Saturday, August 31, 2019
New Healthy Fruit Smoothie at Burger King Essay
If fast food is unhealthy and is believed to cause obesity, why is there still a fast food restaurant every few blocks? Perhaps because there are a lot of people who are still consuming fast food and backing its business, the fast food industry survives and appears to even increase. The fact that modern life is fast paced as well as the economy hasnââ¬â¢t fully recovered makes people prefer to work more consistent and eat faster. Needless to say, the competition among well-known brand names is getting more challenging, and advertising plays an important role in marketing and drawing consumersââ¬â¢ attentions. Knowing the only disadvantage of fast food is its unhealthiness, Burger King has recently introduced their healthy real fruit smoothie using David Beckham. By equating his charm, his famous credibility, and his physique, David Beckham endorses the new Burger Kingââ¬â¢s smoothie to not only women but also soccer fans and whoever seeks healthy choices at a fast food restaurant. Throughout the commercial, Burger King shows their true intentions: to visually attract the audience with their appealing and healthy smoothie, to interest them by using a celebrity along with the slogan ââ¬Å"exciting things are happening at Burger Kingâ⬠, and to show part of the American culture through the story and the conversation. In the commercial, Burger King is attempting to refresh their reputation of being unhealthy and creates a visual appeal for their smoothie. By showing how the ripest strawberries are being cut and blend nicely, the commercial effectively forms a visual image of the drink and stimulates the audienceââ¬â¢s curiosity to try it out. In addition, strawberry is definitely one of the most favorite flavors for kids while banana is a very healthy fruit. As a result, a mixing of those two fruits surely captures the attention of children and mothers who want to purchase a possibly healthier choice. As given on the Burger Kingââ¬â¢s website, the smoothieââ¬â¢s nutritional facts are acceptable, 200 calories and forty grams of sugar per twelve ounce serving (small size). Even though forty grams of sugar is a little bit too much for a 200 calorie drink, most of it comes from real fruits and plus, there isnââ¬â¢t any saturated fat or anything else. These definitely wonââ¬â¢t kill you or make you fat compared to other sugary, creamy drinks. However, people often think that healthy food is boring and tasteless. By filming the ad expertly and convincingly with high definition, Burger King is able make the smoothie look realistically tasty and delicious. Its most visual appeal is when it was poured into the glass. The fluid looks amazingly delicious and well-blended. The color also appears to be reddish orange as it is well-balanced between strawberries and bananas. As Hirschberg mentioned in his ââ¬Å"The Rhetoric of Advertisingâ⬠, Burger King does create ââ¬Å"the distinctive image for the productâ⬠in their commercial. The smoothie glass is shown closely on the half left of the image while other half is showing a bunch of fresh strawberries. They also blur the strawberries in the background to emphasize the prominence of the smoothie glass. This allows the audience to see its smooth viscosity closely and triggers their appetites as well as interests. Instead of illogically exploiting well-shaped models and athletes to promote unhealthy products like other franchises, Burger King utilizes Davidââ¬â¢s healthy and lean physique to indicate their product as a naturally healthy smoothie. Starting off with a spokesperson claiming ââ¬Å"exciting things are happening at Burger Kingâ⬠, the setting of the commercial is refreshing, exciting, and appealing just like the smoothie itself. Surprisingly, the spokespersonââ¬â¢s tone isnââ¬â¢t too excited as expected. It is rather a normal, not-a-big-deal tone. It seems to imply that it is usual to have exciting things at Burger King, and in this case, it is David Beckham with the strawberry banana smoothie. Apparently, Burger King tries to persuade the audience that many celebrities do actually visit Burger King, and that they should come and eat at Burger King as well if they want to meet their idols. Using David Beckham to promote the smoothie is brilliant. Not only David Beckham is appealed to women, but also his classy fashion style is attracted the young adults, let alone his recognition as a professional soccer player. Additionally, like David, those kinds of frosty, sweet, and fruity smoothies have always been attracted to women rather than men. Furthermore, his healthy body makes the drink even healthier. Also, David has been recently promoting for the Sainsburyââ¬â¢s Active Kids as an ambassador. He has been on many posters and advertisements that encourage children to eat healthy and exercise. Burger King apparently knows whatââ¬â¢s going on and has their commercial set. Through the conversation between David Beckham, the cashier, and the manager, the commercial creates an entertaining situation and shows part of the American culture. Humor is definitely one of the American cultures. Mostly everything we see on TV has entertaining and humorous elements. In the commercial, audience will be able entertained as soon as David orders his smoothie and mesmerizes the cashier. As the cashier is being fascinated by his charming radiance, David shifts into a luminous gentleman wearing a classy, black suit and reorders his smoothie in a very heavy English accent. The way David pronounces ââ¬Å"strawberry banana smoothieâ⬠and the cashierââ¬â¢s daydreaming look are what make it worth a giggle. The music is also very antiquated. It sounds like one of those Western classic, love songs that appeared in ââ¬Å"Gone with the Windâ⬠. The commercial also exploits homosexual agenda by showing the male manager, after snapping his cashier out of Davidââ¬â¢s charm, is also stunned by Davidââ¬â¢s dazzle. Same sex attraction is just a daring joke as it either makes the audience impressed or offended. Nonetheless, whether it is offensive or not, the scene creates an emotional appeal and makes an impact on the audience as one of the advertising techniques Hirschberg has discussed, ââ¬Å"They supply the unstated major premise that supplies a rationale to persuade an audience that a particular product will meet one or another of several different kinds of needsâ⬠. After all, the homosexual joke serves its purposes: to make impressions and to indirectly persuade that the strawberry banana smoothie is just irresistible for both sexes. It is not a surprise to see celebrities or well-known professional athletes appearing in a commercial nowadays. Using David Beckham to promote the new smoothie is a great move of Burger King. Burger King shows that fast food does not necessarily mean unhealthy. To get the word out about their changes, they have to pull out their biggest marketing campaign ever using a lot of well-known celebrities. So far, David Beckham as well as the new healthy smoothie menu is definitely the aces and the most success compared to other commercials. Its views jump over 20,000 in a matter of hours proving that it works. ââ¬Å"With their latest initiatives, Burger King is showing commitment to areas that Iââ¬â¢m passionate about, such as supporting charities, helping children and improving the healthier eating options. I am happy to help the brand launch its first smoothie platform, which is a great addition to any dietâ⬠, said David Beckham.
Friday, August 30, 2019
Sustainable Tourism from Http: //Www.Sustainabletourism.Net/Index.Html
ISSUE: As more regions and countries develop their tourism industry, it produces significant impacts on natural resources, consumption patterns, pollution and social systems. The need for sustainable/responsible planning and management is imperative for the industry to survive as a whole. FACTS: TOURISM IMPACTS: â⬠¢880 million people travelled internationally in 2010 and this is expected to reach 1. billion by 2010 â⬠¢The average international tourist receipt is over US$700 per person â⬠¢Travel and tourism represents approximately 10% of total global Gross Domestic Product (GDP) (if it include tourism related business (eg catering, cleaning) â⬠¢The global travel and tourism industry creates 10% of world employment (direct & indirect) â⬠¢At least 25 million people spread over 52 countries are displaced by violence, persecution and/or disasters ââ¬â tourism receipts in every country are affected by this. ENVIRONMENTAL IMPACTS: â⬠¢The average Canadian household used 326 liters of water per dayâ⬠¦. a village of 700 in a developing country uses an average of 500 litres of water per month AND a luxury hotel room guest uses 1800 litres of water per person per nightâ⬠¦ â⬠¢The average person in the UK uses approximately 150 litres of water per day ââ¬â 3 times that of a local village in Asia â⬠¢A species of animal or plant life disappears at a rate of one every three minutes â⬠¢70% of marine mammals are threatened The Western world (with 17% of the worlds' population) currently consumes 52% of total global energy. â⬠¢1 acre of trees absorbes 2. 6tonnes of CO2 per year â⬠¢58% of the worlds coral reefs are at risk â⬠¢Seawater is expected to rise 70 cm in the next 10 years â⬠¢By 2050 climate change could have directly led to the extinction of 30% of species, the death of 90% of coral reefs and the loss of half the Amazon rainforest. â⬠¢Since 1970 a third of the natural world has been destroyed by human activity â⬠¢Half the world's population lives in urban areas and this figure is expected to increase. In Latin America and the Caribbean, 76% of the population live in urban areas â⬠¢By 2036, there will be 1200 million cars on earth ââ¬â double the amount today â⬠¢A European uses 14x more energy than someone living in India â⬠¢For every 1 degree rise in temperature above 34 degrees Celsius, yields of rice, maize and wheat in tropical areas could drop by 10% â⬠¢Although 70% of the earth's surface is water, only 3% is potable Sources: FOC, 2002, WTO, 2000 & 2002, UNWTO, 2011, www. risingtide. co. uk, 2004, UN, 2003, Gov't of Canada, 2005, Tourism Concern, 2011, Science Msusuem, 2006) SOLUTION: Sustainable tourism is about re-focusing and adapting. A balance must be found between limits and usage so that continuous changing, monitoring and planning ensure that tourism can be managed. This requires thinking long-term (10, 20+ years) and realising that change is often cumulative, gradual and irreversible. Economic, social and environmental aspects of sustainable development must include the interests of all stakeholders including indigenous people, local communities, visitors, industry and government. WHAT CAN YOU DO? Address environmental and social concerns through policies, practices and initiatives with others. â⬠¢Are you traveling? Use these guidelines for being a responsible traveler? â⬠¢Are you traveling? Use these guidelines for being a carbon conscious traveler? â⬠¢Are you a business or organization? Use these questions to guide you. â⬠¢Have us help you with policy development, environmental management, business planning and marketing efforts. â⬠¢ Read more or contact us directly. Click here for definitions and information about sustainable tourism.
Thursday, August 29, 2019
Antonio Salieri Biography
Austrian dukedom of Mantra, was a composer and conductor who received considerable public acclaim in his day. He studied violin and harpsichord with his brother Francesco, who was a student of Giuseppe Tartly. After the death of his parents, he moved to Pad, then to Venice, where he studied thoroughness with Giovanni Peppiest. In 1766 Saltier met Florien Leopold Gamesman, who Invited him to attend the court of Vienna and there trained him in composition based on Fix;sGrades ad Apparatus. He remained in Vienna for the remainder of his life, and in 1774, when Gamesman died, Saltier was appointed the court composer by Emperor Joseph II, and Imperial Royal Experimentalist in 1788. During his time in Vienna he acquired great prestige as a composer and conductor, particularly of opera, and also of chamber and sacred music. The most successful of his 43 operas were Less Dandies (1784), which was first presented as work of Clucks, and Tartar (1787). He wrote comparatively little Instrumental music, including Just llano concerti written In 1773. He attained an elevated social standing, and frequently associated with other celebrated composers such as Joseph Haydn. As children, Beethoven, Schubert and List all benefited from his tutelage. He also taught Czerny, Hummel and a son of Mozart. Antonio Saltier is buried in the Contraindicated in Vienna, Austria. Allegations by Mozart In Vienna in the sass, Mozart accused Saltier of plagiarism and of attempting to murder him with poison. As Mozart music became more popular over the decades ND Callers music was forgotten, Mozart unsubstantiated allegations gained credence and tarnished Galleries reputation. The biographer Alexander Hellhole Thayer believes that Mozart suspicions of Saltier could have originated with an incident in 1781 when Mozart applied to be the music teacher of the Princess of W;retriever, and Saltier was selected instead, and the following year Mozart was not selected to be the Princesss piano teacher either.Later on, when Mozart Eel Nozzle did Figaro was not liked by either the Emperor Joseph II nor by the public, Mozart blamed Saltier for the failure. Saltier and his tribe will move heaven and earth to put it [Figaro] down, wrote Leopold Mozart. But at the time of the premiere of Figaro, Saltier was busy In France with his own operas. Thayer believes that the Intrigues surrounding the failure of Figaro were instigated by the poet Abate Casts against the Court Poet, Ad Point, who wrote the Figar o libretto. F his Don Giovanni, the poet was ordered back to Vienna for a royal wedding for Inch Galleries Gaur would be performed. Obviously, Mozart was not pleased by this. And yet Saltier did not intend to hinder Mozart career. When Saltier was appointed Experimentalist in 1788, instead of bringing out an opera of his own, he revived Figaro. En in his later years, Galleries health declined and he was hospitalized, there were rumors that Saltier confessed to Mozart murder.Galleries two nurses attested that Saltier said no such thing and that at least one of the two of them was with Saltier during his hospital stay. After Galleries death, the opera by Nicolai Rims-Karaoke, Mozart et Saltier (1898) darted a tradition of dramatic license crossing into slander based on Mozart allegations, continued by the play by Peter Shaffer, Amadeus (1979; and the Oscar inning original film based on the play, released in 1984, and Directors Cut was released on 2001 with an additional 20 minutes of footage).
Wednesday, August 28, 2019
Control room Movie Review Example | Topics and Well Written Essays - 1000 words - 3
Control room - Movie Review Example Al Jazeera showed the true picture of the war and not what the American government wished for its people to see; the realities of the war. In fact, if one carefully considers the information that this channel broadcast during this war, there would be a realization that the American public would not have supported such a war had they seen what it did not, only to the Arabs of Iraq, but also to the American men and women who went to fight in the war. Control Room is a revelation towards some of the events that took place in Iraq and how these events were covered by the Al Jazeera network. It reveals that, despite the statements made against it by the Bush administration, none of the statements made were true and were, in fact, an attempt to cover up the truth about the war from the American public. This documentary is an attempt to show the news about the Iraq war, not from the perspective of the media of the west, but that of the region in which the war occurred. The first scenes of this documentary seem to reinforce the belief that the network sole purpose is spreading anti-American propaganda. The people who are seen working behind the scenes are all dressed in traditional Arab headgear, and when the American president issues an ultimatum to the Iraqi president, it is seen that those observing in the room jeer at the former. While, for many, this would reinforce the stereotype that has come to plague the Al Jazeera network, the truth is that the scene was inserted in the documentary to show that this network is not as different from those in the west as many would think. The documentary reveals that the statements by President Bush and his secretary of defense, Donald Rumsfeld, that Al Jazeera was the mouthpiece of Osama bin Laden and that it was the Centre of anti-American propaganda in the United States are completely unfounded (Turan). In fact, it is revealed that the exact opposite is the truth; that Al Jazeera is a network that is ded icated
Tuesday, August 27, 2019
Creating a table of contents Assignment Example | Topics and Well Written Essays - 250 words
Creating a table of contents - Assignment Example The law is applicable to employers with 20 or more employees including state and local governments. ADEA was amended by Older Workers Benefit Protection Act of 1990 (OWBPA) to prohibit employers from depriving the older workers from benefits (EEOC, n.d.). The cost of providing benefits to older workers was greater than the cost of providing the same benefits to younger workers. This works as a disincentive to employers to hire older workers. It has however been permitted that an employer can reduce the benefits based on age as long as the cost of providing the benefits is the same as the cost of providing the benefit to the younger workers. There has been a sharp increase in the number of age-discrimination complaints filed with the EEOC and has been largely attributed to the weak economy and an aging workforce. Today there are more older employees to discriminate against and more economic incentives to do so (Puri, 2003). According to EEOC age discrimination claims were up by 29% in 2008 which is almost double the increase in age discrimination claims (Ghilaarducci, 2009). When it comes to cutting costs, older workers are the targets of layoffs. When companies are forced to reorganize, the older workers are perceived as incapable of keeping up with new technologies. The employers get the support of the law and hence use business strategies as a cover to purge older workers (Puri, 2003). However, an aging workforce can be invaluable asset and organizations using age discrimination as a measure of cost savings are actually spending more than what they would in retaining older employees. The organizations have a perception that older workers do not and cannot perform as well as the younger workers and they cannot or will not change to the market requirements (Cappelli, 2009). It is just a belief that the older workers cannot perform as well as the younger workers. Older workers cannot adapt to change, are not tech savvy and cannot keep with the changing
Monday, August 26, 2019
Confederate Constitution Essay Example | Topics and Well Written Essays - 1000 words
Confederate Constitution - Essay Example As such, before the point in time that Jefferson Davis was elected as President of the Confederacy, Cobb was the de-facto leader of the Confederacy and served as the executive power under whose signature the Confederate Constitution was able to be passed into law. With regards to the ââ¬Å"whyâ⬠question, this document served as a means of proclaiming a level of self determination, a la the much earlier Declaration of Independence that the founding fathers of the United States had penned. Moreover, it served to differentiate the means whereby the Confederate States sought to define the most important concepts of power and the relationship which the member components of their own union must relate to the central Confederate government. As such, the document specified that at any time and for any reason, the dissolution of a member state from such a confederacy was entirely possible and allowable under the legal terms in which the document was penned. Similarly, with regards to t he ââ¬Å"whereâ⬠question, the document was ratified in Montgomery Alabama. With regards to the key differentials that the document noted as compared to the United States Constitution, these were many and will be explained within the following bullet points: The preamble to the Confederate Constitution placed emphasis upon the fact that all signatory states were acting in their own sovereign and independent character. Establishes the 3/5ââ¬â¢s compromise as the law of the land; thereby denoting that a slave can only be counted as 3/5ââ¬â¢s of a person when determining the overall population total of each state. Provided the President of the Confederate States with the power of line item veto but reqruierd that once the president would use the veto power that... With regards to the ââ¬Å"whyâ⬠question, this document served as a means of proclaiming a level of self-determination, a la the much earlier Declaration of Independence that the founding fathers of the United States had penned. Moreover, it served to differentiate the means whereby the Confederate States sought to define the most important concepts of power and the relationship which the member components of their own union must relate to the central Confederate government. As such, the document specified that at any time and for any reason, the dissolution of a member state from such a confederacy was entirely possible and allowable under the legal terms in which the document was penned. Similarly, with regards to the ââ¬Å"whereâ⬠question, the document was ratified in Montgomery Alabama.With regards to the key differentials that the document noted as compared to the United States Constitution, these were many and will be explained in the following bullet points:ï ¶ The preamble to the Confederate Constitution placed emphasis upon the fact that all signatory states were acting in their own sovereign and independent character.ï ¶ Establishes the 3/5ââ¬â¢s compromise as the law of the land; thereby denoting that a slave can only be counted as 3/5ââ¬â¢s of a person when determining the overall population total of each state.ï ¶ Provided the President of the Confederate States with the power of line item veto but required that once the president would use the veto power that the bill would then be resubmitted to both houses for a possible override.
Sunday, August 25, 2019
LLB FAMILY LAW (Coursework) Essay Example | Topics and Well Written Essays - 2500 words
LLB FAMILY LAW (Coursework) - Essay Example In this case the property in question is the house, which though held in Paulââ¬â¢s name, Lauren has an interest in because of their shared history in it and the fact that she did make a contribution of some sort to Paulââ¬â¢s acquisition of it. A constructive trust is implied in law in both a domestic and a commercial context. In this instance it is in the domestic context. The main features of the constructive trust are that it relies upon three basic components, the first of which is common intention. There was indeed common intention in the coming together of Lauren and Paul in their living together. There has not been up to now not been any agreement among the two parties, Lauren and Paul either directly or in an implied manner, been an agreement that they would be sharing the house out for the purpose of benefiting from it separately. The common intention was that they live together in the house, even though its title was under Paulââ¬â¢s name, Lauren was able to play her part in the common interest by paying for the utility bills and assisting with household expenses and thus freed up Paulââ¬â¢s income for use in servicing the mortgage of the property or paying for its acquisition. By contributing towards the household expenses and the utility bills she therefore can claim to have made a material contribution towards Paulââ¬â¢s acquisition of the said property. She thus has rights under constructive trust, to the use of the property. The common intention is both implied and actual even in the absence of any written agreement. The absence of a written or structured agreement cannot therefore negate Laurenââ¬â¢s right to the use of the property in question and therefore she is entitled to stay there together with the children that resulted from and during their cohabitation.1 The fact that they have lived together for such a long time anchors the argument of common intentions to live together even though they are not married. The second c omponent of constructive trust is the detrimental reliance by the claimant. By detriment here is included the things that Lauren had to give up or make do without in order to ensure that Paul was able to acquire the property ââ¬â the fact that she had to forego her job and chose to be a stay at home mother and take care of the children and also the fact that she gave up her State benefits to be used in the common household expenses and also the fact that she paid some of the utility bills. These are all factors to be considered in looking at the common intention constructive trust that protects the contribution that Lauren put into this enterprise. Lauren continued to live with Paul in the house even when the relationship became strained and even when she was treated to continued verbal abuse. She had every right to continue staying there and even now she has the right to stay there since the agreement that was in place that they would live together in the house is still in effe ct. And she has every right to go back there, together with her children, as long as she is assured that there will not be a return to the abusive and violent behaviour. Lauren, by virtue of her contribution to the acquisition of the property in question, would therefore suffer if the court or law determined that she was not entitled to its fair use and occupation. She should therefore have her constructive tr
Human wk10 Essay Example | Topics and Well Written Essays - 1250 words
Human wk10 - Essay Example These were questions that came to my mind when I started reading this chapter. Reeve (2009) points to research that suggests that extroverts are happier than introverts but I am not sure this is true. I know several introverts who live very happy lives without having to be very social. When I think about teens in Liberia, I would think that many of them would be happy with their lives because they may have no reason not to be happy. As an example, these children may all have similar experiences that move them more towards happiness than towards sadness. Many of the girls will be motivated to achieve more because they are feeling happy. Reeve (2009) states that arousal is important when thinking about motivation. The inverted-U curve suggests that when someone has a low level of arousal they are more likely to have a poor level of performance. In my understanding, arousal could be seen as engagement. In other words, if someone is engaged in learning, they are more prone to follow thro ugh with their goals. The girls may have a low level of arousal in the beginning, but if their education is stimulating and begins to engage them, they would be more prone to have a higher level of arousal. I would also think that stress would come into play with else girls because they may not have been in a classroom or formal education in the past. This could initially mean that they could become overly aroused. Reeves states that this could cause anxiety and other negative emotions that could impede their progress. When looking at personality and goal achievement, Jayasurija, Caputi, Gregory and Meloche (2007) found that students with a high achievement motivation were more prone to develop self-efficacy skills in computer use. They saw that goal orientation was a personality trait for those students who were the most motivated were more prone to develop self-efficacy skills in computer use. They saw that goal orientation was a personality trait for those students who were the m ost motivated to achieve their goals. Lee, Sheldon, and Turban (2003) suggest that individuals must have an understanding of self-control in order to develop strong mental focus. Mental focus helps an individual become more involved in their goal orientation, thus allowing a student to have a way to feel more positive about achieving their goals. Mental focus would also help in perceived control when an individual has challenges sticking to their goal. Students in Liberia may have difficulty understanding how to set and achieve goals but it would seem that their personalities would show quickly as to those who would have a higher or lower level of perceived control. Reeve (2009) states that those with higher levels of perceived control would be more apt to move their goals from inaction to action. References Jayasuriya, R., Caputi, P., Gregory, P, and Meloche, J. (2007). The role of achievement goal orientation in the development of self-efficacy during computer training. Retrieved February 5, 2011 from http://www.pacis-net.org/file/2007/1288.pdf Lee, F.K., Sheldon, K.M., and Turban, D.B. (2003). Personality and the goal striving process: The influence of achievement goal patterns, goal level, and mental focus on performance and enjoyment. Journal of Applied Psychology, 88 (2), 256-265. Doi: 10.1037/0021-9010.88.2.256 Reeve. J. (2009). Understanding motivation and emotion (5th ed.). CA: Wiley. Assignment 3 Loretta is a professional illustrator who decided to go back to school. She chose a well known, accredited correspondence school that
Saturday, August 24, 2019
Light Lab Report Example | Topics and Well Written Essays - 1250 words
Light - Lab Report Example I used five different colors in the experiment. According to Timmermans, (2010) different colors of light have a significant effect on growth of plants, where the amount of energy obtained is different. However, it depends on other conditions, such as temperature, light intensity among others. In this experiment, the researcher has four variables in place. They include independent variables (photosynthesis rate), dependent (effect of wavelength) and factors that are in control and those that were not in control. Control favors included number of leaflets, volume of NaHCO3, concentration of NaHCO3, size of disc used and power of the light that was used. On the other hand, uncontrolled factors were the room temperature that the experiment was carried in. The Hedera Helix discs (leaflets) in our experiment responded differently to different colors of light. The hypothesis of the study is that the rate of photosynthesis varies in different colors of light. The blue color was expected to show the highest rate and yellow color the least effect to the rate of photosynthesis. The requirements for carrying out this experiment successfully include a syringe and beaker/containers. Others incldued leaves (the Hedera Helix discs (leaflets)), holes cutter, NaHCO3 and source of light (colored light bulb). I set up the five sources of colored light in an enclosed system and allowed it to warm up so as to attain equilibrium. I left the Hedera Helix Plant exposed to different light colors for 1.5 hours (90 minutes) using an analog-digital clocks to record the time elapses. This ensured that all the leaves were exposed to light equally. Using the prepared leaves, I prepared the NaHCO3 solution from 0.60g of sodium bicarbonate by diluting it with 300ml of distilled water in a 500ml beaker and added I added one drop of soap. I stirred the mixture gently ensuring that it does not form froth. First I cut small holes into the leaves to obtain numerous
Friday, August 23, 2019
World War I Diaries Essay Example | Topics and Well Written Essays - 1000 words - 1
World War I Diaries - Essay Example Germany failed to attach because of its exhausted manpower reserves. However,, the German home front revolted forming a new German government which signed a conditional surrender called the armistice, terminating the war in November, 11, 1918. The worldââ¬â¢s great powers were divided into allies involving the United Kingdom, France and Russia, and the central powers consisting of the triple alliance of Germany, Italy and Austria Hungary (Lymann 13-17). World War 1 was peculiarly a current affair. It was the first major contest of arms fought by large, centrally organised nation states since the dawn of the new revolution. Germany, Italy and Austria-Hungary were creations of the nineteenth century. The mechanized production of goods in vast quantities came from Europe and facilitated the pace of technological innovation. The scale of conflict heightened and fighting engulfed all the main states of the European continent as well as Britain, French and German imperial colonialists in Africa, Asia and pacific islands. It also raged the high sea sucked in the colonial peoples from Australia and Indochina to India and Canada and forced the distant and isolationist united states to undertake arms. Modern technology put unprecedented lethal arsenals at the armyââ¬â¢s disposal: artillery that could propel explosives from distances up to seventy-five miles, poison guns, airplanes, dreadnoughts and submarines. Fought mainly by soldiers in trenches, the war saw an estimated death of 10 million military men (Browne and Snead 560). It was a world war battle fought between September 12-15, 1918, which involved the American expenditory force and French groups under US commander John J. Pershing against German troops. The Americans expenditory force consisted of 14 divisions (550,000) soldiers while the German fifth army and French army was made up of 10 and four divisions respectively. The United States army air service played a
Thursday, August 22, 2019
Friction and the Variables of Friction Using a Wooden Block Essay Example for Free
Friction and the Variables of Friction Using a Wooden Block Essay I am going to perform an experiment on friction and the variables of friction using a wooden block, a piece of string and a Newton meter. I will test 3 variables: weight, surface area and surface texture. Each test will be repeated 5 times to get a fair range of results. Friction is the force of two objects rubbing together and slowing and/or stopping each other. The amount of friction produced depends on the appearance of its surface for example: The surface of the sandpaper has deep slopes and the surface of the paper has to move up and down those slopes to proceed, causing friction. My first test will be done to measure the affect of weight on the amount of friction between the block and the table top. The block ill be placed on the table and the Newton meter tied to it. Then the Newton meter will be pulled until the block starts to move and as soon as it does the amount of Newtons required to cause that movement will be recorded. This will be done 5 times then averaged. To make sure it is a fair test I will: use the same Newton meter and the same wooden block to avoid introducing other variables; I will also use the same section of table using the same side of the block every time. I will be vigilant of how I pull the Newton meter, the moving force should be parallel to the supporting surface because pulling it up will lessen friction and pulling it down will increase friction. I predict that as the weight on the block increases so therefore does the down force, increasing the amount of friction because it becomes more difficult for the ridges to pass over each and so a block with less/smoother ridges would find its passage a lot easier. When the experiment was carried out, as I predicted, when the weight on the block increased so therefore did the Newtons required to move it from a fixed position. The test was done with 2 Newton meters over 2 days. Using the same Newton meter was impossible as it broke. My results were as follows: Weight of block = 2.0N Weight T1(N) T2(N) T3(N) T4(N) T5(N) Average(N) Block 1.2 0.8 1 1 1 1 Block + 1N 1.6 1.5 1.5 1.8 2 1.7 Block + 2N 1.8 1.8 2.5 2.4 2.5 2.2 Block + 3N 2.2 2 3 3.2 3.3 2.7 Block + 4N 2.6 2.6 3.8 3.5 3.5 3.2 Block + 5N 2.8 3.5 4 3.5 3.6 3.5 In the first experiment weight was tested and a set of results produced. In this second experiment the surface area in contact with the desk will be tested. To obtain my results I will use the following method, the block will be placed on two sheets of paper a measured distance apart with a Newton meter tied to it. The block will then be pulled and as it begins to move the amount of Newtons required to cause this will be recorded. Each test will be done 5 times then averaged. To make sure it is a fair test I will; as the same Newton meter ensuring non-introduction of new variables, use the same side of the block, use the same two pieces of paper and make sure the blocks movement is parallel to the supporting surface. I predict that as the surface area of the block exposed to the desk increases so will the amount of Newtons required to move it because there will be more sharper ridges to pass over therefore requiring more Newtons. My results were as follows: Exp mm2 T(n) T2(n) T3(n) T4(n) T5(n) Avg(N) 11.3 0.5 0.9 1.1 1.2 0.7 0.88 22.6 0.6 0.6 1.1 0.7 0.6 0.92.72 33.9 1.2 1.1 1.1 1.1 0.9 1.08 45.2 1.1 1.1 1.1 0.9 1.1 1.06 56.5 1.1 1 0.9 0.7 0.6 0.86 68.1 1.1 1.1 0.9 1.1 0.6 0.96 My prediction on 1 or 2 of the results was correct or partially correct but on the whole I fear my prediction was incorrect as it seems the surface area (exposed to the desk) does not greatly affect the amount of Newtons that is required to move it, any affect it does have is not continual and seemingly erratic. The friction experiment has now been done with 2 variables: weight and surface area. I have now come to the third and final, surface texture. To test the affect of surface texture on friction, I will, Place the block on the surface with a Newton meter tied to it, the meter will then be pulled and as soon as the block shows signs of movement I will record the amount of Newtons needed. Each test will be done 5 times then averaged. To make sure it is a fair test I will: unless it breaks use the same Newton meter, I will use the same block and the same side of the block every time, I will use the same substance/type of substance for instance making sure the sandpaper comes from the same sheet. I will also keep the movement of the block parallel to the supporting surface. Although smoothness is hard to measure I predict that the smoother a substance is to the touch, the less friction will be produced, because the smoother a substance is to the touch the less sharp or outstanding the ridges are, therefore the less resistance they cause. Key Substances: Silicon based carbon paper: Si Emery paper: Bs Sand paper: S Table top: TT Plastic Bag: Pb Substance T1(N) T2(N) T3(N) T4(N) T5(N) Average Si 3 2.5 2.5 2.5 2.5 2.6 Bs 2 1.5 1.5 1.6 1.6 1.64 S 2 2 1.75 2 2 1.95 TT 1 1 0.9 0.9 0.9 0.94 Pb 0.4 0.4 0.4 0.4 0.4 0.4 As I predicted the smoother a substance feels to be, the less it causes resistance, as shown in the results. I followed my method very strictly any variation caused by my hand is small to negligible, and would not greatly affect the results. I have come to the conclusion that for a substance to reach minimal resistance it can achieve this being light weight, smoothly textured and have minimal contacting surface area with the opposing surface. If a substance is required to have maximum resistance it would be the opposite. I feel the experiment was performed rather well but there is room for improvement, to have maybe got fairer more accurate results I could have maybe repeated the experiment once or twice on all of them, then I would have more data to analyse giving me a better chance at accuracy. In all the three experiments instead of using the human hand to pull the Newton meter use a machine which would be less prone to inconsistency and use a table top free of blemishes. In the second experiment the block could have been placed on previously constructed platforms each measured to have 4 sides the same and those sides to be the measurements used meaning the non need of paper and a lot more accurate readings.
Wednesday, August 21, 2019
Social Advantages of EU Memebership
Social Advantages of EU Memebership Introduction The following working paper presents the Social assistance and social advantages in the European Union and third country nationals (with special attention for Turkish persons). It has been organized in seven main chapters which are summarized briefly in the following paragraphs. In order to have a view of what makes the legal basis for TCNââ¬â¢s rights in European Union, this paper tries to describe the most important International and European legal instruments.à These instruments set minimum standards relating to the protection of migrants, their families and refugees as well as for international co-operation on migration. International law protect migrant according to fundamental principles like; equality of treatment between regular migrant workers and nationals in the realm of employment and occupation; universal human rights apply to all human beings, including all migrants, regardless of status. International instruments provide normative standards for all national legislation and policy on migration. The main international human rights Conventions and Covenants apply to all human beings, including migrants and refugees. The Council of Europeââ¬â¢s migration instruments cover general human rights and more specific agreements relating to migrants and migrant workers. The Community has power to enter into agreements with third countries which agreements may either be limited to matters within the exclusive competence of the Community or cover a wider mix of issues including areas of shared competence between the Member States and the Community[3].à Agreement with third countries in this working paper are mentioned not because they provide direct social rights (referring to the Turkey agreement) to TCNââ¬â¢s but because the European Court of Justice often make reference to them conferring direct effect[4]à for the equal treatment of TCNââ¬â¢s. Under the EU law, where a right deriving from an agreement is found to be directly enforceable by the ECJ (direct effect), it is part of the acquis communautaire and must be applied by the Communitys national courts. The jurisprudence of the ECJ clarify the treatment of third country nationals having an advantageous legal status close to nationals of Members States. Moreover, it has been tried to provide a general view of social advantages for TCNââ¬â¢s in European Union. It is well known that social advantages and social rights forà TCNââ¬â¢s depend mainly on their legal status. Different categories of TCNââ¬â¢s are treated differently in respect of social rights within the Union.à Irregular immigrants and persons illegally residing in a country are mentioned in this paper but are not treated deeply considering that they have very restricted rights in respect of social rights. Regular immigrants have a more favorable situation and enjoy rights and obligations comparable to those of citizens of the European Union. A description of different directives and regulations has been made in order to explain what social rights and advantages have the category of third country nationals within the European Union. Reference to the definition of social advantages according to ECJ case laws has been made. In the following chapter, Social assistance in the European Union, it has been tried to explain several definitions that exist for social assistance, Social Regimes and Social Protection Delivery Systems, the role of social assistance, its personal scope, level and duration of social assistance benefits and conditioning of social assistance. The general situation of social assistance is further analyzed in four European countries; Germany, Austria, France and Belgium. European Union Countries provide social assistance for persons in need in different ways. They are guided almost from the same principles but apply different provisions and eligibility criteria because access to social assistance is governed according to national rules. This section aims to present an analysis of how social assistance systems are administered in Germany, Austria, France and Belgium, their legal and administrative structures and rules of eligibility, relative rules which determine the benefits etc. In general, immigrants with permanent residence status have access to social security benefits on the same basis as nationals in all Member States. There are greater differences in regulations relating to social assistance, where the great majority of the States provide access to long-resident third-country nationals on the same basis as for nationals. Regulations and practices regarding the provisions available for asylum seekers also differ. Contribution-based benefits are generally accessible on the same basis as they are for nationals.à However, there are often limitations linked to minimum contributions or waiting periods. Conditions of access to social assistance can have an important impact on the social inclusion of immigrants. Considering the above, in the chapter 6 of this working paper ââ¬Å"Social assistance for third country nationals in four European union countriesâ⬠, it has been tried to provide a view of how TCNââ¬â¢s are treated in Germany, Austria, Franc e and Belgium as regarded to social assistance. The selection of these countries has been made according to the differences they have in providing social assistance to third country nationals. France and Germany have more liberal social assistance system concerning third country nationals than Belgium and Austria. In the first two countries social assistance is provided for all persons without any condition relating to period of residence in the national territory, meanwhile in Belgium and Austria residence condition is mandatory for being eligible to social assistance.à In the last chapter of this paper has been described different social rights, which are found in different directives and regulations for Turkish persons in European Union.à Even though, it is obvious that the arrangements for Turkish migrants under the association instruments provide less legal protection compared nationals of Member States, they have a more favorable social situation than other third country nationals. The methodology used is that of qualitative content analyses of International and European primary and secondary legal instruments as well as a description of the situation of social assistance in four Europeanà Union Countries. 1.à Legal Instruments For Social Security of TCN In European Union International and European legal instruments set minimum standards relating to the protection of migrants, their families and refugees as well as for international co-operation on migration. Although States have their sovereign rights over migration policies in their countries, international law protect migrant according to fundamental principles like; equality of treatment between regular migrant workers and nationals in the realm of employment and occupation; universal human rights apply to all human beings, including all migrants, regardless of status. International Legal Instrumentsà International instruments provide normative standards for all national legislation and policy on migration. The main international human rights Conventions and Covenants apply to all human beings, including migrants and refugees. Nonetheless, specific sets of instruments have been elaborated to address the particular situations of, respectively, refugees and asylum seekers, migrant workers, and trafficking and smuggling of human beings. Certain aspects of other international treaties also apply to migration, notably International Labor Standards, international consular law and certain international trade agreements. International Human Rights Conventions provide a broad and ample normative framework for the protection of migrants. The Universal Declaration of Human Rights of 1948 laid out a comprehensive set of universal human rights principles. It is not legally binding, but it has provided the foundation for the recognition of social secuà rity rights in treaties subsequently adopted. Art. 22 of The Universal Declaration of Human Rights guarantee the right to social security. Art. 25 of The Universal Declaration of Human Rights recognizes the right of everyone to security in the event of unemployment, sickness, disability, widowhood, old age and other lack of livelihood in circumstances beyond his or her control[5]. Specific conventions subsequently explicitly extended the application of universal rights to victims of racial discrimination, women, children, and migrants: Convention for the Elimination of Racism and Racial Discrimination (CERD), Convention Against Torture (CAT), Convention for the Elimination of Discrimination Against Women (CEDAW), the Convention on the Rights of the Child (CRC), and the Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families(CMR)[6].These instruments have been characterized as fundamental human rights instruments that define basic, universal human rights and ensure their explicit extension to vulnerable groups world-wide[7]. The Convention on the Status of Refugees 1951 provides essential standards regarding recognition, protection of and assistance to refugees and asylum seekers. The Convention defines who is a refugee, sets out rights of individuals granted asylum, delineates the responsibility of States to non-refoulement and provides other provisions such as regarding refugee travel documents. ILO Convention No. 102 on Social Security (Minimum Standards) recognizes the following nine speà cific branches of social security: medical care, sickness benefits, unemployment benefits, oldà age benefits, unemployment injury benefits, family benefits, maternity benefits, invalidity benefits and survivorsââ¬â¢ benefits[8].à Minimum reà quirements are stipulated as to the coverage of the population, the content and level of benefits, the protection of the rights of conà tributors and beneficiaries and matters of administration. Other relevant Conventions of ILO are: Maternity Protection Convenà tion (Revised), 1952 (No. 103); Equality of Treatment Social Seà curity) Convention, 1962 (No. 118) (concerning equality of treatment of nationals and non-naà tionals); Maintenance of Social Secuà rity Rights Convention, 1982 (No. 157). International Labor Standards to policy and practice regarding employment dimensions of migration have repeatedly underscored the applicability to all migrant workers of International Labor Standards covering conditions at work, occupational safety and health, maximum hours of work, minimum remuneration, non-discrimination, freedom of association, collective bargaining, and maternity leave, among others. European Legal Instruments The Council of Europeââ¬â¢s migration instruments cover general human rights and more specific agreements relating to migrants and migrant workers. The European Convention on the Protection of Human Rights and Fundamental Freedoms (ECHR)[9] applies clearly to everyone within the jurisdiction of a state party, which means that all migrants in Council of Europe member states are covered by its provisions irrespective of their country of origin[10]. The importance of this Convention is because, unlike other Council of Europe instruments, its personal scope is not limited to nationals of other states parties. The ECHR primarily safeguards civil and political rights and that the legal status of migrant workers. This convention is strongly connected to the protection of their economic and social rights but its role in this field is limited. Nevertheless, the discriminatory application of economic and social rights in respect of migrants may well lead to a violation of the ECHR.à While there are no specific provisions on migrant workers in the ECHR, migrants have obtained remedies from the European Court of Human Rights under its cas e law in protection of their right to respect for family life and the non-discrimination principle (Arts. 8 and 14 respectively)[11]. The European Social Charter (1961) and its Additional Protocol (1988), as well as the Revised European Social Charter (Council of Europe, 1996) which entered into force in July 1999[12], in contrast to the ECHR, has a limited personal scope because it only applies to foreigners who are nationals of other contracting parties.à The Charter is the only treaty which guarantees the right to social and medical assistance. The dichotomy between social security and social assistance is highly controversial, it appears in the Charter, which approaches the two areas in two separate Articles (Article 12 and Article 13) carrying different undertakings. Article 12(4), is concerned with ensuring equal treatment between the nationals of contracting parties in respect of social security rights by the conclusion of bilateral or multilateral agreements (or by other means) and Article 13(4), is concerned with the treatment of foreigners lawfully within the territory of contracting parties in respect of social and medical assistance in accordance with the obligations of contracting parties under the European Convention on Social and Medical Assistance. It considers as social assistance, benefits for which individual need is the main criterion for eligibility, without any requirement of affiliation to a social security scheme aimed to cover a particular risk, or any requirement of professional activity or payment of contributions. European Convention on the Legal Status of Migrant Workers (Council of Europe, 1977) includes provisions relating to the main aspects of the legal status of migrant workers coming from Contracting parties, and especially to residence and work permits, medical examinations and vocational tests, recruitment, housing, family reunion, travel, conditions of work, transfer of savings, expiry of the contract of employment, dismissal and re-employment, social and medical assistance, social security, and preparation for return to the country of origin[13]. European Convention on Social and Medical Assistance ensure that nationals of contracting parties lawfully present in the territory of another contracting party, and who are without sufficient resources, are entitled to social and medical assistance on the same basis as nationals (Article 1) [14]. As of 15 September 2002, this convention was in force in seventeen member states[15]. The convention prohibits a contracting party from repatriating nationals from other contracting parties who are lawfully resident in its territory on the sole ground that they are in need of assistance (Article 6.a), although it may still do so if the following three conditions in Article 7.a are satisfied: the person concerned has not been continuously resident in the territory of that Contracting Party for at least five years if he entered it before attaining the age of 55 years, or for at least ten years if he entered it after attaining that age, he is in a fit state of health to be transported, and has no close ties in the territory in which he is resident[16]. The importance of this convention is that both the provisions concerning social and medical assistance in the European Social Charter (Article 13(4)) and the European Convention on the Legal Status of Migrant Workers (Article 19) refer specifically to the obligations of contracting parties under the convention. Articles 13(1)-(2) of the Charter require contracting parties to ensure that persons without adequate resources are provided with adequate assistance and health care and that they do not suffer from the diminution of their political and social rights because they receive such assistance. Article 13(3) provides that everyone should be able to benefit from public or private services to prevent, remove or alleviate personal or family want. These rights also apply to nationals of contracting parties who work regularly or reside lawfully within the territory of another contracting party on the same basis as nationals. Article 13(4) of the Charter extends the scope of these provisio ns by stipulating that they are to be applied by contracting parties on an equal basis to the nationals of other contracting parties lawfully within their territories in accordance with their obligations under the European Convention on Social and Medical Assistance[17]. Treaty Establishing the European Community (EC Treaty) provides for freedom of movement for workers from EU member states, although transitional arrangements are in place limiting this freedom for nationals from certain new member states. The Treaty prohibits any discrimination based on nationality between these workers as regards employment, remuneration and other conditions of work and employment, including social security (Arts. 12 and 39). The EC Treaty also invites the EU Council of Ministers to take measures necessary to ensure equality of treatment and to combat discrimination based on, inter alias, race, ethnic origin, religion or belief, and sexual orientation. The Council is also empowered to take measures in the field of asylum, immigration and safeguarding of the rights of nationals of third countries, although the measures adopted to date on legal migration have afforded third-country nationals lesser rights than those granted EU citizens. European Union Charter of Fundamental Rights, adopted in 2000, sets out in a single text, for the first time in EU history, the whole range of civil, political, economic and social rights of EU citizens and all persons resident in the European Union. Council Directive 2003/109/Ec f 25 November 2003 on 3rd country nationals who are long term residents respects the fundamental rights and observes the principles recognized in particular by the European Convention for the Protection of Human Rights and Fundamental Freedoms and by the Charter of Fundamental Rights of the European Union[18]. It promotes the integration of third-country nationals who are long-term residents in the Member States as a key element in promoting economic and social cohesion[19]. This directive specifies that long-term residents should enjoy equality of treatment with citizens of the Member State in a wide range of economic and social matters.à With regard to social assistance, the possibility of limiting the benefits for long-term residents to core benefits is to be understood in the sense that this notion covers at least minimum income support, assistance in case of illness, pregnancy, parental assistance and long-term care[20]. The modalities for grantin g such benefits should be determined by national law. A broader view of directive 109 provisions is presented in the chapter with social advantages for TCNââ¬â¢s in EU. Council Recommendation 92/441/EEC[21] of 24 June 1992 on common criteria concerning sufficient resources and social assistance in social protection systems. This Recommendation, adopted in June 1992 at the Lisbon European Council, recognizes the basic right of a person to guaranteed sufficient resources and social assistance, as part of a comprehensive and consistent drive to combat social exclusion, and to adapt their social protection systems as necessary. It is open to all individuals resident in the Member State in accordance with national and Community provisions that do not have access to sufficient resources individually or within the household in which they live. Council Regulation (EEC) No 1408/71 of 14 June 1971 on the application of social security schemes to employed persons and their families moving within the Community (5), provide Third-country nationals with refugee status equal social security rights with EU nationals. Council Regulation (EC) No 859/2003 extends the provisions of Regulation (EEC) No 1408/71 and Regulation (EEC) No 574/72 to nationals of third countries who are not already covered by those provisions solely on the ground of their nationality. It ensure fair treatment of third country nationals legally residing in the territory of Member States, granting them rights and obligations comparable to those of EU citizens. In this regulation is enhanced social and cultural life and the legal status of TCN is approximated to that of Member States nationals. A high level of social protection is promoted and a set of uniform rights as near as possible to those enjoyed by EU citizens is granted to TCN. European Community agreements with third countries The Community has power to enter into agreements with third countries which agreements may either be limited to matters within the exclusive competence of the Community or cover a wider mix of issues including areas of shared competence between the Member States and the Community[22].à Turkey Agreement: The EEC-Turkey Association Agreement[23], implemented by Association Council Decisions 2/76, 1/80 and 3/80,4 provides for certain rights for Turkish nationals and their family members employed and resident in EU member states. Turkish workers resident in EU member states are also entitled to the same protection from expulsion as EU nationals employed in other member states. With regard to social security rights, the European Court of Justice has also held that Article 3(1) of Decision 3/80, which affords Turkish workers and their family memberââ¬â¢s treatment equal to that of nationals of member states, confers direct effect[24]. Algeria, Morocco and Tunisia: The agreements with the Maghreb countries of Algeria, Morocco and Tunisia[25] confer equal treatment on Maghreb nationals employed and resident in EU member states as regards their working conditions or remuneration and social security[26]. These non-discrimination provisions have been found by the European Court of Justice as containing sufficiently clear and precise obligations to confer direct effect in EU countries of employment[27]. Equal treatment in social security extends to family members, who have been defined broadly by the ECJ to include the parents of the worker and his or her spouse residing in the host member state[28]. In the field of social security, these agreements are generally based on the following principles: Equal treatment with nationals of the Member States in which they are employed, of Moroccan workers and members of their families living with them, for all branches of social security covered by Regulation 1408/71. Aggregation of periods of insurance, employment or residence completed in the Member States for each of the above social security branches, with the exception of unemployment benefits, industrial accident or occupational disease benefits, and death grants; Transfer of family benefits to other Community countries; Transfer to Morocco of old-age, survivorsââ¬â¢ and invalidity benefits, and industrial accident or occupational disease benefits; Application of these principles by Morocco to Community workers, with the exception of aggregation. Europe Agreements: The Community can enter into Europe Agreements with third countries which may also be candidates for accession to the EU. These agreements include a provision guaranteeing equal treatment of migrant workers and nationals as regards working conditions, remuneration or dismissal. In contrast to the agreements with the Maghreb countries, however, equality of treatment in the Europe Agreements in respect of social security is dependent on the adoption of provisions for the co-ordination of social security schemes by the Association Council established under each agreement. The Ruling of the European Court of Justice Under the EU law, the rights of non-EU nationals (including Turkish nationals) to entry, residence, work, social security benefits, education and other social and tax advantages are based either on their relationship with EU nationals or firms (derivative rights) or on their status as a national of a country with which the Community has concluded an international agreement (direct rights)[29]. The EU law differs from other instruments of international law in that decisions, agreements and acts of the institutions of the Community are directly applicable in the Member States. Of course, not all provisions of directly applicable international law are capable of direct effect[30]. When a provision of EU law is directly effective, domestic courts are under an obligation not only to apply it, but to do so in priority over any conflicting provisions of national law according to the principle of primacy of EU law[31]. Therefore, EU law has priority over national laws in the areas in which they apply. Under the EU law, where a right deriving from an agreement is found to be directly enforceable by the ECJ (direct effect), it is part of the acquis communautaire and must be applied by the Communitys national courts. Furthermore, if it appears to a national court that a national provision does not comply with community law, the court is under an obligation to apply Community law and if necessary grant interim relief while the opinion of the ECJ is being asked[32]. Despite the jurisprudence of the ECJ clarifying the treatment of third country nationals having an advantageous legal status close to nationals of Members States, a comprehensive and exclusive Community competence in this area still remains to be unresolved. A dichotomy was developed over the years by the Member States, by explicitly recognizing, on the one hand, the requirement of much closer consultation and co-operation at Community level in the implementation of national migration policies vis-ÃÆ'à -vis third countries[33]. On the other hand, Member States always underlined that matters relating to the access, residence and employment of migrant workers from third countries fall under the jurisdiction of the governments of the Member States and nothing shall stop them to take measures to control immigration form third countries[34]. 2.à TCN In European Union Definition of TCN According to Article 17(1) of the Treatyâ⬠[35] ââ¬Ëthird country national (TCN) is ââ¬Å"any person who is not a citizen of the Union within the meaning of this definition includes a number of categories of persons: Refugees, asylum seekers, migrant workers, those who enter through family reunion, and legally resident and undocumented immigrants. It also includes stateless persons, in accordance with the definition in the Constitutional Treaty. Categories of TCN Third country nationals are contrary to EU-nationals. Their situation differs not only from European Union Nationals but also between the different categories of third country nationals. Referring to the definition of TCN the following categories can be distinguished: Asylum Seeker: is someone who makes a claim for asylum in a country other than their own. The rights of asylum seekers are more restricted than the rights of refugees in relation to movement (where they can travel to), employment, health care and social security. Illegal Immigrant: is someone who has moved from one state to another without any legal claim, such as a visa or a claim for asylum. Migrant Unlike refugees, migrants do not fear persecution from their home state. Instead, they make a conscious decision to move and have the freedom to return to their state of origin if they wish. Refugee: in the 1951 Convention relating to the Status of Refugees a refugee is defined as someone who: owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country[36]. Stateless Person: is someone who does not belong as a citizen to any state. A stateless person may also be a refugee but this is not always the case. For example, a person may leave their home state without persecution. Some people are also born into statelessness due to their parents either being stateless themselves, or unable to register the birth of their child. According to the legal base which covers TCN the following categories can be distinguished[37]: Third country Nationals from EFTA states. They are covered by regulation (EEC) No 1408/71 and their situation is similar to EU-nationals. Third country Nationals who are family members of EU nationals, partly covered by Regulation (EEC) No 1408/71. Third country Nationals covered by agreements concluded between the community and third countries. Third country Nationals covered by multilateral agreements such as agreements of the Council of Europe, ILO etc. Third country Nationals covered by bilateral agreements. Third country Nationals who are not covered by any agreement. Legal Status of TCN According to their legal status, immigrants in European countries can be grouped into four different categories[38]: The immediate citizenship model. The receiving state recognizes the immigrants as citizens immediately on their arrival. The quasi-citizenship model, immigrants have a similar status but not completely identical to the citizenship model. Alien resident have the same rights as the citizens of the host state in almost all fields of social life. Privileged treatment for special categories of immigrants, rights to enter or stay in the country are granted to certain special categories of aliens. Their residence rights are protected. Those aliens have limited possibilities for expulsion or deportation[39]. They have special rights or same treatment as citizens in several areas. Denizen[40] status, or semi-citizen status, aliens receive almost full residence rights (expulsion being limited to exceptional cases). Equal treatment with citizens is granted in most areas of public life (access to all jobs, equal rights to housing, education and social security) and sometimes even in political life. The exact content of the rights included in each model may differ slightly from country to country. The main differences in Social and political rights granted to immigrants are between the first model and the other three models. Full set of social and political rights are granted only to immigrants with citizenship of the country of residence. As for the other three models immigrants social and political rights are limited to the right to participate in elections on the local or the regional level and the access to certain jobs in the public service. 3.à Social Advantages of Third Country Nationals In European Union It is not easy to define social advantages of TCNââ¬â¢s in European Union. Social advantages and social rights of TCNââ¬â¢s depend on their legal status. Different categories of TCNââ¬â¢s enjoy different social rights within the Union.à Illegal immigrants, for example, cannot claim any rights and are not eligible for any welfare schemes because of their impossibility of presenting any official documents (identification, residence or work permit, etc.) regarding their status. Regular immigrants have a more favorable situation and enjoy rights and obligations comparable to those of citizens of the European Union. According to their status, their social rights are included within different directives and regulations. The European Council, in its special meeting in Tampere on 15 and 16 October 1999, acknowledged the need for harmonization of national legislation on the conditions for admission and residence of TCNââ¬â¢s. In this context, it has in particular stated that the European Union should ensure fair treatment of third country nationals residing lawfully on the territory of the Member States and that a more vigorous integration policy should aim at granting them rights and obligations comparable to those of citizens of the European Union. Council Regulation (EEC) No 1408/71 has a restricted personal scope of application and provides equal social security rights with EU nationals only to third-country nationals with refugee status.
Tuesday, August 20, 2019
Diabetes Education: The Increase In Diabetes
Diabetes Education: The Increase In Diabetes Diabetes is becoming a worldwide epidemic. It is one of the biggest health challenges that the United Kingdom (UK) is facing today with one person being diagnosed with diabetes every 3 minutes (Diabetes UK, 2009). The latest data indicates that there are now 2.8 million of people with diabetes in UK and nine out of ten people diagnosed with diabetes are Type 2 diabetes (2.5 millions). According to health experts, UK is now facing a huge public health problem and the figure is set to rise to four million by the year 2025. (Diabetes UK, 2010). The alarming increase in diabetes prevalence is a great cause of concern and has a devastating economic effect. Recent estimate shows that 10% of National Health System (NHS) spending equivalent to 9 billion pounds a year, 1 million pounds per hour goes on diabetes (Diabetes UK, 2008). The direct and indirect cost to the NHS of caring for people with Type 2 diabetes and its complications are staggering and will continue to rise with the increasing incidence of the disease. As a result of this health crisis and significant financial burden, the NHS needs to respond to this massive strain by looking at more effective and efficient ways of providing diabetes care. It is therefore of primary importance for our local primary care diabetes services to identify ways to deliver an effective quality care for people with diabetes to counter this worrying trend. 1.1 Diabetes Education Diabetes education has been considered as one of the key components of diabetes care since the 1930s and has been increasingly recognised as an integral part of the disease (Atak Arslan, 2005). Nicolucci et al (1996) demonstrated that people who have never received diabetes education had a striking fourfold increased risks of developing major diabetes complications. Furthermore, the study done by Rickiem et al (2002), showed that diabetes education has an overall positive effect on the health and psychosocial outcome. It helps to improve patients skills and knowledge on the condition and enables beneficial change in the behaviour. Diabetes education has a profound effect on glycemic control, quality of life and treatment satisfaction (clinical governance support team, 2004). Stratton et al (2000) suggested that improving Hba1c by just 1% through diabetes education can significantly reduce risk of complications. In view of all the evidence, the importance of diabetes education has been highlighted and well advocated by the National Service Framework (NSF) and National Institute of Clinical Excellence (NICE, 2003) . The NSF emphasizes that diabetes education should be made available from the point of diagnosis onwards and proposes that education should involve a structured program for people who have been newly diagnosed. This has been encouraged by NICE which recommends that all patients received structured education at initial diagnosis and then on a regular basis according to need (NICE, 2003). However there is insufficient evidence currently available to recommend a specific type of education or provide guidance on the setting for, or frequency of, sessions. In this context, how best to provide structured education to people with diabetes is an important question. NICE acknowledge the limited evidence to suggest which approach is most appropriate and state that to achieve maximum effectiveness, some principle of good practice should be in place(NICE, 2003). According to NICE criteria, diabetes education should reflect the principle of adult learning, provided by trained educators including a DSN or practice nurse with diabetes experience, and a dietitian, use a variety of techniques to promote active learning, be accessible to the broadest range of people taking into account their ethnicity, culture and beliefs. 1.2 Aim of Diabetes Education The National Institute for Health and Clinical Excellence (NICE, 2003) states that the aim of education for people with diabetes is: To improve their knowledge and skills, enabling them to take control of their own condition and to integrate self-management into their daily lives. Diabetes education should allow people to engage in their own health to put what theyve learned into action. Traditional health education can give them the information they need but the learning experience may not engage and empower them to use what theyve learned in their daily lives. Education was focused on passive didactic format where patients do not interact with the educator and generally use a lecture or print format (Norris et al, 2001). Middleton et al (2006) found that its purpose was often unclear to both patients and health care professionals. The old model of education is outmoded and ineffective (Skinner et al, 2007). Education has now moved towards a collaborative format where patient actively participate in the learning process through small group discussion, role playing and other interactive techniques (Norris et al, 2001). 1.3 Patient Centered Approach and Empowerment The National Service Framework for diabetes (DoH, 2001) standard 3 states that all people with diabetes will: Receive a service which encourages partnership in decision-making, supports them in managing their diabetes and helps them to adopt and maintain a healthy lifestyle. The purpose of diabetes education is clear. It should empower people with diabetes to make informed choices about their condition (Funnel and Anderson, 2003). Anderson et al (1991) at the Michigan Diabetes Research and Training Center (MDRTC) introduced empowerment into patient education in diabetes at the beginning of the 1990s in the US. They implemented empowerment group education programmes in diabetes (empowerment programme) and evaluated their programme. An improvement in self-efficacy and glycaemic control was reported among the patients who had participated in the programme compared to those in the wait-listed control group. Following the valuation of patient educational interventions for people with type 2 diabetes during the 21st century, Deakin et al (2006) showed that there is a trend to actively involve patients in their care in accordance with the empowerment philosophy. The investigator compared group education programmes with routine diabetes care and found that group-based programmes involving patient empowerment has positive effect on biomedical and psychological out come. The concept of empowerment requires an initial understanding of what the treatment pathway is trying to achieve and is continual information sharing process encompassing learning and behaviour change which aims to allow the patient to take responsibility for their own condition. (Meetoo and Gopaul, 2004) For empowerment to be effective it is important for patients to have the appropriate information to enable them to make informed choices, if they have the capability and desire to do so. They need to be able to agree plans and set goals with the support of the care team. To do so, it is important for them to understand their disease.The NSF set to ensure that people with diabetes are empowered to enhance their personal control on a day to day management of the condition. Implications for service planning were highlighted detailing how NHS will need to develop, review and audit education program to empower people with diabetes, (DoH, 2001) People are more likely to make behavioural changes if they are facilitated through patient centered care rather than imposed by care based on the medical model of delivery (DoH, 2001a).The philosophy of practice which support patient centered approached for diabetes education is well documented in chapter 3 of the DoH publication structured patient education in diabetes: report from the patient education working group (DoH, 2005). Specific strategies that grew out of the patient centered model included the following: affirming that the person with diabetes is responsible for and in control of the daily self-management of diabetes; educating patients to promote informed decision making rather than adherence/compliance; learning to set behavioural goals so that patients can make changes of their own choosing; integrating clinical, psychosocial, and behavioural aspects of diabetes self-management; affirming the participants as experts on their own learning needs; affirming the ability of participants to determine an approach to diabetes self-management that will work for them; affirming the innate capacity of patients to identify and learn to solve their own problems; respecting cultural, ethnic, and religious beliefs of the target population; creating opportunities for social support; and Providing ongoing self-management support. Overall the diabetes education must provide knowledge and skills, be tailored to the needs of the individual and include skills-based approaches to education. It should support people with diabetes to adopt and maintain a healthy lifestyle, prevent and manage diabetes related complications that will result in improved quality of life and self-management. Healthcare professionals are encouraged to work in partnerships in the decision-making process to support the individual to manage his or her condition. 1.4 Effectiveness of Diabetes Group Education The manner in which education is delivered can be the subject of much debate. Education can be delivered in a one to one session or in group settings. Diabetes group education has been seen as an effective intervention since 1970 (Mensing, 2003). Traditionally, it was more of a medical model where patients handed their medical problem for the doctors to cure. They are told what to do and expecting good results (Calabretta, 2002). As the process of group education has evolved over time, diabetes education has changed from a medical didactic presentation to more of theoretical, patient centered and empowerment model. Diabetes group education is now seen as a first line approach to improve diabetes outcome. With the increase in number of people diagnosed with diabetes, more education is being delivered now in groups as compared to the past. The environment should support and reinforce self management and patients and their health care should work in collaborative way. Self management can only be successful in a well organised and coordinated diabetes service where patients are supported to make informed choices (Norris et al, 2001). Several reviews and meta- analyses provide valuable information on the effectiveness of group education. Mullen et al( 1985) found that patient knowledge about their medication significantly improved in group education, one to one counselling , written and other audiovisual material. Norris et al (2002) suggest that the literature in diabetes education is divided although there may be more positive effect on group education as compared to the individual one. Deakin et al(2006) showed that there is some evidence to support group-based diabetes self-management education as an effective way to improve knowledge and glycemic control and to reduce BP, body mass index (BMI), and the need for diabetes medication. However, a number of issues arise when reviewing the literature on the relative effectiveness of group education compared to individual ones. Some researchers make comparison difficult by focusing on different outcome rather than the delivery format whereas others compare it with usual program without considering the relative effectiveness (Mensing,2003). Wilson (1997) noted that it is not easy to figure out whether the outcome is from an educational approach based on a specific theory or from intervention applied to a specific setting and population. Given these issues and limitation, it is difficult to draw conclusion about group effectiveness. More evaluation research must be done in this field to answer these questions. NICE (2003) has highlighted the effectiveness of group education sessions .For healthcare professionals, group sessions are considered as the most cost-effective way of delivering education. In the present financial climate, and with the increase in the numbers of people with newly diagnosed diabetes, it could be argued that group education is the only way forward if healthcare professionals are to be able to provide education for the majority of people with diabetes. A group approach to patient education makes sense from what we already know about the positive effects of peer support and the inadequacies of the brief medical appointment. The potential benefit of an effective group education programme for people with type 2 diabetes is to enhance skill and knowledge, to make positive behavioural changes for better metabolic outcome, psychological outcome and improve quality of life. 1.5 The Two National Programs for people with type 2 Diabetes : XPERT AND DESMOND Most people diagnosed with diabetes are offered some sort of education, at least when they are diagnosed (NICE, 2008). However, there is still much debate over the educaà tional approach that is most effective in delivering such crucial health information in a way that leads to measurable changes in patient behaviour and improved clinical outcomes. The two national group education programs available for adults with type 2 diabetes are (DESMOND) and X-PERT program. Both are patient centered, meet the NICE key criteria, flexible in their content and adaptable to patients educational and cultural background. However, the two structured group varies in their cost implication and duration of the program. Depending upon primary care trust funding funding, avaibility of health care professionals and what best suits patients, either DESMOND or X_PERT are chosen to be delivered by the primary care trust. 1.51 XPERT DIABETES PROGRAM The X-PERT diabetes programme is a six-week professionally-led programme based on the theories of patient empowerment and patient activation. The X-PERT course is designed to be delivered to anyone diagnosed with diabetes It aims to increase knowledge, skills and confidence leading to informed decisions regarding diabetes self-management (Deakin Whitham,2010). Participation in the X-PERT Programme by adults with type 2 diabetes has been shown at 14 months to have led to improved glycaemic control, reduced total cholesterol level, improved body mass index and waist circumference, reduced requirement for diabetes medication, increased consumption of fruit and vegetables, increased enjoyment of food, and improved knowledge of diabetes, self-empowerment, self-management skills and treatment satisfaction (Deakin et al, 2006). Contents of the X-PERT Diabetes Programme include: What is diabetes? The eatwell plate and energy balance. Carbohydrate awareness and glycaemic index. The benefits of physical activity. Supermarket tour and understanding food labels. Possible complications of diabetes and their prevention. Lifestyle experiment. Are you an X-PERT? Game. Care Planning: the lifestyle experiment. There is a one off cost to run X-PERT and this is approximated to à £1400. 1.52 DESMOND The DESMOND programme was launched in 2004, and is currently the most familiar education programme provided in the UK. It was developed as a collaborative project involving a multidisciplinary, multicentre collaborative team which agreed upon a core set of philosophical principles to the use of informed choice as the key to empowerment. They drew the program on three theoretical approaches: the common-sense model of illness, social learning theory, and use of a discovery learning process (DESMOND, 2004). DESMOND aims to educate patients about type 2 diabetes. It provides resources for them to manage their disease, and offer a group-based opportunity to meet and share experiences with others in the same situation .The DESMOND programme is facilitated by two health care professionals who have been formally trained. The course is usually delivered for 6 hours and is based on a formal curriculum. It is offered either as a 1-day or 2 half-day sessions and accommodates 6-10 patients in one group. DESMOND helps to promote the understanding of type 2 diabetes, allowing the patients to be more knowledgeable about the condition and what can benefit their long-term health. It encourages patient to work together with the health care professionals to take an active role in the management of their type 2 diabetes. It helps patients to see their illness in a well define way which drives them for positive changes. The program content includes: Thoughts and feelings of the patients around their condition. Understanding diabetes and glucose: what actually happens in the body. Understanding the risk factors and complications associated with diabetes. Understanding monitoring and medications. How to take control: Food Choices and Physical Activity. Future care plan. DESMOND was piloted in 15 English PCTs between January and May 2004 (Skinner, 2006). Initial abstracts of preliminary research findings were presented at the Diabetes UK annual conference in 2005. Pilot data indicated the DESMOND course for newly diagnosed individuals changed important illness beliefs. At three month follow-up there was a reported improvement in quality of life and metabolic control. DESMOND was revised following feedback from all involved parties. A larger randomised controlled trial was conducted involving 824 adult patients in 207 general practices in 13 primary care sites in the United Kingdom. The results showed that compared to patients who did not undergo the DESMOND programme there were greater improvements in weight loss and smoking cessation and positive improvements in beliefs about illness but there were no differences in haemoglobin A1C levels up to 12 months after diagnosis (Davies et al,2008). The author feels that it is difficult to compare DESMOND to X-PERT because of the different populations (newly diagnosed diabetes compared with established diabetes) and because the study concerned multiple sites and educators. In response to the Hba1c the author commented that it is usual for noticeable reductions to occur in levels shortly after diagnosis and in terms of showing a difference in levels between groups, patients with newly diagnosed type 2 diabetes may be the most difficult in which to demonstrate this(Davie s et al,2008). To investigate this further, a follow-up was carried out three years later. 743 participants were eligible for follow-up at 3years. Biomedical data were collected from 604 (81.3%) and questionnaire data from 536. Those followed up were older, had a higher BMI , higher waist circumference and higher depression score than those who were not. The result indicates a lack of difference in biomedical and lifestyle measure but the author reckoned that this is not unexpected as drift towards pre intervention values is commonly observed (Khunki et al, 2010) . However accumulated effects, which were not significant individually, did manifest themselves as a difference in UKPDS score. The differences in illness belief scores show that attending DESMOND results in positive changes in understanding of diabetes, which are sustained at 3 years.Therefore attending a single course at diagnosis is beneficial, but patients need to continue receiving ongoing support to help them to manage their diabetes. The study done on cost effectiveness for DESMOND found that per patient cost of providing the DESMOND Newly Diagnosed or Foundation programme compares very favourably to the provision of oral glycaemic agents(Gillet et al, 2010). The therapeutic benefit of the DESMOND structured education programme is effective as a once-off intervention to help lower biomedical markers as well as having a positive impact on peoples health beliefs and health outcomes (Gillet et al, 2010). Although it is likely that the one off DESMOND intervention is cost effective, it must be noted that the DESMOND programme was never intended as a one off intervention. Moreover, in the real world, costs of delivering the DESMOND programme are likely to vary considerably across primary care trusts. The main variables affecting the cost are the number of educators trained, the grade of healthcare professional delivering courses, venue cost, ratio of demand to head of population (including participation rate), number of patients per course, and overhead rates. It hopes to promote understanding of type 2 diabetes, allowing patients to be more knowledgeable about what will positively benefit their long-term health as they live with the condition. 1.6 Diabetes Conversation Map: Recently, healthy interaction in collaboration with Diabetes UK, sponsored by Lilly company, has introduced Diabetes Conversation Maps in UK. Diabetes Conversation Maps was created in 2005 in Canada and since then over 60% of diabetes educators has been trained for the program. It was next launched in America in 2006 and now over 20,000 health professionals have been trained. Diabetes Conversation Map serves as a facilitation tool to engage individuals in conversations around their condition and usually last for 2 hours. (Healthyi, 2005) Diabetes Conversation Map is an educational tool which has transformed healthcare education throughout the world by engaging people in meaningful conversations about their health(Healthyi, 2005). The American Diabetes Association (ADA) believes that it is one of the most important innovation in a decade. Conversation Mapà ¢Ã¢â¬Å¾Ã ¢ education tools have been developed by Healthy Interactions. They are built on the philosophy that people respond better when they are engaged, empowered, and draws their own conclusions as to why they need to change behaviours (ADA, 2006). In this way, that will be an impact on their overall health as opposed to didactic interventions where patients are told what to do by a healthcare professional. The Diabetes Conversation Map methodology creates an experience whereby patients develop their own self-management solution that accounts for their individual challenges and situation. The patients, in turn, then own the solution because it is theirs. They are subsequently much more likely to embrace and implement the change needed to improve their condition The main philosophy is that people will act on their own conclusions by engaging themselves in an experience(Healthyi, 2005). It allows them to explore health facts through dialogue and enable decision making. Conversation map shapes the way in which people are motivated for positive behavioural change. The 6 components of the map are map visuals, facts, questions, group interaction, facilitator and action plan. The program is delivered to a small group of 3-10. It facilitates discussion, not lectures and must be delivered by trained health professionals. It benefits the patients as people are visual learners and like exploring and discovering their own answers. The map is fun and provides a process that patient use to internalise and personalise health information. For educators, it is simple to use, portable and non technology dependent. The program content includes basic facts about diabetes, healthy eating, self-monitoring of blood glucose, diabetes complications, and gestational diabetes The evaluation done in Enfield showed that Diabetes Conversation Map offers several advantages (Monk, 2009). First and foremost, it enables better use of staff time as it requires one member of the healthcare team to facilitate the session, allowing more time for direct patient contact. In terms of financial implication, to run the education program, cost is very minimal. Hand-outs are provided for free from Diabetes Uk and Lilly company which can be photocopied. Although the non-attendance rate remains high in enfield, it was observed that the number of patients attending Conversation Map is better and most patient who come to the first session the other sessions. It is reported that patient get to know each other during the program which help to break down barriers and improve group dynamics (Monk , 2009). Overall, the evaluations done in Enfield area have been positive. However, the result could have been influenced by the fact that the evaluations were completed at the end of the session and handed to the facilitator. In April 2008 a survey was done to assess the effectiveness of the Diabetes Conversation Map training sessions and initial impact on diabetes self-management education (Grenci, 2010). The survey results indicated that sixty-five percent of diabetes educators attribute improved patient self-management to the Diabetes Conversation Map tools. Eighty percent of healthcare professionals say that the tools make group facilitation more interactive and engaging. More than sixty percent say that there was an increase in patient interest in diabetes education and it boosts their willingness to learn. When asked about the most effective method in helping patients to adopt positive behaviours and achieve good outcomes, forty percent of the diabetes educators believe that Diabetes Conversation Map session is most effective. Only twelve percent report that the traditional education means as effective in this survey. Ninety percent of those who have had firsthand experience with the tools suggest that they would recommend them to their peers (Grenci,2010). In terms of metabolic outcome such as Hba1c, cholesterol, blood pressure, weight and patient satisfaction, so far there is no data available. However there will be an upcoming clinical trial called Interactive Dialogue to Educate and Activate (IDEA), which is sponsored by Merck, to identify outcomes using three separate treatment arms:, patients using the Conversation Map tools, patients using individual intervention without using the Conversation Map tools, patients using no formal diabetes education but the data will only be available in five years time. The data will be gathered on an annual basis over the duration of five years and the study will look into metabolic outcomes (A1C, blood pressure, cholesterol, weight) as well as patient and educator satisfaction, knowledge retention and several other behavioural markers of success(Merck , 2009). Nevertheless, the group-based IDEA education method using the Conversation Map approach was executed as planned and showed promise to improve diabetes self-management behaviours. Clinical and behavioural outcome data are necessary and will be forthcoming. 1.7 Current Diabetes Group Education Program in NHS Bromley To fulfil the NICE criteria and provide a quality diabetes care, the NHS Bromley chose to deliver DESMOND education program for all patients who are newly diagnosed patients. DESMOND has been ongoing for the past four years but the cost implication to deliver DESMOND is à £5000 per year plus ongoing à £5/person for the resources. With a diabetes population of 13,000 and about 10-15 referrals received on a weekly basis for DESMOND, NHS Bromley is striving towards an enhanced Diabetes Service to meet the increased demands and to curb the economic burden. In view of the strong positive feedback from diabetes educators in the US, the short duration of the program and the cost, NHS Bromley feel that Diabetes Conversation Map may be an alternative that could be used. As there is a lack of data for metabolic outcome and patient satisfaction, this study will be undertaken to evaluate which group education is more effective to be delivered at NHS Bromley. 2.0 Aim of the study: The aim of the study is to evaluate the effectiveness of DESMOND Group education program versus Diabetes Conversation Map group education program for people who are newly diagnosed with type 2 diabetes at NHS Bromley. It is a requirement of the NSF for diabetes that education is available to everybody with type 2 diabetes. At present, DESMOND is the most widely used programme available in the community setting, however this may not meet the needs of every local population. The Conversation Map tools may be an alternative or additional tool that could be used. In Enfield these have been used with success. The author is aware of work that has been ongoing to ensure that this method of education is fully compliant with the NICE criteria and is keen to implement this as soon as it is available. 2.1 Objectives: To measure patient biomedical outcome before and 3 months after the delivery of both group educations To assess patient satisfaction before and after the delivery of both group educations. 2.2 Hypothesis: DESMOND and Diabetes Conversation Group Education will have different biomedical outcome DESMOND and Diabetes Conversation Group education will have different patient satisfaction and quality of life outcome. 2.3 Study Design: Questionnaire Survey involving both quantitative and qualitative design analysis.
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