Im writing how global warming affects to penguin (penguin living in cold climate like an Antarctic) because many of them are decreasing.
write A. global warming affect their habitat
B. it affects their reproduction (example: penguins walk to the ice grounds to breed, ice melting prevent them from breeding grounds)
C. penguins cant live in warm weather.
could you write essay about 2~3 pages? if you have works cited let me know. thank you!
I have to finish it in 2 hours
Compare and contrast two models of conceptualizing addiction.
Write a 1,050-to 1,400-word paper briefly describing the models, how they are synergistic, or how they take competing views.
Include a summary about which theory you feel is most useful for helping intervene on addiction.
Format your paper consistent with APA guidelines.
Submit to the Assignment Files tab
You CANNOT use other sources for this essay besides the ones provided and attached. This an analytical essay based on the readings It is NOT a personal opinion piece. Therefore, your writing must be based on the course material. The pronoun I must not appear in this paper and neither should your personal experience or opinions.
Assignment
From all of this Learning Modules readings answer the following 4 questions. Your answers to these questions should be a synthesis of the readings.
1. What defines rampage mass shootings and how do they differ from other types of gun related murders?
2. Who are the perpetrators?
3. Why do the perpetrators engage in this type of violent behavior?
4. Are there any possible ways to prevent or reduce mass shootings?
You MUST use these questions as headings to organize your paper.
Assignment 3: Gender Identity
We are socialized at every stage in life to conform to our gender identity. Societal reinforcement of tendencies of gender identity is relentless. For example, in hospitals, little girls are wrapped in pink and little boys in blue. This difference in colors influences how we learn and how we internalize our role in our society.
Girls tend to grow up to play feminine roles and boys tend to grow up to play masculine roles. This differentiation of gender identity has implications in social stratification. The videos given below will provide you with a better understanding of the differentiation of sexual identity from an earlier generation.
Search for and watch an episode of at least one of the following shows. You may find these videos using a variety of search methods including visiting your local library, using Netflix or your local video store, or searching on YouTube. If you have difficulty locating an episode of one of the following shows, contact your instructor for assistance in finding an alternative.
I Love Lucy
All in the Family
The Mickey Mouse Club
The Honeymooners
Leave it to Beaver
Father Knows Best
Gilligans Island
The Brady Bunch
I Dream of Jeannie
As you watch the video, ask yourself the following questions:
To what extent have things changed and to what extent have they remained the same in regards to gender roles, expectations, division, and identity from the time this show was originally popular and today?
How conscious and sensitive are the characters regarding gender prejudice, power inequality, and subordination?
Did they take inequality of the sexes for granted?
Based on your readings and understanding that you have gathered after watching the above-noted video, write a short biographical description of your life if you were to wake up tomorrow morning in the time period of the video you watched and find you have a different gender identity. Write a description of how you lived your life a day after your hypothetical change in gender as you answer the following questions:
Discuss how you would react on finding out that your sex is opposite. Would you feel a sense of relief, indifference, or elation? Why?
Discuss three ways your attitude towards the opposite sex was enlightened or would change as a result of what you learned from this project. If you would not change your attitude, why?
Write down the ideas and attitudes you have taken for granted a member of your actual gender. Consider how your roles at home and in the office would change if you were a member of the opposite gender.
Relate the ideas of sexism and racism to the videos. How do you think sexism and racism have changed since the 1950s?
Use the following file naming convention: LastnameFirstInitial_M1_A3.doc. For example, if your name is John Smith, your document will be named SmithJ_M1_A3.doc.
By Wednesday, September 28, 2016, deliver your assignment to the M1: Assignment 3 Dropbox.
Assignment 3 Grading Criteria
Maximum Points
Expressed vividly and clearly how you would react on finding out that your sex is opposite, and whether you would feel a sense of relief, indifference, or elation.
20
Discussed three ways that your attitude towards the opposite sex was or was not enlightened or changed, and why.
20
Listed ideas and attitudes you take for granted as a member of your gender, and how your roles at home or work would change if you were a member of the opposite gender.
20
Discussed racism and sexism as shown in the videos and then explored how the concepts have changed since the 1950s.
20
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources; displayed accurate spelling, grammar, and punctuation.
Prepare: In order to prepare for this assignment, you should review the following tutorials in the Ashford Writing Center:
Also, review the following information from the Ashford University Library:
Takes notes by listing examples and differences between these types of resources.
Reflect: Compare your list of examples between primary and secondary resources. Good research is a combination of many types of sources. Prior to taking this course, did you understand the differences between these resources and the importance of finding one type of resource over another?
Write: Provide your initial post that addresses these prompts:
Explain the differences between primary and secondary sources used in research.
Identify a type of resource for your Final Research Project topic that would be considered a primary source and one that might be a secondary source, and explain why they fit in those categories.
Explain the advantages of using primary source documents in your research on your Final Research Project topic.
Review two peer-reviewed, scholarly resources from the Ashford University Library that you will use for your Final Research Project, and explain why they were chosen.
Provide full reference information of the two scholarly articles chosen in APA format at the end of your response.
Download and attach the two articles that you found from the Ashford University Library to your answer using the Attachments: Add/Remove function located below your response.
Support your claims with examples from required material(s) and/or other scholarly sources, and properly cite any references.
Your initial post should be at least 250 words in length.
Discussion Questions
By the due date assigned, post your response to the assigned discussion questions in the below Discussion Area. It is important to support what you say with relevant citations in the APA format from both the course materials and outside resources. Include the South University Online Library in your research activities utilizing not only the nursing resource database, but also those pertaining to education, business, and human resources.
No later than by the end of the week, review and comment on the discussion question responses posted by at least two of your peers. Be objective, clear, and concise. Always use constructive language. All comments should be posted to the appropriate topic in this Discussion Area.
Discussion Question
For this discussion, you are asked to review the student learning outcomes for this course and discuss how you met these outcomes. The intention here is to provide you an opportunity to reflect on the learning achieved during this term and how you successfully met these learning outcomes. If you do not feel you successfully met the objective, discuss your plans to successfully complete the objective in the future.
Upon completion of this course, the student should be able to:
Critically analyze current practice to formulate researchable problems.
Evaluate research as the basis for decision-making to improve outcomes through translation into evidence-based practice.
Synthesize an understanding of the research process through development of a proposal to address a nursing problem or focus area identified in nursing practice.
Investigate ethical issues related to the conduct of scientific research, including informed consent, data management, data analysis, and protection of human subjects.
Explore national and international initiatives and research priorities.
I feel that I have gained a core of formulating research questions to problems. I feel that I have gained a broad perspective improving outcomes with evidence based practice. The proposal development was a challenge initially, but everything seemed to fall into place until the statistical portion of the class. At that point, that is where I struggled and I feel that it is because I am not mathematically inclined. Even though I knew about the Tuskegee incident, I learned more about the incident. This new gained information was an eye-opener for me, and I was more horrified at the events. I learned some new ethical issue related information regarding the informed consents and how difficult it was to write in laymans terms as well as more information on the protection of human subjects. Most of the ethical information to me was understood or common knowledge and made sense. Research is a process of discovering new knowledge. The charter rules (45 CFR 46.102 (d)) have been defined as related to the survey results. The purpose of the National Academy of Sciences is to broaden the knowledge of the people in the physical, biological and social world as well as the study of the knowledge of other types of knowledge reading, etc.), using a systematic process called a different scientific approach.As far as the exploration of national and international initiatives and research priorities, this information is minimal. I feel that I have a lot to learn and that this class was only an exposure. Also, I feel that I need to explore these topics beyond this class to further myself and the core knowledge that was gained from this course.Although I have learned to research, I feel that I am no expert but have gained good base knowledge. I am supposed to be able to form my own research. However, I feel that again with a good basic familiarity; I will probably never do my own research. Instead, I would be involved with research done by others or create performance improvements. I do not feel that I can create my own research trial all by myself and therefore would learn by others. This was an opportunity to get my feet wet. Additionally, since I am somewhat statistically challenged, I would need help with creating my own research. Therefore, I feel that I would never be alone and would bring in the people who would help me create a well-designed and well written study. In the end, it is all about teamwork. When researches are done in the real world and money is spent and political people or doctors or scientists do the research. The researchs unique features are one of the common criteria published in academic journals. (Callaham, Michael et al., 2002) Diploma students usually need to conduct their first research as part of a dissertation.
ReferencesCallaham, Michael; Wears, Robert; Weber, Ellen L. (2002). Journal Prestige, Publication Bias, and Other Characteristics Associated With Citation of Published Studies in Peer-Reviewed Journals. JAMA. doi:10.1001/jama.287.21.2847.
Review the ISTE Standards for Educators. Create a 10-12 slide digital presentation for your colleagues depicting technology in special education. Your presentation should include:
Examples of technologies that improve student learning within a special education environment.
Examples of technologies that could be used collaboratively within a special education environment.
Considerations regarding student access to and use of technology for learning.
Include a title page, presenters notes, and a reference slide.
Support your position with 3-5 sources from the required readings or the GCU Library.
Attachments checked for originality?
Yes
Top of Form
Assignment Instructions
Major Paper Assignment Instructions and Grading Rubric
This assignment meets the following Course Learning Objectives:
Articulate basic drug terminology and drug taking behavior Identify the various addictive substances legal and illegal and their classifications Analyze the reasons people commonly abuse substances Analyze how substances affect the mind and body and society
In 2010, The American Academy of Pediatrics (AAP) released a policy statement addressing the complex relationships among children, adolescents, substance abuse, and the media. This assignment requires a critical examination of the AAP publication and a critique of a media portrayal of substance use, with links made to the AAP statement and course material. Conclusions about the implications of the media portrayals and the policies recommended by the AAP also should be made. Successful completion of this paper will require work over multiple weeks. A two paragraph summary of the proposed example of substance use portrayal in the media was due by the end of Week 3. The full paper is due at the end of Week 7.
This is part one of the assignment that you did
This assignment proceeds in four steps:
Preparation
Step One: Read the AAP Policy Statement located below. Make some notes for yourself about points of agreement or disagreement you have with the statement and specific findings regarding media depictions of substance use that you want to assess when you write the paper.
Step Two: Find a current example of substance use portrayal seen in the media; for example, scenes from a movie, a television show, or a commercial; print ads; or portrayals found in new media as discussed in the AAP article. The Internet is a good tool for finding film or television portrayals of substance use as well as examples of print ads if ready access to first-hand media is not available. A two paragraph summary of the proposed example of substance use portrayal in the media that will be used for the paper is due by the end of Week 3. This proposal is a separate assignment and is worth 10 points.
Construction
Step Three: Write the paper. Begin the paper with an introduction that summarizes the main findings of the AAP article and previews what will be covered in the coming pages. Next, compare and contrast the portrayal of substance use found in the media with the information learned about that substance in the class and course readings. What messages about the substance are being portrayed? How accurate are those messages relative to the actual data on substance use? Be sure to cite the course readings as needed.
Continue by comparing and contrasting the portrayal of substance use found in the media with the criticism of media portrayals found in the AAP paper. Does the media example match their arguments or contradict them? What links and connections can be made? Be sure to cite the article as needed.
Next, draw some conclusions about the portrayal of substance use found in the media, addressing the following: What are the implications of this type of portrayal? What messages are being sent and to whom? Are those messages an accurate representation of the use of this substance? Should media portrayals be required to be accurate in their depictions of use, showing both positive and negative consequences?
Finally, review the guidelines suggested by the AAP at the end of their policy statement and address the following: Although directed specifically at pediatricians, which of those recommendations is most important? Why? Are these recommendations necessary? If followed, will they be effective in addressing the concerns raised earlier in the article? Be sure to cite sources as needed.
Step Four:
The required length of this paper is 11 pages, plus a required a cover page and a reference list. Papers must comply with APA formatting rules, including font size and margins, and must have a scholarly focus and tone. Quoting of published material and use of the first-person I are not permitted and will result in point loss. All source material must be paraphrased into your own words and cited appropriately.
On submission your work will auto-run through Turnitin.coms plagiarism checker software.
The grading rubric below details specific grading criteria.
The Final Major Paper document should be attached in the appropriate Assignment tab and will be evaluated using the rubric below:
Introduction
15 Points Possible
Student provides a clear introduction which summarizes the AAP article and previews the major points to be covered in the paper.
Student provides a mostly accurate introduction which summarizes the AAP article and previews the major points to be covered in the paper. At times description lacks coherence.
Student provides a marginal introduction which summarizes the AAP article and previews the major points to be covered in the paper. Sufficient details and supporting evidence are lacking.
Student does not provide an introduction which summarizes the AAP article or preview the major points to be covered in the paper.
Choice of Media Example
15 Points Possible
Discussion of chosen media portrayal is clear, accurate, and related to the assignment. Sources are credited and cited appropriately.
Discussion of chosen media portrayal is mostly accurate, and related to the assignment. Sources are credited and cited. At times description lacks coherence.
Discussion of chosen media portrayal is marginally accurate, and related to the assignment. Sources are credited and cited but not using appropriate formatting. Sufficient details and supporting evidence are lacking.
Student does not chose a media portrayal that is accurate and/or related to the assignment. Sources not credited and cited.
Comparison of Media Example to Class Material
25 Points Possible
Student provides a comparison of media with information from class material that is clear and thoughtful. Questions outlined in the assignment are answered. Sources are credited and cited appropriately.
Student provides a mostly accurate comparison of media with information from class material that is largely clear and thoughtful. Questions outlined in the assignment are mostly answered. Sources are credited and cited appropriately. At times description lacks coherence.
Student provides a marginal comparison of media with information from class material that is partial clear and thoughtful. Questions outlined in the assignment are marginally answered. Sources are credited and cited appropriately. Sufficient details and supporting evidence are lacking.
Student does not provide a comparison of media with information from class material. Questions outlined in the assignment were not answered.
Comparison of Media Example to AAP article
25 Points Possible
Comparison of media presented by the student with information from the AAP article is clear and thoughtful. Questions outlined in the assignment are answered. Sources are credited and cited appropriately.
Comparison of media mostly presented by the student with information from the AAP article is mostly clear and thoughtful. Questions outlined in the assignment are mostly answered. Sources are credited and cited appropriately. At times description lacks coherence.
Comparison of media marginally presented by the student with information from the AAP article is mostly clear and thoughtful. Questions outlined in the assignment are marginally answered. Sources are credited and cited appropriately. Sufficient details and supporting evidence are lacking.
Student did not compare media presented with information from the AAP article. Questions outlined in the assignment were not answered.
Strength of Conclusion
40 Points Possible
Student provides an insightful and creative conclusion, logically summarizing the main elements of the case and the scholarly literature findings, articulating a personal reflection on the case study analysis process
Student provides a mostly cogent conclusion, logically summarizing the main elements of the case and the scholarly literature findings, articulating a personal reflection on the case study analysis process
At times description lacks coherence.
Student provides a marginal conclusion, loosely summarizing the main elements of the case and the scholarly literature findings, articulating a personal reflection on the case study analysis process
Sufficient details and supporting evidence are lacking.
Student does not provide a clear conclusion or logically summarizing the main elements of the case or reference scholarly literature findings; lacks a personal reflection on the case study analysis process
Paper Format and Mechanics; Spelling, Grammar and Punctuation
30 Points Possible
Work is presented in a logical and coherent way. Writing is clear, articulate, and error free. Citations are composed in proper format with few or no errors. Paper is the required length, is double-spaced with 1-inch top, bottom, left and right margins, and in Calibri or Times New Roman styles, size 12 font. Cover page, paper body, citations and References are in the correct APA format. There are few to no spelling, grammar, or punctuation errors.
Work is grammatically sound with a few minor errors. Citations are composed in the proper format with some errors.
Work contains frequent grammatical errors. Citations are inaccurate or improperly formatted.
Work does not demonstrate appropriate graduate level writing.
Summary Comments:
Total Points: (150 points total)
Supporting Materials
Submission
READING
Alcohol
One of the most problematic, licit drugs in our society is alcohol. The simple process of fermenting sugar from a variety of naturally occurring fruits and grains has been ubiquitous across cultures and societies since the beginning of civilization. It is so pervasive within our society as to also seem to be a seamless part of it. One cannot easily characterize a particular type of person or group that is likely to be alcohol dependent; the affliction cuts across all imaginable demographics of society. Some people are able to drink on occasion for pleasure, whether alone or with friends. Others drink on a daily basis; others periodically binge.
Heres a quick, 9-minute history of the science, creation and use of alcohol across cultures, courtesy of SciShow.com:
At present, it has been estimated that approximately 18 million Americans have a serious problem related to the use of alcohol. These 30% of all consumers of alcohol account for about 80% of all alcohol consumed. Men outnumber women in heavy alcohol use by a ratio of around three to one.
The heaviest users of alcohol, in turn, directly or indirectly impact an even larger percentage of the population with their subsequent behaviors while intoxicated. The costs of alcohol abuse and dependence are significant: this drug is the third leading cause of death and is implicated in over half of all deaths and injuries in car accidents and half of all physical assaults and homicides. Further, it has been estimated that at least four family members are directly affected from the maladaptive behaviors that follow from the alcohol-abusing individual; you can quickly begin to see extensive the social, familial, occupational, and emotional impact of this disorder.
Whats the difference between alcohol abuse and alcohol dependence?
The initial psychiatric diagnosis that could be made for an individual that habitually uses alcohol to excess would be alcohol abuse. This diagnosis is characterized by the continued use of alcohol for at least a period of one month, despite having a recurrent physical problem or some serious personal problem in ones social or occupational functioning because of the excessive drinking or the repeated use of alcohol in situations (e.g., driving) when consumption is physically hazardous.
The diagnosis of alcohol dependence reflects an even greater degree of impairment in individuals compared to alcohol abuse. Alcohol dependence typically involves at least three of the following serious circumstances: (1) drinking alcohol in greater amounts and over a longer period of time than intended by the individual; (2) a strong desire by the individual to reduce consumption and several unsuccessful attempts to do so; (3) spending a great deal of time drinking or recovering from the negative effects of excessive drinking; (4) continued drinking even though physical and/or psychological problems are apparent and problematic in the individuals life; (5) social, work, or recreational activities have been significantly reduced or abandoned because of excessive drinking; (6) the development of marked tolerance for alcohol; and (7) consumption of alcohol specifically to avoid the symptoms of withdrawal. About 15 percent of men and 10 percent of women in the United States have met the diagnostic criteria for alcohol dependence during their lifetime.
How does alcohol affect the brain?
Alcohol, as a drug, acts as a depressant on the individuals central nervous system. It is a small molecule and is quickly absorbed in the bloodstream. Alcohol is linked to inhibiting receptors for the neurotransmitter GABA. In low doses, alcohol depresses the inhibitory functions of the brain, including those areas of the brain that typically adhere to the social controls and inhibitory rules that people typically follow in society. As the alcohol concentration increases in the bloodstream, the depressive function of alcohol extends from the cerebral cortex to areas of functioning that are further (and deeper) into the brains primitive and reflexive areas of functioning. In extreme dosing, inhibition of respiratory and motor centers can occur with other symptoms that include stupor or unconsciousness, cool or damp skin, a weak rapid pulse, and shallow breathing. It should be noted that alcohol can only be metabolized and leave the body at a specific rate, regardless of how quickly (or how much) alcohol has been taken in by the individual, so attempts to quickly sober up an individual will be unsuccessful.
For more illustration of the science and physical problems associated with habitual alcohol consumption, check out this 4-minute SciShow.com video:
What are the behavioral effects of using alcohol?
Individuals experiencing alcohol intoxication will exhibit a variety of maladaptive changes in their behavior and psychological functioning. Examples include inappropriate sexual or aggressive behaviors, impaired judgment, quickly changing moods, incoordination, impaired gait, slurred speech, impaired attention and memory (sometimes to the point of blackout), stupor, and unconsciousness. The degree of symptoms is dose dependent with more pronounced symptoms occurring as the alcohol blood-level increases.
Withdrawing from alcohol intoxication (i.e., a hangover) is also dependent on recent dosing, history of chronic abuse, and involves a variety of symptoms which can include autonomic hyperactivity in the form of profuse sweating and rapid heartbeat, hand tremors, nausea or vomiting, fleeting illusions or hallucinations, psychomotor agitation, anxiety. At worst, grand mal seizures can occur following periods of prolonged and heavy use. Another significant withdrawal phenomenon that chronic, prolonged abusers of alcohol can experience is delirium tremens that is characterized by disturbances in cognitive functions (especially consciousness), autonomic hyperactivity, vivid hallucinations, delusions, and agitation.
Chronic alcohol dependence can lead to a medical condition known as Alcohol-Induced Persisting Amnestic Disorder (also known as Wernicke-Korsakoffs Syndrome). This disorder is believed to be caused by deficiencies in thiamine and Vitamin B because their absorption in blocked with habitual alcohol consumption. Individuals afflicted with this disorders experience retrograde (the past) and anterograde (new knowledge) amnesia as well as confabulation, which is the tendency to attempt to compensate for memory loss by fabricating memories.
What are some of the life problems associated with heavy alcohol use?
The pervasive impact of chronic alcohol abuse can be seen across several important areas of in life that generally impair ones ability to function adaptively (i.e., take care of oneself in a manner appropriate for ones age) and experience a good quality of life. It is a complex problem in living with psychological, physical, and behavioral components. These include (1) demonstrating a preoccupation with alcohol and drinking; (2) demonstrating emotional problems (e.g., depression); (3) having overt problems at work, within ones family, and other important social relationships because of alcoholism; and (4) associated physical problems that result from habitual alcohol consumption.
Given that alcohol is a central nervous system depressant, it shouldnt be a surprise that depression can become a comorbid (or co-occurring) condition for some individuals. In general, the incidence of depression in substance abusers is quite high. People who drink alcohol heavily to the point of intoxication can experience very strong emotions and are frequently disinhibited (i.e., impulsive). Feelings of hopelessness, helplessness, and suicidal thoughts often accompany bouts of heavy drinking.
To review the relationship among amount (dosing) of alcohol consumed, blood alcohol levels, and effects on the central nervous system and behavioral performance, check out this five-minute Healthy McGill video here:
Who is at greatest risk for abuse or dependence?
Research has demonstrated that two risk factors can contribute significantly to the manifestation of alcohol abuse and dependence in the individual. The first risk factor is a family history of chronic alcohol abuse. Children of alcoholic parents have a higher statistical risk of becoming alcoholics themselves when compared to children of nonalcoholic parents. Whether this represents an increase genetic or environmental risk, however, is difficult to determine since both are intertwined in such instances. A second and independent risk factor that has been identified is those cases where an individual has a genetic predisposition to have low response to the psychoactive effects of alcohol (and, as a result, requires higher amounts of alcohol to become intoxicated). Individuals with this lower response to alcohol are more likely to abuse alcohol, as they require considerably more drinking to obtain the level of intoxication experienced by others who drink less to get the same effect.
When taken together, an adult child of an alcoholic who also possesses a low response to the effects of alcohol has an even higher statistical chance of developing a pattern of alcoholism. Keep in mind that all of these examples are just risk factors and statistically probabilities none of these outcomes are written in stone. Further, research demonstrates that there are also protective factors (variables) in the environment that can also help promote resiliency in some individuals and lead them not to drink alcohol in an excessive or maladaptive fashion when they are present. Clearly, again, the path to alcoholism (and responsible drinking and abstinence) is multi-factorial.
What are some of the treatment options for Alcohol Dependence?
Unfortunately, flaws in methodology jeopardize much of the research on the effectiveness of alcohol treatment programs. That is, the studies arent well controlled in terms of error variance and it cannot be clearly determined whether the observed changes in the studies are due to the employed treatment or other, uncontrolled, factors during the study. For example, many studies do not use untreated comparison groups. One generalization that can be made from the available research is that formal treatments are not always adequate or even necessary. A positive outcome to treatment appears to be related more to the presence of certain psychosocial factors like specific threats to ones physical or social well-being (i.e., hitting rock bottom) than any particular intervention.
There are, however, some treatments that have had some success. These treatments have several components in common, including covert sensitization and other forms of aversive counterconditioning. Antabuse, for example, is a medication that, when taken, will result in an individual becoming violently ill should they consume alcohol. Other treatments that put together broad-spectrum interventions such as social skills training, learning to drink in moderation, stress management techniques, and teaching coping skills and other self-control techniques help to teach the individual better, healthier alternatives methods when faced with environmental triggers to consuming alcohol.
Many modern programs incorporate aspects of Alcoholics Anonymous and/or the drug Antabuse. However, the effectiveness of these treatments has not been empirically demonstrated. One criticism that has been levied on these treatments is that they do not take into account individual differences and the wide variety of psychosocial problems and/or lack of resources that can make successfully managing alcohol consumption. In general, individuals with severe problems with alcohol require more intensive treatments (e.g., inpatient hospitalization), while those who experience less pathological problems require more periodic, milder interventions.
Another criticism that has been raised about some current treatment programs for alcohol abuse and dependence is that they tend to be based on the belief that failures in treatment are largely due to the individuals denial of having a problem or otherwise not having an adequate level of motivation. Many therapists have not supported this line of thinking, however. Research on treatment outcome, alternatively, points to the importance of therapist factors such as their level of empathy toward clients and their attitudes about what constitutes healthy recovery as being more related to positive outcomes than clients own motivation or personality characteristics.
Some experts in the field of alcohol research have emphasized the importance of the clients reaction to instances of relapse, especially from a cognitive (how they think) and emotional (how they feel) perspectives. Researchers stress the need to get away from the idea that a relapse represents a violation of abstinence which can lead to anxiety, depression, self-blame and an increased likelihood of further alcohol consumption. Alternatively, relapses should be characterized as a mistake that came about from external, controllable factors and not the result of internal factors (e.g., personality characteristics) that are essentially thought to be out of ones control.
Dually diagnosed individuals (those with a mental illness or personality disorder in addition to a substance abuse disorder) usually have a hard time finding treatment in one place. In many jurisdictions, they have to see a therapist at a mental health center and a separate therapist at a substance abuse center, or they are forced to make a choice of one over the other. You will find that there is often a lack of cross-training between mental health and substance abuse professionals, and that makes it harder for clients to get the treatment they need. Furthermore, in some places, you may find that the treatment support groups for substance abuse have an interpretation of sobriety that prohibits the use of psychotropic medication.
Legal Drugs in Our Society Part II
Hopefully, you have found the historical account to date of which drugs have largely been considered illicit, those that have typically been licit and readily available, and those that have switched from one designation to the other, to be an interesting review. Such distinctions among different groups of people and across different periods of time often speak to the changing cultural, social, religious, and scientific beliefs and morays of the time. This week, you will be studying two very popular and legally sanctioned drugs, tobacco and caffeine, that have been readily consumed by people since the beginnings of structured societies.
Tobacco
From its use in religious ceremonies and purported medicinal herb thousands of years ago to the image of sophistication and modernism it has held in industrialized societies over the last few hundred years, tobacco has occupied a role of prominence among individuals and groups alike. Think about it: what other drug has been so popularized in society as to be physically accommodated with lighters and ashtrays in automobiles and airplanes? What about spittoons in the restaurants and bars of the late 1800s and early 1900s? How about the smoking cars in trains and smoking sections at airports and restaurants? All these examples serve to demonstrate just how indoctrinated tobacco use has been in modern culture.
How did tobacco, the plant, get to be such a big deal? Check out this 8-minute history and science video from DNews Plus:
How have patterns of tobacco use changed over the decades in the United States and the world? What are some of the reasons for these changes?
Tobacco is interesting and noteworthy in that it is one of the only drugs that has been commercially available, openly accessible, and integrated within the culture of many societies for hundreds and hundreds of years. Further, it has been monetized as a commodity with economic value for the purposes of trade and payment of debts. In some circles, over time and across cultures, tobacco was even used as its own form of currency. In fact, one could certainly argue that the colonization, formation, and military defense of the United States of America occurred largely in part through the economic power generated through tobacco cultivation, sale, and distribution to other European countries.
It is interesting to note the relationship between the amount of government regulation that exists with the tobacco industry and the resultant use by population. There is a clear relationship between the growing regulation in the United States that began in the early 1970s and the eventual decline of tobacco use among large segments of the U.S. population. This can be especially seen in new generational cohorts; that is, the adoption of chronic smoking habits by younger people. Many other European and South American countries do not employ such heavy restrictions on the advertisement, marketing, and accessibility of cigarettes and other tobacco products upon their population. As a result, the decreases in use and dependence that have been realized in the United States have not been generalized to other countries across the world. The zenith of tobacco use in the United States has come and gone. The preponderance of research has clearly demonstrated its pathological effect on the body and that information, plus rigorous regulation, has helped contribute to the decline in its use.
There are a variety of ways to consume tobacco products as a vehicle by which to introduce the drug nicotine into the bloodstream and the brain. Smoking (via cigars, pipes, and cigarettes), chewing, and snuffing are all legitimized drug-using behaviors whose differing favorability has waxed and waned over the years. Over the years, most individuals were shaped into eventually preferring the use of tobacco cigarettes, which could be mass-produced in very high volumes inexpensively.
The intense and intentional role of marketing has been very significant in shaping the appeal to certain demographic groups of the population. The aggressiveness of early mass marketing campaigns also extended themselves, ultimately, to the denial and cover up by corporate America with regards to the deleterious effects of tobacco use. It wasnt until 1964 that the federal government began to formally investigate the health effects and cost of tobacco use and to institute policies that would eventually lead to the restriction of marketing and sales in the United States.
What are some of the adverse consequences of smoking?
The deleterious effects, both physically and psychologically, that result from chronic tobacco use have been well documented. The three-fold combination of carbon monoxide, tar, and nicotine can produce a wide variety of lifelong physical ailments, including a higher risk for cardiovascular disease, respiratory disease, and lung cancer than for nonsmokers. As is widely popularized, there are literally thousands of chemical found in cigarette smoke, including ones commonly used in pesticides. Additionally, other forms of cancer have also been implicated with chronic tobacco use. In fact, the vast majority of deaths each year that can be attributed to drug use and dependence are the result of tobacco use and nicotine dependence.
The primary psychoactive drug in tobacco, nicotine, has been determined by research trials to be a dependence-producing substance. As you recall from previous lectures, drug dependence is defined by continued use of a drug even in the face of obvious occupational, physical, familial, and social problems that one experiences in direct relation to its use. This also includes the psychological experience of craving and high drug-seeking behaviors. The rate at which nicotine is absorbed into the blood stream and penetrates the blood-brain barrier certainly speaks to its strong psychoactive properties. Withdrawal symptoms begin as early as six hours after the last dose. Within 24 hours, common complaints can include headache, irritability, problems concentrating, and sleep disturbance. Finally, in the late 1990s, the tobacco industry finally conceded publically that the products they were producing were not only physically harmful to individuals but also that the nicotine contained within then was a dependence-inducing substance.
What are some of the best strategies to employ when attempting to stop using tobacco products?
You know just how difficult it is to treat nicotine addiction in terms of a smoking cessation program. The research has demonstrated, much like successful treatment programs for other types of drugs, that have a high degree of dependence, that a multimodal approach is best. This type of additive treatment program incrementally increases the probability of success by systematically addressing addiction from a biological, social, operant conditioning, and environmental cue framework. Individuals are encouraged to think deeply about, and even write down, their personal reasons to stop smoking. This cognitive-behavioral approach helps an individual really contemplate the meaning and reasons behind their decision to stop smoking beyond the simplistic reasons often given by others or conveyed through warning labels or public service announcements.
Much like treatment for opiate dependence, a gradual reduction of the addictive drug nicotine helps lessen the severity of the withdrawal symptoms that can often make smoking cessation very difficult. In other words, the strategy of simply going cold turkey often does not result in a successful outcome. The research has shown that a gradual reduction in smoking, often coupled with the intermittent use of medications that can regulate nicotine such as transdermal patches, tends to have better and more long-lasting effects.
Other strategies that have been shown to be useful in an individuals armamentarium of treatment strategies include attempting to stop smoking within the context of a social support group. Research has demonstrated that when you confide your goals to others who have your best interests at heart, this can be a powerful social reinforcer to maintain attempts at smoking cessation. The support of other individuals can often also help assuage feelings of stress that one has in their life. Certainly,
Researching background literature.
Developing a research question.
Creating hypotheses.
Conducting experiments.
Recording and analyzing data.
Presenting results.
Ensuring quality standards are met.
Organizing testing.
Developing original solutions to problems.
Keeping current with relevant scientific, professional, and technical changes or developments.
Developing your scientific research skil
After reading the study materials in this unit on scientific research skills, respond to the following:
What are the three scientific research skills you are most comfortable with and the three you feel you need to work on the most?
How will you continue to evolve in your understanding of those scientific research skills with which you feel most confident?
What resources will you use to enhance your learning and comprehension of those scientific research skills with which you feel less confident?
Respond using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, and evidence
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Reference:
Skloot, R. (2010). The immortal life of Henrietta Lacks. New York, NY: Crown Publishing Group.
MAIN POST
Ethical Dimensions of Research Studies
Nursing research and research studies can offer many gains in the healthcare field and offer clear, conscience evidenced-based practices (EBP). Before diving into conducting a research study it is essential to understand ethical issues and ethical dilemmas. Research ethics demand necessity on daily work, the protection of test subjects and the publicizing of information from the research (Fouka Mantzorou, 2011). Ethical dilemmas are situations where the test subjects rights are in conflict with the studies requirements (Polit Beck, 2017). Nursing researcher need to be aware of any ethical issues and develop a research plan to help alleviate any problems or ethical dilemmas.
Transfusion of Prematures
Transfusion of Prematures (TOP) Trial was an open, parallel-group multicenter randomized controlled trial (RCT) analyzed by the intention to treat (Kirpalani et al., 2012). The main point of the TOP trial was to determine whether higher hemoglobin levels for giving transfusions to extremely low birth weight infants could result in higher hemoglobin levels leading to the improvements in neurodevelopmental impairment at 22-26 months of age and the primary outcome to be survival (ClinicalTrials, 2019). The trial explained that by avoiding a breach the current practice boundaries of the hemoglobin levels that would require an infusion by using a transfusion algorithm. This would avoid dilemmas and minimize risks to the test subjects. There are no real results of this trial. The test subjects will be seen for follow-up visits at around six years old to assess neurological and functional outcomes based on the transfusion threshold (Kirpaplani et al., 2012).
Ethical Principles
Three principles that standards of ethical conduct in research are based on are beneficence, respect for human dignity and justice (Polit Beck, 2017). Beneficence can be explained as a duty to promote good and eliminate harm to the test subjects. The TOP trial was seen by the Institutional Review Board (IRB) as harmful by veering away from usual care and harmful risks were posed by the deviations (National Public Radio, 2013). The researcher could have maintained usual care and not deviate from routine care on the test subjects. The second ethical principle is respect for human dignity which is the right to know what will take place or full disclosure (Polit Beck, 2017). The TOPS trial had defects and faced criticism for not telling all this risks that the subjects would face. In this trial the consent forms did not elaborate on previous studies about when to transfuse. The studies suggested that premature infants that had transfusions later had a higher chance of death, brain injury and emergency care for transfusions (National Public Radio, 2013). The researchers should have been honest to the test subjects parents regarding the previous studies and the risks of participation in the study. The third principle is justice which allows for fair treatment and the right to have privacy (Polit Beck, 2017). In the TOPS trial it was suggested that the subjects parents were not aware of what was being asked. Parents were giving up their rights to a physician to make decisions on what they feel was in the best interest of the infant. This would impede on the right to fair treatment. The researchers need to make sure that the parents of the test subjects understand every aspect of the trial and have the rights to make decisions on what they feel is in the best interest of their child. The parent should have the say so in what is being done to their child and not a physician. Research can be done on sensitive issues while protecting the rights of the research subjects by following the ethical principles. Adopting the ethical principles will help avoid ethical dilemmas in research.
Conclusion
Nursing research has many benefits to the practice and can produce evidence- based practices to help provide the best care to our patients. Ethical dilemmas can be avoided by conducting a study that poses minimal conflicts with patient rights. Making patient safety the main goal is essential in the success of a research study. Keeping ethical principles of beneficence, respect for human dignity, and justice intertwined in the development or framework of the study is the only way to ensure that participants are being protected.
References
ClinicalTrials. (2019). Transfusion of Prematures (TOP). Retrieved March 18, 2019, from http://www.clinicaltrials.gov/ct2/show/NCT01702805.
Fouka, G., Mantzorou, M. (2011). What are the major ethical issues in conducting research? Is there a conflict between the research ethics and the nature of nursing? Health Science Journal, 5(1), 3-14. Retrieved from the Walden Library databases.
Kirpalani, H., Bell, H., DAngio, C., Hintz, S., Kennedy, K., Ohls, R., Poindexter, B., Schibler, K., Schmidt, B., Vohr, B., Widness, J., Das, A., Higgins, R., Zupancic, J., Roberts, R., Whyte, R., Chaudhary, A., Johnson, K. (2012). Transfusion of Prematures (TOP) Trial: Does a Liberal Red Blood Cell Transfusion Strategy Improve Neurologically-Intact Survival of Extremely-Low-Birth-Weight Infants as Compared to a Restrictive Strategy? Neonatal Research Network. Retrieved from http://www.nichd.nih.gov/sites/default/files/about/Documents/ TOP_Protocol.pdf.
National Public Radio (2013). Another Study of Preemies Blasted Over Ethical Concerns. Retrieved March 18, 2019, from http://www.npr.org/sections/health-shots/2013/08/23/214800726/another-study-of-preemies-blasted-over-ethical-concerns.
Polit, D.F., Beck, C.T. (2017) Nursing Research Generating and Assessing Evidence for Nursing Practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
