administrators, insurers, and purchasers in delivering and supporting effective treatments for tobacco use and dependence (Fiore et al., 2008). A meta-analysis displayed the effectiveness of the first-line smoking cessation medications compared with placebo at 6 months post-quit. They determined the estimated abstinence rate and odds ratio at 6 months post-quit (95% CI) compared with placebo estimated abstinence rate of 13.8% and estimated odds ratio of 1.0. Varenicline had the highest estimated abstinence rate and odds ratio (33.2% and 3.1), while nicotine gum had the lowest estimated abstinence rate and odds ratio (19.0% and 1.5). Another multicenter, randomized, double-blind, placebo-controlled trial compared the efficacy and safety of varenicline with placebo for smoking cessation in 714 smokers with stable cardiovascular disease that had been diagnosed for > 2 months. Participants received either varenicline (1 mg twice daily) or placebo at ratio 1:1, along with smoking-cessation counseling, for 12 weeks. Follow-up lasted 52 weeks. The primary end point was carbon monoxide-confirmed CAR for last 4 weeks of treatment. The secondary outcomes were the CAR from week 9 through 52; CAR for weeks 9 to 24 and 7-day point prevalence of tobacco abstinence at weeks 12 (end of drug treatment), 24, and 52. The CAR was higher for varenicline than placebo during weeks 9 through 12 (47.0% versus 13.9%; odds ratio, 6.11; 95% CI, 4.18 to 8.93) and weeks 9 through 52 (19.2% versus 7.2%; odds ratio, 3.14; 95% CI, 1.93 to 5.11). The varenicline and placebo groups did not differ significantly in cardiovascular mortality (0.3% ve rsus 0.6%; difference, _0.3%; 95% CI, _1.3 to 0.7), all-cause mortality (0.6% versus 1.4%; difference, _0.8%; 95% CI, _2.3 to 0.6), cardiovascular events (7.1% versus 5.7%; difference, 1.4%; 95% CI, _2.3 to 5.0) (Rigotti et al., 2010). Nides and his colleagues conducted a multicenter, double-blind, placebo-controlled, trial to evaluate the efficacy and tolerability of three varenicline doses in adult smokers. Bupropion hydrochloride was included as an active control. Participants were randomized to receive varenicline 0.3 mg once daily, varenicline 1 mg once daily, varenicline 1 mg BID, bupropion SR 150 mg BID, or placebo for 7 weeks, with the option of participation in follow-up through week 52. The varenicline groups received active drug for 6 weeks, followed by placebo for 1 week. The primary efficacy outcome in this study was CAR for any 4-week period from baseline through week 7. Secondary efficacy outcomes involved the 4-week CAR for weeks 4 through 7, 4 through 12, 4 through 24, and 4 through 52; cravings and withdrawal symptoms, assessed using the MNWS and the brief Questionnaire of Smoking Urges (QSU-brief); reinforcing effects of smoking, assessed using the mCEQ; and changes in body weight (Nides et al., 2006). The findings of this study presented that the patients treated with varenicline (except of those who received varenicline 0.3 mg once daily) or bupropion SR had significantly higher CARs for any 4 weeks compared with placebo (P < 0.001 and P = 0.002, respectively). The CARs for any 4 weeks were 48.0% for varenicline 1 mg BID (OR = 4.71; P < 0.001), 37.3% for varenicline 1 mg once daily (OR = 2.97; P < 0.001), 33.3% for bupropion SR (OR = 2.53; P=.002), and 17.1% for placebo. No statistical comparison was performed between the varenicline and bupropion SR groups. Only varenicline 1 mg BID was significantly more efficacious than placebo throughout the entire follow-up period (P à ¢Ã¢â‚¬ °Ã‚ ¤ 0.01). Varenicline 0.3 mg once daily and varenicline 1 mg once daily were significantly more efficacious than placebo through week 7 (P à ¢Ã¢â‚¬ °Ã‚ ¤ 0.05), and bupropion SR was significantly more efficacious than placebo through week 12 (P à ¢Ã¢â‚¬ °Ã‚ ¤ 0.05). Scores on the MNWS and QSU-brief indicated reductions from baseline in cravings with varenicline 1 mg BID compared with placebo at each weekly time point during active treatment (week 2: P < 0.01; weeks 1 and 3-6: P < 0.001). Varenicline 1 mg BID was also associated with consistent improvements from baseline (the day before the TQD) to week 1 in scores on several subscales of the mCEQ compared with placebo, including satisfaction (mean change, -4.82; P < 0.05), enjoyment of respiratory tract sensations (mean change, -0.84; P < 0.05), and aversion (mean change, 0.82; P < 0.05). (The mCEQ was not used beyond week 1 of the active-treatment period.) There were no significant differences on any of the mCEQ measures between the lower doses of varenicline and placebo (Nides et al., 2006). Rationale/Justification Few studies examined the prevalence of tobacco use with diabetic patients, information that is critical for targeting prevention efforts. To our knowledge, there is no estimated prevalence for smoking in diabetes mellitus patients in Malaysia. Most people today recognize major health risks from smoking, but this general knowledge does not necessarily translate into a belief that one is personally at high risk of becoming seriously ill as a consequence of smoking. Furthermore, general awareness of health risks does not mean that people are adequately informed about smoking in ways that might influence their smoking behavior. Because the knowledge, beliefs, and preferences of smokers facilitate maximum receptivity to programs, these are important considerations when developing effective cessation interventions. Therefore, we will investigate smokers knowledge about the health risks of smoking and their awareness of nicotine medications. Unfortunately, there is a dearth of information on the efficacy of smoking cessation pharmacotherapies in diabetic patients because large-scale studies involving this group do not report results separately for them. Additionally, there are few direct head to head comparison studies among them in this subgroup population. Objectives General objectives Determine the prevalence of smoking among diabetic patients in outpatient clinic at General Hospital Penang. To investigate diabetic smokers knowledge about the health risks of smoking and their awareness of nicotine medications. To estimate direct head-to-head comparison between varnicline and nicotine patch regarding to their efficacy in smoking cessation. Specific objectives Determine the prevalence of smoking among diabetic patients. To assess the knowledge of diabetic smokers about the health risks of smoking and their awareness of nicotine medications. To compare between varenicline and NRT in the abstinence rate of smoking. To compare between varenicline and NRT in the cravings and withdrawal symptoms, assessed using the MNWS and QSU-brief. To compare between varenicline and NRT in the reinforcing effects of smoking, assessed using the mCEQ. To compare between varenciline and NRT in changes in body weight. Research Methodology Study design This study comprises different types of study design according to the different objectives. For estimating the prevalence of the smoking among DM patients, it will be achieved by review the medical records for all diabetic patients who attend the diabetic outpatient clinic during 2010. Besides assessing the smoking status, we will collect also specific demographic and diabetic-related data. Any medical records does not contain information about smoking status will be excluded. The second objective in investigating knowledge and awareness of diabetic smokers about the health risks of smoking, smoking cessation and smoking cessation pharmacotherapies, the study design it will be cross-sectional survey. All the diabetic smoker patients who attend the outpatient diabetic clinic at General Penang Hospital in 2011 will be invited to participate in the survey. The questionnaire will be either distributed or interviewed by the clinical staff. The questionnaire will be based on another study. More detailed information on how the survey was conducted can be found elsewhere (Cummings et al., 2004). The questionnaire will be divided to two sections involving: socio-demographic, tobacco-related and diabetes-specific health information; knowledge and awareness towards the health risks of smoking and their knowledge of smoking cessation and smoking cessation pharmacotherapies. The sociodemographic information will include (age, sex, race à ¢Ã¢â€š ¬Ã‚ ¦ etc); diabetic-related information, it will contain: type of diabetes, type of diabetic treatment, duration of diabetes; while for smoking related information will involve: number of cigarettes smoking per day, age started smoking, duration of smoking, are there any attempt to stop smoking for any period of time, Are there other smokers in the household. To compare treatment effect of varenicline and nicotine patch in abstinence rate of smoking cessation for diabetic smoker patients and to investigate the impact of the smoking cessation on the diabetic control. The study design will be randomised, open-label, parallel group study. The participants will be randomized in a 1:1 ratio either to varenicline or nicotine patch treatments. Subject who will receive varenicline will administer 0.5 mg/day for 3 days, 0.5 mg twice daily for 4 days, then 1 mg twice daily thereafter. Full dosing was achieved by the target quit date (TQD) and continues up to 12 weeks. Participant who will receive nicotine patch applied transdermal patches each morning starting on the TQD for 10 weeks. Doses of NRT were 21 mg/day for the first 6 weeks, 14 mg/day for 3 weeks, then 7 mg/day for 3 weeks. We choose these two treatments (nicotine patch and varenicline) for several reasons. Nicotine patch is the most commonly used pharmacotherapy for smoking cessation (Burton et al., 2000, Pierce et al., 1995, West et al., 2001). Given that many smokers in general population use this treatment to quit smoking, it is important to determine treatment effect of other agents relative to the patch. Furthermore, recent data suggest that there is decline in the efficacy of nicotine patch over the previous 10 years (Irvin et al., 2003, Jorenby et al., 1999, Pierce and Gilpin, 2002). Varnecline is selected in this study because yet there is limited studies publish about the effectiveness of this treatment in the diabetic smoker population. Also, varnecline was found to be the highest efficacy in the 2008 PHS Guideline meta-analysis (odds ratio 3.1) comparing to placebo (Fiore et al., 2008). Finally, smokers could be encouraged to seek out this prescribed agent, and insurers and health care syste ms could be encouraged to make this treatment more widely available, if it could be demonstrated that varnecline is more efficacious than over-the-counter medication (such as nicotine patch). In this study we will collect three types of end points: efficacy, measuring of craving and withdrawal symptoms, and investigating the impact of smoking cessation on diabetic outcome. The primary outcome for efficacy in the study it will be self-reported CAR, confirm by exhaled CO levels of 6 ppm or below, during the last 4 weeks of treatment (varenicline and NRT, weeks 9-12 after TQD) The secondary is the CAR from the last 4 weeks of each treatment until 6 months. Other secondary outcomes are 7-day point prevalence of tobacco abstinence at weeks end of drug treatment and at 6 months. Continuous abstinence define as self-reported abstinence from any tobacco- or nicotine-containing product during the specific period and it will be verified by carbon monoxide (CO) level à ¢Ã¢â‚¬ °Ã‚ ¤ 10 ppm. If the CO level is more than 10 ppm will be classified as a smoker regardless of self-reported abstinence. Point prevalence abstinence define as self-reported abstinence from any tobacco- or nicotine-containing product in the past 7 days that was not contradicted by expired air CO > 10 ppm. These are traditional standards for assessing efficacy of smoking cessation interventions (Fiore et al., 2008, Hughes et al., 2003). The Minnesota Nicotine Withdrawal Scale (MNWS) (Cappelleri et al., 2005) will be used to assess urge to smoke, depressed mood, irritability, anxiety, poor concentration, restlessness, increased appetite and insomnia. The modified Cigarette Evaluation Questionnaire (mCEQ) (Cappelleri et al., 2007) will be used to assess smoking satisfaction, psychological reward, aversion, enjoyment of respiratory tract sensations and craving reduction. The two previous questionnaires will be administered baseline visit and at each weekly visit through week 6 (after TQD) and at the end of treatment or at termination for participants who discontinued the study before week 6 (TQD). While the MNWS will be administered to all participants, the mCEQ will be administered only to participants who report smoking since their last completed questionnaire. Furthermore, we will assess the level of the nicotine dependence by using the Modified Fagerstrà ¶m Test for Nicotine Dependence (Heatherton et al., 1991) that range to three score ranges: (0-3) score indicate to low dependent, (4-6) score indicate to moderate dependent and (7-10) score indicate highly dependent. It will be administered at the baseline of the study. Schematic presentation of study design: Screening all diabetic patients medical records to estimate prevalence of smoking among them Interviewed structured questionnaire for all diabetic smoker to: To know characteristics of diabetic smoker (sociodemographic, diabetic history and tobacco use history) Investigate the knowledge towards smoking cessation and its pharmacotherapies Patients who attend quit smoking clinic Assessed for eligibility Excluded: Did not meet entry criteria Withdrew consent Randomized at ratio 1:1 Allocated to Varnicline (2mg or 1mg) (For 12 weeks) and arrange for quit date Allocated to nicotine Patch (For 12 weeks) and arrange for quit date Follow up at the end of treatment (12 weeks) and at 6 months to assess: Abstinence rate of smoking cessation the cravings and withdrawal symptoms the reinforcing effects of smoking changes in body weight Analysis Inclusion criteria The inclusion criteria it will be varying among the different objectives: For investigating the knowledge and awareness towards smoking cessation and its pharmacotherapies, smoker and ex-smoker diabetic patients (either type I or II) of both sexes aged à ¢Ã¢â‚¬ °Ã‚ ¥18 years will be included. For the direct comparison between nicotine patch and varenicline, Diabetic smokers of both sexes aged à ¢Ã¢â‚¬ °Ã‚ ¥18 years who smoke à ¢Ã¢â‚¬ °Ã‚ ¥10 cigarettes/day and willing to quit smoking. Exclusion criteria Patient is currently using any form of tobacco other than cigarettes; any form of NRT or other smoking cessation therapy. Significant depression requiring behavioral counseling and those using medications with psychoactive effects (e.g., antidepressants, antianxiety agents). other active psychiatric diseases because of previously identified limitations with delivery of the specific counseling intervention in such subjects. History of skin allergies or evidence of chronic dermatosis. Patient has medical contraindications for any of the study medications. Pregnant, breastfeeding women or at risk of becoming pregnant. Drug abuse or HIV infected patient. Recent (à ¢Ã¢â‚¬ °Ã‚ ¤3 months) history of myocardial infarction, angina pectoris, serious cardiac arrhythmia, or other medical conditions that the healthcare provider deemed incompatible with study participation. Participation within the last 12 months in a formal smoking cessation program.

Parks, Moments and Forests Endangered Essay -- Conservation

Parks, Moments and Forests Endangered One of the best ideas this country did was the creation our system of national monuments, parks, and forests; as well used as a model for our state parks. Historically, parks and forests were the domain of the very rich, influential, and the powerful where they could hunt and relax. Here in the United States that mindset prevailed that until the mid-1860s. With the discovery in the early 1800’s by who were called mountain men of boiling hot mud, steam being emitted out of the ground, water being ejected out of the ground that at first was dismissed as nonsense and was dubbed â€Å"Colter’s Hell† (Burns). This is until a prestige’s expedition brought back detailed description of hot springs, the boiling mud, and of course the geysers. After this time a sense was gaining momentum that we, as a nation, should preserve such wonders for not only the rich and powerful, but for all citizens to enjoy. Our parks became the last refuge of animals that otherwise hav e disappeared forever (Burns). Our national park system for the creating of the first national park at Yellowstone, they continue to evolve of who should control the national parks, what should be contained within their boundaries, even if they should exist at all (Burns). A push for the creation of a â€Å"Nations Park† came due to the near ruin of Niagara with landowners owning every vista and overlook of the falls and charging a fee, commercialization gone wild and what became a national embarrassment (Burns). While Yellowstone is officially the first national park, Yosemite with a bill passed in 1864 introduced a bill to protect the Yosemite Valley and signed by President Lincoln. This became a cascade of more parks being created, but not only fo... ...dea. Prod. Ken Burns and Dayton Duncan. Perf. Peter Coyote. PBS, 2009. DVD. Sharon, Susan. Maine Lawmakers Resolve to Oppose Creation of a National Park. PBS. MPBN, Maine, 17 June 2011. Maine Lawmakers Resolve to Oppose Creation of a National Park. PBS, 17 June 2011. Web. 13 Mar. 2012. United States. Department of the Interior. National Park Service. Budget. By GPO. National Park Service, 18 Jan. 2012. Web. 11 Apr. 2012. United States. Department of the Interior. National Park Service. National Park Service Cultural Resources Discover History. By Robert W. Righter. The Western Historical Quarterly. Web. 13 Mar. 2012. United States. Department of the Interior. National Park Service. Wildland Fire in Yellowstone. By GPO. National Park Service. Web. 11 Apr. 2012. The Yosemite Valley Case. Supreme Court. Dec. 1872. FindLaw. Thomson Reuters Business. Web. 8 Apr. 2012. Parks, Moments and Forests Endangered Essay -- Conservation Parks, Moments and Forests Endangered One of the best ideas this country did was the creation our system of national monuments, parks, and forests; as well used as a model for our state parks. Historically, parks and forests were the domain of the very rich, influential, and the powerful where they could hunt and relax. Here in the United States that mindset prevailed that until the mid-1860s. With the discovery in the early 1800’s by who were called mountain men of boiling hot mud, steam being emitted out of the ground, water being ejected out of the ground that at first was dismissed as nonsense and was dubbed â€Å"Colter’s Hell† (Burns). This is until a prestige’s expedition brought back detailed description of hot springs, the boiling mud, and of course the geysers. After this time a sense was gaining momentum that we, as a nation, should preserve such wonders for not only the rich and powerful, but for all citizens to enjoy. Our parks became the last refuge of animals that otherwise hav e disappeared forever (Burns). Our national park system for the creating of the first national park at Yellowstone, they continue to evolve of who should control the national parks, what should be contained within their boundaries, even if they should exist at all (Burns). A push for the creation of a â€Å"Nations Park† came due to the near ruin of Niagara with landowners owning every vista and overlook of the falls and charging a fee, commercialization gone wild and what became a national embarrassment (Burns). While Yellowstone is officially the first national park, Yosemite with a bill passed in 1864 introduced a bill to protect the Yosemite Valley and signed by President Lincoln. This became a cascade of more parks being created, but not only fo... ...dea. Prod. Ken Burns and Dayton Duncan. Perf. Peter Coyote. PBS, 2009. DVD. Sharon, Susan. Maine Lawmakers Resolve to Oppose Creation of a National Park. PBS. MPBN, Maine, 17 June 2011. Maine Lawmakers Resolve to Oppose Creation of a National Park. PBS, 17 June 2011. Web. 13 Mar. 2012. United States. Department of the Interior. National Park Service. Budget. By GPO. National Park Service, 18 Jan. 2012. Web. 11 Apr. 2012. United States. Department of the Interior. National Park Service. National Park Service Cultural Resources Discover History. By Robert W. Righter. The Western Historical Quarterly. Web. 13 Mar. 2012. United States. Department of the Interior. National Park Service. Wildland Fire in Yellowstone. By GPO. National Park Service. Web. 11 Apr. 2012. The Yosemite Valley Case. Supreme Court. Dec. 1872. FindLaw. Thomson Reuters Business. Web. 8 Apr. 2012.