Team Communication Essay Example | Topics and Well Written Essays - 1000 words

A Critique on Drug Testing in Employment by Joseph Desjardins and Ronald Duska Essays

A Critique on Drug Testing in Employment by Joseph Desjardins and Ronald Duska Essays A Critique on Drug Testing in Employment by Joseph Desjardins and Ronald Duska Paper A Critique on Drug Testing in Employment by Joseph Desjardins and Ronald Duska Paper Corresponding to this, the creators current circumstances wherein it is permissible to demand a worker to submit to medicate testing yet again it may not be expected of the representative. Additionally precluded are the utilization of coercive measures to cause the representative to submit to tranquilize testing, for example, the danger of losing work or even certain business benefits. It must be brought up that while the creators do stand firm for the insurance of the security of workers, the contentions that have been introduced must be dismissed for absence of adequate premise and choices for the accompanying reasons. Most importantly, no right, even those allowed by the constitution, is total. Each correct that an individual is allowed is constantly dependent upon specific impediments and limitations. Similarly that a person’s right to security might be attacked on the quality of a court order. The setting of being in a working environment isn't so very different that it is fit for being given an alternate treatment. Truth be told, more limitations on the privilege to protection can even be forced as a result of the setting. It must be recalled that in the circle of human rights, there is a relationship between's the privileges of one individual and that of another. One is just allowed to act inside the limits of his protection or rights as long as such acts don't unduly or unreasonably meddle with the privileges of others. As the creators would contend, medicate testing can be executed yet the cooperation by the representatives must be willful. This view can't be continued in accordance with the contention that no privilege is supreme. The explanation for this is there is a more noteworthy worry behind the entirety of this and this is open wellbeing. While it might be a limitation on one’s protection, it is for a more noteworthy reason; a reason that everybody in the nation has submitted to and promised to maintain. The second and maybe all the more convincing motivation behind why medication testing ought not be made deliberate is the way that it doesn't actually abuse the sacred right to security. The creators expand the inclusion of the privilege to security to tranquilize testing. In a long queue of cases settled on by the United States Supreme Court, it has been reliably held that physical testing of an individual can be constrained. There is no infringement of the privilege to protection for this situation except if the test was done without fair treatment. For this situation, requiring a worker who is associated with ingesting destructive medications or those that can influence work execution can be required without stress of disregarding the employee’s right to security. While the contentions introduced by the writers are not plainly validated in the article, the must, be that as it may, in any case be praised for their endeavors in attempting to maintain the individual’s right to security. Medication testing can be utilized as a methods for annoying representatives or even as a method of terminating those workers who are unsuitable without experiencing the whole lawful procedure of pulling out. No legitimate framework, no plan of action is great. There will consistently be a battle between privileges of representatives and that of the businesses. The arrangement might be far away yet one thing stays clear. Until and except if a specific trade off can be made to in this manner balance these comparing rights there will be more discussion encompassing this issue. The worker is as of now very much ensured under the Labor Laws of this land and his exertion is extraordinarily refreshing yet one should likewise consider that without the business or capital a large portion of these representatives would not have any occupations whatsoever.

Dallas, George Mifflin

Dallas, George Mifflin Dallas, George Mifflin, 1792â€"1864, American statesman, vice president of the United States (1845â€"49), b. Philadelphia; son of Alexander James Dallas . He read law, was admitted (1813) to the bar, and was secretary to Albert Gallatin . After serving as solicitor (1815â€"17) of the Bank of the United States, Dallas was city attorney (1817â€"19) and mayor (1819) of Philadelphia. An active Democrat, he was appointed (1829) U.S. district attorney for E Pennsylvania, then served as a U.S. senator (1831â€"33), as attorney general of Pennsylvania (1833â€"35), and as minister to Russia (1837â€"39). He returned to his law practice, and a sharp political rivalry developed between him and James Buchanan in Pennsylvania. In 1844, Dallas was elected vice president on the Democratic ticket along with James K. Polk . Dallas was later appointed (1856) minister to Great Britain and was succeeded (1861) in that post by Charles Francis Adams . Dallas conducted the negotiations leading to the Dallas-Clarendon Convention, signed in 1856, which set a basis for the settlement of difficulties in Central America. He also secured from Great Britain a disavowal of the right of search, a historic matter of dispute. He wrote a biography (1871) of his father. See his letters from London (1869) and his diaries (1892) while a minister to Great Britain and Russia. The Columbia Electronic Encyclopedia, 6th ed. Copyright © 2012, Columbia University Press. All rights reserved. See more Encyclopedia articles on: U.S. History: Biographies

Maltreatment and diabetes - Free Essay Example

Sample details Pages: 26 Words: 7702 Downloads: 6 Date added: 2017/06/26 Category Health Essay Type Research paper Did you like this example? Study Rationale The primary goal of this study is to conduct an empirical investigation of the association between an early life stressor such as childhood maltreatment and subsequent diagnosis of Type II diabetes in adulthood. This study will specifically explore if a relationship exists between the type and severity of childhood maltreatment encountered and participants diabetes-related quality of life. To provide a context for the current study, background literature focusing on two dimensions that have received considerable attention in the psychological literature is first thoroughly reviewed: definition and effects of childhood maltreatment and the biopsychosocial aspect of Type II diabetes. Don’t waste time! Our writers will create an original "Maltreatment and diabetes" essay for you Create order The current studys purpose, hypotheses, method, and data analytic strategy will then be proposed. Background Information Childhood Maltreatment Childhood maltreatment refers to, any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child (Centers for Disease Control [CDC], n.d., para. 1). In their report, Child Maltreatment Surveillance, Leeb, Paulozzo, Melanson, Simon, Arias (2007) defined acts of commission as deliberate and intentional use of words or actions that cause harm, potential harm, or threat of harm to a child. Examples of acts of commission include physical, sexual, and/or psychological abuse. Acts of omission, on the other hand, are the failure to provide for a childs basic physical, emotional, or educational needs or to protect a child from harm (Leeb et al., 2007). Thus, acts of omission include physical, emotional, medical, or educational neglect, the failure to supervise or insufficient supervision, and/or exposure to a violent environment. According to the most recent publication by the U.S. Department of H ealth and Human Services (USDHHS) on childhood maltreatment, an estimated 905,000 children were determined to be victims of abuse or neglect (USDHHS, 2006). Specifically, 64.2 percent of child victims experienced neglect, 16.0 percent were physically abused, 8.8 percent were sexually abused, and 6.6 percent were emotionally or psychologically maltreated. The report suggests that rates of victimization by maltreatment type have fluctuated only slightly during the past several years. The long-term consequences of child maltreatment are significant and include the risk of alterations of brain structure and function, sexual risk taking behaviors, eating disorders, suicidal intent and behavior, lower self-esteem, adjustment problems, internalizing problems (i.e. anxiety and depressive disorders), externalizing problems (i.e. personality disorders and substance abuse), adult trauma, continuation of intergenerational violence and/or neglect, and developmental and cognitive disabilities (Anda, Felitti, Bremner, Walker, Whitfield, Perry, Dube, Giles, 2006; Arata, Langhinrichsen-Rohling, Bowers, OFarrill-Swails, 2005; Bardone-Cone, Maldonado, Crosby, Mitchell, Wonderlich, Joiner, Crow, Peterson, Klein, Grange, 2008; Johnson, Sheahan, Chard, 2003; Kaplow Widom, 2007; Kaslow, Okun, Young, Wyckoff, Thompson, Price, Bender, Twomey, Golding, Parker, 2002; Lewis, Jospitre, Griffing, Chu, Sage, Madry, Primm, 2006; Medrano, Hatch, Zule, Desmond, 2002; Smith, 1996; Sobsey, 2002; Taft, Marshall, Schumm, Panuzio, Holtzworth-Munroe, 2008). A consistent relationship between abuse history and poorer overall health has also been demonstrated in a stratified, epidemiological sample of both men and women within the United States (Cromer and Sachs-Ericsson, 2006). Childhood Maltreatment and Physical Health Problems A consistent dose-relationship between abuse history, poorer overall health, and sustained losses in health-related quality of life has been well established (Cromer Sachs-Ericsson, 2006; Golding, 1994; Corso, Edwards, Fange, Mercy, 2008). Childhood sexual abuse has been associated with physical complaints such as migraine, irritable bowel syndrome, fibromyalgia, and chronic pain (Goldberg, Pachas, Keith, 1999; Goodwin, Hoven, Murison, Hotopf, 2003; Ross, 2005; Walker, Keegan, Gardner, Sullivan, Bernstein, Katon, 1997). Furthermore, using data from the National Corbidity Study, a nationally representative general population study, Arnow (2004) found that abused children were likely to have pelvic and musculoskeletal pain as adults, and utilize health care services at a greater proportion in adulthood. However, a major limitation of these studies is exclusion of emotional and/or psychological abuse experienced in childhood. Additionally, results regarding the incidence of types of childhood maltreatment and diabetes have been mixed. Diabetes Diabetes is a chronic disease characterized by the deficiency or resistance to insulin, a hormone needed to convert sugar, starches and other food into energy needed for daily living. As such, insulin deficiency compromises the body tissues access to essential nutrients for fuel or storage. According to the American Diabetes Association (ADA), there are 23.6 million children and adults in the United States, or 7.8% of the population, who have diabetes, many of which unaware that they have the disease (ADA, n.d., para. 2). Diabetes occurs in two primary forms. Type I diabetes is characterized by absolute deficiency and typically occurs before the age of 30. Type II diabetes, however, is typified by insulin resistance with varying degrees of deficiencies in the bodys ability to secrete insulin. Sedentary lifestyle and diet have been linked to the development of Type II diabetes. Other risk factors for this type of diabetes include obesity, pregnancy, metabolic syndrome, and variou s medications. Physiologic and emotional stress has also been thought to play a key role in the development of Type II diabetes specifically. Prolonged elevation of stress hormones, namely cortisol, glucagon, epinephrine, and growth hormone, increases blood glucose levels, which in turn places increased demands on the pancreas. Such stress ultimately leads to the inability of the pancreas to keep up with the bodys need for insulin and high levels of glucose and insulin circulate in the bloodstream, setting the stage for Type II diabetes (Diseases, 2006). Role of Stress in the Onset of Diabetes Animal Studies Researchers have found that both a history and presence of existing stressors play a significant role in the onset and course of diabetes. Through the use of animal studies, researchers have been able to prospectively test the influence of stress on both types of diabetes. For example, Lehman, Rodin, McEwen, and Brinton (1991) investigated whether an environmental challenge promoted the expression of diabetes in bio-breeding rats. Researchers introduced a triad of stressors to the animals over a 14-week period, including rotation of the cage, vibration, and restraint in individual containers. They found that the administration of these stressors repeatedly increased the likelihood of the rats developing Type I diabetes as indicated by elevated blood sugar levels (Lehman et al., 1991). One of the first observations that stress could contribute to the expression of Type II diabetes was made during metabolic studies of the native North African sand rat (psammonys obesus). Once fed with laboratory chow and allowed to become obese, the North African sand rat will eventually develop Type II diabetes in response to an environmental stressor (Surwit, Schenider, Feinglos, 1992). Notably, Mikat, Hackel, Cruz, and Lebowitz (1972) administered an esophageal intubation of saline in an effort to control the dietary intake of the sand rat. This tube feeding resulted in an alteration of glucose tolerance and precipitated the onset of Type II diabetes in these rats. Similar research was done on the genetically obese (ob/ob) mouse, which is used as a prototype of Type II diabetes in humans because of its pattern of obesity, hyperinsulinemia, hyperglycemia, insulin resistance, and glucose intolerance (Surwit, Feinglos, Livingston, Kuhn, McCubbin, 1984). To study the effects of environmental stress and sympathetic nervous system arousal on plasma glucose in ob/ob mice, Surwit et al. (1984) designed two experimental conditions. In the first condition, 15 ob/ob mice were shak en in their cage at a rate of 200 strokes per minute for five minutes. In the second condition, 16 ob/ob mice were injected with epinephrine bitartrate, a chemical whose effects mimic those of the stress response. Plasma glucose levels in mice from both conditions were found to be significantly elevated. The researchers concluded that environmental stress was partially responsible for the expression of the diabetic phenotype in this animal model of diabetes. Role of Stress in the Onset of Diabetes Human Studies Data gathered on the impact of life events on Types I diabetes in a human sample has yielded inconsistent results. An early study by Grant, Kyle, Teichman, and Mendels (1974) examined the relationship between the occurrence of life events and the course of illness in a group of 37 diabetic patients. Using Holmes and Rahes Schedule of Recent Events (SRE), a scale in which 43 significant recent life events are assigned a numeric value of life change units as a measurement of life stress, Grant et al. (1974) found that of the 26 participants who had a positive correlation between undesirable life events and illness, 24 had a positive correlation between undesirable events scores and diabetic condition. This data suggests that negative events were primarily responsible between life events and changes in diabetic condition since the inclusion of neutral and positive events did not increase the magnitude of the correlations. Despite the significant results, this study had a number of lim itations, including the utilization of a small sample size, difficulty in establishing reliable criteria for assessing subtle changes in the diabetic condition, lack of sufficient time to elapse between assessments for significant life changes to occur, and the lack of delineation of the types of diabetes studied (i.e. Type I vs. II). However, in a more recent meta-analysis, Cosgrove (2004) found no evidence to support the hypothesis that life events cause or precipitate Type I diabetes. Using an electronic and manual literature search of appropriate key words (namely, diabetes and depression, diabetes and depressive, diabetes and life events, diabetes and stress) in the literature up to July 2003, Cosgrove (2004) aimed to establish whether there might be a link between depression, stress, or life events and the onset of Type I diabetes. A total of nine papers were found from the electronic and manual search. It was concluded that when the number and severity of life events was c ompared to controls in all nine reviewed studies, no differences were detected in the diabetics (Cosgrove, 2004). Though data from small, older studies and large, randomized studies showed that early losses in childhood increase the risk of developing Type I diabetes, no evidence was found to support the hypothesis that life events cause or precipitate this diagnosis. Meta-analyses with more recent studies have not been found studying the relationships between stressful life events in both types of diabetes. As such, it is unknown whether links have since been found by other researchers. More consistent evidence was found supporting the notion that stressful circumstances precipitate Type II diabetes. In their study of environmental stress on Type II diabetics, McCleskey, Lewis, and Woodruff (1978) measured glucagon and glucose levels on 25 patients who were undergoing elective surgery, a physical stressor. Ten samples were obtained during pre-operative, intra-operative, and post -operative periods for each patient. It was found that throughout the sampling period, diabetic patients had two times the amount of glucagon (a hormone produced by the pancreas that stimulates the increase of blood sugar levels) in their body compared to their non-diabetic counterparts (McCleskey, Lewis, Woodruff, 1978). This effect was also found in Pima Indians, who have an approximately 60% chance of eventually developing Type II diabetes, compared with 5% of the Caucasian population (Surwit, Schenider, Feinglos, 1992). The effects of a simple arithmetic task on blood glucose levels were studied in both Caucasian and Pima Indian samples. Surwit, McCubbin, Feinglos, Esposito-Del Puente, and Lillioja (1990) found that blood glucose was consistently higher during and following the stressful task in ten of 13 Pima Indians, concluding that altered glycemic responsivity to behavioral stressors anticipates the development of Type II diabetes in individuals who are genetically pred isposed to the disease (Surwit et al., 1990). Results from The Hoorn Study further illustrated the effects of stress on Type II diabetes. Mooy, De Vries, Grootenhuis, Boutner, and Heine (2000) analyzed data from a large population-based survey of 2,262 adults in the Netherlands upon which the researchers were able to explore whether chronic stress is positively associated with the prevalence of Type II diabetes. Analysis of data confirmed their hypothesis; a high number of rather common major life events that are correlated with chronic psychological stress, such as death of a spouse or relocation of residence, were indeed found to correspond to a significantly higher percentage of undetected diabetes (Mooy et al., 2000). Because the study was conducted in the Netherlands on a Caucasian, middle-aged population, it is uncertain whether these findings are generalizable to other demographics in different geographic regions. Childhood Maltreatment and Diabetes Thus far, with the exception of one study, the research discussed has demonstrated a positive correlation between a variety of recent or current environmental stressors, such as anesthesia, surgery, cognitive tasks, death of a loved one, and other significant losses, and the onset of Type I and/or II diabetes in animals and human beings. However, the literature is somewhat limited as to the relationship between a past environmental stressor, namely childhood maltreatment, and Type II diabetes in adulthood. Numerous researchers examined the prevalence of medical problems in abused populations and have reported that diabetes is one of the most common health conditions among those who have experienced maltreatment. For example, using data drawn from the National Comorbidity Study conducted in the early 1990s, Sachs-Ericsson, Blazer, Plant, and Arnow (2005) examined the independent effects of childhood sexual and physical abuse on adult health status in a large community sample of 5 ,877 men and women. Sachs-Ericsson et al. (2005) found that childhood sexual and physical abuse was associated with the one-year prevalence of serious health problems for both men and women. Specifically, participants who experienced any form of childhood abuse were more likely to report having a medical condition, including AIDS, arthritis, asthma, bronchitis, cancer, diabetes, high blood pressure, kidney or liver disease, neurological problems, stroke, gastrointestinal disorders, or any other serious health problem (Sachs-Ericsson et al., 2005). Though data from this epidemiological study likely represents the U.S. demographics, a number of limitations exist. Specifically, the researchers did not report the prevalence of each disorder endorsed and thus, the actual incidence of diabetes in the population sample is unknown. Furthermore, Sachs-Ericsson et. al (2005) did not look at additional forms of maltreatment, such as verbal abuse, emotional abuse, and neglect. Similarly, Wal ker, Gelfand, Katon, Koss, Von Korff, Bernstein, and Russo (1999) found a significant association between childhood maltreatment and adverse adult health outcomes. In particular, the researchers administered a survey to 1,225 women randomly selected from the membership of a large HMO in Washington State. Results indicated that women with childhood maltreatment histories were more likely to have an increased number of physician-coded ICD-9 diagnoses, grouped together as high blood pressure, diabetes, dermatitis, asthma, allergy, acne, and abnormal menstrual bleeding. Though the group of women in this study who reported threshold levels of sexual maltreatment had the poorest health outcomes, a major limitation of this study is the uncertainty as to whether additional forms of maltreatment were concomitantly experienced. Specifically, the authors do not establish whether sexual abuse solely was the cause of poorer health or is largely due to multiple forms of maltreatment in girls who were not properly protected in their early families. Moreover, Walker et al. (1999) do not differentiate between types of diabetes. Gender differences have been established in the association between physical abuse in childhood and overall health problems in adulthood. Analysis of data from 16,000 individuals interviewed in the National Violence Against Women Survey found that female abuse victims were at greater risk for health problems than their male counterparts (Thompson, Kingree, Desai, 2004). Furthermore, women with maltreatment history tend to have more distressing physical experiences, have an increased number of physician-coded diagnoses, and were more likely to engage in multiple health risk behaviors, including obesity a significant risk factor associated with Type II diabetes (Trickett, Putnam, Noll, 2005; Walker, Gelgand, Katon, Koss, Von Korff, Bernstein, Russo, 1999). Moreover, sexual assault history throughout ones lifespan was also associated with chronic di sease (i.e. diabetes, arthritis, and physical disability) in a sample of women from Los Angeles (Golding, 1994). Conversely, in their sample of 680 primary care patients, Norman, Means-Christensen, Craske, Sherbourne, Roy-Byrne, and Stein (2006) found that the experience of trauma significantly increased the odds of arthritis and diabetes for men, while trauma was associated with increased odds for digestive disorders and cancer in women. Although the data suggests that childhood maltreatment is related to adverse health outcomes in adulthood, they do not address as to why associations differed by gender. Analyzing data from the Midlife Development in the United States Survey (MIDUS), Goodwin and Weisberg (2002) sought to determine the association between childhood emotional and physical abuse and the odds of self-reported diabetes among adults in the general population. Their results revealed that self-reported diabetes occurred in 4.8% of its representative sample of 3,032 adul ts aged 25-74 years. Childhood abuse was associated with significantly increased odds of self-reported diabetes, which persisted after adjusting for differences in socio-demographic characteristics and mental health status (Goodwin Weisberg, 2002). Moreover, individuals who specifically reported maternal emotional abuse and maternal physical abuse had significantly higher rates of diabetes (Goodwin Weisberg, 2002). Furthermore, data gathered from a sample of 130 patients (65 abused, 65 non-abused controls) drawn from an adult primary-care practice in a small, affluent, predominantly Caucasian community in northern New England revealed that patients with a history of victimization were more likely to report diabetes or endorse symptoms of this illness than non-abused participants (Kendall-Tackett Marshall, 1999). Specifically, four patients in the abused group reported diabetes, with none in the control group. Interestingly, those patients in the abused group did not have a sig nificantly higher family history of diabetes than those in the non-abused group and a higher percentage of patients in the abused group reported having three of more symptoms than did those in the control group. Kendall-Tackett and Marshall (1999) assert that although only four people identified themselves as having diabetes, this number should be interpreted in the broader context of incidence of diabetes in the general population. Nonetheless, this finding could have been due to chance and many of the symptoms endorsed could have been related to other diseases (Kendall-Tackett Marshall, 1999). Additional limitations include the failure to differentiate between the types of abuse endured and the use of a non-empirically validated measure to gather data. Furthermore, the researchers did not specify which type of diabetes the participants were diagnosed with and did not indicate the severity of the disease. Data from the Adverse Childhood Experiences Study (ACE), however, found a lternative results. Researchers Felliti, Anda, Nordenberg, Williamson, Spitz, Edwards, Koss, and Marks (1998) mailed questionnaires about adverse childhood experiences to 9,508 adults who had completed a standardized medical evaluation at a large HMO in California. It was found that abuse and other types of household dysfunction were significantly related to the number of disease conditions, with the exception of diabetes. Specifically, when those who had experienced multiple forms of childhood maltreatment were compared to those with no experiences, the odds-ratio for the presence of diabetes was a non-significant 1.6 (Felliti et al., 1998). The researchers believe that their estimates of the long-term relationship between adverse childhood experiences and adult health are conservative. Specifically, it is likely that, consistent with well-documented longitudinal follow-up studies, that reports of childhood abuse were underestimated due to the premature mortality in persons with mu ltiple adverse childhood exposures (Felliti et al., 1998). Similarly, in a sample of 1,359 community-dwelling men and women aged 50 years or older, Stein and Barrett-Connor (2000) found no relationship between sexual assault history in participants lifetime and reported rates of diabetes. Rather, a history of sexual assault was associated with an increased risk of arthritis and breast cancer in women and thyroid disease in men (Stein Barrett-Connor, 2000). In this study, the researchers posit that the possibility of response bias is a major limitation. Namely, Stein and Barrett-Connor (2000) consider the likelihood that previously assaulted respondents have a greater tendency to visit doctors, leading to the increased opportunities for health conditions to be detected. Additional limitations include the lack of consideration for other types of abuse encountered in childhood. The Link between Childhood Maltreatment and Diabetes The above findings provide support for the hypothesis that childhood maltreatment may be associated with increased likelihood of the diagnosis of a medical condition, with the inclusion of diabetes in some studies. An essential question posed by this observation is by what mechanisms are adverse childhood experiences linked to health risk behaviors and adult diseases? A number of researchers have found that psychological stress, in particular, has been associated with the onset of Type II diabetes. This impact of stress on the etiology and course of Type II diabetes can be considered via the metabolic pathways by means of obesity and/or activation of the hypothalamic-pituitary-adrenal (HPA) axis, the gene-environment interaction, and the correlation of coping with diabetes and stressors. The stress response is a physiological coping response that involves the HPA axis, the sympathetic nervous system, the neurotransmitter system, and then immune system. There is growing evidence that victims of various forms of abuse and stressors often experience biological changes, particularly in the neuroendocrine system implicated in the stress response, as well as the brain (Glaser, 2000; Goenjian, Pynoos, Steinberg, Endres, Abraham, Geffner, Fairbanks, 2003; King, Mandansky, King, Fletcher, Brewer, 2001; McEwen, 2000). The HPA axis is the primary mechanism studied in the literature on the neurobiology of stress and is estimated through the non-invasive measurement of cortisol in saliva samples. During psychological stress, cortisol is elevated beyond normal levels in response to adrenocorticotropic hormone from the pituitary, mobilizing energy stores, and facilitating behavioral responses to threat (Diseases, 2006). In the presence of prolonged stress, especially in which the individual has difficulty coping, this physiological response may occur to an atypical extent and prove harmful. Dienstbier (1989) asserts that prolonged and/or extreme stress can create a vic ious cycle of pathology, as individuals with a history of abuse may become even more vulnerable in the face of new victimization because they become threat-sensitized, resulting in either an over- or under-reaction of the HPA system to new stressors. As Vaillancourt, Duku, Decatanzaro, Macmillan, Muir, and Schmidt (2008) cite, this process is best illustrated by Cicchetti and Rogoschs (2001) study of maltreated children attending a summer day camp. These authors found that in comparison to non-abused children, children who had been both sexually and physically abused, in addition to emotionally maltreated or neglected, exhibited higher morning cortisol levels, whereas a subgroup of children who had only been physically abused exhibited lower levels. Recent evidence suggests that increased cortisol concentrations may contribute to the prevalence of metabolic syndromes, such as Type II diabetes. For example, in their assessment of 190 Type II diabetic patients who volunteered from a population study of 12,430 in suburban Germany, Oltmanns, Dodt, Schultes, Raspe, Schweiger, Born, Fehm, and Peters (2006), sought to assess the relationship between diabetes-associated metabolic disturbances and cortisol concentrations in patients with Type II diabetes. The target population comprised of men and women born between 1939 and 1958 who completed a postal questionnaire about their health status. Results demonstrated that in patients with Type II diabetes, those with the highest cortisol profiles had higher glucose levels and blood pressures (Oltmanns et al., 2006). Their findings suggest that HPA axis activity may play a role in the development of Type II diabetes-associated metabolic disturbances. Cartmell (2006) proposes a model by which this may occur. Namely, high levels of cortisol decreases metabolism of glucose and increase mobilization and metabolism of fats. This decreased metabolism of glucose contributes to increased blood glucose levels. Furthermore, increa sed blood fat levels contribute to insulin resistance. This increase level of blood glucose and fats are characteristic symptoms of diabetes (Cartmell, 2006). Researchers Chiodini, Adda, Scillitani, Colleti, Morelli, Di Lembo, Epaminonda, Masserini, Beck-Peccoz, Orsi, Ambrosi, and Arosio (2007) extended the literature by studying HPA axis secretion of cortisol and chronic diabetic complications. An evaluation was conducted on HPA activity in a sample of 117 Type II diabetic patients with and without chronic complications and in a sample of 53 non-diabetic patients at a hospital in Italy. Chiodini et al. (2007) found that in diabetic subjects without chronic complications, HPA axis activity was comparable with that of non-diabetic patients, whereas in diabetic subjects with chronic complications, cortisol level was increased in respect to both diabetic subjects and control subjects. Though the design of their study did not look for a cause-effect relationship, Chiodini et al. (200 7) purport that higher levels of cortisol, either due to a constitutive HPA axis activation or secondary to a chronic stress condition, may predispose an individual to the development of chronic diabetic complications. Type II diabetes is now a well-recognized syndrome characteristic of hyperglycemia, insulin resistance, obesity, dyslipidemia, and hypertension (Sridhar Madhu, 2001). One theory that purports the biological plausibility of a stress-diabetes association has been formulated by Swiss researcher, Dr. Per BjÃÆ'Â ¶rntorp. BjÃÆ'Â ¶rntorp (1997) postulated that stress could be responsible for sympathetic nervous system activation, hormone abnormalities, and obesity. This theory states that perceived psychological stress with a defeatist or helplessness reaction leads to an activation of the HPA axis. This in turn results in endocrine abnormalities, including increased cortisol and decreased sex steroid levels that disrupt the actions of insulin. In addition, this horm onal imbalance causes visceral adiposity, which plays an important role in diabetes and cardiovascular disease by contributing to the development of insulin resistance (Cartmell, 2006). Researchers of The Hoorn Study described above tested BjÃÆ'Â ¶rntorps theory and found only partial support (Mooy et al., 2000). Specifically, the accumulation of visceral fat did not seem to be the major mediating factor between stress and diabetes and fasting insulin concentration, which is an approximation of insulin resistance, was not higher in the individuals in their sample who had experienced more stressful events. Study Significance The significance of this study is its potential to provide medical practitioners with information regarding the impact of past psychosocial factors, such as childhood maltreatment, on the current physical health of Type II diabetics. Diabetes and its complications affect a significant portion of the United States population and has become the fifth leading cause of death in the country (Florida Department of Health, 2008). As researchers continue to look for the cause(s) of diabetes and methods to treat, prevent, or cure the disorder, it is vital that practitioners take a holistic and comprehensive approach to assessing the diabetics life. As long as abuse and other potentially damaging experiences in childhood contribute to the development of risk factors, then these childhood exposures should be recognized as the basic causes of morbidity and mortality in adult life (Felliti et al., 1998). Major limitations of past literature include lack of specificity of type of diabetes, famil y history, and self-reported diabetes without data on physiological measures. In addition to replication, future studies should include detailed studies on diabetes-type, a ruling-out of serious medical conditions that could potentially act as confounds, and identify maltreatment subtypes experienced. This study aims to uncover a relationship between childhood maltreatment and adult physical health, namely with Type II diabetes, so as to assist with screening and intervention. If doctors caring for adults who suffer from a medical condition associated with diabetes are unaware of this relationship, they will neither obtain early maltreatment history nor make appropriate patient referrals leading to higher health care utilization and poorer outcomes (Arnow, 2004; Springer, Sheridan, Kuo, Carnes, 2003). Research Questions and Hypotheses This study aims to answer the following questions: Is a history of childhood maltreatment associated with diabetes-related quality of life? If so, is a decrease in diabetes-related quality of life associated with an increase in the types of childhood maltreatment experienced? It is hypothesized that the more types of abuse endured during childhood (i.e. physical, emotional, and/or sexual, neglect, and/or the witnessing of family violence), the more chronic and severe an individuals diabetes will be and the greater impact of their illness on their reported quality of life. Method Participants Data will be collected from individuals with Type II diabetes, recruited from psychiatric practices located in Plant City and Tampa, Florida. Participants will be recruited from these sites due to likelihood that patients receiving psychiatric care have a history of childhood maltreatment. Participants will be included in the study if they are aged 40 and older, as non-insulin dependent diabetes appears after this age. Participants will be excluded from the study if they have additional existing physical conditions which may negatively impact their quality of life, as discussed in the Measures section. A projected sample size of 100 total participants has been chosen, using a sample size calculation provided by a statistics consultant. Procedure Details regarding the study will be posted in the form of a flyer (Appendix D) in the waiting rooms of the psychiatric practices. Patients interested in participating in the study will inform the front office staff, who will provide the prospective participant with a packet including informed consent and all measures. Specifically, the informed consent will include the purpose of the research, the procedures to be followed, risks and discomforts as well as potential benefits associated with participation, and alternative procedures or treatments, if any, to the study procedures or treatments. Once potential participants have read the consent document, have their questions are answered, and agree to participate in the research, the informed consent document will be signed, dated, and stored in a secure location. Participants will then be asked to fill out the questionnaires either in the waiting room or in a more private location of the office as they wait for their appointment. Once completed, participants will place the questionnaires in an attached blank envelope and placed in a collection box. A notation will be made in their chart signifying that they have completed the study so as to avoid duplicates. Potential subjects will also be given a copy of the informed consent document so they can carefully review the document and discuss the research with the significant others and/or physician and develop questions to ask at their next psychiatric appointment and subsequent meeting with the researcher. Measures Once informed consent has been obtained, each participant from either group is to complete a demographics questionnaire, as well as two measures that explore maltreatment in childhood and diabetes quality of life. These measures are to be self-administered and anonymous. The demographics questionnaire (Appendix A) will inquire about participants age, height, and weight. This information will be used to obtain a measure of their body mass index (BMI). The BMI provides a standardized measure, and thus, reliable indicator of body fatness for most people and is used to screen for weight categories, such as obese, that may lead to health problems (CDC, n.d., para. 2). Since obesity is known to be a significant predictor leading to poorer quality of life (Sundaram, Kavookjian, Patrick, Miller, Madhavan, and Scott, 2007), it is important for the purposes of this study to exlude those participants who fall into this weight categories so as to avoid confounding variables. The demographic s questionnaire will also include exclusionary criteria consisting of a variety of chronic physical conditions. In their research on comorbidity of chronic diseases, Rijken, van Kerhof, Dekker, and Schellevis (2005) note that the presence of multiple comorbid conditions complicates the question how a specific disease is related to quality of life and other outcome variables. It has been found that arthritis, osteoarthritis, cardiovascular diseases, chest pain, stroke, respiratory diseases, and cancer significantly reduces the quality of life in patients with Type II diabetes (Bowker, Pohar, Johnson, 2006; Maddigan, Feeny, Johnson, 2005; Miksch, Hermann, Rolz, Joos, Szecsenyi, Ose, Rosemann, 2009; Rijken et al., 2005; Stone, Khunti, Squire, Paul, 2008; de Visser, Bilo, Groenier, de Visser, Meyboom-de Jong, 2002). Therefore it is vital for patients with these comorbid conditions to be excluded from the present study so as to accurately ascertain the impact of childhood maltreatme nt on their diabetes-related quality of life. Maltreatment status is to be measured using the Childhood Trauma Questionnaire (CTQ; Bernstein et al, 2003; Scher et al., 2001). The CTQ is a self-report instrument that consists of five subscales assessing emotional, physical, and sexual abuse, as well as emotional and physical neglect. Rather than duration and intensity of traumatic experiences, the extent of the maltreatment is measured using a score that is calculated for each subscale and reflects the total number of items endorses. Each subscale score is categorized into four groups: none or minimal, low to moderate, moderate to severe, and severe to extreme (Bernstein and Fink, 1998). The CTQ has been well validated in both clinical and non-clinical populations. Furthermore, it has excellent reliability (.70-.93) for all subscales, with the lowest reliability for physical neglect and the highest for sexual abuse (Bernstein and Fink, 1998; Paivio and Cramer, 2004). The Diabet es-39 questionnaire (D-39; Appendix C; Boyer Earp, 1997) specifically asks patients to indicate the impact of items on their quality of life and elicits responses that reflect the individual burden of diabetes and its impact on the overall life of the patient. The instrument consists of 39 items and covers five dimensions of the patients lives: energy and mobility (15 items), diabetes control (12 items), anxiety and worry (4 items), social burden (5 items), and sexual functioning (3 items). Reliability of the D-39 instrument as measured by Cronbachs coefficient alpha ranged from 0.82 to 0.93. In a review of health outcome measures for diabetes, Garratt, Schmidt, and Fitzpatrick (2002) note that this instrument has good evidence for reliability, and internal and external construct validity. Proposed Data Analytic Strategy To measure the degree of relationship between childhood maltreatment and diabetes-related quality of life, two continuous variables, the Pearsons product moment correlation coefficient r will be calculated. The coefficient of determination, or r2, will also be calculated so as to ascertain how much of the variability (if any) in diabetes-related quality of life is explained by the variability in childhood maltreatment. After computing the r, it will be tested for significance with alpha set at .05. References American Diabetes Association. (n.d.). All about diabetes. Retrieved February 10, 2009 from https://www.diabetes.org/about-diabetes.jsp Anda, R., Felitti, V., Bremner, J., Walker, J., Whitfield, C., Perry, B., Dube, S., and W. Giles. (2006). The enduring effects of abuse and related adverse experiences in childhood: A convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256, 174-186. Anderson, R., Clouse, R., Freedland, K., and P. Lustman. (2001). The prevalence of comorbid depression in adults with diabetes. Diabetes Care, 24(6), 1069-78. Arata, C., Langhnrichsen-Rohling, J., Bowers, D., and L. OFarrill-Swails. (2005). Single versus multi-type maltreatment: An examination of the long-term effects of child abuse. Journal of Aggression, Maltreatment Trauma, 11(4), 29-52. Arnow, B. (2004). Relationships between childhood maltreatment, adult health and psychiatric outcomes, and medical utilization. Journal of Clinical Psychiatry, 65(12), 10-15. Bardone-Cone, A., Maldonado, C., Crosby, R., Mitchell, J., Wonderlich, S., Joiner, T., Crow, S., Peterson, C., Klein, M., and D. le Grange. (2008). Revisiting differences in individuals with bulimia nervosa with and without a history of anorexia nervosa: Eating pathology, personality, and maltreatment. International Journal of Eating Disorders, 41(8), 697-704. Beck, A., Ward, C., Mendelson, M., Mock, J., and J. Erbaugh. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561-571. Beck, A. T., Steer, R. A., Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8, 77-100. Bjorntorp, P. (1997). Body fat distribution, insulin resistance, and metabolic diseases. Nutrition, 13, 795-803 Bowker, S., Pohar, S., and J. Johnson. (2006). A cross-sectional study of health-related quality of life deficits in individuals with comorbid diabetes and cancer. Health and Quality of Life Outcomes, 4(17), 1-9. Boyer, J. and J. Earp. (1997). The development of an instrument for assessing the quality of life of people with diabetes. Medical Care, 35(5) 440-53. Cartmell, J. (2006). Cortisol and Diabetes. Townsend Letter. Centers for Disease Control. (n.d.). Childhood Maltreatment Prevention Scientific Information: Definitions. Retrieved February 10, 2009 from https://www.cdc.gov/ncipc/dvp/CMP/ CMP-def.htm Centers for Disease Control. (n.d.). About BMI for Adults. Retrieved August 2, 2009 from https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html Chiodini, I., Adda, G., Scillitani, A., Colleti, F., Morelli, V., Di Lembo, S., Epaminonda, P., Masserini, B., Beck-Peccoz, P., Orsi, E., Ambrosi, B., and M. Arosio. (2007). Cortisol secretion in patients with Type 2 diabetes. Diabetes Care, 30(1), 83-88. Corso, P., Edwards, V., Fang, X., and J. Mercy. (2008). Health-related quality of life among adults who experienced maltreatment during childhood. American Journal of Public Health, 98(6), 1094-1100. Cosgrove, M. (2004). Do stressful life events cause type 1 diabetes? Occupational Medicine, 54, 250-54. Cromer, K. and N. Sachs-Ericsson. (2006). The association Between childhood abuse, PTSD, and the occurrence of adult health problems: Moderation via Current Life Stress. Journal of Traumatic Stress, 19(6), 967-71. De Groot, M., Anderson, R., Freedland, K., Clouse, R., and P. Lustman. (2001). Association of depression and diabetes complications: A meta-analysis. Psychosomatic Medicine, 63, 619-30. Dienstbier, R. (1989). Arousal and physiological toughness: Implications for mental and physical health. Psychological Review, 96, 84-100. Diseases: A Nursing Process Approach to Excellent Care (4th Ed.). (2006). Philadelphia: Lippincott Williams and Wilkins. 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Goenjian, A., Pynoos, R., Steinberg, A., Endres, D., Abraham, K., Geffner, M., and L. Fairbanks. (2003). Hypothalamic-pituitary-adrenal activity among Armenian adolescents with PTSD symptoms. Journal of Traumatic Stress, 16(4), 319-323. Goldberg, R., Pachas, N., and D. Keith. (1999). Relationship between traumatic events in childhood and chronic pain. Disability and Rehabilitation, 21(1), 23-30. Golding, J. (1994). Sexual assault history and physical health in randomly selected Los Angeles women. Health Psychology, 13(2), 130-38. Golding, J. (1999). Sexual assault history and long-term physical health problems: Evidence from clinical and population epidemiology. Current Directions in Psychological Science, 8(6), 191-94. Goodwin, R. and S. Weisberg. (2002). Childhood abuse and diabetes in the community. [Letter to the Editor]. Diabetes Care, 24(4), 801-02. Goodwin, R., Hoven, C., Murison, R., and M. Hotopf. (2003). Association between childhood physical abuse and gastrointestinal disorders and migraine in adulthood. American Journal of Public Health, 93(7), 1065-67. Grant, I., Kyle, G, Teichman, A., and J. Mendels. (1974). Recent life events and diabetes in adults. Psychosomatic Medicine, 36, 121-28. Higgins, D. and M. McCabe. (2001). The development of the comprehensive child maltreatment scale. Journal of Family Studies, 7, 7-28. Ingram, R. and D. Luxton. (2005). Vulnerability-Stress Models. In B. Hankin and J. Abela (Eds.), Development and Psychopathology: A Vulnerability-Stress Perspective. Thousand Oaks: Sage Publications. Johnson, D., Sheahan, T., and K. Chard. (2003). Personality disorders, coping strategies, and Posttraumatic Stress Disorder in women with histories of childhood sexual abuse. Journal of Child Sexual Abuse, 12(3), 19-39. Kaplow, J. and C. Spatz-Widom. (2007). Age of onset of child maltreatment predicts long-term mental health outcomes. Journal of Abnormal Psychology, 116(1), 176-187. Kaslow, N., Okun, A., Young, S., Wyckoff, S., Thompson, M., Price, A., Bender, M., Twomey, H., Goldin, J., and R. Parker. (2002). Risk and protective factors for suicidal behavior in abused African American women. Journal of Consulting and Clinical Psychology, 70(2), 311-319. Kendall-Tackett, K. and R. Marshall. (1999). Victimization and diabetes: An exploratory study. Child Abuse and Neglect, 23, 593-96. King, J., Mandansky, D., King, S., Fletcher, K., and J. Brewer. (2001). Early sexual abuse and low cortisol. Psychiatry and Clinical Neurosciences, 55, 71-74. Leeb R, Paulozzi L, Melanson C, Simon T, and I. Arias. Child maltreatment surveillance: Uniform definitions for public health and recommended data elements, Version 1.0. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2007. Lehman, C., Rodin, J., McEwen, B., and R. Brinton. (1991). Impact of environmental stress on the expression of insulin-dependent diabetes mellitus. Behavioral Neuroscience, 105(2), 241-45. Lewis, C., Jospitre, T., Griffing, S., Chu,. M., Sage, R., Madry, L., and B. Primm. (2006). Childhood maltreatment, familial violence, and retraumatization: Assessing inner-city battered women. Journal of Emotional Abuse, 6(4), 47-67. Lustman, P., Griffith, L., and R. Clouse. (1988). Depression in adults with diabetes: Results of 5-yr follow-up study. Diabetes Care, 11(8), 605-10. Lustman, P., Griffith, L., Clouse, R., Freedland, K., Eisen, S., Rubin, E., Carney, R., and J. McGill. (1997), Effects of nortriptyline on depression and glycemic control in diabetes: Results of a double-blind, placebo-controlled trial. Psychosomatic Medicine. 59, 241-50. Lustman, P., De Groot, M., Anderson, R., Carney, R., Freedland, K., and R. Clouse. (2000). Depression and Poor Glycemic Control: A meta-analytic review of the literature. Diabetes Care, 23(7), 934-942. Lustman, P. and J. Gavard. (n.d.). Chapter 24: Psychosocial aspects of diabetes in adult populations. In M. Harris, C. Cowie, M. Stern, E. Boyko, G. Reiber, and P. Bennett (Eds.), Diabetes in America (507-517). Bethesda: National Diabetes Information Clearinghouse. Maddigan, S., Feeny, D., and J. Johnson. (2005). Health-related quality of life deficits associated with diabetes and comorbidities in a Canadian National Population Health Survey. Quality of Life Research, 14, 1311-1320. Mayerson Center. (2005). Longitudinal study summary. Cincinnati: Trickett, P., Putnam, F., and J. Noll. Mazze, R., Lucido, D., and H. Shamoon. (1984). Psychological and social correlates of glycemic control. Diabetes Care, 7(4), 360-66. McCleskey, C., Lewis, S., and R. Woodroof. (1978). Glucagon levels during anesthesia and surgery in normal and diabetic patients. Diabetes, 27: 492. McEwen, B. (1999). Allostasis and allostatic load: Implications for neuropsychopharmacology. Neuropsychopharmacology, 22(2). Medrano, M., Hatch, J., Zule, W., and D. Desmond. (2002). Psychological distress in childhood trauma survivors who abuse drugs. American Journal of Drug and Alcohol Abuse, 28(1), 1-13. Mikat. E., Hackel, D., Cruz, P., and H. Lebowitz. (1972). Lowered glucose tolerance in the sand Rat (psammonys obesus) resulting from esophageal intubation. Proceedings of the Society for Experimental Biology and Medicine, 139, 1390-91. Miksch, A., Hermann, K., RÃÆ'Â ¶lz, A., Joos, S., Szecsenyi, J., Ose, D., and T. Rosemann. (2009). Additional impact of concomitant hypertension and osteoarthritis on quality of life among patients with type 2 diabetes in primary care in Germany a cross-sectional survey. Health and Quality of Life Outcomes, 7(19), 1-7. Mooy, J., De Vries, H., Grootenhuis, P., Bouter, L., and R. Heine. (2000). Major stressful life events in relation to prevalence of undetected Type 2 diabetes: The Hoorn Study. Diabetes Care, 23(2), 197-201. Nemade, R., Reiss, N., and M. Dombeck. (2007). Current understandings of major depression- Diathesis-Stress Model. Retrieved on February 10, 2009 from https://www.mentalhelp.net/ poc/view_doc.php?type=docid=12998cn=5 Oltmanns, K., Dodt, B., Schultes, B., Raspe, H., Schweiger, U., Born, J., Fehm, H., and A. Peters. (2006). Cortisol correlates with metabolic disturbances in a population study of type 2 diabetic patients. European Journal of Endocrinology, 154, 325-331. Peyrot, M. and J. McMurray. (1992). Stress buffering and glycemic control: The role of coping styles. Diabetes Care, 15(7), 842-46. Peyrot, M., McMurray, J., and D. Kruger. (1999). A biopsychosocial model of glycemic control in diabetes: Stress coping and regimen adherence. Journal of Health and Social Behavior, 40, 141-58. Rijken, M., van Kerkhof, M., Dekker, J., and F. Schellevis. (2005). Comorbidity of chronic disases: Effects of disease pairs on physical and mental functioning. Quality Life Research, 14, 45-55. Ross, C. (2005). Childhood sexual abuse and psychosomatic symptoms in irritable bowel syndrome. Journal of Child Sexual Abuse, 14(1), 27-38. Sachs-Ericsson, N., Blazer, D., Plant, E., and B. Arnow. (2005). Childhood sexual and physical abuse and the 1-year prevalence of medical problems in the National Comorbidity Survey. Health Psychology, 24(1), 32-40. Smith, C. (1996). The link between childhood maltreatment and teenage pregnancy. Social Work Research, 20(3), 131-141. Sobsey, D. (2002). Exceptionality, education, and maltreatment. Exceptionality, 10(1), 29-46. Springer, K., Sheridan, J., Kuo, D., and M. Carnes. (2003). The long-term health outcomes of childhood abuse: An overview and a call to action. Journal of General Internal Medicine, 18, 864-70. Sridhar, G. (2007). Psychiatric co-morbidity and diabetes. Indian Journal of Medical Research, 125, 311-20. Sridhar, G. K. Madhu. (2001). Stress in the cause and course of diabetes. International Journal of Diabetes in Developing Countries, 21, 112-119. Stein, M. and E. Barrett-Connor. (2000). Sexual assault and physical health: Findings from a population-based study of older adults. Psychosomatic Medicine, 62, 838-41. Stone, M., Khunti, K., Squire, I., and S. Paul. (2008). Impact of comorbid diabetes on quality of life and perception of angina pain in people with angina registered with general practitioners in the UK. Quality Life Research, 17, 887-894. Sundaram, M., Kavookjian, J., Patrick, J., Miller, L., Madhavan, S., and V. Scott. (2007). Quality of life, health status and clinical outcomes in Type 2 diabetes patients. Quality of Life Research, 16, 165-177. Surwit, R., Feinglos, M., Livingston, E., Kuhn, C., and J. McCubbin. (1984). Behavioral manipulation of the diabetic phenotype in ob/ob mice. Diabetes, 33: 616-18. Surwit, R., McCubbin, J., Feinglos, M., Esposito-Del Puente, A., and Lillioja, S. (1990). Glycemic reactivity to stress: a biological marker for development of type 2 diabetes (Abstract). Diabetes, 39 (Suppl. 1):8A. Surwit, R., Schenider, M., and M. Feinglos. (1992). Stress and diabetes mellitus. Diabetes Care, 15(10), 1413-22. Taft, C., Marshall, A., Schumm, J., Panuzio, J., and A. Holtzworth-Munroe. (2008). Family-of-origin maltreatment, Posttraumatic Stress Disorders symptoms, social information processing deficits, and relationship abuse perpetration. Journal of Abnormal Psychology, 117(3), 637-646. Talbot, F.and A. Nouwen. (2000). A Review of the relationship between depression and diabetes in adults: Is there a link? Diabetes Care, 23(10), 1556-62. Talbot, F., Nouwen, A., Gingras, J., Belanger, A., and A. Audet. (1999). Relations of diabetes intrusiveness and personal control to symptoms of depression among adults with diabetes. Health Psychology, 18(5), 537-42. Thompson, M., Kingree, J., and S. Desai. (2004). 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British Medical Journal, 65. doi: 10.1136/bmj.38874.652569.55.

Paul Olsen Case Essay - 673 Words

The Paul Olsen case describes the situation for a decision that Paul Olsen needs to make. Paul and Robert Rose devised a plan to open a piano bar in a new urban mall development in Pittsburg, PA. If successful, Paul and Robert would add a restaurant and cafà © at the same location to grow their business. With three and a half months before opening, Paul did not have enough investors to fund the startup costs, so he needs to decide whether to invest all of his student loan money ($12,500) to maintain the timetable for the opening. Similar to the Ramp;R case, the Paul Olsen case is about identifying risks and developing strategies to manage that risk. By controlling risk, Paul is able to minimize his exposure to potential losses if the†¦show more content†¦Although the restaurant industry is perceived to have high risk of failure, the risk of a restaurant failing is not too different from other small businesses. 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American Prisons Free Essays

As far as memory could recall, man has continually developed laws to keep resolute civilization along with criminal sanctions to discourage the infringement of those laws. Accordingly, the number of inmates in federal and state penal colonies in the United States has soared to about 200,000 since the 1940s, and at the start of 1997, about 645 out of every 100,000 American citizens lived behind bars (Dakrat 1). However, alternative sanctions during the last decade have become prevalent in the United States, as well as in other western nations. We will write a custom essay sample on American Prisons or any similar topic only for you Order Now The introduction of alternative sanctions has turned into one of the most significant developments in punishment principles in the country, in view of the fact that it reflects on the victims, offenders, community, as well as sentencing as a whole, in an absolutely different outlook. In a country with the world’s largest prison population, adding up to more than 2. 2 million, and where a number of States allocates more funds to the maintenance of criminals than on education, alternative punishments are at this time a matter of necessity. Problems Faced By American Prisons It is not easy for most people to offer compassion for the millions of convicts incarcerated in the overcrowded prisons of America. A good number of the country’s population even believes that what takes place inside every prison establishments do not affect them. On the contrary, what occurs in prisons comes back to the society with a vengeance. Approximately 13. 5 million people in the country have served their own time in prisons and jails over the course of the year, and in the long run 95 percent of them are discharged back into the society (â€Å"Rising prison problems begin to trickle into society†). Because too many prisons are inhumane, unhealthy or unsafe, several of the released inmates return to the society as more hardened criminals eager to perpetrate new transgressions as well as to blame for spreading communicable diseases, such as tuberculosis, hepatitis, HIV, etc. , that were not taken cared of during the time that they were locked up. Currently, prison problems involve: 1. Corrections officers and inmates alike are constantly in fear of being assaulted. Even so, numerous prisons still do not report or collect information concerning the assaults, and when they do, the information is generally untrustworthy. 2. Education lessens rule-breaking and is proven to cut the rate of recidivisms by almost half (â€Å"Rising prison problems begin to trickle into society†). However, despite the fact that the prison population has doubled since the 1990s, the pace of funding for prison vocational training and education has not persisted. 3. In excess of 1. 5 million prisoners carrying severe communicable diseases are discharged every year (â€Å"Rising prison problems begin to trickle into society†). In fact, a number of penal complex with as many as 5,000 prisoners have no more than two resident doctors. 4. Incarceration can no longer be viewed as the main form of criminal punishment given the growing expenses of both management and construction of prisons as well as the crisis of prison overcrowding (Junger-Tas 9). At this time, America is contending with the menacing economic recession that is acting as a powerful brake on advancing the country’s utilization of large funding in support to resolve the foregoing problems. The development of alternative punishments is therefore the result of the justice system’s exploration for new sentencing strategies to rise above these intertwining problems. Effects of Traditional Prison Sentence Anchored in the findings of the Center for Criminal Justice Studies at the University of New Brunswick and the Criminal Justice at the University of Cincinnati, unwarranted use of imprisonment has enormous expenditure implications. On the average, each American spends $50,000 annually to keep criminals in prison (Dakrat 2). In addition, prisons should not be employed with anticipations of reducing illicit behavior. The soaring recidivism rate signifies that the risk of getting arrested and returned to prison does not deter criminals. Moreover, a research points out higher rates of recidivism among incarcerated youthful delinquents than those granted alternative sanctions (Dakrat 2). Incarceration devoid of appropriate treatment, criminals with severe infectious disease, criminal behavior or with mental health disorders are generally expected to leave prison in substandard health as well as character than when they initially went in. The problem can have an enormous impact on communities, since 97 percent of all incarcerated criminals are in time released from prison and live along with the entire population (Webb). Alternatives to Prison Opponents of long-established imprisonment have disputed the destructive potentiality of the punishment because it falls short of addressing the fundamental economic and psychological reasons that lead individuals to perpetrate crimes (Rierden 2). Alternative sanctions, on the other hand attempt to transform behavior of criminals in addition to giving the necessary tools that will help them in not making the same mistakes again when released. Moreover, because of prison overcrowding, this modern sanction will give the country the opportunity to appropriately incarcerate and rehabilitate more serious criminals for extended portions of their prison term. There are basically an enormous number of useful alternative programs. Compensation, restitution, community service, intensive probation supervision, electronic monitoring, and regular house searches, for instance, still endure a sense of redress for the injured party and a sense of atonement to the legal order violated. In addition, there are several new and unconventional alternative programs that as well do not involve imprisonment. The most practical and astounding programs among them are the â€Å"drug treatment, and classes and fees: for the rich program† (David). Drug treatment program are aimed for nonviolent drug dependents with prior convictions. Criminals who qualify are required to join in a residential drug-treatment program. Those who graduate were found to be 87 percent less expected to re-offend than others (David). Conversely, while not yet put into practice, the whole idea of classes and fees program is to require corporate offenders to teach in low-income academes (David). Since a number of these offenders have been educated at first-rate schools, they are more valuable if allowed to teach in classrooms rather than be placed behind bars throughout their sentence at the taxpayers’ expense. The imposition of prison sentence should only be selective depending on each circumstances, such as: to protect the public from violent crime; when all other sanctions are incompatible taking into consideration the gravity of the crime; when the criminal is a habitual delinquent; to safeguard the morality of the criminal justice administration; and if the entire sanctions have not effected to conformity with the arrangements set forth in the punishment (Junger-Tas 7). In other words, imprisonment shall only be employed if the gravity of the offense is such that all other punishment is totally unsatisfactory. The Best Alternative The best alternative to imprisonment is one that is less restraining than incarceration yet more confining than conventional probation. Community service intends criminals to work for the advantage of the community, to make amends to the community, as well as to be penalized. Community service is expected to lessen the undesirable effects induced by imprisonment, decrease prison overcrowding, as well as offer a constructive experience for criminals for working in a typical community (Junger-Tas 11). The essential feature of the punishment lies in the supervision and control of the implementation of compulsory orders in the community, instead of confining the criminal’s movement within a penal complex. In the early 1990s, developing countries regarded community service as an official alternative to prison, although it was already practiced in several communities. Community service is designed to punish criminals who are worthy of intermediate punishments. The program is applied to criminals that deserve to endure more than average probationers but not as much as criminals in prisons and jails (Samaha 428). Community service necessitates offender complete within a given time frame a particular number of hours of voluntary community work. In particular, criminals are required to wash automobiles in an agency motor pool, rake leaves or cut grass in parks, sweep up around housing projects or public structures, and clear garbage from playgrounds. Community service in the Federal courts is a special condition of supervised release or probation. However, community service is a commendable alternative for non-habitual criminals who perpetrated minor offenses or requires a prison term of one year or less. Criminals sentenced to community service must be expansively screened to get rid of those with histories of violent behavior. Because of community service, there might be a slight possibility of additional nonviolent transgressions; nevertheless, the degree the program manages to keep nonviolent offenders outside penal complex creates opportunity for the government to imprison and rehabilitate the more violent ones. Community service positively embraces the treatment factor as well on account of cautious matching of offenders to projects and services that constructively relates with their issues (Harding 78). In imposing the program, judges must consider the offenders’ availability and skills, and then match them with works available at nonprofit agencies and government. In the course of performing the community service, offenders are expected to learn how to take responsibilities as well as remunerate the communities they once damaged. However, failure to abide with the community service program results to the re-sentencing of the criminal. Many observers believe that offenders who previously benefited from community services gained confidence, self-respect, and a sense of accomplishment from their community work (Tonry and Hamilton 82). The rate of recurrence of conviction is lower among criminals who had found their experience in community service to be meaningful (Tonry and Hamilton 83). Moreover, rates of recidivism among those who completed the program are not higher than for criminals sent to prison. Not only is community service more effective and compassionate, they are as well less expensive. When both indirect and direct expenses are taken into consideration, an average-sized community service sentence is less expensive than incarceration. Imprisonment costs ranges from $30,000 to $59,000 annually, while community service generally costs only $2,000 annually and up to $20,000 in other alternative programs (Agosin 217). Conclusion The high cost of imprisonment and overcrowded prisons are among the most multifaceted concerns surrounding the criminal justice system. Unfortunately, because of these, prisons make uncertain the successful reintegration of criminals in the community. They transform the imprisoned offender, but the transformation is likely to be more depressing than encouraging. Alternative programs, on the other hand, particularly community service encourage a sense of social responsibility among criminals and permit them to enhance their character in the course of serving the community. Prison alone will never get to the bottom of the crime problems in America. Leaders and citizens alike must be more unconventional and tolerant to alternative programs. Alternative sentencing gives defense lawyers, prosecutors and judges a better range of sentencing options. It is not easy to resolve how much community service serves as a substitute for incarceration; nevertheless, one thing is for sure, that sentencing a non-habitual and less violent offender with community service works out the dilemma of prison overcrowding and saves the country an enormous amount of money. Works Cited Agosin, Marjorie. Women, Gender, and Human Rights: A Global Perspective. New Jersey: Rutgers University Press, 2001. Dakrat. â€Å"Alternatives to Prison: Why Imprisonment Doesn’t Work and What to Do About It. † 26 April 2007. Associated Content. 27 January 2009 http://www. associatedcontent. com/article/217666/alternatives_to_prison_why_imprisonment. html. David, Ruth. â€Å"Ten Alternatives To Prison. † 18 April 2006. Online: Forbes Magazine. 27 January 2009 http://www. forbes. com/2006/04/15/prison-justice-alternatives_cx_rd_06slate_0418alter. html. Harding, John. Probation and the Community: A Practice and Policy Reader. London: Taylor Francis, 1986. Junger-Tas, J. Alternative to Prison Sentences: Experiences and Developments. Netherlands: Kugler Publications,1994. Rierden, Andi. â€Å"Alternatives to Prison Mends Fences and Lives. † 23 June 1991. Online: The New York Times. 27 January 2009 http://query. nytimes. com/gst/fullpage. html? res=9D0CE2D71338F930A15755C0A967958260sec=spon=pagewanted=1. â€Å"Rising prison problems begin to trickle into society. † 11 June 2006. USA Today. 27 January 2009 http://www. usatoday. com/news/opinion/editorials/2006-06-11-our- How to cite American Prisons, Papers

The Pros of Apec Essay Example

The Pros of Apec Essay APEC allows a forum to discuss issues that arises among members countries. For example during conflict regarding Spratly Island, APEC has become a forum to discuss about the issue and not only focusing on economic matters. Free flow of labors also being discussed in APEC, to ensure the labor is sufficient among members country thus making the development process maintain at the optimum level. For example, if Vietnam reporting that they are shortage of workforce, APEC will discuss the matter with other members if they can help to contribute some of their local workforce to work in Vietnam. In return, Vietnam shall take advantage by using the workforce to their optimum level but still not neglect their duties towards the labors (wages, allowance, shelter, etc). APEC also helps in business facilitation. If a member country is insufficient of some services or supplies, other member countries should willing to help as they are from the same regional cooperation area. For example, if New Zealand do not have the specialities needed in manufacturing their very own national car, they can borrow some specialist and experts from members who have produce their own car such as Malaysia. Malaysia will sent their skillful technician and workers to assist New Zealand from designing, manufacturing, and needed services. We will write a custom essay sample on The Pros of Apec specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on The Pros of Apec specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on The Pros of Apec specifically for you FOR ONLY $16.38 $13.9/page Hire Writer By obeying to the â€Å"give and take† rule, New Zealand can offer Malaysia some advantages such as reduced tax for New Zealand’s product that was exported to Malaysia, increase quota for new labor from Malaysia, or even inviting Malaysia’s best students to further their studies in New Zealand and give them New Zealand’s scholarship. APEC allows Asian countries to dialogue with economic power houses such as Japan and USA. This will ensure poor member countries will benefit from new technology and can adapt their country to build more development projects. For example, less developed member’s country such as Vietnam can adapt some of Japan’s technology to modernize Vietnam’s outdated machinery and thus increasing output and national income. Vice versa, Japan can take something from Vietnam’s specialities such as in textile, traditional music, and culture. Besides that, dialogue with economic power houses also can make poor and tiny country feels being in attention and not being isolated. Their voice is counted and can make a difference in changes of regional’s regulations, law, or orders.