Muscle Training Intervention in Heart Failure Article Review

Muscle Training Intervention in Heart Failure Article Review Principles of Research in Nursing Practice A Critical Appraisal of Padula, C. A., Yeaw, E. and Mistry, S. (2009) A home-based nurse-coached inspiratory muscle training intervention in heart failure. Applied Nursing Research, 22: 18-25. Guidelines by Burns and Grove (2011) form the basis of this appraisal. Statement of the problem purpose of the study Padula et al. (2009) begin by discussing the clinical problem that led to the research being conducted. Disabling dyspnoea in heart failure (HF) is affecting patients’ quality of life. Impaired inspiratory muscle function has been recognised as a potential source of dyspnoea in HF. The purpose of the research emerges logically from the clinical problem which is to determine the effectiveness of an inspiratory muscle training intervention (IMT) on dyspnoea and health-related quality of life (HRQOL). The purpose of the study is directly linked to the clinical problem because the experimental hypothesis; if upheld may facilitate improved therapies for HF patients. Literature Review This section is clearly defined and well organised. A review of the abstracts for the eight sources cited in the ‘IMT in HF’ section denotes that all are relevant primary data-based studies. There are only two sources cited within 5 years of the acceptance date for publication. Sources should be current (Burns Grove, 2011). The researchers fail to acknowledge whether a systematic search strategy was exercised (Moule Goodman, 2009). Furthermore, the investigators may have found additional sources if they had included theoretical literature. Padula et al. (2009) paraphrase the knowledge gleaned from each source and form a critique of the overall methodology used in these studies. Three of the studies did not employ a control group; this decision may have threatened their capacity to infer causal relationships. In the RCTs, sample sizes were small and effect sizes were not published. Consequently, the ability to detect differences in outcomes between groups was compromised (Seers Critelton, 2001). The literature review identifies gaps in the knowledge base which builds a case for the present study. Padula et al. (2009) report that further research is necessary to determine the precise intensity of IMT. Study Design Sample There is ambiguity regarding the study design as the researchers refer to the study as an RCT on two occasions. On closer inspection, the study does not meet the criteria for this classification as complete experimental control is not possible (CASP, 2014). The study is a two-group quasi-experiment with pre- and post-test design (Hek Moule, 2006). This design is appropriate to address the research question. Although participants are assigned to groups with equal probability, the method selected (i.e. coin toss) is not entirely appropriate for small sample sizes (i.e. n=31) because it may lead to imbalance between the size of the experimental group and control group. Schulz Grimes (2002) explain that when a succession of tails or heads is thrown, it is tempting for the researchers to modify the results. This may result in subtle differences between groups. A more sophisticated method would be to use computer generated random numbers (Crombie, 2005). RCTs are conducted in research units to ensure greater control over extraneous variability. The present study was conducted in patients’ homes. The research population was stable HF patients without coexisting pulmonary disease or cognitive impairment. The sampling method is nonprobability convenience because the researchers recruited participants by means of newspaper advertisements and physicians’ offices (Clark-Carter, 2001). This method may have excluded patients who did not visit their physician on a regular basis. The article fails to include a power analysis; a test to assess the study’s ability to detect significant differences. The researchers acknowledge that the sample was small (n=31). An effect size for IM strength was reported (d=0.48). Data Collection The data collection methods are appropriate for measuring the dependent variables (Padula et al. 2009). Test-retest reliability values are documented for the following measures: PI max, the Borg scale (1982), and self-efficacy. These values should be documented for all data collection methods (Burns Grove, 2011). This useful statistical test is a measure of the stability of the scores elicited over time (Sim Wright, 2000). A Chronbach’s alpha score was only documented for one of the measures. This statistical test measures internal consistency; i.e. how confident are we that the individual items in a scale are accurately measuring the same construct (Clark-Carter, 2001). The article reports that the research assistants followed a specified protocol, however this is not provided in the report. The article should document all the steps taken to reduce errors during the data collection process (Burns Grove, 2011). For example, it is unknown whether steps were taken to reduce user error in taking physiological measurements such as respiratory pattern. Measurements were taken at spaced intervals (i.e. weeks 1, 3, 6, 9 12); this design feature strengthens our confidence in the findings. Mention should be made here of the possibility of demand effects; the notion that participants may have modified their responses on the Borg scale to match the expectations of the study (McCambridge et al. 2012). Analysis The inferential analyses (ANOVA) conducted are appropriate for the type of data collected (Ratio/interval and ordinal; Dancey Reidy, 2011). Post hoc analyses were used to detect the location of the differences in two of the dependent variables; a best practice approach. A table showing all mean scores including significance levels for each dependent variable would be beneficial to the reader. A significant difference was detected for IMT strength in the experimental group (p Discussion The key findings are clearly stated and are consistent with previous literature. The researchers offer an alternative explanation to account for why a significant improvement in IM strength and dyspnoea in the IMT group was found. Participants may have become accustomed to the technique of generating high maximal inspiratory pressures; this is referred to as the training effect. This is a confounding variable that could compromise the internal validity of the study. The researchers account for why the secondary aim of the study was not met. The measurement for self-efficacy (the CSES) was inadequate for the purpose it was intended for. The researchers acknowledge the study’s limitations – the relatively small sample size (n=31). The strict inclusion criteria effects external validity as the findings cannot be generalised to patients with HF and coexisting COPD which is prominent in the population. This is acknowledged as a potential source of error. The study contributes to an evidence base for the use of IMT as an additional treatment for stable HF and provides recommendations for future research. Word count: 1100 References Borg, G. (1982). Psychophysical bases of perceived exertion. Science in Sports and Exercise, 14 (5): 377-381. Burns, N. and Grove, S. K. (2011) Understanding nursing research: building an evidence-based practice. 5th ed. Maryland Heights, MO: Elsevier Saunders. Critical Appraisal Skills Programme (CASP) (2014) CASP checklists [online]. Available from: http://www.casp-uk.net/#!casp-tools-chcklists/c18f8. [Accessed 1 June 2014]. Clark-Carter, D. (2001) Doing quantitative psychological research. East Sussex, UK: Psychology Press Ltd. Crombie, I. K. (2005) The pocket guide to critical appraisal. London: BMJ Publishing Group. Dancey, C. and Reidy, J. (2011) Statistics without maths for psychology. 5th ed. London: Prentice Hall. Hek, G. and Moule, P. (2006) Making sense of research: an introduction for health and social care practitioners. 3rd ed. London: Sage Publications Ltd. McCambridge, J., de Bruin, M. and Witton, J. (2012) The effects of demand characteristics on research participant behaviours in non-laboratory settings: a systematic review. PLoS One, 7 (6): e39116. Moule, P. and Goodman, M. (2009) Nursing research: an introduction. London: Sage Publications Ltd. Padula, C. A., Yeaw, E. and Mistry, S. (2009) A home-based nurse-coached inspiratory muscle training intervention in heart failure. Applied Nursing Research, 22: 18-25. Schulz, K. F. and Grimes, A. (2002) Blinding in randomised trials: hiding who got what. The Lancet, 359 (9307): 696-700. Seers, K. and Critelton, N. (2001) Quantitative research: designs relevant to nursing and healthcare. Nursing Times Research, 6 (1): 487-500. Sim, J. and Wright, C. (2000) Research in health care: concepts, designs and methods. Cheltenham, UK: Stanley Thornes. 1

International Business Machines (IBM) :: essays papers

IBM International Business Machines Corporation The Big Blue is often a name use by many to describe the world’s largest provider of computer of hardware, software, and service. Years ago many said International Business Corporation (IBM) wouldn’t as prosperous, but who would have said they were wrong. Know one would of forecast the success of IBM. It was obvious that they would be successfully because computers are extremely important in todays world. Without computers society wouldn’t be advance in technology and other areas. Many of IBM customers consist of such companies as insurance companies, airlines, some banks, and many other large corporation. IBM sales consist of programs for large companies with enormous computer system which needs software. IBM is also trying to get involve in the on-line service. The history of the International Business Machine Corporation began with a 40 year-old salesman name Thomas Watson. In 1914 Thomas Watson was a National Cash Register, he was trying to save a company known as the Computing-Tabulating-Record Company(C-T-R).At this time he was trying to sell or marketed C-T-R’S Hollerith machine and other tabulators to the US government during WW1. He wanted to sell punch cards tabulator. Once he had supplied the US government, with these tabulators, he had triple (C-T-R) revenues to nearly $15 million by 1920. In 1924 Computing-Tabulating-Record was change to International Business Machines.IBM then began to take over the worlds market for tabulators, clocks, and electric type writers. By 1940 it was the us largest office firms that deals with machines. There sales had reach $50 million. In the year of 1944, IBM had perfected the the calculator it was known as Harvard Mark I. It was actually a electromechanical calculation. It is said that this was the first potentially computers. In 1951 Remington Rand’s came out with the UNIVAC it began to replace the IBM machine. In the 1960s and the 1970s IBM came out quickly and built a market share near 80%. IBM used its superior marketing. In 1952 Thomas Watson Jr became president and presented its first computer, 701. While Jr was president he introduce the Stretch system, which get rid of vacuum tubes. Also during this time the first family computes, which were called the 360. In 1957 the first programming language came, it was called FORTRAN. and also the first floppy it was introduce in 1971. IBM then came out with more advance computers such as System/38 in 1978 and the AS / 400 in 1988.

Merge of American Airlines and Us Airways Essay

The buzz in the airline industry in February 2013 was all about the potential merger between American Airlines and US Airways since that would make the merged company the number one airline in the industry globally. Despite the some cynical comments veteran investors hold for investing in the airline industry, which will be mentioned below, as well as the unforeseen lawsuit being thrown at their way, it is an investment that is strongly suggests a profitable investment in the long run. First of all, the potential profitability of the merger could be foreseen by reviewing past cases of airlines mergers such as the merge between United Airlines and Continental Airlines as well as Delta Airlines and Northwest Airlines. Delta Airlines and Northwest Airlines merged in 2008 and United Airlines announced their merger with Continental Airlines 2 years later in 2010. Delta was not profitable right off the bat after their merger but took them a few years to turn things around balancing with th e economical situation and oil prices. â€Å"Most pros consider the industry untouchable because the airlines have historically operated irrationally and have always been at the mercy of oil prices, unions and new competition†(Feinberg, 2013) but then again Feinberg says that United, Delta as well as US Airways â€Å"have been making money for the past three years and may achieve record profits in 2013† (Feinberg, 2013). Post merger of United Airlines and Continental Airlines, â€Å"the parent company of United Airlines, one of the world’s largest carriers, reported a $448 million quarterly net loss, pressured by high fuel costs and expenses related to problems integrating some operations of United in its merger with Continental Airlines†(2012). †But the problems appear to be largely over. So far this year, United shares are up 22%, the S&P 500 Index is up 14.5% and Delta shares are up 66%. No doubt, Smisek seeks room to grow (Reed, 2013).† United is also looking to enhance their services for corporate customers by â€Å"revamping its aircraft that fly from JFK to Los Angeles and San Francisco, adding â€Å"flat bed† seating and faster, complimentary Wi-Fi to its premium sections. American is adding state-of-the-art Boeing 777-300ER aircraft to its fleet, the largest new aircraft used by a U.S. carrier since 1990. Its premium cabin has a walk-up bar stocked with snacks–a first for any U. S. airline, the company boasts† (Fickenscher, 2013). Another crucial factor that indicates sustainable growth are the soft skills; â€Å"A new American Airlines combining US Airways is fortunate to have US Airways CEO Doug Parker at the helm, because he appears to understand not just the nuts and bolts of merging logistics systems but also the human process of ego suppression. This would be the second time his smaller airline has merged with (taken over, some would say) a larger one, and the second time he has let go of the identity of the enterprise he built (HBS Working Knowledge at Forbes, 2013). † Creating an executive management team that is functioning well as a strong team is crucial to an M&A situation. They also need to have a clear vision of the company in order to overcome all the minor speed bumps they will inevitably go through with the merger. Currently, American Airline s and US Airways are facing on going lawsuits against the US Justice department. Depending on the outcome of this lawsuit, American Airlines will either move on with their original merger plan or if blocked, then they would have to reorganize a new plan while operating in bankruptcy. References Feinberg, Andrew. 2013. â€Å"News Flash: Airlines Soar.† Kiplinger’s Personal Finance 67, no. 7: 38. Business Source Complete, EBSCOhost (accessed September 15, 2013). 2012. â€Å"United Continental’s Loss Widens, but Less Than Expected.† New York Times, April 27. 4.Regional Business News, EBSCOhost (accessed September 15, 2013). Reed, Ted. 2013. â€Å"No Wonder United’s CEO Is Buying United Stock.† Forbes,com, September 1. Accessed September 15, 2013. http://www.forbes.com/sites/tedreed/2013/09/01/no-wonder-uniteds-ceo-is-buying-united-stock/. Fickenscher, Lisa. 2013. â€Å"Mergers put biz travelers in first class.† Crain’s New York Business 29, no. 27: 3. Regional Business News, EBSCOhost (accessed September 15, 2013). 2013. â€Å"Big Deal: Reflections on the American and US Airways Megamerger.† Forbes.com 10. February 19. Business Source Complete, EBSCOhost (accessed September 15,2013).

Graduate Admissions Essay Dos and Donts

Graduate Admissions Essay Dos and Don'ts Nearly all applicants to graduate school are required to submit one or several admissions essays, sometimes referred to as personal statements. This component of the graduate admissions application permits the admissions committee to see beyond the statistics to see you as a person apart from your GPA and GRE scores. This is your chance to stand out so make sure that your admissions essay truly reflects you. An essay that is truthful, appealing, and motivating can increase your chances of acceptance but a poor admissions essay can eliminate opportunities. How do you write the most appealing and effective admissions essay possible? Admissions Essay Dos Prepare an outline and create a draft.Answer all the questions asked.Make sure your essay has a theme or a thesis.Provide evidence to support your claims.Make your introduction unique.Write clearly and make sure it is easy to read.Be honest, confident, and be yourself.Be interesting and positive.Make sure your essay is organized, coherent, and concise.Write about yourself and use examples from your own life experiences.Use a mixture of long and short sentences.Discuss your future goals.Mention any hobbies, past jobs, community service, or research experience.Speak in the first person (I†¦).Mention weaknesses without making excuses.Discuss why youre interested in the school and/or program.Show, don’t tell (Use examples to demonstrate your abilities).Ask for help.Proofread and revise your statement at least 3 times.Have others proofread your essay. Admissions Essay Donts: Have any grammar or spelling errors. (Proofread!)Be wordy or use jargon (don’t try to impress the readers by using big words).Swear or use slang.Digress or be repetitive.Be boring (ask someone to read your essay).Generalize.Include cliches or gimmicks.Be comical (a little humor is okay but remember it can be misconstrued).Be defensive or arrogant.Complain.Preach.Focus on other individuals.Discuss politics or religion.Make lists of accomplishments, awards, skills, or personal qualities (Show, don’t tell).Write a term paper or an autobiography.Summarize your resume.Include information already cited on the application.Forget to proofread.

The Theatrical Effectiveness of The White Devil essays

The Theatrical Effectiveness of 'The White Devil' essays The White Devil is atypical of a revenge tragedy play. As a result, the action has to be ingenious and at times gruesome, whilst also being translatable to the stage. Webster uses many techniques and methods whether it is in staging, language or characterisation, to bring the action closer to the audience and heighten the theatrical effectiveness of the play. Act One Scene Two is the first introduction of the main characters; Brachiano, Vittoria, Camillo, Cornelia and Flamineo. It is a scene full of ambiguities and contradictions, the sense of ambivalence coming from both the language and the action. The staging of the play is effective in itself. The carpet and cushions which Zanche laid out implies a sexuality which contrasts with the romantic and almost cliched lovers conversation leaving the audience confused at their true motives or emotions. Likewise, the counterbalance of Flamineo and Zanche overseeing the action on one side, with Cornelia representing the virtuous holy maternal figure on the other is reminiscent of the morality play which characterises Vice and Virtue. Also, the observation of such private action allows Webster to include three viewpoints, gloating, passion and agonised despair. This open presentation of an important scene allows the audience to enter into the drama and choose their own moral angle on the events unfolding before them. The Jacobean audience would have immediately recognised the traditional characters of the Vice, Virtue and malcontent, making them less distanced by the paradoxical language, for example, the inverted collocation excellent devil. Another method of inciting an audience response is Websters use of bawdy humour with the sexual innuendo of the jewel imagery. However there is always another interpretation, jewel could either represent married chastity or more negatively, sexual organs. Another double meaning used to great effec...

Inequalities And Its Eeffects Essay Example | Topics and Well Written Essays - 2250 words

Inequalities And Its Eeffects - Essay Example a from the World Bank, the World Health Organization, the United Nations and the Organisation for Economic Cooperation and Development (OECD), and others. â€Å"To avoid being accused of picking and choosing our measures, our approach in this book has been to take measures provided by official agencies rather than calculating our own† (Wilkinson and Pickett 2009, pg. 18). However, this approach of the authors to prove their hypothesis was not accepted by all the experts. They found loopholes in this methodology, particularly the statistical analysis part, and thereby found loopholes in their arguments as well. The point put forward was, by just drawing lines or even a â€Å"line of best fit† based on a various variables and series of data points does not hold any statistical significance, unless the statistical analyses was done. They are convinced that these statistical tables do not provide the correct picture, as adequate analyses were not done. This was pointed out by Moore (2010) â€Å"Drawing a line through a series of data points signals nothing concrete†¦ The authors promise that they "have only included a best-fit line through the points"†¦But since they do not provide any statistical analyses, this can't be verified.† Kay (2009) further adds up against the methodology and thereby the argument of the authors by pointing out how regression methods may not correctly aid in analyzing the economic and importantly social statistics. As social statistics could be influenced by various variables, and is an evolving process, it cannot be easily focused. In addition, adequate data were not given in relation to the estimated equations. Thus, if one â€Å"removes the bold lines from the diagram, the pattern of points mostly looks random, and the data dominated by a few... This esssay stresses that the inequality can be measured as the one that happens between the rich and the poor in a particular country, and not inequalities between the rich countries and the poor countries. The key point or differentiation, the authors make, is that wellbeing of a country’s people, cannot be actualized or should not be judged based only on the wealth or economic status of that particular country. Instead, the focus should be far more deeper, with the economic inequalities between the rich and the poorer sections of the population mainly deciding the welfare of the people. Spatial based concentration of anything including population, industries and also income could also lead to inequalities. Authors Wilkinson and Pickett points out how more equal distribution of resources and thereby the income status â€Å"will mean fewer people will be living in shanty towns, with dirt water and food insecurity†. This paper makes a conclusion that these inequalities is prevalent for the past few centuries only because of the advancements particularly in economic, social and technology sphere, which took place mainly in the last few centuries. In the earlier centuries, human beings lived in a mostly egalitarian prehistoric hunting and gathering societies with very minimal inequalities. However, as the world advanced certain sections of the population utilizing the various advancements, progressed optimally, while leaving behind others. This inequality is now visible in various facets of human life and is leading to various repercussions for the people

How Does Cyber Bulling Affect Teenagers Research Paper

How Does Cyber Bulling Affect Teenagers - Research Paper Example This essay approves that cyber bullying victims are persistently tormented by their peers through text messages or emails, and this may rekindle the feeling of worthiness and hopeless and may therefore decide to commit suicide to escape all the pain. More so, online bullying triggers the feelings of sadness, anger and most commonly, embarrassment. In addition, cyber bullying has a negative impact on the quality of the relationship that the teenagers have with their families, peers or even teachers because they often feel disinterested in life and they start perceiving life as hopeless and meaningless, and in some cases, the victims may feel angry and vengeful, to revenge on the bullies. This report makes a conclusion that cyberbullying can have devastating impacts on teenagers’ lives such as depression, isolation or even suicide. Various studies show that cyber bullying is common and is some cases can be severe and adversely affect teenagers’ lives. Cell phones and computers cannot be entirely be blamed for cyber bullying because the social networking sites are supposed to be used positively such as connecting with other people, using them for learning activities, and entertainment among others. In order to stay safe online, it is advisable not to post or even share personal information online including internet passwords, inform parents or any other responsible adult about what they are doing online, and never meet anyone that they have only met online among others.