Bad habits

â€Å"There are a thousand excuses for failure, but never a good reason†, I agree. Some psychologists think that bad and good habits people get through lifetime period. If so, then people can get rid of undesirable habits, but how? Some people would say that to get rid of bad habits is easy when person has a desire. Also, some will say that who love God can rely on his help and blessing. However, a lot of people would say that it is not that easy to kick a bad habit.In fact, bad habits affect our lives actively, but when person follow these steps, she can easily overcome a problem. First of all, people should find a motivation to stop a bad habit. A person who has a motivation is always looking for solutions while others are looking for reasons and excuses. Before person makes any bad move in her life, she should ask herself one question: â€Å"For what or for whom I should stop doing a bad habit? † A lot of people would say that it is not worth it. However, some people would stop their bad habit for the loved ones.For example, there is could be internal reason for solving this robber. People often break bad habits because they do not want to spoil their children. Moreover, children usually pick up bad habits from parents and peers. To prevent that unlikable situation, parents would do their best for break a habit. Also, smoking is a cause of heart and lung diseases. Moreover, smoking can cause a cancer. 90% of lung cancer patients developed their disease because of smoking. There is, also, external reason for motivation. For example, smoking is a cause of yellow teeth, super dry skin and breaking hair.Smokers often are nervous, irritable, old not focus their thoughts, and could not sleep well. These causes affect peoples social life in many ways. Therefore, smokers have difficulties in Job interviews and relationships because they have low self-esteem and self-confidence. All in all, West Virginia University about the bad habits say:† if yo u want to quit smoking, you should focus on decreasing your risk of lung cancer and heart disease. If you are driven by positive motivation, think of how much whiter your teeth will be and how much more breath you will have when you climb stairs.Also, you will save some money by not eying cigarettes. † Second, create conditions and be away from people who have bad addictions. People learn the features of behavior in their environment. It is very difficult to deny alcohol in the cheerful company of friends. In Russia, for instance, when people are visiting each other at home, they should drink three shots of vodka before they enter the house. However, even when person is not drinking at all, householder finds it unrepeatable and would not ask that person to come to his house again.Another example, at the party there are two groups: in-group and out- roof. In-group people are those who run the party. Of course, alcohol is included for this group. However, people from out-group d o not have bad addictions. In-group can make bad Jokes and encourage drinking, and out-group does not feel themselves such as all, so they Just can give up. Nevertheless, not only alcohol can make people in-group. Furthermore, if person is attractive, interesting and outgoing, he do not need alcohol to be in-group. Briefly, to be separated from those who have bad habits, does not mean to be away from them.It is mean, that people should put a task in heir head, for do not give up on the goal to break a habit.. That is how people separate themselves at parties. Briefly, people should follow some quote in life, for pushing themselves for something valuable. Third, people should never give up, but go to their target to the end. People should not be disappointed after the first obstacle. This is not the end of the world. Nothing comes easy, especially when people are trying to get rid of bad habits that exist in their lives. For instance, I knew the girl Katherine. She was drinking beer every single night.Katherine wasn't aware of her problem until she got an addiction to alcohol. Moreover, she lost communication with her friends. For them, she was simply alcoholic. She was like a blind Capitan who can not notice a leak in the vessel until it finally sinking. Soon, Katherine understood that she needs to get rid of her addiction. For this purpose, Katherine started looking for a solution. After a lot of tries, she finally found a solution. Instead of bottle of beer, she was drinking a glass of orange Juice. There were a lot of doubts from her friends that she not going to cake it.They Just did not believe in her. Although, she did not give herself up, but was fighting with her bad habit till it gone. Indeed, Katherine throws away a bad habit of her because she believed in herself. Fourth, do not make any exceptions. When people decide to kick bad habits, in any case or situations do not give concessions. Once people start thinking: â€Å"Oh, today is a nervous day, so I can smoke one cigarette†, or â€Å"l would not gain weight if I will have some ice-cream. † Our bad habits begin to fight for a place in people's life. When people make exceptions, it s an illusion to break a bad habit.The number of exceptions will increase every day until the bad habit will not take his place again. For example, humans can imagine that our good and bad habits like two wolves that always are fighting with each other. Who will win? Answer is the wolf whom you feed will win. Nevertheless, stop feed and give support to a bad habit. â€Å"If you do not pour water on your plant, what will happen? It will slowly wither and die. Our habits will also slowly wither and die away if we do not give them an opportunity to manifest. You need not fight to stop a habit.Just don't give it an opportunity to repeat itself. (67)† ? Swami Statisticians, The Yoga Sutras. Last step is to imagine you without a bad habit. Just turn an imagination, and you will see yourself succeed. The people are very likable to a person without a bad habit. People don't like see you hiding your hands because of bitten nails or smell the cigarette smoke from someone's mouth. Let it all go! Imagine, when you are going to give a speech in front of many people, you would not stammer in front of audience, but behave discreetly and fluently. Imagination acts as hypnosis.If a person presents himself without bad habits, he subconsciously is hypnotize himself to quit one. As a result, a person could get rid of the bad habit. For instance, I was biting my nails. I wanted to quit hundreds of times, but couldn't. Then I started imagine myself as a bride, but how bride would have bitten nails in the ceremony? How the groom would put the ring on the bride hand? Consequently, I quit biting my nails. In short, imagination helped me to get rid of nail biting problem. Imagination set a desire to be better person, and to increase in someone's eyes.TO conclude, bad addictions c ause an unpleasant influence in our life. Bad habits have negative impact on people's health and social life. However, people can overcome them by find a motivation, create conditions and be away from people with bad habits, never give up, do not make any exceptions, and turn imagination in which there is no place for a bad habit. â€Å"Bad habits are like a comfortable bed, easy to get into, but hard to get out of. † ?Unknown. If people would follow these steps, they can kick bad habits very willingly. Bad habits â€Å"There are a thousand excuses for failure, but never a good reason†, I agree. Some psychologists think that bad and good habits people get through lifetime period. If so, then people can get rid of undesirable habits, but how? Some people would say that to get rid of bad habits is easy when person has a desire. Also, some will say that who love God can rely on his help and blessing. However, a lot of people would say that it is not that easy to kick a bad habit.In fact, bad habits affect our lives actively, but when person follow these steps, she can easily overcome a problem. First of all, people should find a motivation to stop a bad habit. A person who has a motivation is always looking for solutions while others are looking for reasons and excuses. Before person makes any bad move in her life, she should ask herself one question: â€Å"For what or for whom I should stop doing a bad habit? † A lot of people would say that it is not worth it. However, some people would stop their bad habit for the loved ones.For example, there is could be internal reason for solving this robber. People often break bad habits because they do not want to spoil their children. Moreover, children usually pick up bad habits from parents and peers. To prevent that unlikable situation, parents would do their best for break a habit. Also, smoking is a cause of heart and lung diseases. Moreover, smoking can cause a cancer. 90% of lung cancer patients developed their disease because of smoking. There is, also, external reason for motivation. For example, smoking is a cause of yellow teeth, super dry skin and breaking hair.Smokers often are nervous, irritable, old not focus their thoughts, and could not sleep well. These causes affect peoples social life in many ways. Therefore, smokers have difficulties in Job interviews and relationships because they have low self-esteem and self-confidence. All in all, West Virginia University about the bad habits say:† if yo u want to quit smoking, you should focus on decreasing your risk of lung cancer and heart disease. If you are driven by positive motivation, think of how much whiter your teeth will be and how much more breath you will have when you climb stairs.Also, you will save some money by not eying cigarettes. † Second, create conditions and be away from people who have bad addictions. People learn the features of behavior in their environment. It is very difficult to deny alcohol in the cheerful company of friends. In Russia, for instance, when people are visiting each other at home, they should drink three shots of vodka before they enter the house. However, even when person is not drinking at all, householder finds it unrepeatable and would not ask that person to come to his house again.Another example, at the party there are two groups: in-group and out- roof. In-group people are those who run the party. Of course, alcohol is included for this group. However, people from out-group d o not have bad addictions. In-group can make bad Jokes and encourage drinking, and out-group does not feel themselves such as all, so they Just can give up. Nevertheless, not only alcohol can make people in-group. Furthermore, if person is attractive, interesting and outgoing, he do not need alcohol to be in-group. Briefly, to be separated from those who have bad habits, does not mean to be away from them.It is mean, that people should put a task in heir head, for do not give up on the goal to break a habit.. That is how people separate themselves at parties. Briefly, people should follow some quote in life, for pushing themselves for something valuable. Third, people should never give up, but go to their target to the end. People should not be disappointed after the first obstacle. This is not the end of the world. Nothing comes easy, especially when people are trying to get rid of bad habits that exist in their lives. For instance, I knew the girl Katherine. She was drinking beer every single night.Katherine wasn't aware of her problem until she got an addiction to alcohol. Moreover, she lost communication with her friends. For them, she was simply alcoholic. She was like a blind Capitan who can not notice a leak in the vessel until it finally sinking. Soon, Katherine understood that she needs to get rid of her addiction. For this purpose, Katherine started looking for a solution. After a lot of tries, she finally found a solution. Instead of bottle of beer, she was drinking a glass of orange Juice. There were a lot of doubts from her friends that she not going to cake it.They Just did not believe in her. Although, she did not give herself up, but was fighting with her bad habit till it gone. Indeed, Katherine throws away a bad habit of her because she believed in herself. Fourth, do not make any exceptions. When people decide to kick bad habits, in any case or situations do not give concessions. Once people start thinking: â€Å"Oh, today is a nervous day, so I can smoke one cigarette†, or â€Å"l would not gain weight if I will have some ice-cream. † Our bad habits begin to fight for a place in people's life. When people make exceptions, it s an illusion to break a bad habit.The number of exceptions will increase every day until the bad habit will not take his place again. For example, humans can imagine that our good and bad habits like two wolves that always are fighting with each other. Who will win? Answer is the wolf whom you feed will win. Nevertheless, stop feed and give support to a bad habit. â€Å"If you do not pour water on your plant, what will happen? It will slowly wither and die. Our habits will also slowly wither and die away if we do not give them an opportunity to manifest. You need not fight to stop a habit.Just don't give it an opportunity to repeat itself. (67)† ? Swami Statisticians, The Yoga Sutras. Last step is to imagine you without a bad habit. Just turn an imagination, and you will see yourself succeed. The people are very likable to a person without a bad habit. People don't like see you hiding your hands because of bitten nails or smell the cigarette smoke from someone's mouth. Let it all go! Imagine, when you are going to give a speech in front of many people, you would not stammer in front of audience, but behave discreetly and fluently. Imagination acts as hypnosis.If a person presents himself without bad habits, he subconsciously is hypnotize himself to quit one. As a result, a person could get rid of the bad habit. For instance, I was biting my nails. I wanted to quit hundreds of times, but couldn't. Then I started imagine myself as a bride, but how bride would have bitten nails in the ceremony? How the groom would put the ring on the bride hand? Consequently, I quit biting my nails. In short, imagination helped me to get rid of nail biting problem. Imagination set a desire to be better person, and to increase in someone's eyes.TO conclude, bad addictions c ause an unpleasant influence in our life. Bad habits have negative impact on people's health and social life. However, people can overcome them by find a motivation, create conditions and be away from people with bad habits, never give up, do not make any exceptions, and turn imagination in which there is no place for a bad habit. â€Å"Bad habits are like a comfortable bed, easy to get into, but hard to get out of. † ?Unknown. If people would follow these steps, they can kick bad habits very willingly.

Evidence based practice in antenatal Essay

INTRODUCTION In this globalization world, the nursing career had become more challenges and competence. IOM Report (2003) title â€Å"Health Professions Education; A Bridge to Quality† have recommended evidence based practice (EBP) as one of the integration of core set competencies into health professions education. Now days, EBP is the most popular topic to be talk and written about in nursing, nationally and internationally. Hitherto, nurses at times don’t understand what is EBP and some nurses are even called it buzzword. The latter couldn’t be further from truth. EBP is here to stay and nurses must understand it. Sacket et al (2000) described EBP as the integration of the best research evidence with clinical expertise and patients values. Evidence base practice is the application of the best available empirical evidence, including recent research findings, to clinical practice in order to aid clinical decision making evidence based practice is based on the notion of rational decision making. Higgs and Jones (2000) have purposed that evidence in evidence-based practice should be considered to be knowledge derived from a variety of source that has been subjected to testing and has found to be credible. Here the nurse selects all research that has been done in area. These research results are analyzed together, synthesized, coming up with a through integrate review. Then, the research put into the context of clinical expertise and the value system of the patient, and particular protocols or best practices are developed. In this paper, the important of EBP will be explored in relation to antenatal clinic. The objective of the study is to assess the effect on obstetric practice and pregnancy outcome of routine late pregnancy ultrasound define as greater than 24 weeks gestation, in women with either unselected or low risk pregnancy .The Australasian Genetics Resource Book (2007) highlighted ultrasound is the use of high frequency sound waves to make an image. In pregnancy, an ultrasound gives a picture of the developing baby in the uterus (womb). It is regularly considered part of the routine care for all  pregnant women. The ultrasound is used as both a screening and a diagnostic test either give an indication that the baby is at an increased risk of a problem (a screening test), or it can detect a definite problem in the baby’s physical development for example, in the heart or the kidneys (a diagnostic test). Mostly, a mother will question the nursing staffs working at the antenatal clinic regarding the ultrasound screening whether the process is safety of their unborn baby and themselves. In the rural area of Malaysia, most of the antenatal clinics have no facility such as ultrasound machine. As a result, the pregnant women with medically indicated and get referral letter from medical officer or midwife have to go to government hospital in the city to have an ultrasound. In difference, the private hospital performed routine ultrasound screening for pregnant women in their late pregnancy. The selected evidence are cited by Bricker L and Neilson J (2000) ; Routine ultrasound in late pregnancy ( after 24 weeks gestation) track down from Cochrane Library. Cochrane Database of Systemic Review , 2007, issues 1,published by John Wiley and Sons,Ltd. This research is done by qualified person because one of two reviewers was Dr Leanne Bricker who was the consultant in fetal and maternal medicine of Liverpool Women’s NHS Foundation Trust. It could be argue that the reviewer is eligible to do this research and this made the research the more reliable. WHO Statistic (1999) mentioned that annually 585 000 women die of pregnancy related complications. It is 99% in developing countries and 1% in developed countries. So, we can summarize that every minute one women dies from a pregnancy related complication. In Malaysia, high rate of prenatal and maternal morbidity and mortality continue to be a major problem in the country. A crucial factor of good obstetrics is the provision of adequate care during the antenatal period. Antenatal care was first introduced to medicine in the first decade of this century. Hence, there no qualm that it has a brought gigantic benefit to women and their children. The main purpose of antenatal care is to ensure an uncomplicated for the mother and the safe delivery of a life and healthy infant. At present, modern technology and  information technology have beyond more complicated. The equipment such as the ultrasound machine also was greatly up to date. The users of ultrasound as one of the obstetrician a rmamentarium have been part of the cause to improved antenatal and intra partum care. An ultrasound scan uses high frequency sound waves in very short pulses. These travel from a transducer, which rests on your skin, and are reflected off different tissues inside you and then received back at the transducer. The transducer passes the signal into a computer that displays an image of your insides on a screen. Usually this image represents a thin 2 dimensional slice of your anatomy. The operator moves the transducer around to get the best views to help diagnosis, whilst watching on the screen for anything abnormal. They will record several images or short video clips to illustrate the scan and these are kept in a computer database that is part of your patient record. The operator will use a small amount of gel on your skin to ensure the transducer contacts your skin effectively. Routine ultrasound can be used in late pregnancy to detect problems which may not otherwise be apparent, such as abnormalities in the placenta in the fluid surrounding the baby, or in the baby’s growth. The process of evidence base practice involved critical appraisal as one of the step. Hill & Spittlehouse (2001) defined critical appraisal as the process of systematically examining research evidence to access its validity, results and relevance before using it to inform a decision. Ahead of implementation of critical appraisal it is essential to understand research process principal and being able to recognize a well conceived designed of conducted study. The Critical Appraisal Skills provide us what is the best evidence in order to understand the methods and result of research besides to access the quality of the research. Oxman et al 1994, mentioned that the piece of evidence will be critically appraise for it validity and quality using and appraisal tool named, Critical Appraisal Skills Programme (CASP). The word research means to search again and examine carefully, more specifically, research is a diligent, systematic inquiry or study that validate and refines existing knowledge and develop new knowledge. In fact,  research is determined, hand on, received, understand and accepted by nurse practitioner only, (Brown 1999). Furthermore, the ultimate goal of research is the development of a research body of knowledge for a discipline or profession like nursing. Joppe (2000) highlighted that the reliability of result is the key questions in a research. Brown ,1999;Melnyk & Fineout- Overholt;2005 stated that evidence based practice is the conscientious integration of best research evidence with clinical expertise and patient values and need in the delivery of high quality , cost – effective health care. In this research, the reviewer has made the research more reliable by provided data of all research finding plus a clear precise description of the research methodology. BODY This title of the research clearly indicates the focus of the study. Above and beyond, the abstract includes the study problem, objectives, search strategy, selected criteria, data collection and analysis, significant result and implications of the findings for nursing practice. This research is significance to read because all relevant information is presented in a way that captures the attention of the reader. Crosby (1990) point out that a well-written abstract gives readers a good idea of what the study is about, how it was conducted and the findings or recommendations by the author. It is being stated clearly that, the reviewers drew on the search strategy developed for the pregnancy and childbirth as a whole. Relevant of trial were identified in the groups specialized registered of control test. The pilot reviewer assessed trial quality and abstract data under supervision of co-reviewer. Moreover, the trial were not assess blinded as the reviewer have the information about the author identification, source of publication and result when making inclusion criteria. In fact, regarding the disagreement and insufficient data, the reviewer contacted the author personally above and beyond search in all relevant studies in published and unpublished studies. The publication prejudice is less because all of the studies were in English. The neonatal upshot measures of the research also  seek advice from professor of perinatal medicine. By the way, any debarred trial was undoubtedly given a reasonable accused and all the information of follow up was stated in the references. The participants included all women in late pregnancy (after 24 weeks gestation) in both unselected population and the sample size of the trial wide-ranging. The type of intervention used was routine ultrasound examine in late pregnancy (after 24 weeks gestation) to assess one/some/all of the conclusion measure on fetal size; amniotic fluid volumes; placental grading; fetal structural anatomy; fetal presentation. In relation to Crombie (1996), when choosing a study design, many factors must be taken into account because different types of studies are subject to different types of bias. It claimed that in this study there is no mention about consent and participants were kept in murkiness about the study. Almost certainly, it is great to mull over in the ethical aspect. It could be quarrel that the participants have been treated purely as a source of data. Theoretically, the ethical considerations in all research are the same; the safety and protection of human rights. These rights are mainly could be achieved by informed consent. While no inform consent was taken even so confidentially has maintained. On no account mention any involvement of ethical committee it is a poor steps as explaining the study design is the core of understanding the methodology. Olsen (2003) put in plain words that they are three elements of ethical research to firmly practice. In this review, all results were presented clearly and were similar from study to study. The reviewers have assessed the quality of each study and include all RCTs of routine ultrasound in late pregnancy after (24 weeks) in the research. Quasi-randomized trials were regard as for inclusion due to scarcity of RCTs. The study was good in view of the fact that the limitations of the research and the reason for any variation in the result were discussed in particular by reviewers. The ultrasound selection were differed among trials; some offering routine scans to all participant earlier in the pregnancy (before 24 weeks gestation), some offering no routine scan at anytime in pregnancy to the control group and some offering scan at all stages of the trial, but only revealing results of late  pregnancy ultrasound (after 24 weeks gestation) for the study group. Furthermore, the rationale for routine ultrasound scan after 24 weeks gestation differed among trials as it is difficult to assess the effect of scan before 24 weeks gestation on the outcome measures. Although the reviewers has point out that the most effective approach to assess the cause of routine late pregnancy ultrasound would be trials where the intervention in late pregnancy ultrasound alone, but this is not such trials exist. However, the reviewers also have reported on the predictable finding in this study. In the Perth 1993, they were significantly higher intrauterine growth restriction on the Serial ultrasound and Droppler examination group. Even, the author states that it may have a chance finding, it is possible that frequent exposure to ultrasound may have influence fetal growth. On the other hand, none of the addressed long term neurodevelopment results. Exposure of the expectant mother to uncertainty and possible anxiety about the health of her baby has implication of which may be far reaching. The reviewers also have identified the future research on the maternal psychological outcome and long term neurodevelopment outcome. From the time when, it is not mention what type of ultrasound machine was used and which group of personal is performing the procedure. Sometimes this could probably introduce preconceived notion to the results. In some situation, the ending measured effect the result because the quality of ultrasound imaging is not reach the standard regarding the technical capabilities of the ultrasound equipment and also on the skills or expertise of operators. METHODOLOGY There are two type of research method; quantitative research method and qualitative research method. The quantitative research method defined by Burn and Grove (2005), is conducted to test theory by describing variables, examining relationship among variables and determining cause – and – effect interactions between variable. It is a formal, objective, systematic process using numerical data to obtain information about the world. In addition, quantitative method is research method dealing with number and anything that  is measurable agreed by (Smith, 1988) that quantitative research involves counting and measuring of events and performing the statistical analysis of a body of numerical data. Counting and measuring are ordinary structure of the method. More often than not, the outcome or result of the study is presented in tables, graphs or other form of statistic because it is a kind of number or a series of numbers. If truth be told, the quantitative analysis endow with result that is more reliable for statistical approaches. The main concerns of the quantitative paradigm are that measurement is reliable, valid, and generalize in its clear prediction of cause and effect (Cassell & Symon, 1994). The strengths of the quantitative method are it stating the research problem in very specific and set terms as stated by (Frankfort-Nachmias & Nachmias, 1992). It also clearly and precisely specifies both the independent and the dependent variables under investigation. As well, quantitative method include following firmly the original set of research goals, arriving at more objective conclusions, testing hypothesis, determining the issues of causality. In view of (Balsley, 1970) it’s help achieving high levels of reliability of gathered data due to controlled observations, laboratory experiments, mass surveys, or other form of research manipulations. To boot, this method are also allowing for longitudinal measures of subsequent performance of research subjects. Kealey & Protheroe (1996) indicated that quantitative method rally round eliminating or minimizing subjectivity of judgment. Despite the fact, the weaknesses of the quantitative method are failure to provide the researcher with information on the context of the situation where the studied phenomenon occurs and inability to control the environment where the respondents provide the answers to the questions in the survey. Limited outcomes to only those outlined in the original research proposal due to closed type questions and the structured format. More to the point, not encouraging the evolving and continuous investigation of a research phenomenon are the disadvantages of using quantitative approach. According to Munhall (2001) the qualitative research method is a systematic,  subjective approach used to described life experiences and situation and to give them meaning. The knowledge generated the qualitative research will provide meaning and understand of specific emotions, values and life experiences. As said by Morgan (1980), the qualitative research shares the theoretical assumptions of the interpretative paradigm, which is based on the notion that social reality is created and sustained through the subjective experience of people involved in communication. Some researcher using qualitative method are concerned in their research with attempting to accurately describe, decode, and interpret the meanings of phenomena occurring in their normal social contexts as declared by Fryer (1991). In view of that, qualitative approach in general is more likely to take place in a natural setting acknowledged by Denzin, 1971; Lincoln & Guba, 1985; Marshall & Rossman, 1989. The strengths of the qualitative method as declared by Bogdan & Taylor, 1975; Patton, 1980, it provide a holistic view of the phenomena under investigation. Furthermore, qualitative method is the process of obtaining a more realistic feel of the world that cannot be experienced in the numerical data and statistical analysis used in quantitative research. It also provides the flexible ways to perform data collection, subsequent analysis, and interpretation of collected information. Kirk & Miller, 1986 writes that it gives the ability to interact with the research subjects in their own language and on their own terms. Summarizing, the qualitative approach present descriptive capability based on primary and unstructured data However, the qualitative method coming up with some weaknesses of as point out by Cassell & Symon (1994) that it departing from the original objectives of the research in response to the changing nature of the context. In that case it also arriving to different conclusions based on the same information depending on the personal characteristics of the researcher. The inability to investigate causality between different research phenomena and difficulty in explaining the difference in the quality and quantity of information obtained from different respondents and arriving at different, non-consistent conclusions appeared as the disadvantage of qualitative method. It follows requiring a high level of experience from the researcher  to obtain the targeted information from the respondent. Lastly, it also contributes lacking consistency and reliability because the researcher can employ different probing techniques and the respondent can choose to tell some particular stories and ignore others. In spite of that, the quantitative research method is used in this research. Seven eligible Randomized Controlled Trials (RCTs) were participated in this survey. The methodology mostly could be summarized as quality and the reporting of reports were good. Yet, the Glasgow 1984 (UK) study was ‘quasi randomized’ with allocation according to the hospitals number and this had probable to engender bias. On the other hand, RCTs for evaluating the effect of intervention in this study, is used even though it is less in effect in answering questions about patient’s personal experience, attitude or psychological outcome. Sequentially, to explore psychological aspect of the pregnant women during the routine ultrasound screening, it could be squabble that it will be more apt to include qualitative research in this study. Review Manager (Revman) software was used to act upon statistical analysis. Meta – analysis was used to analyze and combine the result of the studies and it is an appropriate technique of data analysis. The plus of using this type of analysis is that it increases the sample size so that if the significant differences exist they are more likely to be demonstrated. Sacket (1996) mentioned that evidences from systematic review and Meta – analysis has taken the top place of the hierarchy because it provides misleading about the effect of intervention. In this research, quantitative and qualitative approaches were bringing into being be a foil for each other while the scantiness of each were essentially counterbalance. Conversely, it also point out the time and cost implications, from the time when the volume of data produced was enormous and an tremendously extensive knowledge foot was vital to analyze it. Seeing as the â€Å"method† section is a strength of the study. In this study, the sample size was large (25 036 women) and included variety of subjects. This heterogeneity of the subject has increases the generalizability of the findings as agreed by Burns & Groove (2005). The sampling method, sampling  criteria, and sample characteristics are clearly presented. The study could be considered as ethical because it was approval for conduct by an institutional review board but in state of affairs unethical because no informed consent was obtained from the object or sampling. RESULT In this research seven trial comprising 25,036 women were included ( Alesund 1999 ); Glasgow 1984; Perth 1993; new Zealand 1993;Trondheim 1984;Peterborough 1987 ; Radius 1993) . The attribute of the incorporated test on the whole was acceptable as assess by reviewers. There was no difference in antenatal, obstetric and neonatal intervention or morbidity in screened versus control group. From the result of the studies, routine ultrasound in late pregnancy was not associated with improvement in overall perinatal mortality. However, placental grading as an adjunct to third trimester examination scan was associated with a significant reduction in the stillbirth rate in the one trial that assessed it. There was no data on maternal psychological effect. Data with regard to long term substantive outcome in fetal neurodevelopment is lacking. IMPLICATIONS The study originated that there is thus far no evidence that routine ultrasound improves outcome or increase interventions. The fact, ultrasound could be used in late pregnancy to find the cause of compilation such as bleeding. In some situation, ultrasound screening in late pregnancy appears to be useful in placental grading. In some country, screening all pregnant women for possible problem late in pregnancy is controversial. The ultrasound is seen not demonstrated fetal harm if we use properly followed proper procedure. For the long term side effect, the users of repeated ultrasound are still not fully known regarding the exposure of the fetus. Some problems occur with such screening are increasing major intervention without benefit like caesarian section. Till now, there is no specific epidemiological evidence that ultrasound screening during pregnancy is harmful but no fact conclusion has been reached from available data, for  that reason continue awareness is necessary. In sp ite of that, the policy practice in the antenatal care needs a changeable. So, it is highly recommended that routine ultrasound in late pregnancy only be done for high risk mother such as mother with placental previa. RECOMMENDATIONS In fact, further studies on maternal physiological outcomes and long term neurodevelopment outcome for the fetus is essential to be carried out. In addition, the level of performance of technical operator and equipment should be sporadically audited and governed by a dogmatic body to prevent the mother and unborn child. In our day, nursing care is grant access to be root on the modern best evidence, interventions will be more useful and will effect in superior patient outcomes. So, nurses are motivated to learn how to group and interpret data to implement in their practice on the best evidence available. Evidence based practiced (EBP) has grows to be a critical concept for ethical liable in professionals nursing practice. As said by Mckenna et al (2004), negative beliefs, Krishbaum et al (2004), attitudes and value (Pravikoff et al 2005) have been shown to be powerful barrier to EBP. In order to overcome barriers in EBP, strategies are needed to recover such as awareness, knowledge and skills in evaluating evidences. It is also importance to have administrative support by providing access to EBP or research mentor in practice arena. As indicated by Avis (2006), the Randomized Control Trials (RCTs) are remains one of the best means to make your mind up whether one form of care is better than another. Since RCTs is purely and evaluation technique, the consequence of knowledge cannot be condense to the application of procedure to fabricate evidence. Besides, understand the result as well as the limitation of relevant research study, it also need an awareness of the background theories which influenced particular research studies. CONCLUSION In my view, this research is simply good because it provide complete information include literature review, sampling method, sampling size and etc. Basically the methodology was performed clearly and the result was presented well. All the statistical tools used were shown and the barrier exist were explained particularly. It is the most swollen with pride that the study had achieved the objectives and was helpful in development of nursing practice.

Terra Gatson Essay

They similar because they tend have we as people questioning and have also different perceptions about the world we live in. Hey both were misled as to what the world we live in is and how it operates as a whole. There are also other topics as well that can be pointed to show exactly what else can be depicted about the comparison between them. The Matrix is Greek philosophy which is very interesting to a lot of people. The definition behind is the idea of freeing one's soul or mind as even presented in the Allegory of Cave is a well-known idea attached to Greek philosophy.The difference between them is that The Matrix and The Plat's tend to have reasons that justify and reasons as to why they tend to do what they do. It is something that they come up to make whatever wrong they are doing to give a good reasons as to why they are doing it. Seems like a wrong thing to do, but looking at my life I have ran into a lot of people that make up excuses to cover their behinds so others will be believers of their wrongs. A wrong is a wrong and a right is a right not the other way around.The bible is a great source to find out the truth to a lot so if you want to know if something is true pick up a bible to retrieve some of your information so you will have a better understanding. At the end of the Matrix we were left with a piece to my understanding that had me thinking we were living in a computer based world but looked passed it, but it sometimes have me thinking. The Matrix is really based on Descartes which is about the human race being deceived in many different ways.Many scientist research a lot to prove that we are not living in this or that but it is left to only one person to determine what our lives are and that is the man up above. I have my doubts about a lot but I know God is the reason for everything but would have to say were are not computer based which is my opinion and I'm sticking to it. The world that we are living in today is a test of our faith but the devil will not take the faith that I have in my awesome God because I know it is him who has watched over me for 21 years ND I love him for that.I WOUld have to say for me that the in question three that I don't like either but if I had to decide would say Ignorance is bliss because it's something I tend to say a lot. I don't want to dwell on that topic because the most important one is question and I think it was covered well. The three synopsis were good but its nothing like watching the actual movie to get every fine detail as to why this happened and how it actually occurred, but the synopsis was great to go by because I'm sure everyone doesn't have time to look at three movies in a week.

Journals Article Example | Topics and Well Written Essays - 250 words

Journals - Article Example You†¦,kill a man or take a tire off his car† (pg.9). The misfit then orders his two accomplices to take the family members and kill them one by one. This act shows how heartless a man can be. Killing a fellow human being in cold blood indicates how hard it is indeed hard to get a good man. Equal in Paris is a narrative that tells of an American who had been in Paris and was arrested for receiving stolen goods. The narrator spends much time in the prison rooms without trial and keeps on waiting for trial. He spends in prison with inmates among them a fellow American. The prisoner says that, â€Å"One had, in short, to come into contact with an alien culture in order to understand that a culture was not a community basket-weaving project, nor yet an act of God† (pg103). The prisoner now feels just equal to the inmates as they are treated the same way. Leaving America, he goes to become equal to other prisoners in

Globalization Essay Example | Topics and Well Written Essays - 1000 words - 8

Globalization - Essay Example Majority of the working mothers seek help from day care centres so that they can work more independently without any responsibility or hassel. (Darling, 2003, 290) They do not get enough time to teach moral and cultural values to their children. It is not much about ethnicity of mothers, but more about the economical, social and cultural back ground they belong. For example, children of separated or diviced parents seem to be more insecure and less confident. Such children are used by their parents to get their motives. Seperated parents use their children to justify their break ups. (Stoll, 2000, 202) When a child experiences all this happening around him, that makes him feel no body loves or want to have them in the whole world. When such children grow up they tend to have more apprehension and aggression and are more expected as grown ups to get into similar type of weak relationships. This has been observed that the rate of poverty is much lesser in married couples that is nearly 5.7%; as compare to single-parent family that is nearly 33.4%. Single mothers end up in getting welfare dependent. Single parent welfare programs and policies are a major cause of traditional nuclear family collapse and they contribute in lowering work and responsible conduct on part of parents. (Charles, Nickie, 2002, 02) Such programmes have also caused a sky scraping rate of break ups, which eventually results in even greater number of welfare recipients, a high rate of poor health conditions, crime, and behavioral dilemmas, lesser interest in education and add to the possibility of obstacles in future for such persons. Statistics reveals that children who are brought up in a single-parent family are more expected to be deprived and encounter more psychological and behavioral difficulties in life. They are more likely to start substance addition and get involved in criminal activities later in life. (Maccoby & Martin,

Media Log and Analysis Essay Example | Topics and Well Written Essays - 1000 words

Media Log and Analysis - Essay Example Through an analysis of my media consumption, I managed to draw some conclusions and decipher a pattern. I will highlight the issue of sending text messages first. I realized that I am accustomed to sending more text messages during periods that I am not engaging actively in another activity. For example, I am likely to send very few texts when I am driving or playing video games. From my records, I sent a minimum of 30 messages over the 7 hours that I was busy playing video games. On the contrary, I sent 150 messages over a similar duration when I did not have much to do. This makes it clear that sending messages is a preferred preoccupation during times when I have nothing else to do. My first day of recording was a Friday and considering the fact that I sent 263 messages on Friday and 150 on Saturday, I deciphered that Saturday is a busier day translating to lesser time spent sending messages. The number of messages sent on Friday tells it all that I had little to do and I needed t o preoccupy myself through catching up with friends via messages. From this, I deciphered a negative relationship between the level of activity in the realistic world and the level of engagement in the electronic media world. Although sending text messages is fun, I realize that is should engage in real-time conversations with people. In addition, text messages often leave the recipient with a lot of room of reading in between the lines and deciphering more that a simple text intended to communicate. Moreover, I realized that it is easier for me to send a text message that starting up a conversation when I am around people (Wankel and Shaun 139). This serves to highlight the negative effects of relying on electronic media. Apparently, although I spent a lot of time sending text messages, phone calls are limited. On the first day, which was a Friday, I recorded fourteen calls. Interestingly, half of these calls were from family while the rest were from my close associates. The other two days had fewer phone calls because I was a lot busier. Sunday had only five phone calls and this implies that I spent quality time having real time conversations. Sending more text messages and having few phone calls reveals a different pattern in electronic media consumption. It shows sending messages is a preference over telephone conversations. The fact that I only engage in only fourteen phone calls while sending 263 text messages to friends only implies that I find it easier to talk to peers who are miles apart through messaging services. Moreover, I sent 126 messages on Friday from 22hrs to 4.00 am, but only had three phone calls. This implies that there is great preference to text friends during the night than during the day. However, this only happens when I am not busying myself with another form of electronic media, such as video gaming. It is evident that sending text messages has taken away the beauty of face-to-face relationships. Before this analysis, I had never r ealized that I have detached myself from the real people in my life. This has occurred in two ways. During my free time, I am busy with my phone instead of engaging actively with the people next to me (Wankel and Shaun 139). For example, it is likely for me to be sending text messages, active on the internet or checking mails instead of catching up with family over dinner. Alternatively, I would also watch a movie

Marketing for Construction Essay Example | Topics and Well Written Essays - 4250 words

Marketing for Construction - Essay Example Marketing decision variables play a central role in the retailing company's overall strategy. There are a range of priorities for the businesses which need to prioritised according to the business philosophy of the business. In fact, market segmentation and opportunity prioritization go hand in hand. Construction related products like houses cannot be replaced as frequently as FMCG goods. Therefore, the company in FMCG sector requires to be regularly in touch with the customers and take care of their future needs as well. While in FMCG the packaging of the products holds a significant value proposition, in construction business, packaging doesn't hold much significance. Instead, the quality of the construction material is more crucial for the customer In the FMCG sector, in order to bring about a difference in product, the research and development activities are always on the lookout for a product or system, which can deliver better value for money. But the construction sector being capital intensive doesn't require such frequent upgrades. What needs to be ensured is that the building material being supplied happens to be of the best quality. ii. A1b. What do you believe are the main reasons for the differences that you identified in Ans: The main reasons for the difference in marketing approach are; i. The nature of product: While a majority of the products from FMCG sector are meant to be discarded after using it for a while, the product from construction sector last really long. ii. Consumption pattern: While making use of a product from FMCG, the consumer realises the time spent with the product, value delivered by the product etc. but in case of a house, if the consumer is getting good value for the money spent, then such a realisation seldom comes. iii. There has been a marked shift in the treatment of a supply chain over the last couple of decades, especially in retail and grocery markets. It is widely accepted that the most influential members of marketing channels for FMCGs are now the retail supermarkets (Stem and El-Ansary, 1992). But there are no such outlets for the construction sector as yet. iv. While the constructed house or property can be easily customised to suit the specific needs of the customer even after the purchase, by adding or altering the construction. But such customisation is not easily possible for FMCG products. A1c. Identify three (3) marketing activities common to leading FMCG companies that you believe are; (i.)

How effectively did the three armed services combine in the Falklands Essay

How effectively did the three armed services combine in the Falklands campaign - Essay Example Despite being over 8,000 miles away and at a tremendous logistical disadvantage, Prime Minister Thatcher sent an invasion force consisting of ships of all varieties, airplanes, helicopters, soldiers and one British Prince. Mrs. Thatcher wanted to prove to the USSR and communist governments throughout the world that western powers were not going to back down from a conflict, especially a colony or territory that contained a large number of western inhabitants. Thatcher was informed that Soviet intelligence reports stated that even if Thatcher were to go ahead with a military invasion, the English would lose if they went at it alone. Again, The Iron Lady took offence and set out to prove them wrong. The British Prime Minister realized the implications of this crisis. She knew that what ever she chose to do would be setting one precedent or another. It was in Thatcher's hands to decide which precedent she would set. For her, there was no question, she could not let it seem that the Sovi ets could freely choose a Western territory or colony and simply invade it without fearing the consequence of military action. In most of the renowned strategists’ opinion, the Falklands War has been referred to as like two bald men fighting over a comb. Neither country particularly needed the Falklands, and the Falklands had very little that either country coveted, but it was the symbol that was important. (Gordon 2006) Argentina lost the war in part because the comb wanted to go to England but more importantly because they simply were not prepared to fight a war against the whole world. How did British Royal Forces Show Leadership Styles The British royal armed forces used dramatically different leadership styles portrayed by British Officers at the battle of Goose Green. As regards to these two characters are the most prominent: the Battlegroup Commander Colonel H Jones who was famous for assaulting a trench single handedly and was subsequently killed. The second character is that of the B Company commander Major John Crosland who successfully lead an assault on Burntside Hill and demonstrated a markedly different style of leadership than that of Colonel Jones. These two characters have been chosen because of their almost polar opposite approaches to initially the orders process and then their own leadership style. They demonstrate just how subjective the orders process can be and the affect that a differing approach can have on the battle itself. Jones demonstrated how an autocratic style of leadership coupled with a positionalist approach to war fighting lead to near disaster, whereas Crosland showed how a slightly more Laisser Faire attitude and an understanding of mission command could prove successful. How could two such different approaches be present in what was to all intents and purposes was the same organization? The first - the orders delivered by Jones for the Assault on Goose Green and secondly his individual leadership style. These will then be contrasted with that of Major Crosland and his assault onto Burntside Hill. Colonel H Jones was a renowned figurehead of the 2nd Battalion the Parachute Regiment. He was known for his fiery temper, his embrace of the Parachute Regiment ethos and his dogged tenacity (Middlebrook, 1985). His actions

The identification of Harry's rights Essay Example | Topics and Well Written Essays - 3000 words

The identification of Harry's rights - Essay Example At this point, it should be noted that there is no problem as of the capacity of Harry to proceed to the purchase since he is not minor nor he suffers from a mental illness (s.3 Sales of Goods Act of 1979, MacLeod 2002). When ordering the table, Harry mentions to the sales assistant that he wants a table similar to that of the poster in the shop’s window; it is implied that the bed ordered should be of the same size, technical characteristics and colour as the bed illustrated in the specific poster (s.13(1) SOGA, Curtis v Ghemical Cleaning and Dyeing Co Ltd [1951], Andrews v Hopkinson [1957]); otherwise an issue of misrepresentation about quality would exist (Cranston 2000, p.148) In accordance with the case study, that bed was grey; therefore, Harry expected to receive a similar bed when making the order (s.13 (1) SOGA). At the same time, Harry picked a chair from the shop’s catalogue and made the relevant order. Again, the item ordered, the chair is defined through a photo of the item presented to the customer. This means that Harry did not have the chance to examine, closely, the size or the other qualities of the items ordered (Law Commission, 2009, p.9). He was only able to define their required characteristics through photographs. It should be noted that Harry did not explain to the seller the purpose of the goods, so the court could decide that the seller is not liable for the fact that the products are not fit for purpose (Reddy & Johnson 2011, p.22, Jewson Ltd v Leanne Teresa Boyhan [2004], BSS Group Plc v Makers (UK) Ltd (t/a Allied Services) [2011]). At this point, the following issues should be discussed: a) whether the items were accepted (s32 SOGA), and b) whether the items met the requirements of the law in regard to not fit for purpose products. The time framework available to Harry in order to make his claims should be also examined. In accordance with the Sales of goods Act 1979, the time framework for the buyer to develop claims against the seller in regard to the items sold is 28 days from the date of the sale (as such term is commonly added in contracts in order to define the ‘reasonable’ time during which the right of the buyer to reject the goods sold is retained, s35(4) SOGA). Harry’s rights, as derived from the specific sale, are active. Harry can approach the seller with a claim for faulty products within the period of 28 days from the date of the sale, meaning the date when the sale was completed, i.e. when the buyer accepted the goods (Chen-Wishart 2007, p.595). The period of 28 days had not passed; it begins from the day that Harry checked the goods, in the context that the seller has to give to the buyer a reasonable time for checking the goods and Harry was absent which means he could not check the goods (s.35 SOGA, Law Commission, 2009, p.10). Also, the English courts have held that the silence of the buyer cannot be considered as acceptance of the goods sold (Felthouse v B indley [1862], Hannah Blumenthal [1983]). However, in order for the above claims to be valid, it needs to be proved that the products sold are not fit for purpose. The law, the Sales of goods Act 1979 (SOGA), sets the criteria under which a product is considered as not fit for purpose: ‘a) it does not match the description (s.13, SOGA), b) is not of satisfactory quality (s14.2 SOGA) and c)

Adam Smith's View on the Declarations of Woman,Man, & Independence Essay

Adam Smith's View on the Declarations of Woman,Man, & Independence - Essay Example The exact person or people for influence that Jefferson used in Europe have been debated since the original drafting. The Declaration of the Rights of Man authored by Jerome Champion de Cice was brought about during the French Revolution and was not just about â€Å"man’s† rights but about rights of all those living in France during the time with the exception of many rights for women. The French were not content with the Declaration of the Rights of Man and created the Declaration of the Rights of Woman. This declaration written by Olympe de Gouges was specifically about French women’s rights in contrast to Cice’s Declaration to men’s rights. Adam Smith was a highly intellectual individual who attended the University of Glasgow early in life. Following graduation, Smith attended the Oxford University which played heavily in his future writings (Hanson 298). Although educated in many subjects, it was economics and specifically western European economics that Smith lectured on. Soon however, Smith began to tour Europe with a student at which time Smith met many influential leaders of the time (Hanson 298). Following the end of his tutoring, Smith returned to his birth place to begin writing. Smith leaned heavily on enlightenment philosophy in his writings and his own personal beliefs on the world. Smith wrote about the morality of the time as well as what he believed to be an important aspect of wealth, the division of labor. Historically, his work has survived both in morality philosophy as well as economic studies. Across the ocean, Thomas Jefferson was born into a different socio-economic class and personally owned slaves when he turned 21. Jefferson, unlike Smith, attended college young in life. Unlike Smith, however, Jefferson became enthralled with law studies and soon became a practicing lawyer. Due to his privileged status, Jefferson was asked to

Your choice Essay Example | Topics and Well Written Essays - 750 words

Your choice - Essay Example To serve the best interests of the people, it is seen as a necessary requirement to have the people actively involved in the running of the system (Shafritz, 2006). This paper will review the importance of a strong and effective public administration system in society. In order for there to be organization and order in a society, there must be the existence of an organized system that helps run the society. Respect for law demands that all those that want to be involved in the running of the administration need to understand it. This is in order for them to understand the principles behind such governance. Understanding this helps them, not only to understand being governed, but it also helps those governing, how to govern. Public administration offers people a forum to be heard and attention is given to their needs (Shafritz, 2006). According to Woodrow Wilson, he believed that public administration that was put in place failed. He believed that public administration and the government that were in place were two separate entities. There was the belief that there was to be a distinction from politics and administration. This is all in line with the case of The Blast in Centralia No. 5. It is difficult for any system of governance to create a system that is safe for everyone whilst it has leadership problems. This is next to impossible. A system has to be morally upright in order for it to function as it should. Without the internal order, it is not possible for it to govern external affairs. The need to re-establish government services around the area of administration is particularly vital (Stillman, 2009). Government services enable society to be served without much tussle. It is their job to represent the people on a much higher level. Public administration has a crucial part to play in the creation, and implementation of goals in a society. These goals and objectives help in the alleviation of poverty and the creation of employment.

Transition Services for Special Education Students Essay Example for Free

Transition Services for Special Education Students Essay Abstract This study examined the issues on life-span transition services for special education students. By exploring the existing approaches to transition services and analyzing outcomes they provide for the disabled persons the study tried to find out the strengths and weaknesses of these approaches as well as to define the future trends able to enhance transition programs designed to increase the likelihood that the disabled person will be able to secure and maintain employment, function independently in the community, and ultimately become a satisfied and productive member of society. The results of the study demonstrated that to be successful transition services have to be transdisciplinary in nature. Besides, the use of collaborative teaming among professionals, agencies, the student, and family members, the use of the curriculum that focuses on the interactions between the student and his/her environments as well as the establishment and use of interagency linkages to facilitate the smooth transfer of support and training from the school to adult and community agencies when the student exits public schools are the most important components of successful life-span transition programs. A few decades ago the society faced disturbing outcome data of the students with disabilities (Repetto, 1995, p. 128) and fully realized that due to little concern given to vocational and transition programs for these students the latter experienced increased school dropout and unemployment rates as statistics showed. Those students have often graduated from the school lacking the skills essential to live or function autonomously in the community, and often failing to find and keep job (Levinson, 1998, p. 29). It is evident such state of things has been costly for both financial and personal considerations. On the one hand, the society was to provide social security for these persons, and on the other hand, the person himself was not satisfied with job career and own dependence. The necessity to change this state of affairs has led to growing concentration upon enhancing transition services for the persons with disabilities within the past one and a half decade. Three factors contributed to this process: adoption of federal legislation supporting and promoting transition services; availability of state, federal, and local funds invested in their development (Shapiro Rich, 1999, p.51); and a number of scientific and empirical studies on effective transition practices (Kohler Field, 2003, p. 174). The purpose of this study is to explore how life-span transition services can ensure smooth integration of the special needs students into the community and provide them with the skills sufficient for successful career development. Toward this end we will scrutinize prevailing approaches to transition services, discuss their advantages and shortcomings; analyze the components making transition programs implementation successful; and make the conclusions as to the ways of these programs improvement. Definition of Transition Services Transition services were defined in by the law as: A coordinated set of activities for a student, designed with an outcome-oriented process, which promotes movement from school to post-school activities, including post-secondary education, vocational training, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation. The coordinated set of activities shall be based on the individual students needs, taking into account the students preferences and interests, and shall include instruction, community experiences, the development of employment, and other post-school adult living objectives, and, when appropriate, acquisition of daily living skills and functional vocational evaluation (P.L. 101-476, pp. 1103-1104). Thus, transition services, mandated by legislation, reflect the major performance areas that are typically addressed by transition services: work or education, independent living including activities of daily living, and community participation, which may include community mobility and transportation, access to community services and activities, recreation and leisure, and socialization and relationships. This definition distinctly implies that transition services should involve a diversity of school and community staff. It also assumes that they have to contain the parents of the children and the children themselves (Shapiro Rich, 1999, p. 132). Besides, the definition entails that a transition program is an outcome-oriented, well-planned and methodical process to be launched long before the student is graduating from school (Levinson, 1998, p. 2) to achieve its goals. Legislative Background of Transition Services As it was mentioned above one of the main factors promoting transition services prevalence was adoption of supporting federal legislation and availability of state, federal, and local funds invested in their development. Since the 1970s the United States Congress has passed several legislative acts that have directly affected the availability and use of transition services for the individuals with disabilities. Since the passage of Public Law 94-142, The Education for All Handicapped Children Act of 1975 (EHA), special education and related services have been made available through the public education system to the nations children and youth who have disabilities (Levinson, 1998, p. 27). The Rehabilitation Act, which was first introduced in 1973 and then rewritten in 1986 (Public Law 99-506), stipulates for provision of transition services to individuals with disabilities to (1) have greater control over their lives; (2) participate in home, school, and work environments; (3) interact with peers who do not have disabilities; and (4) otherwise do acts taken for granted by individuals without any known disability (Repetto, 1995, p. 127). The EHA and its subsequent amendments (Individuals with Disabilities Education Act (IDEA), 1990, 1997) guaranteed the provision of transition services as required to provide free and appropriate education for all children with disabilities (Benz, Lindstrom Yovanoff, 2000, p. 509). An appropriate education is one in which children with disabilities acquire, to the maximum extent possible, the skills, knowledge, and behaviors that will ultimately help them function successfully as adults. After initial passage of the EHA, several major benefits were realized: Formal mechanisms were established to identify and bring children with disabilities into the public education process. Parents and guardians were identified as essential members of the educational team and were provided with legal rights related to their childs education. All identified children were provided with Individualized Education Programs (IEPs) developed by an educational team that included the students parents or guardians (Shapiro Rich, 1999, p. 131). The 1997 amendments to IDEA continued to emphasize the use of transition services to enable the success of students with disabilities in their educational and school-to-career programs. These legislative acts have improved the access to transition services by children with disabilities (Levinson, 1998, p. 29). Moreover, through the Tech Act (Public Law 100-407), states have established resource centers and information systems for consumers of transition services. The goals of this legislation are to foster interagency cooperation, develop flexible and effective funding strategies, and promote access to transition services for individuals with disabilities throughout their life spans (Johnson et al., 2002, p. 520). The Goal of Transition Services – Life-Span Assistance for the Student’s Empowerment Such well-founded legislation on transition services paved the way for their wide spread implementation all over the nation, successful realization and continuous enhancement of the delivered services. From the definition of transition services it is clear they require â€Å"an outcome-oriented approach that looks at future vocational placements, residential options, funding sources, and community resources† (Nuehring Sitlington, 2003, p. 23). A number of studies examined the practical ways of applying this approach. In particular, Wehman Revell (1997) found the following: Transition for any student with a disability involves several key components, including: (1) an appropriate school program; (2) formalized plans involving parents and the entire array of community agencies that are responsible for providing services; and (3) multiple, quality options for gainful employment and meaningful post-school education and community living. (p. 67). All these components in combination are assigned to promote the smooth movement of young children with disabilities from a preschool program to a kindergarten class and into a school setting, and further the movement of young adults from one grade of the secondary school to the next and to post-school activities.   Thus, the special needs children may spend from 12 to 18 years getting the certain form of transition services (Spencer 2001, p. 893) which Donald Super in his theory of career development called â€Å"life-span and life-space transition† (Szymanski, 1994, p. 402). Many scholars agree that early childhood influences are the crucial determinants of later professional behavior (Turner Szymanski, 1990, p. 20). Reflecting this concept, IDEA 1997 while not requiring the local education agency to consider transition activities and sites for students with disabilities before the students 14th birthday, does require that services be provided earlier if the IEP team feels such is appropriate (Daugherty, 2001, p. 45). Therefore, families and educators should consider the child’s abilities, interests, and opportunities for community-based activities and kindergarten- or home-based special education while the child is in pre-school years and in elementary school. Doing so should help the child to develop skills and interests for maintaining that activity later in life (Levinson, 1998, p. 10). Research indicates that such early involvement of the child with special needs into transition programs improves and enhances self-concept, competence, and social skills of him/her (Szymanski, 1994, p. 403). The very important thing here is that professionals and families should recognize that families play an integral role especially in early year’s transition planning (Scott Baldwin, 2005, p. 173). The scholars suggested a number of guidelines for such planning: transition should be viewed within a larger context of community inclusion and participation; transition should be family- and individual-directed; families should be educated and empowered to acquire and assist in the creation of appropriate inclusive services and supports; transition should be embedded in elementary and secondary curriculum reform; the process required to create the Individualized Transition Plan (ITP) should not distract families; to achieve the most satisfactory result for their children, families should provide basic support to one another (Levinson, 1998, p. 3). As to the instruction the basic academic skills in reading, writing, and computation is usually emphasized at the elementary school level, but some elements of them are being taught as early as during pre-school years (Repetto, 1995, p. 125). When structuring instruction, educators sequence skills properly. Each skill is taught in sequence, and only when mastery of one skill is attained the next skill should be introduced. This is particularly important with skills that are dependent upon each other (Levinson, 1998, p. 91). Indeed, it may be difficult for some families to focus on post-school transition needs when their child is just in the kindergarten. If this is the case, professionals should take care not to overwhelm families with transition planning. Professionals should appropriately explain the importance of developing skills and interests in mental and physical activity while the child is young in order to maximize current and future involvement in various activities offered through the school and community. Such explanations, among other advantages, allow to prevent secondary disabilities, to help the child to socialize and get the necessary social skills as early as in childhood (Scott Baldwin, 2005, p. 174). Research proved that it is never too early to begin planning for transition to family- and community-based transition programs. Good planning always includes identification of the childs abilities and the childs and familys interests and goals for education considering their cultural beliefs and values. Such transition plan for the pre-school or elementary student remains flexible, because the childs abilities may change and/or the childs or familys interests and resources may change (Benz, Lindstrom Yovanoff, 2000, p. 512). General education and special education teachers are in the best position to encourage parents of pre-school and elementary school children to facilitate the transition planning. Studies show that children who are participants of transition programs from the early years have a better chance of becoming socially active, intelligent, competent and healthy adults (Carter Wehby 2003, p. 450). Moving from the kindergarten and elementary school to the secondary school implies the new challenges for the students of special education. Scholars defined what secondary transition practices are contributing to the future children retention and success when they enter high school and further get job. These are: direct, individualized tutoring and support to complete homework assignments, attend class, and stay focused on school; 2. participation in vocational education classes during the last 2 years of high school, especially classes that offer occupationally specific instruction; 3. participation in paid work experience in the community during the last 2 years of high school; 4. competence in functional academic [†¦] and transition [†¦] skills; 5. participation in a transition planning process that promotes self-determination; 6. direct assistance to understand and connect with resources related to post-school goals [†¦]; 7. graduation from high school. (Benz et al., 2004, p. 39). Such comprehensive list of factors evidently testifies that due to recent standards-based secondary school reform the requirements to academic performance raised substantially. Accepting this challenge special education teachers have worked hard to make sure that the special needs students are involved in these general reform efforts (Benz, Lindstrom Yovanoff, 2000, p. 511). They developed adoptive methods helping to ease the process of learning. For instance, when the student has difficulty in learning needed skills combined with incapacity to readily transfer or generalize learning to new environments or situations, they provide education in the actual environments that the student will be using, which allows for explicit teaching to the real-life demands of a particular environment and eliminates the need for the student to transfer skills (Spencer 2001, p. 884). At this all it is significant that emphasizing of an environmental curriculum on preparing the students of secondary school to functionate in main life domains (domestic, school, community, leisure, and vocational), efficient transition practices demand continuous assessment of the extent and quality of performance in each domain (Turner Szymanski, 1990, p. 22). Modern science in the sphere of special education developed several methodologies which allow achieving high academic performance by the secondary school students with disabilities. They include direct instruction, meta-cognitive reading comprehension strategies, peer-mediated instruction and interventions, and social skills training (Conderman Katsiyannis, 2002, p. 169). One of the important issues in secondary school transition services is inclusion of the students with disabilities in the general curriculum. Federal legislation gives the clear mandate for educating all children with disabilities in the regular classroom to the maximum extent appropriate or possible (Daugherty, 2001, p. 48). The inclusion of students who have disabilities in typical educational activities and environments is believed to promote student performance, offer rich opportunities for learning, provide age-appropriate role modeling, increase awareness among all students of diverse learning styles and abilities, and provide opportunities for relationship building that is so important especially during adolescent development (Scott Baldwin, 2005, p. 175). Age-appropriate placement does not mean that students with disabilities are simply placed in a typical class or at a community job site. Appropriate support services and resources that facilitate the students full inclusion and maximum participation in the environment must accompany these placements. Thus, IDEA recognizes that a students successful transition from school to adult life requires opportunities to learn and to practice skills in a variety of relevant school and non-school learning environments. These environments may include the classroom, school lunchroom, home, public transit bus, work site, community recreation facility, and a variety of other relevant settings (Daugherty, 2001, p. 49). But here a danger exists that content instruction could impede the goals of inclusion education. As more special needs students are included in general education curriculum, they often need supplementary assistance from the special education teacher to do class and home assignments, to review the learned material, and to prepare for the exams which sometimes is given by these teachers when their students pass the tests, for example. The pressure on special educators to provide academic progress of their wards could make more harm than good for them. Passing grades in school progress record sometimes do not mean quality of the student’s knowledge and skills (Conderman Katsiyannis, 2002, p. 170). Although the general education curriculum contains both academic (e.g., math, science) and nonacademic (e.g., career education, arts, citizenship) domains, student performance is assessed primarily in academics. As a result, it is not uncommon for portions of the general curriculum as well as transition goals to receive limited or no attention. There also may result a narrowing of curriculum and instruction to focus on content assessed in state or local tests. This may limit the range of program options for students due to intensified efforts to concentrate on areas of weakness identified by testing. Efforts must be undertaken to ensure that students with disabilities remain on a full curriculum track, with learning expectations that guide the instruction of general education students. IEP teams must work to ensure that high expectations are maintained and students are afforded opportunities to develop skills through a wide range of curriculum options, including vocational education, service learning, community work experience, and adult living skills (Repetto Correa, 1996, p. 553). The present challenge is to integrate the IDEA requirements concerning access to the general education curriculum with the transition service provisions. There is an urgent need to view these requirements as unified and complementary in helping students to achieve the broadest possible range of school and post-school goals and results. Strategies for accomplishing this include promoting high expectations for student achievement and learning, making appropriate use of assessment and instructional accommodations, and ensuring that students have access to the full range of secondary education curricula and programs (Benz et al., 2004, p. 41). Another important issue, especially concerning the students with mild disabilities, is availability of continuous instruction of basic skills within the curriculum at the middle school and high school levels. Those skills need to be taught within the context of real-life applications (Spencer 2001, p. 881). That is, in elementary school, students are taught to add, subtract etc. using worksheets and other materials but are rarely given the opportunity to apply those skills to balancing a checkbook or determining whether they have received the correct change during a purchase. Additionally, in elementary school little opportunity is provided to apply those skills to vocationally or occupationally relevant activities. Although to make a successful transition from high school to work, college, or community living, students need to possess basic academic skills in reading, writing, and computation, at both the middle school and high school level students need to be provided with continuing opportunities to practice those basic skills in real-life situations (Conderman Katsiyannis, 2002, p. 172). At the same time after the students with disabilities graduated from the school they are still eligible for the transition services. At this stage namely the student is a person who defines which areas are given emphasis. For instance, the student with learning disabilities planning to enter the college may not need to be provided with extensive vocational and occupational training in high school but may need to focus on the development of academic skills specific to admission to and success in college, and life skills specific to making a successful adjustment from high school to college. In contrast, the student with severe cognitive and physical disabilities may need to focus on vocational and occupational functioning and basic life skills necessary for independent living (Repetto, 1996, p. 553). Besides, several other factors have an effect on the design of the vocational syllabus. Local conditions often define the studens’ plans for the future such as urban or rural district, the peculiarities of local economy and labor market, the rate of employment, the personal traits of the student himself and the type of his/her disability, and indeed availability of transition services. The vocational syllabus has to be designed in such a way to prepare the students with disabilities for jobs in demand on local labor market, because as a rule such students do not leave their communities trying to find job (Levinson, 1998, p. 88). When we consider post-secondary transition services for the college-bound students it is important to pay attention to the differences between high school and college requirements, such as time spent in class, class size, time for study, testing approaches, grading methods, teaching strategies, and freedom and independence. They all pose additional challenges for students with disabilities who are making the transition from high school to college. Discussing those differences and assessing student practices are important for students survival and adaptation. When evaluating post-secondary options, the students need to assess the amount and type of learning disabilities support services they require to be successful (Shapiro Rich, 1999, p. 171). Assisting the students with special needs to cope with the new challenges most post-secondary educational settings have programs for such individuals that provide the necessary support for them. These institutions often have an Office for Students with Disabilities that employs counselors and tutors and that provides a wide array of services for all students with disabilities. For instance, structural accommodations such as ramps and elevators exist to accommodate students with physical disabilities. Large-print and Braille textbooks exist for students with visual impairments. Students with hearing impairments can be provided with prepared lecture notes (Levinson, 1998, p. 152). In addition, modifications in test-taking procedures, tutoring, and academic and personal counseling are available for the special needs students. Given the array of services available, post-secondary educational settings are now an appropriate option for many students with disabilities whose occupational aspirations require advanced formal education (Benz, Lindstrom Yovanoff, 2000, p. 513). Numerous methods are available to provide individuals with the additional post-secondary training they need in order to acquire the skills and credentials necessary for entry into their chosen occupations (Benz, Lindstrom Yovanoff, 2000, p. 510). In addition to the vocational training and work experience programs offered by most school districts, individuals with disabilities may gain additional training after high school via apprenticeship programs, the military, trade and technical schools, community colleges and junior colleges, and four-year colleges and universities. All offer programs that may be suitable post-secondary options for the students with disabilities (Johnson et al., 2002, p. 522). In general, the legislation includes the following in its description of post-school activities: post-secondary education, vocational training, integrated employment (including supported employment), continuing and adult education, adult services, independent living, and community participation. Clearly, then, transition is meant to address not just employment needs, but future needs within the broader focus of life within the community (Repetto, 1995, p. 130). In any case, to the maximum extent possible, the individuals with disabilities should be placed in the least restrictive environment and in settings that facilitate the normalization process. Delivering transition services from high school to work-force, transition personnel should attempt to ensure that a full range of placement options exist for the individuals with whom they work. This often necessitates that transition personnel market individuals with disabilities to employers, neighbors, or admission personnel and conduct public relations campaigns on behalf of their clients. Because many people have unrealistic and faulty expectations and perceptions of individuals with disabilities, transition personnel also have to educate the public about disability issues and have to work hard to overcome the public resistance that so often accompanies the placement of those individuals in occupational, residential, and educational settings (Johnson et al., 2002, p.   520). Both scholars and special educators recognize the importance of specific career development skills to a students success in the workforce. Learning how to search for job openings, write a CV, establish and prepare for an interview, understand the relationship between employer and employee, and be knowledgeable as to the rights of workers are all important areas to address. Additionally, successful transition programs address work ethics, work habits, and motivation issues as well. For instance, the students with disabilities would greatly benefit from preparation regarding employers expectations in terms of work habits. For instance, they should learn the importance of taking responsibility for calling in if they were unable to be at work. Very often these major work habits and ethics are missing from the students skills. Besides, students with disabilities are excessively sheltered and are often not compelled to take responsibility for their own actions while responsibility is crucial for getting and keeping employment (Nuehring Sitlington, 2003, p. 28). Conclusion In summary, the study showed that the transition process is in fact a part of the broader process of career development. Moreover, transition is about societal empowerment not only of the individuals with disabilities, but of all of us. Our communities and our society will be enriched and empowered when all citizens, including those with disabilities, are valued and seen as contributing members. The challenge of transition professionals is to facilitate that empowerment through appropriate transition services that empower individuals and their families and through the actions as community catalysts who work in a respectful partnership with people with disabilities. The conducted study clearly demonstrated the concept of transition-focused education represents a shift from disability-focused, deficit-driven programs to an education and service-delivery approach based on abilities, options, and self-determination. This approach incorporates quality-of-life issues, life span and life space considerations, and suggestions for seamless transition approaches together with the key elements – outcome-oriented, community-based, student-centered, and family-centered transition services. At the same time the study proved that there is no one fitting all transition planning strategy able to effectively prepare students with disabilities who all have unique needs for successful, fulfilling adult roles. Only through continued attention to establishing effective transition services flexible enough to meet individual student needs, the society can arm students with information and opportunities on which they can build their futures. Thus, the society has to bend every effort to ensure that students with disabilities fully access and benefit from the general education curriculum, and leave our school systems prepared to successfully participate in post-secondary education, enter meaningful employment, live independently in communities, and pursue lifelong learning opportunities.       References Benz, M. R., Lindstrom, L., Yovanoff, P. (2000). Improving Graduation and Employment Outcomes of Students with Disabilities: Predictive Factors and Student Perspectives. Exceptional Children, 66, 509-516. Benz , M. R., Lindstrom, L., Unruh, D., Waintrup, M. (2004). Sustaining Secondary Transition Programs in Local Schools. Remedial and Special Education, 25, 39-44. Carter, E. W., Wehby, J. H. (2003). Job Performance of Transition-Age Youth with Emotional and Behavioral Disorders. Exceptional Children, 69, 449-458. Conderman, G., Katsiyannis, A. (2002). Instructional Issues and Practices in Secondary Special Education. Remedial and Special Education, 23, 169-176. Daugherty, R. F. (2001). Special Education: A Summary of Legal Requirements, Terms, and Trends. Westport, CT: Bergin Garvey. Individuals with Disabilities Education Act Amendments of 1990 (Public Law 101-476). 20 U.S.C., 1400. Johnson, D. R., Stodden, R. A., Emanuel, E. J., Luecking, R., Mack, M. (2002). Current Challenges Facing Secondary Education and Transition Services: What Research Tells US. Exceptional Children, 68, 519-527. Kohler, P. D., Field, S. (2003). Transition-Focused Education: Foundation for the Future. Journal of Special Education, 37, 174-186. Levinson, E. M. (1998). Transition: Facilitating the Post-School Adjustment of Students with Disabilities. Boulder, CO: Westview Press. Place of Publication:. Publication Year:. Nuehring, M. L., Sitlington, P. L. (2003). Transition as a Vehicle: Moving from High School to an Adult Vocational Service Provider. Journal of Disability Policy Studies, 14, 23-34. Repetto, J. B. (1995). Curriculum Beyond School Walls: Implications of Transition Education. Peabody Journal of Education, 70, 125-140. Repetto, J. B., Correa, V. I. (1996). Expanding Views on Transition. Exceptional Children, 62, 551-557. Scott, J., Baldwin, W. L. (2005). The Challenge of Early Intensive Intervention. In   D. Zager (Ed.), Autism Spectrum Disorders: Identification, Education, and Treatment (pp. 173-228). Mahwah, NJ: Lawrence Erlbaum Associates. Shapiro, J., Rich, R. (1999). Facing Learning Disabilities in the Adult Years. New York: Oxford University Press. Spencer, K. C. (2001). Transition Services: From School to Adult Life. In J. Case-Smith (Ed.),   Occupational Therapy for Children (pp. 878-894). St. Louis, MO: Mosby. Szymanski, E. M. (1994). Transition: Life-Span and Life-Space Considerations for Empowerment. Exceptional Children, 60, 402-407. Turner, K. D., Szymanski, E. M. (1990). Work Adjustment of People with Congenital Disabilities: A Longitudinal Perspective from Birth to Adulthood. The Journal of Rehabilitation,   56.3, 19-26. Wehman, P., Revell, W. G. (1997). Transition into Supported Employment for Young Adults with Severe Disabilities: Current Practices and Future Directions. Journal of Vocational Rehabilitation, 8, 65-74.

Secretors and Non-secretors Disease Susceptibility

Secretors and Non-secretors Disease Susceptibility Human population can be categorized into secretors and non-secretors based on A, B and H antigen on basis of presence or absence of these blood group antigens in the body fluids and secretions, such as saliva, sweat, tears, semen, serum, mucus present in the digestive tract or respiratory cavities etc. Secretors are individuals that secrete blood group antigens in their body fluids while non-secretors are the individuals that do not secrete them in their body fluids and secretions. It is a known fact that ABO blood type is controlled by blood type coding genes present on the chromosome 9q34 but the secretor status of an individual is decided by interaction of a separate gene (called secreting gene) with these blood type genes. The presence of the secreting gene in a persons genome makes him a secretor and absence makes him a non secretor. The gene is designated as (Se) for Secretors and (se) for Non-secretors and it is entirely independent of the blood type A, B, AB or O. The individuals secreting antigens in the body fluid are designated as ABH secretors in blood banks. Individuals having O blood group secrete antigen H, A blood group secrete A and H antigens, B blood group secrete B and H antigens in the fluids. A secretor gene helps a person to gain a degree of protection against different environmental conditions especially the micro flora of a particular environment and also the lectins present in them. It helps them in promoting the growth of friendly, stable blood type intestinal bacterial ecosystem which depends on the blood type antigens present in the mucus of an individual. Secretor status does modify carbohydrates in the fluids present in the body and their secretions and it also affects and influences the attachment and persistence of the micro flora present in the body. Secretors are at a higher advantage than non-secretors. Non-secretors have a potential health disadvantage. They possess many metabolic traits such as carbohydrate intolerance, immune susceptibilities. Different tests are available for determining an individuals secretor status. Most common test uses saliva or other body fluids of an individual for testing the secretor status. These tests are based on the principl e of Agglutination Inhibition where the antigens are neutralized by the corresponding antibodies so that these antibodies will not be further be available to neutralize or agglutinate the same antigens residing on the red blood cells. ELISA could also be used for determining the presence of the secreted Lewis antigens in the saliva or other body fluids. The alleles Se and se differ in the frequency and have an anthropological value. They occur in different frequency in different populations. They have a high frequency in the American Indiana and a low frequency in the southern Indians. In US 20% of the population is secretors whereas 80% of the population consist of non-secretors. The fusion allele of the FUT2 (secretor type alpha(1,2)-fucosyltransferase) gene at a high frequency and a new se385 allele in a Korean population SECRETOR AND NON-SECRETOR A person secreting blood group antigens into the body fluids and other secretions like saliva, semen, tear, mucous in the digestive tract and respiratory cavities are named as secretors. In similar terms they put their blood type antigens in the body fluids. They secrete antigens according to their blood type, A secrete antigen A and H, B secret antigen B and H, O secrete antigen O and AB secrete A, B and H antigen. Secretors expresses Lewis b (Leb) antigens on the RBC where as non-secretor expresses Lewis a (Le a) on their RBC.These antigens in the body fluids give additional protection to the individual against the various microorganisms and the lectins present all around us. 15- 20% of the population consists of non-secretor. These individual fail to secrete the blood group antigens in their body fluids hence they become susceptible to bacterial and superficial yeast infections. A large no of them sometimes also suffer from the autoimmune disorder. This could also be correlated with the secretor and non-secretor phenotype. The body secretions of secretors and non-secretors differ quantitatively and also qualitatively. The type and quantity of the antigens present in it differ among different individuals. In some cases the non-secretors may contain the A and B antigens in the saliva but the quantity is less and even quality is very low hence they have similar functional problem. There are certain properties which are specific for secretors and differ in non-secretors. Some are listed below: Intestinal alkaline phosphatase activity ABH secretor correlates the activity of alkaline phosphatase and serum alkaline phosphatase present in the intestine. Non-secretors have low activity of alkaline phosphatase and serum alkaline phosphatase which is responsible for the breakdown of fat and assimilate calcium. Low molecular weight alkaline is present in both secretors and non-secretors and high molecular weight alkaline phosphatase is present only is secretors. Bacterial flora The ABH blood types influence the population of bacteria residing in the local vicinity of the gut mucin glycoproteins. Bacteria produce enzymes that have the capability to degrade the end sugar of A, B, and H blood antigens and which are consumed as food by them. The B antigen degrading bacteria produce enzyme to remove the end alpha-D-galactose and A antigen degrading bacteria produce enzyme to detach N-acetylgalactosamine which are used as a source of food by them. Blood clotting The secretor and the ABO genetics influence each other and effect upto 60% of the vWf concentration variation in plasma. Raised levels of factor VIII and vWf may cause thrombotic and heart disease in future. Secretors have the slowest clotting time, thinnest blood, least tendency of platelet aggregation, low amount of factor VIII and von Willebrand factor (vWf). The non-secretors have highest clotting time, thick blood, high amount of factor VIII and von Willebrand factor (vWf) and low bleeding time. The blood viscosity is also influenced by the secretor status of that individual. Phenotype Lewis Characteristics of Clotting Le (a- b-) maximum action of factor VIII and vWf Very Low bleeding times (seen in A, B and AB) Le (a+ b-) intermediary action Low bleeding times (seen in O) Le (a- b+) minimum action of factor VIII and vWf Very Long bleeding times (seen in O) Blood Type Lewis and Factors effect Blood Clotting Immunoglobulin Variations ABH non-secretors express low concentration of IgG immunoglobulin. The secretion of varying concentration of diverse constituents of the blood group is controlled by the secretor gene and it also affects the phagocytic activity of the leucocytes which provides an added advantage to the non-secretors. The leucocytes of the non-secretors possess a greater ingestion power when compared to the secretors. The O and B blood group non-secretors have the highest phagocytic activity. The presence of different concentration of anti-I in the an individuals serum is affected by the ABO group, secretor status and sex of the individual. The secretors females have a high level of anti-I in the serum as compared to the males. The non-secretor have low levels of IgA and IgG antibodies and hence have frequent problems with the heart valve. Genetics and Biochemical pathways The secretion of the blood group antigens in the body fluids and other secretions are genetically influenced by certain allelomorphic genes. Secretor gene contains two alleles (Se) and (se). The dominant gene Se is present in the homozygous or heterozygous condition in the secretors which lead to the secretion of antigens into the body fluids. se is recessive allele and is present in non-secretors in the homozygous condition. SeSe and seSe produces a dominant secretor phenotype and sese produces a recessive non-secretor phenotype. Basically three genes are responsible for the formation of the A and B antigens. They are namely ABO, Hh, and Sese genes encoding glycosyltransferases which produces the A and B antigens. H antigen present in the individual with O blood group is the precursor for the formation of A and B antigens. H antigen act as a backbone for A and B antigens. The O gene is considered as amorphic. The allele Hh and Sese reside on each locus and are closely linked together. It is also suggested that one of the allele has arisen by the gene duplication of the other. The second allele on the same locus is really rare. The product related to this allele hasnt been discovered yet and hence it is considered as amorph. The oligosaccharide responsible for the formation of the A and B antigen can exist in a simple linear fashion or a complex branched fashion. Infants A, B and H antigens contain high amount of linear chained oligosaccharide whereas oligosaccharides present in an adult contain high amount of branched chained oligosaccharides The A and B antigen is synthesized from a common intermediate known as substance H. The conversion is carried out by the addition of a sugar molecule to the non reducing end of the H oligosaccharide chains. This addition affects the reactivity of H antigen. The ABH substances are secreted in the Urinary respiratory tract, gastrointestinal tract by mucous glands residing there. The secretor gene regulates the synthesis of blood group antigens in the glands of small intestinal mucosa. The secretors and non-secretors produce A and B substances which are basically glycoproteins in pylorus and Brunners glands and produce A and B substances those are soluble in alcohol and glycosphingolipids in nature. The secretors also produce ABH substances in the prostate and lactating mammary glands. The secretion of breast is rich in H substance but poor in substance A and virtually absent in substance B. The synthesis of these constituents in the pancreas and secretory cells of sweat gland is not controlled by the secretor gene. The blood groups substances were also found in the calyxes and collecting tubules of the secretors (Se) but it could not be concluded that whether they are produced by the kidneys or are generally excreted. These secretions were noticed in the eight to nine weeks old salivary glands and stomach and later it appears throughout the gastrointestinal tract. Glycosphingolipids carrying the A or B oligosaccharides are present on the membranes of RBCs, epithelial and endothelial cells and are also present in the plasma in the soluble form. The glycoproteins carrying the similar A and B oligosaccharides are responsible for their activity in the body fluids. In the body fluids they are present in the secreted form. The A and B oligosaccharides which do not contain the carrier proteins are present in the milk and urine. The chromosome 19 containsFUT 1 and FUT 2 genes which code for fucosyltransferase. FUT genes numbered from 1-7 and form clusters which are responsible for the production of enzymes called as fucosyltranferases. The cluster is located on chromosome 19q13.3. Fucosyltranferase helps in the formation of fucose moiety which is added to the H antigen and further gylcosylate the A or/and B antigens. H antigen is a basic blood group antigen present in each and every human being but the content varies in different individuals of the same ABO group. A general pattern indicates that its strength varies as O>A2>A2B>B>A1>A1B. Water soluble H antigen has been demonstrated in the saliva and the body fluids of the individuals.H antigens are fucose containing glycan units which are present on the glycolipids or glycoproteins residing on the erythrocytes membrane or in the secretions. The fucosylatedglycans are the substrate for the enzyme glycosytransferases that are responsible for the formation of the Lewis and A, B blood group antigen epitopes. Secretors contain both the alleles whereas non secretor contains the null allele for FUT2 gene. The FUT 2 gene codes for fucosyltranferaseenzyme in the exocrine tissues which lead to formation of antigens in the body secretions and body fluids. The A and B genes produce glycosyltranferase that add sugar to oligosaccharide chains that is converted to H antigen. The H antigen are constructed on the oligosaccharide chain. The oligosaccharide chains could be of two type : Type 1 and type 2. The glycosphingolipids present in the plasma and on the membranes of glandular and parenchymal cells and glycoproteins present on the cell surfaces or body fluids carry either the type 1 or type 2 chains. The glycolipids antigens present on the RBC contain type 2 chains. A gene encodes N-acetyl-galactosaminyl-transferase and B gene-encodes galactosaminyl-transferase and add   GalNAc   and  Gal   in alpha (1-3) linkages which is acts on the H gene transferase. The H gene produces fucosyltransferase that add fucose to the terminal Galactose molecule of type 2 chain. It forms an alpha (1-2) linkage. A and B antigens are constructed when the A and B transferases attach respective sugars to the type 1 or type 2 chain substituted with Fucose. The secretor gene FUT2 located at 19q13.3 and codes for the activity of the glycosyltransferasesin concert with the FUT1 gene coding for H antigen, needed to assemble both the ABO and Lewis blood group and are active in mucous gland and goblet cells which interact with each other and lead to secretions of antigens in the fluids. The expression patterns of both the genes are different. The FUT1 (H) gene is dominantly expressed in the erythroid tissues which lead to the formation of the H enzyme whereas the FUT2 (secretor) gene is expressed in the secretory tissues and lead to the formation of secretor enzyme. The product of the H enzyme or H gene resides on the erythrocytes and product of secretor gene resides on mucins in secretions. If an individual lack these alleles, he/she will not be able to express the above active enzymes therefore they would be deficient of the substrates which are required by the A or B glycosyltransferases. Therefore they would not express the A and B epitopes. Correlation between Lewis Phenotype and ABH Secretor status The Lewis typing also helps in finding the ABH secretor status. The production of Lewis antigens is genetically controlled. Individuals possessing the Lewis (Le) gene would produce the Lewis antigens which are carried in the plasma by different substances and are absorbed onto the Red blood Cells present in ones blood. The ABO determinants and H/h blood groups factors seem to show structurally corelation to Lewis blood determinants. FUT1 provide the glycans for glycosyltransferases which convert Lewis antigen to ABH antigens. FUT2 allele is expressed in the secretor and is responsible for the expression of type1 H determinant. The secretors convert their Lewis a antigen to Lewis b therefore they are (a-b+) and the non-secretor are (a+b-) as they lack the FUT2 responsible for glycosyltransferase which could convert Lewis a antigen to Lewis b antigen. Lewis (Le) gene and Secreting (Se) gene interact with each other. Initially Lewisais formed and if Se gene is absent in an individual the Lewisa substance is absorbed on the RBC and the individual is typed as Lewisa but in secretors the Se gene controls the activation of the H gene which causes addition of an additional sugar to Lewisa which convert it to Lewisb. Secretors contain both Lewisa and Lewisb in their plasma but absorb Lewisb preferentially on the red blood cells and the individual is typed as Lewisb. Hence we could interpret that presence of Lewis gene would type an individual as Lewisa positive or Lewisb negative or vice versa. An individual could not be positive for both. A person containing both Lewis gene and Secreting gene are typed as Lewisa negative and Lewisb positive whereas a person having the Lewis gene but not the secretor gene is typed as Lewisa positive and Lewisb negative. Individual who does not have Lewis gene regardless of secretor gene is typed as Lewisa negative and Lewisb negative. Note: Lewis Double Negative (LDN) is a sub type of non secretors but Lewis typing cannot be used for them to determine the ABH secretor status. Detection methods The presence and absence of the antigens in the body fluids could be detected by Agglutination Inhibition and Lewis typing. Agglutination Inhibition test could be divided into two parts:- Part I Antibody Neutralization: To determining ones secretor status, the saliva of the individual is mixed by the antiserum (Anti-A, Anti-B or Anti-H) available commercially. In secretors the soluble substances i.e. blood group antigens will react with the antibodies present in the antiserum and will get neutralized. Part II Agglutination Inhibition: The bed blood cells obtained commercially are added to the test mixture. In secretors agglutination of the RBC do not take place as no free antibodies are available to agglutinate them. All the antibodies have reacted with the soluble antigens present in the saliva whereas in non-secretors agglutination would occur upon addition of the RBC as no blood group antigens are present in the saliva so antibodies present in the antiserum are not neutralized and hence would be free to react with the test RBC cells which are added to the test mixture. Hence agglutination is a negative test for secretor status and positive test for the non-secretor status. Note: Anti-H lectin containing phytohaemagglutinin virtually specific for human RBC. Thirteen Cucurbitaceaespecies have been investigated for the anti-H activity present in their seed lectins. Lectins has been extracted and purified from Ulexeuropaeus seeds. It could be used to demonstrate the H secretor status of blood group O individual and also for subgrouping the blood group A individuals. Lewis typing: Individuals carrying the Lewis gene produce Lewis antigens that are carried by the plasma and are also adsorbed on the red blood cells. Lewis antigens do not reside only on the red blood cells. Initially the gene gives rise to Lewisa. If Se gene is present it activates H gene which interact with the Lewisa and add a sugar to Lewisa and hence get converted it to Lewisb. Both Lewisa and Lewisb in present in the plasma of the secretors. If the Se gene is not present then the Lewisa substance is adsorbed on the red cells and individuals are typed as Lewisa. The secretor status of an individual could be determined with help of Lewisa and Lewisb antibodies mixed with an individuals saliva and observing the agglutination macroscopically. Disease Susceptibility among Secretors and Non-secretors Digestive system Non-secretors are more prone to the diseases caused by the oral bacteria in the digestive system of an individual. It includes ulcers, celiac diseases gastric carcinoma pernicious anemia etc. It could lead to dysplasia or increase in the number of cavities present in the digestive tract. Non-secretors are less resistant to the infection caused by Helicobacter pylori which could lead to the formation of peptic and duodenal ulcers. It could easily colonize and cause inflammation in the non-secretors. The non-secretors lack the blood group antigens in the mucus secretions therefore H.pylori attach to the walls of the digestive tract and cause infection. The secretors have a tendency to secrete free ABH antigens in their intestinal secretions which effect the bacterial and lectins adherence to the microvilli present in the gut. The secretors produce these antigens and prevent H.pylori attachment. These antigens act as a decoy in the secretors which prevent them from attaching with the ho st tissues. The non-secretors also show a lower IgG immune response to the H.pylori. They have extreme rate of bleeding and stomach ulcers but correlation between these complications and the secretor status have not been documented yet. The non-secretors are not able to turn off the digestive enzymes and hence they produce large amount of enzyme pepsin and hence are more prone to duodenal ulcers. 50% of the duodenal ulcers are present in non-secretors. 30-40% of group O individuals are affected by the duodenal ulcers and 15- 20 % are affected by the gastric ulcers. They show a high risk factor along with the gene coding for hyperpepsinogenemia I which impact in the risk of duodenal ulcers. Group A individuals have a higher tendency of having gastric cancer and pernicious anemia. Statistics shows that 20% of the group A individuals are affected by gastric cancers and 25% are affected by the pernicious anemia. Oral pathology The non-secretors are more prone to oral diseases like mouth and esophagus cancer, epithelial dysplasia etc. They have more cavities than secretors. Diabetes The ABH non-secretors and Lewis negative (Le a-b-) individuals have a high risk of developing insulin dependent diabetes or complications arising from diabetes. Secretors with juvenile diabetes have a low chance of developing retinopathy. The ABH non secretors which are affected by insulin dependent diabetes mellitus, they show mean levels of C3c and C4 is lower as compared to ABH secretors. Metabolic Syndrome X The Lewis negative men are predisposing to syndrome X and prothrombic metabolism. They have high levels of BMI, SBP, triglycerides and low levels of insulin in serum and plasma glucose while fasting. This relationship is not true for women and is only applicable for the men. Respiratory System   Secretors have an added protection against the harmful environmental assaults directed towards our lungs and as usual non-secretors have a health disadvantage. They are over represented among the people suffering from influenza viruses A and B, rhinoviruses, respiratory synsytial virus and echinoviruses. The secretors who are miners or smokers do receive a protection against the disastrous effects of the cigarette smoking. Asthma is very common among the individuals working in the coal mines. Upon research it was concluded that asthma among them is also related to the non-secretor phenotype present in them. The non-secretor has a tendency to snore and are more prone to COPD (Chronic Obstructive Pulmonary Disease). Heart disease The ABH non-secretor phenotype have a high risk of developing myocardial infarction and Lewis negative individuals have a high risk of developing chronic heart disease (CHD) and also ischemic heart disease (IHD). They contain high levels of triglycerides. Alcoholism has a positive interaction with the Lewis negative individuals. Alcohol consumption is protective in these individuals. Autoimmune Disease   Autoimmune disorders such as Sjogrens syndrome, spondylitis, sclerosis, arthropathy, arthritis, and Graves disease are more prone in non-secretors. The ABH non-secretors affected with graves disease produces high levels of antitubulin antibodies as compared to secretors and are unable to produce the water soluble glycoproteins in the saliva. Fetal Loss and Infertility ABO antigens are also found on the sperm of the secretors. These are obtained from the seminal secretions present in them. ABO incompatibility could exist between the wife and husband if could affect the fertility of an individual. This issue has not been properly studied and is therefore under research. Rheumatic Fever The secretors and group O individuals are resistant to Rheumatic fever and more number of cases have been recorded in the non-secretors. Secretor status could also determine whether the rheumatic fever would be followed by streptococcal pharyngitis or not. Neisseria species The non-secretors who do not produce water soluble antigens in the saliva are at the risk of getting infected by Neisseria meningcococcal disease. The immune capabilities of the secretor provide a relative protection in the secretors. The ABH non-secretors produce low level of anti-meningococcal salivary IgM antibodies which provide protection to the secretors against the microorganism. Candida species Non-secretors are barriers of candida species and therefore are frequently affected by the candida infections. The glycocompounds secreted by secretors in the body fluids inhibit adhesins present on the yeast which are responsible for their adhesion with the body tissues. This leads to the development of the chronic hyperplastic Candidiasis. Statistics shows that 68% on the non-secretors are affected by chronic hyperplastic candidiasis. Non-secretor women are affected by recurrent idiopathic vulvovaginal Candidiasis. An individual with a combination of non-secretors and absence of Lewis gene are at relative risk of developing recurrent idiopathic vulvovaginal Candidiasis. Tumor Markers The individuals with homozygous active Le alleles (Le/Le) and inactive (se/se) alleles shows a highest mean value of CA19-9 tumor marker. The Lewis negative individuals irrespective of Se genotype have negative values for CA19-9. The Lewis negative individuals have higher mean value for DU PAN-2 as compared to Le-positive individuals. We can conclude that CA 19-9 marker is not an appropriate tumor marker for Le-negative individuals but DU-PAN-9 is an appropriate tumor marker. UTI Non-secretors show a higher risk of getting recurrent urinary tract infection (UTI) and renal scars as compared to secretors. This susceptibility is higher among negative Lewis subset. Statistics of a study done on women affected with recurrent urinary tract infection stated that 29% of the non-secretor women were affected by UTI and 26% of Lewis (a-b-) women were affected by the UTI. The non-secretor phenotype and blood group B and AB phenotype work together to increase the risk of UTI among women. Women and children suffering from renal scarring with and without the antibiotic treatment for UTI are prone to UTI and pyelonephritis. 55-60% of non-secretors develop renal scars and 16% on secretors develop renal scars. C-reactive protein levels, erythrocyte sedimentation rate and body temperature are higher in the non-secretors that in secretors with recurrent UTI. Conclusion It concludes that there exist a statistical association between the individuals blood-group secretor phenotype and the diseases they are susceptible to. So knowing your secretor status is advantageous as we can use the nutritional supplements more intelligently and effectively. It also makes us aware of the diseases, illness and metabolic dysfunction we are prone to, difference in the levels of intestinal alkaline phosphatase activity, propensities towards blood clotting, tumor markers and different ingredients of breast milk so that we can manage them before hand and would be prepared for them in the near future.