Monday, August 24, 2020

NASCAR drivers are true athletes

In the open cognizance, sport is regularly connected with human-fueled exercises like football and ball, while those, drawing in with human-helped exercises like dashing, are not seen as obvious competitors as they supposedly needn't bother with extraordinary physical exertion to make progress. This convention gets from Ancient Rome, while the significant accentuation was set upon the exercises, which show the flawlessness of human body, however in the cutting edge world, because of the appearance of new innovative curiosities, it is hasty to restrain the rundown. The current paper presents the explanations behind which NASCAR drivers can be classified as competitors. Above all else, it is important to give a meaning of a genuine competitor: competitor is an individual who has either normal or prepared aptitudes, expected to do a specific sort of sports on the expert premise, takes an interest in the rivalries, watching the standards recommended,  and can utilize the abilities they have in an advantageous manner. In this way, there are a few key perspectives, which describe a competitor, so they can be utilized as arrangement measures. As a matter of first importance, a competitor ought to connect with a specific sort of sports. Hence, demonstrate that engine hustling has a place with the domain of sports; for this reason, it is important to characterize the term â€Å"sport†. â€Å"Sport is a movement that is represented by a lot of rules or customs and regularly occupied with seriously. Sports usually allude to exercises where the physical capacities of the contender are the sole or essential decided of the result (winning or losing), however the term is additionally used to incorporate exercises, for example, mind sports and engine sports where mental sharpness or hardware are major factor† (http://en.wikipedia.org/wiki/Sport, 2006). Moreover, genuine competitors ought to be sufficiently talented to draw in with a particular kind of sports. In the current case, they ought to have finesse, great at vehicle driving and have adequate scholarly capacities and the essential information on the physical laws, which rule the way toward driving. Thirdly, the genuine competitor ought to have the option to utilize their aptitudes and capability in the specific sort of game in the advantageous manner, on the grounds that the use of such capacities decides the upkeep of capability and ability. Fourthly, the genuine competitor partakes in the challenges in their restricted games circle, as rivalry is a chance to take a gander at oneself and survey one’s own abilities in the correct manner. As it has been referenced, the competitor draws in with pro athletics, which require certain turn of events and modification of one’s aptitudes to the necessities of the current day, which could be accomplished uniquely through watching peer execution. At long last, the genuine competitor esteems serious soul and in this manner watches the significant guidelines that manage the opposition, to be specific those which decide the reasonable challenge. It is conceivable to differ with the previously mentioned rules. For example, various incredibly proficient competitors, who take an interest in worldwide rivalries, will in general maltreatment the disciplinary principles and exhibit forceful conduct, yet in the current case significant standards that decide the uniformity and impartiality in the challenge are talked about. These standards typically preclude counterfeit measures, taken to incidentally increment one’s quality or finesse. Furthermore, it is additionally conceivable to reprimand the standards that identifies with the advantageous utilization of one’s aptitudes in sports. Truth be told, the term â€Å"beneficial† doesn’t really focuses to bringing in cash based on sport action, indeed, it may incorporate such minor issues as utilizing solidarity to shield oneself or someone else from rough crooks or using scholarly capacities, created during the long stretches of chess playing, in science. At long last one may guarantee that opposition isn't important for self-advancement as a competitor, as it is conceivable to enlist an extremely qualified mentor and train without drawing in into the connections with other sportspeople, yet as indicated by the previously mentioned definition, constructive and enlivened contention is a center everything being equal and triumph is their motivation. Applying the primary rule, it is important to express that past the conventional games like tennis and aerobatic, there additionally exist exercises, which need progressively mental limits and can be likewise delegated sports. What's more, the NASCAR alludes to the movement it advances and creates (engine dashing) as engine sports, and because of the way that this affiliation is national, it suggests the traditional view on sports, endorsed by the specialists in this circle. Furthermore, NASCAR drivers truly have the essential aptitudes and capacities †else they wouldn’t have been acknowledged by the relationship of the national level. A large portion of them have been preparing for a long time and utilizing proficient race gear so as to give nonstop development of their aptitudes. Thirdly, the people, taking an interest in NASCAR races, have figured out how to make the game bring them cash †along these lines of utilizing the complex of game abilities can be viewed as useful. These days, the NASCAR drivers are among the most extravagant competitors in the nation. Transforming sports into one’s individual gainful work is a genuine craftsmanship, so the NASCAR drivers have prevailing with regards to using their extraordinary ability. Fourthly, the NASCAR drivers take part in an assortment of races among which the NEXTEL Cup, the Busch Series and the Truck Series. So as to have a thought regarding the degree of these rivalries, it is helpful to find out about the NEXTEL, for example: â€Å"The NASCAR NEXTEL Cup Series is the sport’s most significant level of expert rivalry. It is therefore the most mainstream and most gainful NASCAR arrangement. The 2006 NEXTEL season comprised of 36 races more than 10 months, with over $4 million in complete prize cash in question at each race† (http://en.wikipedia.org/wiki/NASCAR#NEXTEL_Cup, 2007). This mean, the NASCAR drivers have a place with the alleged â€Å"high sports†, as they take an interest in the national rivalries. At last, the NASCAR drivers watch the standards of reasonable rivalry. For example, they â€Å"do not use execution improving drugs† (McCormick, at http://nascar.about.com/od/drivers/a/nascarsteroids.htm, 2007) and will in general help the possibility of the soul of positive competition through adhering to the guidelines of amiability and great tone in the associations with different members. Censuring this contention, one can express that NASCAR races are not really a game, but instead a show with minor components of rivalry. For this situation, the accents are set incompetently , as these races are a genuine rivalry in all angles, however the cutting edge broad communications have transformed into a show, communicated by various TV-channels. Actually, the NASCAR is keen on keeping up its notoriety and hence manages pro game as opposed to novice shows . To summarize, the current paper effectively demonstrates that NASCAR drivers are genuine competitors, as they meet the previously mentioned rules, for example, capability, compliance to moral codes, interest in dashing and the relating rivalries and utilization of their aptitudes in the valuable wayâ The paper along these lines outlines that a genuine competitor ought to have not just aptitudes, yet in addition high knowledge, capacity to arrange and make vocation in the field of sports just as satisfactoryâ internal good culture. Works refered to McCormick, S. â€Å"NASCAR Drivers Don’t Use Performance Enhancing Drugs†. 31 July 2007, <http://nascar.about.com/od/drivers/a/nascarsteroids.htm> Wikipedia. â€Å"NASCAR†. 17 July 2007, <http://en.wikipedia.org/wiki/NASCAR#NEXTEL_Cup> Wikipedia. â€Å"Sport†. 4 October 2006, <http://en.wikipedia.org/wiki/Sport>      Â

Saturday, August 22, 2020

CV writing Essay Example | Topics and Well Written Essays - 1000 words

CV composing - Essay Example I will likely deliver a learning situation that cultivates imagination and joint effort among the understudies so self-articulation can be used with objective setting aptitudes so as to satisfy individual yearnings as characterized by the understudies, however encircled inside the learning objectives of the class. Synopsis of Teaching Experience 2010. Gracefully Teacher (Teaching Agencies in UK) Working as spread/flexibly instructor in different optional schools around London. 2001-2009. Mahaicony Secondary School, Guyana (Junior Teacher) Visual Arts educator of the auxiliary school, answerable for training understudies ages 11 - 16. Inspector for last displayed assessment craftsmanship pieces. Directing and rendering backing to other junior instructors inside the office. Visual Arts educator ? Encouraged different territories of visual expressions including Drawing and Painting, Textiles, Graphic plan. ? Arranged exercise intend to address the issues of assorted understudies from va rious societies and foundations. ? Arranged fifth structure (ages 16& 17) understudies to compose Caribbean Examination Council Secondary Education Certificate test. ? Sorted out craftsmanship displays and surveying show-stoppers. ? Built up understudies' inclinations, capacities and co-appointment by method of innovative exercises ? Tried and assessed students’ capacity for singular advancement in composed and oral work. ? Arranged and controlled assignments and undertakings ? Arranged plans of work for whole year gathering. ? Assembled students' certainty, and encouraging effective learning procedures In Assisting the Teacher I Participated in ? Making a decent educator parent cordial relationship ? Urging guardians to be effectively associated with numerous territories of school life while growing close working connections a functioning PTA ? Dealing with the homeroom and sorted out exercises, for example, instructive visits and field trips. ? Distinguishing understudi es with learning troubles and gave learning helps and projects to address their issues. ? Partaking in staff gatherings, meetings and instructive workshops ? Talking about students’ progress and issues with understudies and guardians. Urged guardians to be effectively associated with their children’s school life. ? Urging understudies to become autonomous students by setting testing and requesting desires to advance confidence Junior Teacher Adviser Responsibilities ? Prompted and bolstered staff on arranging, evaluation and assets including exercise arranging. ? Aided disciplinary issues School’s Environment Club Leader ? Sorted out supported occasions, noon and after school clubs. ? Arranged and execute procedures in managing issues, for example, reusing and littering. ? Advanced exercises arranging through association of different schools and guardians. Accomplishments ? Finished the destinations and exercises set in the educational program on schedule. ? 98% -100% goes in tests: Caribbean Examination Council Secondary Education Certificate test. ? Essentially helped with changing the conduct of the whole school towards littering through the usage of strategies. Training ? October 2005 â€July 2009: BA in Fine Arts (Pass with credit), University of Guyana. ? October 2003 †July 2005: Technical Education Certificate in Radio and Electronic Servicing (Pass with unique excellence), Georgetown Technical Institute, Guyana. ? October 1998 †July 2001: Trained Teacher’s Certificate (Grade 1; Class 1), Cyril Potter College of Education, (Guyana Teachers’ Training College). ? October 1991 â€

Toxic Shock Syndrom

Friday, August 21, 2020

Article Analysis. Attachment, Exploration, and Separation Illustrated by the Behavior of One

The discoveries introduced in the article called Attachment, Exploration, and Separation: Illustrated by the Behavior of One-year Olds in an unusual situation give a more profound view on the idea of connection and add to better comprehension of potential methodologies and arrangements expected to advance good connections among guardians and infants.Advertising We will compose a custom paper test on Article Analysis. Connection, Exploration, and Separation: Illustrated by the Behavior of One-year Olds in a Strange Situation explicitly for you for just $16.05 $11/page Learn More This supposition that depends on the analysis led by the creators where various sorts of practices are found during the cooperation among outsider and newborn child. Thinking about the more peculiar as a potential parental figure, the exploration permits to anticipate progressively precise results of these cooperations just as intercessions that can acquainted with dodge misguided judgments and abuse. Furtherm ore, the given research makes a strong stage for laying out the principle issue and limitations that a guardian may confront while building up secure connection with newborn children in a specific setting. Thus, in spite of the constraint of the examination, it is as yet conceivable to depend on the featured suppositions for working out successful intercession systems regarding specific scenes. Primary concerns and Details of the Experiment In the article under examination, the writer features notable highlights of the connection connections just as how they are influenced by abnormal circumstances. The scientist likewise outlines cooperations and reports on the conduct in abnormal circumstance to draw the association between odd circumstance conduct and the one spoke to in observational, test and clinical settings. The examination is made out of 8 scenes to see how 56 white one-year olds act in a peculiar circumstance. The members incorporate moms, newborn child, outsider, and eyew itness who carry on in various manners. The presented scenes are planned for characterizing what classes of conduct (vicinity and contact-chasing, contact-keeping up, association maintaining a strategic distance from, contact and connection opposing, and looking) while at the same time collaborating both with the mother and with the outsider. While introducing the consequences of the investigation, the creator gives specific consideration to explicit angles, such visual regard for the physical condition, to the mother and to the outsider. While examining five classes of conduct, the writer has figured out how to discover kid response to various scenes, for example, crying and looking through conduct, during all times of investigation and separation.Advertising Looking for exposition on brain science? We should check whether we can support you! Get your first paper with 15% OFF Learn More The exploration have likewise indicated that uncovered that crying and looking as nearness advan cing practices have been improved and have stayed unaltered in any event, when the mother comes back to the room. In this regard, it very well may be focused on that both connection and exploratory conduct are fundamentally affected by the division inside the recognized time period. Be that as it may, infants’ response to partition is suggestive of those introduced by primates while isolating for longer terms. In this examination, scanning and bothered purposes for living for the mother were expanded though exploratory conduct has been decreased. In entire, the introduced finding can offer ascent to the examination of connection foundation from a more extensive perspective, which can likewise be altered affected by outside elements. Introducing Supporting Arguments In the examination, Ainsworth and Bell (1970) shed the light on the criticalness of thinking about the connection among connection and exploratory practices, which is the way to cultivating positive relations among little children and essential parental figures. In this discoveries, the analysts state, â€Å"attachment conduct is contradictory with exploratory behavior† when it is improved (Ainworth and Bell, 1970, p. 64). By the by â€Å"the condition appended encourage exploratory behaviors† and â€Å"the baby is probably going to have the option to utilize his mom as a safe base from which to investigate, showing no caution in even a peculiar circumstance as long as she is present† (Ainsworth and Bell, 1970, p. 64). In light of this, momentary nonappearance of connection conduct can't be considered as it debilitating, which demonstrates the chance of building up secure connection between the baby and the parental figure. All the more critically, the introduced scenes can be utilized as a piece of a way to deal with traveling kids from home to kid care foundation in a less distressing manner. Notwithstanding the way that the examination isn't pointed talking about indiv idual contrasts among babies, the exploration specifies, â€Å"attachment connections are subjectively not the same as one appended pair to another† (Ainsworth and Bell, 1970, p. 65).Advertising We will compose a custom exposition test on Article Analysis. Connection, Exploration, and Separation: Illustrated by the Behavior of One-year Olds in a Strange Situation explicitly for you for just $16.05 $11/page Learn More Such a supposition gives a sort of vacillation on the investigation of the idea of connection, however this distinction despite everything give the need to additionally talk about these issues with dependence on social and social components. In this regard, Ebbeck and Hoi Yin Bonnie (2009) bolster the possibility that â€Å"continuation of social practices from home to focuses may not just assistance newborn child/babies feel that they are acknowledged into the center’s culture, however may likewise unite their feeling of security†. Outline of exist ing impediments just as precise portrayal of the examination gave by Ainsworth and Bell (1970) contributes enormously to better comprehension concerning which procedures ought to be actualized to dispose of mental and individual issues during change. Introducing Interventions and Recommendations for Developing Health Attachment for Children It has been perceived that advancement of positive connection connections among guardians and babies is of foremost significance for mental prosperity of youngsters. These connections make a strong ground for future ideal intercession to giving feeling backing to kids. In this regard, two intercessions ought to be executed. The first will infer the expansion of the adjustment time frame and investing more energy for encouraging connections among little children and parental figures (Ebbeck and Hoi Yin Bonnie, 2009). The subsequent methodology will include the upgrade of enthusiastic and responsive responses while correspondence with youngsters. T hinking about the principal technique in more detail, guardians and guardians ought to invest more energy for playing, sustaining and educating them. The subsequent stage will be the advancement of a drawn out trust through being loving and adoring. When the enthusiastic ground has been readied, it is conceivable to set up connection connections. At this stage, guardians should give close consideration to the advancement changes occurred over the span of time just as to infants’ necessities and preferences.Advertising Searching for exposition on brain research? We should check whether we can support you! Get your first paper with 15% OFF Find out More The subsequent methodologies can be helped through a few phases also. In any case, a guardian ought to be as genuinely accessible as could reasonably be expected; he/she should work and speak with a youngster instead of hold up until a kid adjusts to the weird circumstance. At long last, it is indispensable for youngster to feel good in the setting where the correspondence happens that ought not occupy babies from building up connection. Such a methodology will contribute extraordinarily to building solid securities among parental figures and little children where visual and oral correspondence ought to be proficient for fortifying the connection. Critically, social and social issues ought to likewise be taken into the storeroom thought since they are very useful while traveling kids from home to youngster care foundations. Taking everything into account, the exploration under investigation has incredibly extended the review the quintessence of the connection connections and practice s identified with this idea. Specific accentuation ought to be put on the distinctive connection and exploratory conduct that are considered in association. References Ainsworth, M.S., Bell, S.M. (1970). Connection, investigation, and partition: Illustrated by the conduct of one-year olds in an odd circumstance. Youngster Development, 41(1), 49-67. Ebbeck, M., Hoi Yin Bonnie, Y. (2009). Reconsidering connection: encouraging positive connections between newborn children, babies and their essential parental figures. Early Child Development Care, 179(7), 899-909. This exposition on Article Analysis. Connection, Exploration, and Separation: Illustrated by the Behavior of One-year Olds in a Strange Situation was composed and put together by client Brianna Snyder to help you with your own examinations. You are allowed to utilize it for research and reference purposes so as to compose your own paper; be that as it may, you should refer to it as needs be. You can give your paper here.

Sunday, July 26, 2020

The MIT What!

The MIT What! impressively deep= announcers= voice= /impressively/p pAND Now, Ladies And Gentlemen, For Your Viewing Pleasure/p pThe World-Famous, Nationally Renowned, Often Copied But Never Cloned, Unforgettable (No Matter How Hard You Try), Super Phat, Super Fly /p pIts the One, the Only, MIT MARCHING BAND!/p pimg src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/crrazy_640x475.jpg _cke_saved_src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/crrazy_640x475.jpg width=520 alt=I3MITMB/p p/p pFor some reason, people are often surprised to learn that MIT has not only a href=http://web.mit.edu/varf-ball/www/index.html _cke_saved_href=http://web.mit.edu/varf-ball/www/index.htmla football team/a, but also a a href=http://web.mit.edu/marching-band/www/ _cke_saved_href=http://web.mit.edu/marching-band/www/marching band/a. With a a href=http://www.youtube.com/user/MITmarchingband _cke_saved_href=http://www.youtube.com/user/MITmarchingbandYouTube Channel/a./p pThis is, in fact, the 30th anniversary of both the marching band and the modern football team. Looking through this a href=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/newspaperarticle.pdf _cke_saved_href=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/newspaperarticle.pdffascinating piece of history/a from 1978, we see on page 12 that the band enthusiastically played rousing tunes. It also mentions the infamous Gimme an M, gimme an A, gimme an S cheer, which is a personal favorite of mine. Spelling out Massachusetts Institute of Technology takes a while. Nowadays, we often just pull out our ID cards and read off of them to avoid spelling mistakes like the one they mentioned in the article./p pOne of the band members out there was Doug Pape 81, also the trumpet player on the left in this photo:/p pimg src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/ombponcho_640x440.jpg _cke_saved_src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/ombponcho_640x440.jpg width=520/p pHe t ells me that the MIT Marching Band grew out of a group from 2nd East. The guy in the shorts was also on the new football team as well, and gave up his halftime break to play in the band./p pimg src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/o2ndEastMarBand_637x480.JPG _cke_saved_src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/o2ndEastMarBand_637x480.JPG width=520/p pThey advertised around campus, and the MIT Marching Band was born!/p pimg src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/oApproachingSteinbrenner_637x480.JPG _cke_saved_src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/oApproachingSteinbrenner_637x480.JPG width=520/p pimg src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/oMarBandInStands_640x477.JPG _cke_saved_src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/oMarBandInStands_640x477.JPG width=520/p pEd Kinney, the first band director, wrote to the current officers recently to tell us that this was a tim e when they had bake sales and sub sandwich sales to make money. They had to take the train back and forth to NYC to rent sousaphones. Mostly they played Sousa marches, which were easy to acquire, but they went all out on an arrangement of The Imperial March for $300. They eventually got red t-shirts./p pIf I were to tell you about the next 17 years, I would basically be pulling things from a href=http://web.mit.edu/marching-band/www/oldmb/history.html _cke_saved_href=http://web.mit.edu/marching-band/www/oldmb/history.htmlhere/a and rearranging the words in an attempt to avoid blatant plagiarism. I totally recommend reading it though. It covers The Rise and Fall of the Smith Administration, The Triumphant Year 1 AB, The Year of Fascism, The Communist Revolution, and The end of the reign of James./p pSometime after 1995, the band fizzled out, as far as I know. It doesnt seem to have been for lack of creative advertising::/pblockquotebr Join the MIT Marching Band! Sign up NOW to join this prestigious, unforgettable MIT tradition that is our marching band. No experience necessary or assumed, satisfies HASS-D requirements, Institite LAB, (register for 21M666, Riots, Stikes, and Contemporary Marching Bands in Polynesian Society Today, (0-12-0), and youll be eligible to win 10 MILLION DOLLARS or a position as MIT MARCHING BAND AMBASSADOR TO THE ALIEN NATIONS! So sign up NOW, you may already be a winner! (NOTE: Were not all as weird as Dennis; if you want to join a cool marching band but dont care about being ambassador to alien nations, read on wed love to have you! JS)/blockquotep/p pThe next time The Band surfaced, it was due to the efforts of the amazing Bill 07. Hes on the left in this picture. Im next on the right, followed by a href=http://www.mitadmissions.org/Sam.shtml _cke_saved_href=http://www.mitadmissions.org/Sam.shtmlSam/a. Also pictured are Caroline 08, Ken G, Michael 09 (Current President), Diana 08, and Matt 09./p pimg src=http://web.mit.edu/kimfad /Public/rightsize/MarchingBand/waterpolo_640x480.jpg _cke_saved_src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/waterpolo_640x480.jpg width=520/p pBill rewrote the constitution, got us cool shirts, and drummed up (I guess trumpeted up, since he was a trumpeter, not a percussionist) a bunch of members. The bands been approximately doubling in size each year since Fall 04. Its not exactly your traditional marching band; the picture above is from a water polo match, at which we featured music from Jaws./p pOther awesome things in recent history include performing on ice,/p pimg src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/on-ice_640x480.jpg _cke_saved_src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/on-ice_640x480.jpg width=520/p pMaking our own incredible capes,/p pimg src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/capesT_640x480.jpg _cke_saved_src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/capesT_640x480.jpg width=520/p pBuying Engineers caps,/p pimg src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/tstop_640x338.jpg _cke_saved_src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/tstop_640x338.jpg width=520/p pGetting Out, as well as About,/p pimg src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/statehouse1_640x480.jpg _cke_saved_src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/statehouse1_640x480.jpg width=520/p pAnd obtaining some Snazzy New Uniforms,/p pimg src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/andcrowd_640x480.jpg _cke_saved_src=http://web.mit.edu/kimfad/Public/rightsize/MarchingBand/andcrowd_640x480.jpg width=520/p pTheres even a colorguard now!/p pAt least, so I hear. I, unfortunately, have become too hosed to partake of the bands awesomeness these days. Although I do show up once every blue moon or two./p pFor those of you interested in admiring the World-Famous, Nationally Renowned, Often Copied But Never Cloned, Unforgettable (No Matter How Hard You Try), Super-Phat, Super-Fly MIT Marching Band, theres a Basketball game versus Emmanuel this Saturday. If youd like to iplay/i, or get more info, give an email to the officers at marching_at_mit_dot_edu, or show up at a Wednesday rehearsal. And if youre a prospective freshman, Im guessing (but cant promise) that the Marching Band will be leading its Amazing Tour of Campus during Campus Preview weekend again./p pHappy 30th, MITMB!/pp/p

Sunday, June 28, 2020

Gestational Diabetes - Free Essay Example

Gestational Diabetes Mellitus: an Overview Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with the onset or first recognition during pregnancy. Ninety percent of those diagnosed with diabetes during pregnancy will resolve after delivery (Scollan-Koliopoulos, Guadagno, Walker, 2006). Pregnancy causes estrogen, progesterone and human placental lactogen to become elevated which provokes malfunctioning insulin, which can lead to insulin resistance and decreased cellular glucose uptake. The growing placenta causes the production of even more hormones, producing higher glucose levels and increased insulin resistance. When the pancreas can’t satisfy the demands for additional insulin, GDM results (Gattullo Olubummo, 2009). Approximately 7%, or 200,000 pregnant women are diagnosed each year in the United States. Advanced maternal age, family history of diabetes, prior GDM, history of infant with macrosomia, and elevated BMI are all major risk factors for developing GDM. GDM is more often found in women of Asian, Hispanic or Native American descent (Cheng Caughey, 2008). GDM can have negative effects on both the fetus and the mother. These mothers experience an increased number of Caesarian deliveries and use of forceps or vacuum extractions, resulting in severe perineal lacerations, related to fetal macrosomia. Along with the risks associated with macrosomia, the mother is also at risk for developing hypertension and preeclampsia, leading to preterm labor, as well as, developing Type 2 diabetes after the birth of her baby (Cheng Caughey, 2008). The increased amount of glucose in the gestational diabetic is correlated with macrosomia and childhood obesity (Scollan-Koliopoulos et al. 2006). Maternal hyperglycemia can increase the risk of hypoglycemia, respiratory distress syndrome, jaundice and hypocalcemia in the neonate. The negative effects of macrosomia include shoulder dystocia, brachial plexus injuries and clavicle fractures, resulting in a traumatic birth (Cheng Caughey, 2008). Poor glycemic control in the mother can also injure the fetus in other ways such as causing intrauterine hypoxia and placental insufficiency, leading to fetal polycythemia, which causes problems before and after birth (Fink, 2006). Case Study Pertinent History The patient, R. B. , of Hispanic descent, presented to the Eagle Care Clinic, on May 24, 2010, at 14 2/7 weeks. She is â€Å"sure† that her LMP was February 12, 2010. She is G4P2SAB1. She will be 35 years old at EDB (November 20, 2010) and is considered advanced maternal age. She is overweight. She has a history of two previous term vaginal deliveries, in 1995 and 2000, with both neonates weighing almost 9 pounds, which is considered macrosomia. She reports that she does not recall any complications. (The pregnancies took place in Mexico, and therefore we are not able to obtain records. She also had a SAB in 1997, resulting in a DC. She denies bleeding, nausea, vomiting, pain or contractions but does complain of fatigue and breast tenderness. She denies any other medical history or surgeries. She is taking prenatal vitamins and no other medication. She has no known allergies. She eats a typical Mexican diet, high in carbohydrates and fats and does not exercise. She does not use tobacco, alcoh ol or drugs and neither does her husband. This is an unplanned pregnancy, but her family, including two children and her husband, are very supportive and happy about the new baby. She is a stay-at-home mother, and her husband is currently working in the construction industry. They are from Mexico and only speak Spanish. They practice Catholicism. Family medical history is negative except for sister with twins. PHYSICAL EXAM Vital signs: BP- 128/66, P- 70, RR- 16, T- 98. 7 Height- 168cm, Weight- 92 kilos, BMI- 32. 92 General: Pleasant, Hispanic woman, appears overweight, in no acute distress. HEENT: WNL. Teeth intact and evidence of good oral hygiene. Cardiovascular: Heart rate and rhythm regular. No MCR. Respiratory: Lungs clear all fields. Breasts: Assymetrical- rightleft, everted nipples, no discharge, no dimpling, tender bilaterally, no masses, no axillary nodes. Abdomen: Nontender; no organomegaly, bowel sounds x 4. FHT heard-152 bpm, +FM Pelvic: Cervix closed, parous os, creamy white discharge. Gravid uterus, SD, fundus U-2, no active bleeding, no CMT, no adnexal tenderness. Vulva without erythema, lesions. Extremities: No edema. Pedal pulses 2+. No joint irregularities. Labs: CBC, RPR, Type and screen, Hep Bs Ag, Rubella, urine culture, Rh screen, genprobe, pap, obtained today. UA in office shows trace of nitrites. U/S planned for next week with Dr. Petrie. Quad screen discussed for between 16-20 weeks. GTT planned for 20 weeks. R. B. returned to the clinic on June 1, 2010, for second prenatal visit. Lab and ultrasound results were as follows: Blood type: O+ Rh: negative Rubella: non immune Pap: normal RPR: negative GC: negative Chlamydia: negative HCT: 44. 3 Hgb: 15. 1 Hep B: nonreactive Urine culture: contaminated; clean catch obtained this visit. U/S: Viable fetus 16 5/7 weeks, EDC November 11, 2010, limited survey, posterior placenta, not previa. MANAGEMENT OF GESTATIONAL DIABETES R. B. presented with the risk factors for GDM including obesity, previous history of macrosomia, Hispanic descent and advanced maternal age. It is for this reason that I chose the management of gestational diabetes for the topic of discussion for this paper. GDM is occurring in five to nine percent of pregnancies in the United States; however, criteria for diagnosing and appropriate treatment is controversial, with conflicting guidelines and protocols (Hollander, Paarlberg, Huisjes, 2007. According to recent studies, the diagnosis and management of GDM do have favorable effects on maternal and neonatal outcomes, such as reduced shoulder dystocia, fractures, nerve palsies, preeclampsia, preterm labor and Caesarian births (Serlin Lash, 2009. ) Diagnosis of GDM is made using a universal screening at 24-28 weeks, unless the patient has increased risk factors (as did my patient), in which case, the testing can be done at the initial encounter (Colorado Clinical Guidelines Collaborative, 2006. (My preceptor, who is a CNM and FNP, elected to wait until week 20 to do the initial screening. ) The screening test involves using a 50 gram one hour glucose challenge test, followed by a 100 gram three hour oral glucose tolerance test if the screening was positive (130-140 mg/dL). Diagnosis is made if fasting level of 95 mg/dL, one hour level of 180mg/dL, two hour level of 155 mg/dL or three hour level of 140 mg/dL (Serlin Lash, 2009. ) There is a consensus among researchers that first line therapy for gestational diabetics is diet modification (medical nutrition therapy). It is usually prescribed by a dietician, taking cultural preferences into account, and involves carbohydrate counting and specific meal recommendations, as well as lowering caloric intake for those with a BMI greater than 30. Although further research is necessary for definitive conclusions, low glycemic index (LGI) diets have been found to be beneficial to both mother and child. These diets aim to slow down the digestion of the food which allows the body to compensate for the sugar load which comes after the meal (Tieu, Crowther, Middleton, 2008. Moderate exercise is a safe, practical and inexpensive intervention to utilize in the management of GDM. Fasting glucose and insulin resistance can be decreased by physical activity and is one of the most effective interventions for controlling hyperglycemia in the gestational diabetic. Increased hormonal activity associated with pregnancy can cause joint laxity and enlargement of the breasts and uterus which, in turn, can result in higher risk of soft tissue injury due to joint instability and altered sense of balance. Since many women with GDM were physically inactive before pregnancy, it is recommended they start with a light to moderate exercise program, 3-5 days per week for 20-30 minutes, of walking, stationary bike riding or swimming, as long as there are no contraindications. This can be modified based on the client’s physical abilities and symptoms (Dawes, 2006. ) There is no consensus regarding specific glucose targets. The ADA recommends 90 to 99 mg/dL in the fasting state; less than 140 mg/dL one hour postprandial, and less than 120 to 127 mg/dL two hours postprandial. Blood glucose should be self-monitored and a glucometer given to the client upon diagnosis. BG should be checked and recorded four times daily, fasting and one or two hours postprandial, for two weeks. If diet and exercise do not result in what is thought to be the acceptable glucose levels after two weeks of diet and exercise (20 percent of blood glucose values exceed target), then medication therapy should be considered (CCGC, 2006. ) Insulin is the only FDA approved drug for GDM and is the first line pharmacologic therapy. The oral agent, Glyburide, is still under investigation, although it has been found not to cross the placenta, and it is used in many practices as an acceptable alternative for women unwilling or unable to take insulin. There is inconclusive evidence about Metformin; therefore, it is not recommended. For women who are willing to start insulin, the dose is usually 0. 7 units per kilogram per day, in divided doses. NPH and short acting insulin are used together, but the dose must be modified based on amount of exercise, glucose level and BMI (Serlin Lash, 2009. Diagnosis and treatment of GDM remains controversial. There is no gold standard for either diagnosis or treatment, but the existing studies have shown that comprehensive patient education and follow-up of diet, exercise and blood glucose control are important in the management of GDM and can decrease the risks for adverse outcomes, including the development of Type 2 Diabetes later in life for both the mother and the baby (Mulh olland, Njoroge, Mersereau, Williams, 2007. ) IMPLICATIONS FOR ADVANCED PRACTICE NURSING Patient management for GDM can be clinically challenging, and the best possibility for success is early detection and intervention. As nurse practitioners, our focus should be on teaching the mother to maintain glycemic control with diet, exercise or pharmaceutical interventions, thereby creating a healthy intrauterine environment. When a pregnant woman is seen in the clinic, her risk factors for GDM are assessed, either at the initial OB visit or at subsequent prenatal appointments or when she is seen for any other reason. Is she obese? Is there a family history of diabetes? Has she had previous infants with macrosomia? Does she have PCOS? What ethnicity is she? Does she exercise? These are all important questions with which to begin our assessment (Fink, 2006. ) Following the Colorado Collaborative guidelines, routine screening for GDM is offered at 24-28 weeks gestation, unless the patient is in the high risk category, in which case, the screening should be done earliereither at the initial meeting or by 20 weeks. If screening is positive and the GTT also exceeds the normal range, the patient is then diagnosed with GDM (CCGC, 2006. Once we have a diagnosis of GDM, a referral to the registered dietician and diabetic educator can be made, depending on the setting. The NP may serve in this role. The patient should be instructed to manage her condition by eating a culturally sensitive, balanced, low glycemic diet, as well as, safely increasing or starting an exercise program suitable for her level of conditioning. She will also be given a glucometer and be instructed to record her levels in a log which she will bring to each prenatal visit. Our patients will be taught signs and symptoms of hypoglycemia and hyperglycemia and appropriate interventions. If glycemic control is unable to be maintained after 2 weeks of implementing diet and exercise therapy, pharmaceutical interventions such as Glyburide must be considered. If this is not an available alternative, the patient would need to be switched to insulin, and depending on the setting and level of experience of the clinician, a physician may need to be consulted for this now high risk pregnancy. Along with the standard screenings and surveillance of pregnancy, the patient may need additional ultrasounds to assess fetal growth and evaluate the placenta, as well as, NST’s starting at 32 weeks to monitor the fetus closely (Gatullo Olubummo, 2009. ) Women with GDM have approximately 50 percent risk of developing Type 2 diabetes within the next 5 to 10 years and 80 percent risk if they have impaired fasting glucose or glucose tolerance postpartum (CCGC, 2006. ) Therefore, it is critical that the patient return to see the provider 6-12 weeks postpartum for the appropriate follow up, testing and education. Patients are encouraged to continue breastfeeding, not only for the benefits provided to the baby, but also to help the mothers lose weight. Our role as NP’s is also to encourage the patient to maintain her healthy eating habits and exercise regime to reduce the chance of diabetes occurring. She will need to have screenings preferably annually, and if considering another baby, preconception care is recommended (Gatullo Olubummo, 2009. ) Nurse practitioners who care for gestational diabetic patients can offer holistic counseling and support that considers the long and short term health of women and their babies (Scollan-Koliopoulos et al. 2006. ) An innovative area where NP’s could expand their role is in CenteringPregnancy. Studies have shown that CenteringPregancy may have a potential for improved outcomes in at-risk populations. Patients were shown to be more involved in their care and have higher satisfaction with group care versus individual care. The patients also bond with each other and feel a sense of camaraderie (Klima, Norr, Vonderheid Handler, 2009. ) Perhaps this would be effective for our GDM patients, where they could come and learn and share their thoughts and feelings in a safe environment. Our support is a critical component of nursing care and listening to our patients’ concerns and showing our desire to help can alleviate the stress and anxiety that often accompanies the diagnosis of gestational diabetes. With our interventions, along with appropriate referrals, we will continue to improve outcomes. REFERENCES Cheng, Y. , Caughey, A. (2008). Gestational diabetes: diagnosis and management. Journal of Perinatology, 28(10), 657-664. doi:10. 1038/jp. 2008. 62 Dawes, J. (2006). Special populations. The role of exercise in the prevention and treatment of gestational Diabetes mellitus. Strength Conditioning Journal (Allen Press), 28(3), 66-68. Retrieved from CINAHL with Full Text database. Gattullo, B. , Olubummo, C. (2009). Sizing up gestational diabetes. Nursing, 39(12), 54-56. Retrieved from Academic Search Premier database. Hollander, M. , Paarlberg, K. , Huisjes, A. (2007). Gestational diabetes: a review of the current literature and guidelines. Obstetrical Gynecological Survey, 62(2), 125-36. Retrieved from MEDLINE database. Klima, C. , Norr, K. , Vonderheid, S. , Handler, A. (2009). Introduction of CenteringPreg- nancy in a public health clinic. Journal Of Midwifery Womens Health, 54(1), 27-34. Retrieved from MEDLINE database. Mulholland, C. , Njoroge, T. , Mersereau, P. , Williams, J. (2007). Comparison of guidelines available in the United States for diagnosis and management of diabetes before, during, and after pregnancy. Journal of Womens Health (15409996), 16(6), 790-801. Retrieved from CINAHL with Full Text database. Scollan-Koliopoulos, M. , Guadagno, S. , Walker, E. (2006). Gestational Diabetes Manage-ment: Guidelines to a Healthy Pregnancy. (Cover story). Nurse Practitioner, 31(6), 14-25. Retrieved from Academic Search Premier database. Serlin, D. , Lash, R. (2009). Diagnosis and management of gestational diabetes mellitus. American Family Physician, 80(1), 57-62. Retrieved from CINAHL with Full Text data base. Tieu J. , Crowther C. A. , Middleton, P. Dietary advice in pregnancy for preventing gestational diabetes mellitis. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No. : CD006674. DOI: 10. 1002/14651858. CD00674. pub2 CCGC: Colorado Clinical Guidelines Collaborative https://coloradoguidelines. org/pdf/guidelines/gestationaldiabetes/gdm_guideline_long. pdf

Friday, May 22, 2020

Alpha Radiation - Definition of Science Terms

Definition: Alpha radiation is ionizing radiation resulting from the decay of radioisotopes where an alpha particle is emitted. This radiation is denoted by the Greek letter ÃŽ ±. Examples: When Uranium-238 decays into Thorium-234, an alpha particle is produced in the form of alpha radiation.