Why did TV spread so fast around the world Essay

Why did TV spread so fast around the world - Essay Example This has seen the rise in demand of the television. Apart from major towns with good transmission signals, it has also made its mark in small towns and villages in Africa. All television is educative television; the question is its ability to educate (Todorovic pp.117). In recent years television has proved to have a great impact on the modern generation both positively and negatively. Curbing this, many television channels operators have come up with a viewer discretion options to give options of choices depending mostly on age. The reason behind this decision is that only modification of the television is the only lasting solution (Webb, pp.170). The fact that the license to air television can be accessed by a myriad of individuals, a massive global rise has been recorded. In many nations globally, individuals can own a television channel. This gives room for individual or organizations to venture business wise. The establishments of many channels play a major role in growing the television community. This is because every persons taste is represented. In addition to that, nations globally have given the freedom of ownership of televisions: one household can own more than one television set as long they can afford it. This makes television easily accessible. Statistics indicate that, more than 50% households globally own more than one set of television (Williams, pp.30). This promotes the growing culture of TVs. Another major reason behind the global widespread of the television is the development of lifestyle and business. In regard to lifestyle, this proves that the world is turning to an ignorant free society. TV is the new source of life skills, opportunities and services. An upgrade in lifestyle definitely needs the access of a television set. The urge of acquiring a modern lifestyle, and keeping in contact in the contemporary trends drives many people to acquire a set and this grows the culture even bigger. Business development

Poetry Analysis the famous blue raincoat by leonard cohen Essay

Poetry Analysis the famous blue raincoat by leonard cohen - Essay Example The title refers to the unnamed person’s raincoat. This becomes an important symbol in the song. The tearing at the shoulder of the raincoat suggests the passage of time, vulnerability, and also the inability perhaps to â€Å"shoulder† responsibilities like fidelity. Maurice Ratcliff in The Complete Guide to the Music of Leonard Cohen suggests that since Cohen has admitted that the title refers to a â€Å"Burberry† raincoat he owned himself, perhaps the letter is addressed to his own past self (Ratcliff 37). The interpretation of the other being Cohen himself is possible and suggests that writing or singing the letter is a kind of therapeutic act to redeem his own perhaps unjust behavior towards Jane. The form of the poem is roughly in the AABB rhyming scheme with minor variations. For instance, in the stanza following â€Å"Well I see Jane’s awake†, the rhyming scheme shifts to ABCB temporarily. There are also devices to indicate the epistolary nat ure of the poem: â€Å"Sincerely, L. Cohen† at the end and the vague mention of the date and time at the beginning, for instance. Most of the song appears to fall in the metrical pattern of amphibrach, although this varies also. The content of this popular song is obscure and open to interpretation.

Factors in NHS Clinical and Corporate Governance

Factors in NHS Clinical and Corporate Governance Introduction This paper presents a critical insight on the key aspects associated with the deployment of clinical and corporate governance on an organization wide basis. The key managerial elements associated with the management or change, organization wide practices and implementation of policy guidance is presented to the reader. 1.  Organization Wide awareness and governance Lee (1999)[1] argues that the â€Å"Clinical governance has been defined as ‘Corporate accountability for clinical performance†. This makes it clear that the accountability of a given NHS trust can be accomplished only through an organization wide approach to the quality management process in order to ensure that the organization is not only accountable to the process of achieving quality of service in healthcare services but also in the delivery of the processes from a managerial perspective. The implementation of the framework like Total Quality Management is deemed applicable as the TQM approach is primarily aimed to nurture the awareness of quality at all levels of an organization thus leveraging commitment and operational excellence among the staff members as argued by Onion (2000)[2]. The implementation of the TQM would also require the need to review and address the key operational and strategic elements of the overall NHS management process in the given organizat ion in order to effectively implement the quality assurance strategy devised (Onion, 2000). The following sections provide a overview on the key tasks associated with the implementation of the organization wide quality assurance and management process at the NHS trust where the clinical incident due to the mismanagement and inefficient policy control. 2. Quality Assurance The quality of service in the health services environment is a critical aspect associated with the management of the NHS hospitals and primary health care units attached to the each hospital (Savage, 2000[3]). This is not only due to the need for ensuring that the patients are diagnosed successfully and critical illness or transition to critical condition avoided through prompt treatment but also due to the need for effectively managing the process of allocating the resources to the necessary locations and training the medical staff in the use of the equipments alongside communication of changes to policies and procedures. This process of clinical governance is one of the critical elements to ensure that the funds spent on the healthcare services at NHS and other primary healthcare units are realised through providing prompt and valuable services to the patients as argued by Trubek et al (2008)[4]. The implementation of the quality assurance process at the primary health care clinic and the NHS hospital to which it is attached, it is necessary to review the existing policies and procedures of the entire NHS trust that manages the portfolio of hospitals and primary health care centres along with the two that were concerned with the incident. This is necessary in order to ensure consistency in the policies and procedures which can be accomplished through implementing a common procedure to replace those that are locally managed at the healthcare centres or hospitals. This is critical for the effectiveness in the quality assurance process because of the fact that the consistency in the service rendered is the first step to achieving quality of service as the healthcare staff across the organization at a given role will be aware of the tasks and the sequence in which they must be conducted in order to provide medical care to a patient. The process of quality assurance in an organization is mainly concerned with the policies and procedures that are implemented and th e extent to which they are adhered in order to deliver the effective service quality to the customers as argued by reference4. Hence it is necessary to ensure that there is consistency in the policies and procedures followed in order to successfully implement the quality assurance process at the NHS. In the light of the clinical incident, it is clear that the lack of policies and procedures for resuscitation of the patients along with the lack of awareness among the emergency response team on the operational procedures associated with the use of the recovery equipments justifies that the review of existing policies and enforcement of organization-wide policies and procedures for both emergency medical care and the day-to-day operations to achieve quality assurance. 3. Audit Control and Change Management The process of quality assurance can be achieve successfully only when the revision of the existing procedures and policies are in place (i.e.) the changes required at each hospital and attached health care units are achieved and practised effectively. This naturally leads to the need or change control and management of change in order to ensure that changes in the infrastructure, policies or procedure related changes specific to a given care unit or hospital is not only implemented but also managed as part of the NHS trust. This is necessary because of the fact that any emergency response team that is dispatched to the specific unit can be aware of the changes before hand and the relevant personnel with the necessary expertise arrive at the scene. This is evident in the case of the clinical incident where the emergency medical staff that arrived at the primary health care centre was not only aware of the procedures at the primary care unit but also lacked knowledge in operating the equipments at the facility. This process of change management and the audit control when managed in tandem centrally by the NHS trust, can help provide the relevant information that is up-to-date on the paramedic or emergency staff’s handheld devices thus helping the staff overcome the element of surprise due to malfunctioning or outmoded equipments etc., The audit control process in the clinical environment as argued by Onion (2000) is deemed to become effective when the changes to the policies and procedures are incorporated as changes to the then implemented procedures and policies along with upgrades to any equipment at a given healthcare unit will be logged and monitored across the board. This process will also help in devising the training plan for the medical staff. As the emergency medical staff that arrived at the primary healthcare unit was unable to operate the equipments available at the facility because of the lack of knowledge, this makes it clear that the training is a critical part of the change management process. The audit control when enforced alongside the change management process will help achieve the desired result of training the appropriate medical staff and emergency response staff members to deliver the desired health care service at the hospitals and the primary healthcare units that are attached to the hos pital. The major barriers to the change management is the funding and the availability of resources as the implementation of a quality assurance process with consistency in the equipments being used across the hospitals and attached healthcare units will require commitment of resources and funds to procurement of the infrastructure as well as training of the staff as argued by Onion (2000). It is also critical to appreciate the fact that not only the change control, but also the need to realise sustainable return on the investment in specific piece of hardware at a given healthcare unit naturally requires the need to ensure that the change process to achieve quality assurance does not affect the existing investments at the facilities managed b the NHS trust. This makes it clear that the effective delivery of the services at the NHS must be accomplished through introducing the change management process as part of the infrastructure upgrades being conducted but ensure that the policies and pr ocedures for the emergency response and day-to-day medical operations are implemented. As the change management and audit control are expected to govern the managerial elements of the operational and strategic business of the NHS, the aforementioned must be managed effectively. This process itself will help provide the relevant information to the emergency staff in order to effectively respond to a given medical emergency. The aforementioned also includes the process and procedure associated with the dispatch of the emergency medical staff as the failure of the dispatch team to send the staff to the correct location in the first instance resulted in delays to the medical care given to the patient at the primary healthcare unit. The setting of the policies and their implementation can be achieved successfully once they are reviewed and the senior management along with the operational staff are in agreement with the policies/procedures prior to their implementation. This is necessary because of the need to ensure that the staff members are aware of their duties in the light of the new policy thus avoiding potential errors associated with the dispatch of emergency medical staff to the wrong location, lack of training to the staff member at any given facility as well as sending emergency response medical personnel who do not have the relevant training in operating the equipments at the given facility. This makes it clear that the implementation of an organization wide policy would leave the paramedic to be concerned with the equipments at the facility alone. This is because the former when standardised will be the same across the facilities at the given NHS trust thus overcoming the barrier of lack of informati on or misinformation. 4. Clinical Failures and Lessons Learned The case of clinical governance at Greater Manchester NHS Trust (Clinical Governance Support Team[5]) is a classical example for this case where the clinical governance implementation changed the attitude of the staff towards incident reporting and clinical failures. The positive approach to handling the critical incidents through avoiding disciplinary on the staff involved and encouraging the process of taking collective responsibility to the case justifies that the clinical governance is a major element that attributes to the effective use of the lessons learned process and knowledge transfer across the organization in the NHS trusts of the UK. The change in the attitude of the staff towards reporting incidents with the outlook of realizing benefits to the organization through the information gathered in the critical incident in order to help address policy related issues and fill the gaps in the expertise and training required at the Greater Manchester NHS Trust further justifies that personnel management at the NHS trust is the major element that must be addressed as part of the policy and procedure review to implement quality assurance and TQM within a given NHS trust. In case of the primary healthcare unit incident, it is clear that the implementation of the aforementioned would not only encourage the staff to learn from the incident but also avoid potential incidents in future through drafting the best practices that can be implemented organization wide to achieve clinical governance. 5. Conclusion From the research presented above, it is clear that the review of the existing policies and procedures must be conducted at the NHS trust on a organization wide basis in order to revise and implemented the policies along with audit control change management to ensure best practices are devised and adhered to effectively. Footnotes [1] Lee, R. (1999), Clinical governance and risk management, Journal of the Medical Defence Union 15 (2) [2] Savage, J. (2000), The culture of culture in National Health Service policy implementation, Nursing Inquiry 7 (4) [3] Carl W. R. Onion (2000), Principles to govern clinical governance, Journal of Evaluation in Clinical Practice 6 (4) [4] L. G. Trubek, Joseph V Rees, A. Bryce Hoflund, Marybeth Farquhar and Carol A Heimer (2008), Health care and new governance: The quest for effective regulation, Regulation Governance 2 (1) [5] Clinical Governance Support Team (2002/2003), Communicating the need for change: getting better following untoward incidents. Online Resource [URL: www.cgsupport.nhs.uk]

Methamphetamine as a Sleepless Dream or Addictive Nightmare Essay

Methamphetamine as a Sleepless Dream or Addictive Nightmare Methamphetamine has reclaimed a place in the lexicon of "party" drugs. Hailed by nocturnal adventurers, condemned by raver idealists, is speed a sleepless dream or an addictive nightmare? Here at the end of the millennium, the pace of modern life seems fleeting -- a whirl of minutes, hours and days. In dealing with the changes, humans have equipped themselves with the tools to move faster, more efficiently. At the same time a dependence for the marketing, high-speed transportation and pharmacology of this modern age has evolved. In a race to outdo ourselves, we have moved dangerously toward the fine line between extinction and evolution. Therefore, the human capacity to handle the velocity becomes a fragile balance. Our generation (see Gen X, 20-somethings) could be considered the sleepless generation. An age of society's children weaned on the ideals of high-speed communication and accelerated culture has prided itself in mastering many of the facets of human existence -- doing more, sleeping less. The machines of this age have in a way enabled us to create a 24-hour lifestyle. We have pushed the limits of the modern world further -- ATMs, high-speed modems, smart bombs and bullet trains. However, the limitations of human existence, like sleep, may still provide the stumbling block for infinite realization. That is, without chemical aid. In many ways, capitalism fuels the idea. Our society is based upon the mass consumption of these substances. Cultural ideals, while seemingly benevolent as "Have a Coke and a smile" have sold the link to chemical substances like caffeine and nicotine to "the good life." Today, stimulants are the bedrock for consumer culture. For our generation, this appeal was heightened by raising the stakes in the '80s on what it meant to have fun. Late night clubs, high speed music and 24-hour lifestyles brought the specter of drugs to the fold as a necessity for being able to attain more. Leaps away from the psychedelics of the '60s, in the '80s these stimulant drugs became tools -- utilitarian devices to gain wealth, intelligence and prestige. Sleep became a barrier for success. Dreams were the frivolous luxuries of childhood. Raves, founded equally in the post-conservative underground late-'80s and the chaotic early-'90s, are pa... ..., however, by methamphetamine's nature -- as a refined, concentrated addictive substance -- it only perpetuates the cycle for needing more. There is very little factual information about amphetamines and their dangers available to the lay person. Research on the subject, aside from medical journals, is virtually nill. There is however a great deal of dangerous propaganda -- hear-say, lies, rumors. Misinformation sometimes is more dangerous than no information and real answers are only found through communication. Many other drugs have been part of the rave community over the years -- nitrous oxide, Special K (ketamine) and especially ecstasy (MDMA) but none have exhibited the burn-out or addiction rate associated with methamphetamine. While meth (or any drug) is an inert substance that we cannot attribute blame to, by its nature it has raised the question "Are we really built for speed?" It seems that the human body, while naturally resilient to much self-inflicted abuse, may not be a reliable container for the soul at high speeds. Methamphetamine may have the ability to chemically fuel the ride, physically it may just prove the limitations for human society.

How does Stevenson present conflict between good and evil in Dr. Jekyll and Mr. Hyde? Essay

Robert Louis Stevenson was born November 13,1850, in Edinburgh, Scotland. He had heath problems. Stevenson attended Edinburgh university as a science student, because his parents wanted him to be a Civil engineer. However, Robert had other plans. He wanted to become a writer. This made his parent upset. In the late 19th century, Robert Louis Stevenson wrote the novella â€Å"Dr. Jekyll and Mr. Hyde.† The title of the book could mean â€Å"Je† which in French means â€Å"I† and â€Å"Kyll† which could also be written as â€Å"kill†. The title meaning is â€Å"I kill and hide†, this novella has a powerful title and it relates much about the novella. This is because when Jekyll turns into Hyde he has the chance to express the bad side of himself. Forexample when Hyde kills Sir Danvers Carew. In the book Sir Danvers was killed for no reason. This means that when Jekyll turns into Hyde he is expressing his bad side. The novella was set in the Victorian London. In that time people were divided into class(upper and lower class). However, they also had the hypocritical believe, this means that they strongly believe in God. For that reason when Jekyll turned into Hyde it meant that Jekyll was playing with God’s creation. In the novella, Stevenson present the conflict between good and Evil in many different ways. He relates the book to him self as he claims † Jekyll had more than a father’s interest; Hyde had more than a son’s indifference†, this quote means that Jekyll cared much about things but Hyde however lack interest and care. This quote relates to the conflict that happened between him and his dad. The novella has numerous of narratives to build up suspense. Stevenson uses, elaborate description, dialogue, multiple narrators and the novella starts with third person’s narrator, who is Utterson. In the last two chapters however, which are Lanyon and Jekyll’s reports their experience from their own point of view. The narrator knows most things before we do. We know this when it states â€Å"a year later† at the start of a chapter, this quote shows that we don’t know what happened and it jumps a whole year of information. Meaning that it gives us very little information. It build suspense, and creates a gothic atmosphere. The novella follows Utterson’s point of view; this make the book more interesting. He makes the novella interesting because all the event that he faces that is the novella, that is the event we face as well. It also builds and mystery and leads us to wrong conclusion, and delays our understanding. Utterson is also the character in the novella with the ego, because he always tries to understand Jekyll’s behaviour. Jekyll thinks that everyone has two sides, which are the good and the evil. Therefore he tries to play God by wanting to separate the two from each other. As a doctor every one expect you to be a good person. However, Dr. Jekyll wanted to experience the bad side of himself. When Jekyll says â€Å"though so profound a double-dealer†, this quote confess to us that he was a â€Å"double-dealer† meaning that he was Hyde. This also shows that Jekyll wears a mask. Stevenson uses the weather as a symbol to represent the atmosphere in the book, â€Å"a fog rolled over the city†. the quote uses the word â€Å"fog† , this shows that the city is hiding things and it is very secretive because it is very difficult to see through fog, which is the clouds of the truth. As readers when we read this we get the impression that the city has a lot of unravelled secrets. Louis also uses windows and doors to represent a persons character, â€Å"a blind forehead of discoloured wall on the upper†, the quote suggest that Hyde’s house was not well looked after. It continues with â€Å"blistered and distained†, this reflects on the windows, that they are not cleaned. This reflect to Hyde’s character as he was not a clean person and did things that are not clean. This quote also reflect back to the Victorian, as they use to judge people by their outer appearance. This meant that if you were an ugly person you were evil. We experience this when Utterson first saw Hyde and when he said he was † so ugly that it brought out the sweat on me like running.†, This quote admit to us readers that Hyde was a very ugly person. The quote also uses the word â€Å"running†, this word is very strong in the quote because it is the word that exaggerates how ugly Hyde was. In addition he did not just wanted to run away from Hyde because he was ugly but because of his believe Hyde was evil too. As readers when we read this it makes us think back to the title of the novella, â€Å"Dr. Jekyll and Mr. Hyde†, a Doctor is seems to be a nice and innocent person; on the other hand, Mr. Hyde is a person that according to his name is someone who hides, he someone who does not want to bee seen. In the novella Hyde enters the house from the back door to Jekyll house, and Jekyll enters the house from the front door, â€Å"two doors from one corner†, this quote shows that if people looked at Jekyll’s house it is just one house but it has two doors. As a reader when we read this it leaves us in confusion, because we don’t know that if Jekyll’s house was made like how it is because he always had in mind that he was going to separate the god from evil. † The door, which was equipped with neither bell nor knocker†, this quote describe Hyde’s personality because he does not want to be seen so his door was not equipped. In addition this could mean that the back door which lead to the lab could represent hell and the front door which lead to the quite part of the house could represent heaven. This is because in hell that is where bad things happens and Hyde’s entrance to the house is the lab that is where Jekyll makes the dose for himself to turn to Hyde, who is the evil side of Jekyll. Nevertheless, when Jekyll enters the house it is the normal and peaceful entrance of the house. Jekyll has an addiction to Hyde, â€Å"my devil had long being caged, he came out roaring†, this quote suggest Jekyll’s addiction to Hyde. When the quote states â€Å"he came out roaring†, this part of the quote uses anima imagery and it also relates to people who take drugs, alcohol, cigarettes when they take all these stuff his body ask for more and more just like Jekyll’s body ask for more. The weather, most of the times sets the mood in the book, when Hyde became a murderer, Stevenson used the moon along with clouds to represent the atmosphere, â€Å"†¦was brilliantly lit by the full moon†, this quote reflect to the genre of the book which is gothic horror. This is because when you what watch horror movies it has full moon’s most of the times. At the end of the novella when Jekyll makes his statement, he confess about the idea of him playing the role of God, by separating the good form the evil. When Jekyll first turns into Hyde he feels happy and enjoys the feeling we now this when he says â€Å"at the first breath of this new life, to be more wicked, tenfold more wicked† , this quote shows that Jekyll enjoyed the feeling and the thinks he did when he was â€Å"on drugs† . The quote also suggest that it was Jekyll’s intention to turn into Hyde. The book is still relevant today as many doctors and scientist are trying to play God. They do this with GM foods, cloning, steam cells and embryos. Personally as a reader I think that Jekyll had no right to play God especially in his time when people where very religious. If Jekyll really wanted to show people that he had two sides he should have just shown it , instead of transforming himself into a different character. This also shows that Jekyll had a strong felling about how people thought about him as a Doctor. Since no one is perfect Jekyll should have act as a normal human like anyone else and shown his bad side when he needed to.

Critique Nursing Journal Article

Complications from, and economic costs associated with diabetes are on the rise. The concern is that this global health epidemic is only expected to worsen in the coming decades. One quantitative research study aims to improve patient outcomes specifically related to proper control of blood glucose level, by linking patient outcomes with health literacy and patient trust. A quantitative study consisting of a convenience sample of 102 subjects from two urban health care centers was used. Patient demographics, socioeconomic status, and diabetes related knowledge, and depression were measured. The results of this study are mixed in supporting the hypothesis that lower health literacy directly impacts glycemic control. The 2010 journal article titled, â€Å"Impact of health literacy and patient trust on glycemic control in urban USA population† from Nursing Health and Sciences, hypothesizes a direct relationship between a patient’s overall health literacy and the ability to maintain glycemic control. Also read this  Critique of Stuff Is Not Salvation The study’s intent is to examine questions related to health literacy and a patient’s trust in their healthcare provider to make a connection to how well the subjects managed glycemic control. Questions related to potential depression are also relevant. Author, Josephine M. Mancuso, PhD, ANP-BC from Marquette University, has published articles in the following nursing journals: Journal Of Nursing Care Quality, Journal Of Professional Nursing: Official Journal Of The American Association Of Colleges Of Nursing, Western Journal Of Nursing Research, and Nursing & Health Sciences. In this research study, the author seeks to examine correlation between dependent and independent variables. The suspected purpose is often to generate hypotheses that can be tested in experimental research. In her study, Mancuso used the following set of eligibility criterion: subjects were ? 18 years of age, fluent in English, confirmed diabetes type 1 or 2, HbA1c within 6 months of the study, and received treatment for diabetes at least twice in the previous year. Using the above criteria, 102 subjects total ere selected from two different urban healthcare clinics (Mancuso, 2010). This study aims to draw correlation between glycemic control (dependent variable) and overall health literacy and patient trust (independent variables). According to Polit & Beck, a dependent variable is what is measured in an experiment and what is affected during the experiment. The dependent variable responds to the independent variable. It is called â€Å"dependent† because it cannot exist wit hout the independent variable. An independent variable can be controlled and manipulated (Polit & Beck, 2010). Strength of this research is the highlighting positive effects of proper glycemic control on overall health. The author states, â€Å"Control of blood glucose is a central outcome of diabetes management† (2010). This suggests that with proper maintenance of blood glucose levels and by lowering the HbA1c by 1%, patients can extend their life expectancy 5-8 years with lowered risks of eye, kidney, and peripheral nerve complications (2010). Strength is also found in validation of statistical information from the American Diabetes Association. While conducting the study, Mancuso noted that 35% of participants achieved the desired HbA1c of ?7% (2010). She cites the ADA reporting that, â€Å"37% of adults diagnosed with diabetes in the USA achieve glycemic control† (Mancuso, 2010). It is important for all individuals with diabetes to be mindful of blood glucose levels and HbA1c levels to reduce potential life-limiting complications of diabetes. Finally, strength in the research is found in the correlation of a person’s level of depression and trust in healthcare providers. Mancuso states, â€Å"The current ?ndings are congruent with and add to the other studies that evaluated the in?uence of patient trust and depression on glycemic control† (2010). This is important to healthcare professionals in part because communication can be hindered if depression is present. Recognizing depression and opening lines of communication is crucial in establishing patient trust (2010). When a patient trusts the health care professional, they will likely be more open to discussing symptoms, adherence to medication management, and non-compliance with health care regimen. With this information, the health care professional can create a plan of care that is individualized and meets the unique learning style needs of every patient. Improving patient trust will improve patient outcomes. Limiting characteristics that potentially threaten the validity of the results include a relatively small sample size of a homogenous population, potential cultural bias and lack of congruent variables. If a sample size is too small, it may be difficult to find any significance in the relationship between the variables. Also, a small sample size may not provide a representative distribution of the population being studied (Mancuso, 2010). In addition, the study’s objective and design were incongruent. Lack of a control group threatens internal validity because it was not clear if any benefits â€Å"observed† accurately reflected correlation between dependent and independent variables. Perhaps with this low income demographic, simply having access to a physician would have been sufficient to foster improved patient outcomes. In addition, it is not clear how or why these urban health care centers were selected. Whether or not there is any affiliation bias remains uncertain. External validity is questioned because it was not clear to whom the results would benefit. Potential bias is evidenced in the following statement by Mancuso, â€Å"The use of such similar samples that capture the working poor is rather generalized in its interpretations. This could lead to potential bias as socioeconomic and demographic information was collected† (2010). Additionally, patient trust develops from an initial vulnerability that eventually results in a reliance on the provider to care for their interests and needs. If a person is feeling intimidated or their current health literacy level prevents them from fully understanding information given, faulty findings may be demonstrated in this quantitative study. Further limitation is discovered in the lack of identified interventions that increased health literacy and patient trust. Whether an intervention is effective, on whom it is effective, how much benefit it produces and whether or not it is associated with negative outcomes should be addressed. Clearly, this study had many weaknesses that limit its value and the applicability of results. It is not clear why the study was not labeled simply as an exploratory qualitative study. Possibly further research exists on the topic. Ultimately, the convenience sample of 102 patients with diabetes demonstrated that patient trust and patient depression was significant. In addition, there was a significant positive correlation between a test subject’s lack of knowledge of diabetes management and low health literacy (Mancuso, 2010). Discovery of the correlation between an increase in health literacy and an increase in diabetes knowledge was found (2010). A positive correlation was found between a patient’s HbA1c level and that patient suffering from depression. A negative correlation was found between patient trust and HbA1c. As patient trust increased, HbA1c decreased (Mancuso, 2010). These results indicate that promotion of the patient–provider relationship, adequate depression screening in individuals with diabetes, as well as needed exploration of new strategies for diabetes education are much needed interventions in the goal of glycemic control. According to the study, the majority of participants who demonstrated poor glycemic control conversely demonstrated health literacy. It is not known how or why some individuals with satisfactory health literacy revealed poor glycemic control. Because of this, the study fails to connect health literacy and glycemic control in the test subjects (Mancuso, 2010). The significant variables related to proper glycemic control were patient trust and depression (Mancuso, 2010). Brega,et al state, â€Å"results indicated that diabetes-related knowledge is a key mediator of the relationship between health literacy and glycemic control and highlighted the important association of diabetes knowledge with health behavior† (2012). Similarly, a study by Coffman, Norton & Beene, acknowledged a knowledge deficiency related to diabetes. This lack of knowledge when coupled with low health literacy created obstacles to health care and prevented fitting interventions (2012). The importance of the direction of this study is most relevant. The author attempts to address barriers to glycemic control that lead to complications from diabetes. Disease complications and rising costs associated with diabetes, is likened to a public health crisis that is projected to only get worse. The improvement of diabetes related outcomes could potentially positively impact all health care system. Future research in all areas of diabetic monitoring and teaching will be needed to advance the structure of diabetes education. The WHO estimates that 347 million people worldwide have diabetes. The WHO projects that diabetes related deaths will double between 2005 and 2030 (2013). No longer is diabetes associated with the gluttonous rich. The WHO states, â€Å"More than 80% of people with diabetes live in low and middle-income countries† (WHO, 2013). Diabetes has become a disease of poverty in developed countries. Incidents of diabetes is increasing most rapidly in developing countries, in theory, because industrialization and urbanization have led to a decrease in time to prepare a nutritious meal and costs associated with fresh produce is prohibitive. Preservation of functional status and improvement in quality of life can be achieved with proper management of diabetes through adequate glycemic control. Depression and any correlation with patient trust of healthcare providers will need further investigation in other patient demographics. As we struggle to combat diabetes, ongoing encouragement of individuals to change their lifestyle choices may be the best way to proceed.