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Thursday, September 3, 2020
The Role of Sacred Space in Judeo-Christian Religions Essay -- Religio
The Role of Sacred Space in Judeo-Christian Religions Certain physical areas take on significant implications in the worldââ¬â¢s religions. Religions consider different geographic components, for example, various urban communities, areas, mountains, and streams to be hallowed. For instance, Hindus travel to the Ganges River to purge themselves from their wrongdoings (Momen 157). One of the necessities of all Muslims is that they make a journey to the heavenly city of Mecca (Eastman 398). Judeo-Christian religions likewise have certain spots that are held hallowed to their adherents. The idea of hallowed space is imperative to Judeo-Christian religions, since it assists with clarifying the inquiries of presence. Hallowed space gives something substantial to speak to religions while lessening the obstructions that keep strict individuals from having strict encounters. Judeo-Christian religions have broad narratives in which the idea of sacrosanct space has been instrumental to their turns of events. Today, hallowed space stays signific ant in isolating these religions from the remainder of the world. As observed in recorded stories and reflected through the imagery of strict design just as in nature, hallowed space is a significant part of Judeo-Christian religions. One explanation that adherents of Judeo-Christian religions see certain areas as significant is that God has pronounced that specific spots ought to be viewed as sacrosanct. In the Book of Exodus, the Lord addresses Moses on the heap of Horeb, saying ââ¬Å"Remove the shoes from your feet, for where you stand is heavenly groundâ⬠(Exo. 3.5 NAB). In the Book of Genesis, God sends Abraham to the place where there is Moriah. ââ¬Å"When they went to the spot of which God had let him know, Abraham assembled a raised area t... ...position religions from one another by encouraging a sentiment of predominance among certain religions and mediocrity among others. Judeo-Christian religions depend on consecrated space to do these things for adherents. Works Cited Barbour, Ian G. Religion and Science: Historical and Contemporary Issues. San Francisco: HarperCollins, 1997. Eastman, Roger. The Ways of Religion: An Introduction to the Major Traditions. New York: Oxford University Press, 1999. Eliade, Mircea. The Sacred and the Profane: The Nature of Religion. San Diego: Harcourt, Inc., 1987. Heavenly Bible, New American Bible (Iowa Falls, Iowa, 1986) Johnson, Kevin Orlin. For what reason Do Catholics Do That?: A Guide to the Teachings what's more, Practices of the Catholic Church. New York: Random House, Inc., 1994. Momen, Moojan. The Phenomenon of Religion. Oxford: Oneworld Publications, 1999.
Tuesday, August 25, 2020
Meru Cabs: A spectacular growth story Essay
About Meru Cabs: Meru Cabs, working in four metros of the nation has promoted and supported the idea of radio taxis. ââ¬Å"Today very nearly 70 percent of our travelers state that they travel by ââ¬ËMeruââ¬â¢ as opposed to considering it a ââ¬Ëtaxiââ¬â¢ and this is the thing that has been our focus.â⬠â⬠Gavin Dabreo, VP-Sales and Marketing, Meru Cabs Meru now runs an armada of 5,000 cabs in Mumbai, Bangalore, Hyderabad and Delhi and has 700 representatives. The organization has a top line of Rs 350crores (76mn USD) - > resources on streets. The organization intends to contribute $100 million and means to create $500 million income in five years. Meruââ¬â¢s Operational Sub Processes: Client obtaining Booking Management Taxi Delivery Administration Delivery Meru Cabs: Competition Analysis: System Map for Meru Cabs Innovation and Development Challenges Prophet ERP Back-end framework and Siebel CRM Serious Rivalry Inside authoritative Challenges Difficulties from Suppliers and Buyers Development and Potential Challenges Conslusion: Meru taxis is doing a great deal to survice in the market to keep up its situations in the business sectors. Paper: Development and Potential Challenges Chapter by chapter guide Air conditioning 1.2: process engaged with vital marketing:4 Section the market4 Profile the market segments4 Build up a market section promoting strategy4 Situational Analysis4 Advertising Objectives:5 Advertising Strategies:5 The most effective method to Use a Strategic Marketing:5 Air conditioning 1.3: connects between vital promoting and corporate strategy:5 Corporate strategy:5 Key marketing.5 Links:6 Air conditioning 2.1: advertising device for puma car:7 Advertising blend 4p:7 PRODUCT:7 PROMOTION:7 PRICE:8 PLACE8 Nuisance analysis:8 SWOT analysis9 Strengths:9 Weaknesses:9 Opportunities:9 Threats10 Air conditioning 2.3: Current client relationship advertising by the puma vehicle company:10 Email:10 Call:10 Book a test drive:11 Contact with a dealer:11 Keep informed:11 Air conditioning 1.2: process engaged with vital promoting for Jaguar: The key promoting process regularly has three phases: Fragment the market * Geographic * Demographic * Psychographic * Behavior Profile the market fragments * Revenue potential * Market share potential * Profitability potential Build up a market section advertising system * Market pioneer or product offering expansion * Mass advertising or focused on showcasing * Direct or circuitous deals In the wake of breaking down market portions, client premiums, and the buy procedure, itââ¬â¢s time to make the key promoting plan. The vital promoting plan archive typically incorporates: Situational Analysis Where is the organization now? * Market Characteristics * Key Success Factors * Competition and Product Comparisons * Technology Considerations * Legal Environment * Social Environment * Problems and Opportunities Marketingâ⬠¦
Saturday, August 22, 2020
Ralph Emerson And Transcendentalism Essays - Transcendentalism
Ralph Emerson And Transcendentalism The works of Ralph Waldo Emerson managed three parts of supernatural thought, which comprised of profound, philosophical, and abstract substance. In his time, Emerson bestowed an impact upon his counterparts and American writing. He expressly energized different authors by his allure for new American writing and new voices since America had neglected to censure European writing and produce its own artistic grant. Emerson accepted that writing ought to have a profound impact on account of individual strict feelings. Additionally, he figured way of thinking could embrace fundamental structures through which the brain itself measured. At long last, Emerson accepted that abstract credibility had a fundamental impact in the development of American writing. Since Emerson acknowledged America expected to build up its own scholarly works, he propagated the visionary development to design American writing through otherworldliness, reasoning, and scholarly substance. In religion, it was post-Unitarian and freethinking, and he explained it in his Holiness School Address. In the location, Emerson saw religion as a monotonous interest expected to acquire temperance throughout everyday life. The contention of Emerson's reasoning straightforwardly tended to the Christian Church. Jesus Christ in Emerson's retrospection was an extraordinary position, yet he attested that the Christian Church blundered by misrepresenting the supernatural occurrences of Jesus and the repression of disclosure. His goals was brassy: Let me reprimand you, as a matter of first importance, to go alone; to decline the great models, even those which are sacrosanct in the creative mind of men, what's more, date to cherish God without arbiter or cover. To Emerson, the strict perspective of introspective philosophy was proposed to prevent past ways from securing criticalness and to find new, insightful ways to deal with God. Nature, Emerson's first book, fortifies the philosophical ideas of the development. The book is an endeavor to answer the proactive inquiry on the principal page, Let us ask, to what end is nature? Language, one of Emerson's ideal sections, inculcates his legitimate proposition of Nature saying: 1. Words are indications of common realities. 2. Specific Natural realities are images of specific otherworldly Facts. 3. Nature is the image of soul. The utilization of common history is to give us help in powerful history: the utilization of the external creation, to give us language for the creatures and changes of the internal creation. This demonstrates the regular domain exist as a model of the otherworldly domain. Emerson's paper, The American Scholar, expresses the artistic development of Transcendentalism. He explains how the US of America requested and merited another writing, and that this writing would talk about and to the American individuals. His thinking for this clamor is the reliance America kept on having on European writing. Emerson stated that researchers should have been confident through the forces of human instinct. Additionally, he recommended that researchers must be understudies of nature, since nature is the appropriate impact upon the brain of the researcher: 1. The first in time and the first in significance of the impacts upon the brain is that of nature....The scholar....must settle its incentive in his brain. What is nature to him? He is requesting that the researcher expect a similar study he endeavored in Nature. Emerson utilized The American Scholar as a location structured at invigorating American people of letters as people and as a country: We have listened excessively long to the cultured dreams of Europe... We will stroll on our own feet; we will work with our own hands; we will talk with our own personalities. The investigation of letters will be not, at this point a name for feel sorry for, for question, also, for exotic guilty pleasure. The fear of man and the adoration for man will be a divider of resistance and an anger of bliss around all. A country of men will for the first time exist, in light of the fact that each trusts himself enlivened by the Divine Soul which moreover rouses all men. This was planned as a message for America to build up its own culture. At the point when the American researcher is free of Europe, he will perceive that the antiquated statute 'Know Thyself,' and the cutting edge statute, 'Study nature,' become finally one saying. Therefore, Emerson utilizes nature as a impetus for his visionary development. The impact of nature must be formed by the psyche of the past. By grasping characteristic history as far as scholarly and profound finishes, Emerson's work proposes that American writing can incredibly be enlivened by America's tendency.
The Name Of War Essays - Assassinations, John Sassamon,
The Name Of War In this verifiable and socially separated book, Jill Lepore looks at and attempts to characterize the King Philips War and how individuals expounded on it. Toward the start of the settlements it was a beginning of a ?New England and after the King Philip's War with the entirety of the strict clashes and war stories, another American personality was conceived. All through this book she enlightens grisly stories regarding murders, slaughters, and fights. Indeed, even idea his book bounces a great deal in incessantly request she effectively tells the stories for the two sides pretty precisely. I appreciated perusing a few pieces of this book. Particularly the start and the center since I thought the End dropped off and eased back down. Beginning even before the war starts, she tells the story of John Sassamon which she utilizes as the premise of thoughts. This is a middle purpose of the initial segment of her book. Why Sassamon was either executed for reasons unknown or killed? New England Indians at the time were to become familiarize to English products and some were in any event, changing over to Christianity. Not long after the war starts she shows how the Indians use Christianity as a piece of their war. Likewise after the war starts she expounds on what number of scholars attempt to catch the war in words so the provinces don't free their Englishness. This is amusing in light of the fact that by doing whatever it takes not to free their Englishness they structure an American character. Inside the John Sassamon story lays the genuine motivation behind why he was murdered. Sassamon was an informed man, which was uncommon considering he was a Native American. Despite the fact that he was becoming separated from a portion of his companions in the provinces he despite everything had solid ties with them. There are numerous reasons why he would be executed yet none as solid as turning on your own kin. Treachery is viewed as an incredible offense to our nation, envision the offense taken by the Native Americans. Perusing this book I discovered extraordinary similitudes with the Native American culture and one with a posse or a horde family. Every one of them appear to have incredible punishments for one of their own betraying them. The significant contrast would be that the Native Americans religion was additionally a lot of their way of life. A horde family's religion (catholic or example) would struggle with the murdering of another human. In any case, the Native Americ ans were not that way, on the off chance that one was executed and they took prisoners, at that point the one slaughtered could be vindicated by murdering a prisoner. John Sassamon was not just executed on the grounds that he betrayed his kin when he attempted to caution the pilgrims. He likewise spoke to something that King Philip didn't care for, a Native American turned English. In the book it says The principal loss may have been the Pequot man whom an Indian mediator, conceivably Sassamon himself: 'What are you, an Indian or an Englishman?' The answerableness of this inquiry would in the long run execute Sassamon as well. pg 47. The slaughtering of John Sassamon was with out an uncertainty the start of the war. Despite the fact that that no shots were discharged at any settlers war was pronounced by murdering the main individual that could stop it. Numerous individuals accepted that the best approach to halting King Philip was to change over him to Christianity, yet this end up being harder than it appeared. Ruler Philip saw this primitive endeavor to transform him and saw a shortcoming in the pilgrims. He saw that religion had a major impact in the states as observed on page 105 as one pioneer appropriately put it, 'Our Enemies gladly magnify over us and Blaspheme the name of our Blessed God; Saying, Where is your O God?' Religion had the biggest impact in the war in light of the fact that the two sides accepted unequivocally in their religion and were happy to kick the bucket for them. On the settler side they utilized strict plans to legitimize the war. They trusted it to be a heavenly war, page 109 And, as Pope Innocent IV had articulated in the thirteenth century, Christians could take up arms agains heathens soley based on their nonbelief in God. To accept that God is your ally when you are battling until the very end
Friday, August 21, 2020
Security Issues in Peer-to-peer Networking
Security Issues in Peer-to-peer Networking Affirmations: The enthusiasm for the field of systems administration, driven me to take the PC organizing as my course in M.Sc. there are a wide range of sorts of systems. Out of them the more advanced and up and coming pattern of systems are shared systems. This report of my last exposition for the halfway satisfaction of my M.Sc, PC organizing, would not have been conceivable without the help of my director, Mr. Harry Benetatos. He helped me a ton by managing me and pin-pointing the key missteps which I have done during my exploration. My course head Mr. Nicholas Ioannides likewise helped me a great deal to finish this thesis. His prompts and proposals gave me a great deal of consolation and bolster which caused me to do this examination and finish it in time. I am exceptionally appreciative to my college, LONDON METROPOLITAN UNIVERSITY which gave me the free access to the IEEE library which helped me to locate the key papers which are extremely valuable for my exploration. I likewise thank my f olks for their help given to me in all strolls of my life. Devotion: I devote this report to my folks and my well wisher Sakshi for their steady help and support all through my instruction and life. Part 1 Task INTRODUCTION 1.1 INTRODUCTION TO THE PROJECT: This thesis is about the security issues in the shared systems. There are numerous security issues in distributed systems. I have decided to do look into on worm interruptions in distributed systems. In this record I have referenced how the worm spreads in the system starting with one companion then onto the next friend, how the worm can be recognized and how the distinguished worm can be assaulted and spare the system from getting tainted. 1.2 AIM: Security issue in Peer-to-peer systems: Making sure about the shared system from worms.â 1.3 OBJECTIVES: ÃË To see how the companions speak with one another in the shared system ÃË To break down the engendering of worms in the system. ÃË To identify the worms close to the hubs of the system ÃË To safeguard the worms in the system. 1.4 RESEARCH QUESTION: This archive quickly talks about how the worms engenders in the system and how might it be identified and assaulted so as to spare the distributed system 1.5 APPROACH: My methodology for this exposition is as per the following: ÃË Understanding distributed systems ÃË Defining the issue ÃË Data assortment and investigation ÃË Study and understanding the current answers for the issue ÃË Comparing various arrangements ÃË end 1.6 METHODOLOGY: This area of my report contains what significant strides to be followed so as to accomplish the referenced targets. It likewise assists with planning how to create and finish various pieces of the exposition. In this thesis right off the bat I will consider and comprehend about the distributed systems and how the companions in the systems impart and share data with the rest of the friend in the system. At that point I do investigate on how the worm spreads in the system, by what means can the worm be distinguished and how the identified worm can be assaulted and reestablish the network.â In the pictorial structure the various phases of my exposition are 1.7 PREVIEW ABOUT THE COMING CHAPTERS IN THE REPORT: The remainder of the report is sorted out as follows: in the section 2, there is brief conversation about the shared systems, various kinds of distributed systems, preferences and burdens of the distributed systems. There is additionally some data about the worms, its tendency and various kinds of worms. In part 3, there is a conversation about the techniques given by the diverse individual to recognize the worm in the system by the strategy for coordinating the trademark string of the worm. In area 4, there is an answer for this issue. That is numerical strategy for identifying the worm in the system and protecting it. Section 5 comprises of a basic examination and recommendations for the further work. At last, I closed in part 6. Section 2 Outline OF THE GENERIC AREA AND IDENTIFICATION OF PROBLEM: 2.1 NETWORK: System is a gathering of electronic gadgets which are associated with one another so as to convey which each other.â The gadgets can be PCs, workstations, printers and so on systems can be wired or remote. Wired systems are organizes in which the gadgets are associated with the assistance of wires. Remote systems are the systems wherein the gadgets are associated without the wires. There are various kinds of systems and shared is one of the significant and extraordinary sorts of systems. 2.2 PEER-TO-PEER NETWORKS: Distributed systems are risen in 1990 due to the advancement of the shared document sharing like Napster [1].â Peer-to-peer systems curtailed as p2p systems are the systems wherein all the hubs or friends in the system goes about as servers just as customers on request. This is not normal for regular customer server model, in which the customers demands the administrations and server supplies the assets. Be that as it may, if there should be an occurrence of distributed systems each hub in the systems demands administrations like a customer and each hub will gracefully the assets like server on request. Distributed system doesnââ¬â¢t need any concentrated server coordination.â Peer-to-peer organize is adaptable. Expansion of new hubs to the system or evacuation of previously existing hubs on the system doesnââ¬â¢t influence the system. That implies expansion or expulsion of hubs should be possible progressively. All the hubs associated in a shared system run on a similar sy stem convention and programming. Assets accessible on a hub in the system are accessible to the rest of the hubs of the system and they can get to this data without any problem. Shared systems give power and adaptability. All the wired and remote systems can be arranged as distributed systems. Home systems and little endeavor systems are desirable over design in a distributed systems. Most the systems are not unadulterated shared systems in view of they utilize some system interface gadgets. Before all else, the data is put away at all the hubs by making a duplicate of it. Be that as it may, this builds the progression of traffic in the system. Be that as it may, presently, a brought together framework is kept up by the system and the solicitations are coordinated to the hubs which contains the significant data. This will spare the time and the traffic stream in the system. 2.3 WIRELESS NETWORKS: Gadgets associated with one another with no wires can likewise be arranged like shared systems. For a situation of little of number of gadgets it is desirable over design the system in remote distributed systems since it will be anything but difficult to share the information in both the headings. It is much less expensive to associate the systems in remote shared in light of the fact that we don't have to spend on the wires. Distributed systems are partitioned into three sorts. They are: Texting systems Community oriented systems Fondness people group networks[2] Texting systems: In this sort of shared systems, the clients can talk with one another continuously by introducing some product, for example, MSN delegate, AOL moment errand person and so forth. Community oriented systems: This sort of shared systems are additionally called as conveyed computing.â This is broadly utilized in the field of science and biotechnology where the extreme PC handling is required. Partiality people group distributed systems: It is a kind of p2p arrange, where the gathering of gadgets are associated uniquely to share the information among them. Distributed systems are essentially grouped into two sorts. They are: ÃË Structured distributed systems ÃË Unstructured distributed systems 2.4 STRUCTURED PEER-TO-PEER NETWORKS: In the organized distributed hubs associated in the system are fixed. They utilize disseminated hashing table (DHT) for ordering [4]. In DHT information is put away as hash table like (key, esteem). Any hub ready to recover the information can without much of a stretch do that utilizing the keys. The mapping of qualities to the keys are kept up by all the hubs present in the system to such an extent that there will be exceptionally less disturbance in the event of progress in the arrangement of members DHT-based systems are exceptionally effective in recovering the assets. 2.5 UNSTRUCTURED PEER-TO-PEER NETWORKS: In unstructured p2p arrange hubs are set up discretionarily. There are three sorts of unstructured p2p systems. They are Unadulterated distributed Half breed shared Incorporated shared In Pure p2p arranges all the hubs in the system are equivalent. There wonââ¬â¢t be any favored hub with exceptional foundation work. In half and half p2p systems there will be an extraordinary hub called ââ¬Å"supernodesâ⬠[3] . This supernode can be any hub in the system relying upon the fleeting need of the system. Brought together p2p arrange is a kind of half and half system wherein there will be one focal framework which deals with the system. The system can't have the option to work without this incorporated framework Essentially, all the hubs in the shared systems contain the data of the neighbor in its steering table. The pace of proliferation of worms in the distributed systems is bigger than contrasted with different systems. This is on the grounds that the data of the neighbor companions can without much of a stretch accomplished from the steering table of the tainted hub. Various kinds of records are shared between the hubs in the distributed systems. These records can be the sound documents, video documents, music records, content reports, books; articles and so forth there are a ton of distributed programming accessible nowadays in the market for sharing the records. Some of them are bittorrent, limeware, shareaza, kazaa, Imesh, bearshare Lite, eMule, KCeasy, Ares Galaxy, Soulseek, WinMX, Piolet, Gnutella, Overnet, Azureus (vuze), FrostWire, uTorrent, Morpheus, Ants, Acquisition[5]. There are parcel more document sharing programming projects in the market however these are the t
Tuesday, August 4, 2020
Does Being Married Improve Life Expectancy
Does Being Married Improve Life Expectancy Relationships Spouses & Partners Print Does Being Married Improve Life Expectancy? And Why Its OK to Be Single By Mark Stibich, PhD Mark Stibich, PhD, FIDSA, is a behavior change expert with experience helping individuals make lasting lifestyle improvements. Learn about our editorial policy Mark Stibich, PhD Medically reviewed by Medically reviewed by Carly Snyder, MD on November 12, 2019 facebook twitter linkedin Carly Snyder, MD is a reproductive and perinatal psychiatrist who combines traditional psychiatry with integrative medicine-based treatments. Learn about our Medical Review Board Carly Snyder, MD Updated on February 04, 2020 Jose Luis Pelaez Inc / Getty Images More in Relationships Spouses & Partners Marital Problems LGBTQ Violence and Abuse When you grow old, who will take care of you? For many, that is a husband or wife. So does marriage improve life expectancy? Heres what research shows. Marriage was one of the first non-biological factors identified as improving life expectancy. The explanation given was that married people tend to take fewer risks with their health and have better mental and emotional health. Marriage also provides more social and material support, which means having someone to take you to the doctor or care for you when you are sick. However, research shows that the difference between married people and single people, in terms of health, is narrowing. This could be because the definitions of marriage are changing, or that people have other outlets for care. The Changing Face of Marriage and Life Expectancy No one is saying that having a piece of paper that says âmarriedâ on it is going to improve your life expectancy. However, there is something about people who live in a marriage that improves life expectancyâ"or to be more precise, there was something about people who lived in marriage in the 70s that was found to improve life expectancy. Now, people can be listed as âsingle never marriedâ in census data, but be living with someone and be experiencing all the health benefits of marriage without having the marriage certificate. This complicates research on marriage and health. Being Single Can Be Healthy Research shows that people who are single, especially men, are living longer than ever before. In the past, men who were never married typically had the lowest life expectancy, but now the never married men are closing in on their currently married counterparts. Experts believe the difference in life expectancy is becoming smaller because single men now have access to support and health resources that, in the past, only came because their wife took care of them. In other words, 40 years ago, married men had the advantage (over never married men) because they had their wives to make sure they went to the doctor and took care of themselves. Now, men are taking more responsibility for their own health and it is normal for a man to express concern about his health and take action. Why Being Widowed Hurts Losing a spouse who you have lived with your entire life is devastating for husbands and wives alike. As a result, research shows that people who are widowed have slightly worse health than people who are married. This is an issue that has gotten worse in recent years: No one really knows why the experience of being widowed now is more detrimental to health than being widowed in the past, however it is possible that people had more of a community and extended family to help them out. Now, the widowed are more likely to be isolated. Regardless of whether youre single, married or widowed, there are things you can do on your own to improve your longevity outside of a relationship.
Monday, June 22, 2020
Asthma Action Plan A Problem in Clinical Practice - Free Essay Example
Asthma is one of the respiratory diseases that affect all ages. CDC- National Center for health statistics (2016) reported that 20.4 million adults (?â⬠°? 18 years) in America have asthma. They also reported that 62% of the patient who visited the outpatient had a diagnosis of asthma. Asthma is defined according to the National Institute of Health as a chronic lung disease that inflames and narrows the airways. Asthma is associated with recurrent symptoms like wheezing, cough, chest tightness and shortness of breath. The patients fail to recognize the symptoms of asthma like waking up the night, exercise intolerance and recurrent cough, and do not take appropriate action (including short-acting bronchodilator inhalers or corticosteroids) which lead to asthma exacerbation. This led to an emergency department visit, hospital admission, complications, and death. The report also states that the mortality rate of asthma among adults was approximately five times greater than children. The death rate related to asthma was highest among 65 years and older age groups, females and non-Hispanic black patients (CDC, 2018). The uncontrolled and persistent asthma causes a substantial financial burden to the individual, family, and society. They also affect the mental status of an individual, working days and productivity (CDC, 2018). It affects the quality of life. Although asthma is considered a reversible disease condition, there is no prevention or cure. The practice problem within clinical setting was need of Asthma Action Plan. The PICO question formulated was In an out-patient correctional outpatient clinical setting did the use of Asthma Action Plan by a provider when compared to standard care helped the inmate (?â⬠°?17 years) with asthma to manage asthma symptoms. The clinical setting chosen for implementing the DNP project was an outpatient clinic in the correctional facility exclusively for inmate patients with acute and chronic conditions. Most of the inmates faced a lot of challenges like lack of insurance, no health care access, language barriers, illiteracy, unemployment etc. when they were outside the jail. They never got education related to asthma, triggering factors and its management. The provider even though they knew about asthma guidelines and AAP, they did not follow it due to time constraints and other barriers in the clinical setting. These were the reasons most of the inmate patients with asthma frequently visited the clinic with asthma exacerbation. When the provider is unable to control asthma with the treatment provided in the clinic, they had to send them out to the hospital for further evaluation. Therefore, the goal of the provider and asthma patients should be controlling the disruptive outcome of asthma by proper educ ation and following the guidelines and using AAP (Clark and Patridge, 2002). AAP is a written plan tailored for each asthmatic patient and is an important part of the National Heart, Blood and Lung Institutes National Asthma Education and Prevention Program (NAEPP, 2007). It helps the patient to understand the triggering factors, symptoms, treatment, self- manage the asthma symptoms and control exacerbation. It also helps them when to seek medical attention. Internal Evidence for the Need of an Asthma Action Plan The interview conducted by Nomy Thomas Jacob on December 5, 2018, with the provider stated that in the correctional center, 80% of the population suffers from asthma. Fifty percent were well controlled, but the rest are either not well controlled or poorly controlled. Both well controlled and poorly controlled inmates were not educated regarding asthma, triggering factors, treatment plans, and other management. Eighty percent of the inmates when outside the jail did not have insurance coverage, health access or a primary provider. Many inmates were illiterate, unemployed, had language barriers and belonged to a minority group. Most of the inmates were non-compliant with chronic care follow up and signed the refusal form provided by the correctional outpatient clinic as they were unaware of the condition and complications of asthma. The provider also stated that the all the clinicians were aware of the NEAPP guidelines, but they did not discuss regarding written asthma action plan due to several reasons (e.g. busy schedule and time limitations etc.). They provided the inmate asthmatic patients a brief verbal education regarding asthma and the treatments when they came to the clinic for acute or chronic care. External evidence to support the significance for the need of an Asthma Action Plan Evidence proves that the Asthma Action Plan of any form written, or pictorial are beneficial in improving the patients ability to self- manage the symptoms associated with asthma. AAP significantly influence the behaviors to control asthma. According to Akhter, Monkman, Vang, Pfeiffer (2017) in their study, there was an increase in asthma control in both children and adults through written AAP. The asthma control rate increased in adults from 28% to 58% when written AAP was used. The study conducted by Pur Ozyigit, Ozcelik, Ozcan Ciloglu, Erkan (2014) showed that ACT and SGRQ scores were improved by using AAP. The ACT scores at 1 month versus 2 months (22.44 vs 20.75,pâ⬠°=â⬠°0.034; 23.28 vs 21.81, p= 0.010) were higher in the interventional group than in the control group. SGRQ scores which assessed the HRQoL were improved in the interventional group (18.12) when compared to control group (23.96,pâ⬠°=â⬠°0.033). The study by Patel, Valerio, Sanders, Thomas, Clark (2 012) evaluated the relationship between AAP and behaviors in female to self-manage the asthma symptoms and satisfaction of care. Evidence-Based Recommendations for a practice change All the five studies included states that Asthma Action Plan is effective in self- managing and controlling asthma. Please see Appendix A Review and Synthesis of the Literature The overarching conclusion of the five studies emphasizes the effectiveness of the Asthma Action Plan in controlling asthma. Evidence support that Asthma Action Plan of any form plays a significant role in managing symptoms in patients. When one study emphasizes the effectiveness of a written AAP for educated patients another study highlights the benefits of pictorial AAP for illiterate patients. Two studies concluded that AAP is more effective in adults than in children. When one study illustrates the effect of AAP on ACT and SGRQ scores another study states that when AAP is not used it influenzas behaviors like asthma medication noncompliance, not using peak flow meter and failure to initiate a discussion with the provider regarding asthma symptoms and other concerns related to it, which affect their ability to manage the symptoms of asthma. Metric Criteria Asthma Control test which is an evidence-based reliable (test-retest reliability = 0.77) and valid self-assessment tool to measure asthma control are used to measure the outcome. It has a 5 question to be answered in the 4-week recall. It can be used to measure baseline, 4 weeks and post-intervention to evaluate how effective will be the Asthma Action Plan to control asthma. The chart of the asthmatic patients who visited the clinic needs to be reviewed to assess all completed (100%) ACT forms by the patient and AAP forms completed by the provider. This measures the provider compliance with Asthma Action Plan which in turn help the patient to manage the symptoms. Role of the Nurse Practitioners The DNP student is the project manager or team leader. The NP select the asthma champions for the team. The team leader organizes a monthly meeting where the champions meet and discuss regarding the topic. The nurse practitioners role as team leader help to guide other team members of the project. They educate team members regarding asthma, its management and their role in the project. The NP can instruct the registered nurse (asthma champion) to teach the patient regarding Asthma Control Test and encourage to fill the form prior to seeing the provider. They can also be instructed to make sure all the questions of ACT were attempted by the patient and the total scores were calculated. The NP get the score in order to plan for an AAP. Even though evidence state the effectiveness of asthma guidelines and AAP in the control of asthma exacerbation but still it is underused by providers in most of the settings (Mold et al., 2014) Nurse Practitioners (NP) are considered as the frontline ca regivers (Rance, 2011) Therefore, they play a significant role in the health care by identifying asthmatic patients at risk, assess and provide an effective treatment (Rance, 2011). The nurse practitioners play an important role in provider-patient partnership by synthesizing and translating the evidence, providing education, encouraging to use the evidence-based guidelines and AAP to control asthma exacerbations. NP establish a relationship with a patient by open communication, identify and address the patients and family concerns regarding the disease and its management. By using the AAP, they developed an individualized treatment goal. They also help the patients to adhere to the action plan, treatments, and self-monitoring. NP also provide a self-management education which significantly increases the patients health outcome and quality of life. NP can assign an office staff (team member) who can integrate AAP into the EMR. The most important role of NP is assessing the patient h ow well they can control asthma after the implementation of an asthma action plan.
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