Interview guide Introduction

This interview takes place between a psychologist and a client seeking assistance for his continuous headaches and sleeping challenges. It is good to note that sleeping deficiency affects someone not only at night but also during the day; hence, useful to converse with a client on sleep patterns at night and the resulting impact of insufficient sleep during the day. One of the efficient ways through which one can acquire knowledge about sleep deficiency is walking the client through his or her daily experiences. The sole purpose of this interview guide is to gather information, which will in turn help in solving the sleeping challenge and find a sustainable solution that would see the client live a fulfilled life with ease. More so, the information gathered will assist in raising awareness on the issues pertaining headaches and sleep deficiency.

Purpose of the interview

 The purpose of the interview centers on collecting information on sleep deficiency and headaches, formulate an effective treatment plan for the client and walk him or her through various home remedies and lifestyle changes that will help him or her live a better life.

Structure of the interview

When formulating interview question there are three general elements one needs to consider: inquiring on evidence that will aid in the examination of the predicament closer than before, know the manner in which information will assist the psychologist deal with the predicament and later inform or guide in making decision based on the data gathered (Johns, & Gorrick, 2016). On the other hand, an interview should refrain from asking irrelevant question that will not directly shed more light on the situation. In this particular context, the interview takes the form of an in-depth formatted question in need of solid answers, for example, what is your early morning  routine? These types of questions tend to reveal the veil behind the problem and cover vast areas, which helps in finding a solution for the client.

 In addition the interview will contain questions related to sleep deficiency and will require keen answers (Johns, & Gorrick, 2016). Hence, the objectives of the interview will come to fruition with the quality and accurate answers alone. Therefore, the interview structure relies on how well the person corporates with the interviewer.  At the beginning of the interview, the questions focus on disclosing personal information about the client. For example, what is your age? Sex, family background and other pertinent but personal question within the grasp of interviewer. The background questions try to find out or are designed to confirm the origin of the problem. For example, does any of your family member experience sleeping challenges?

 Language of the interview

Communication plays a crucial role during an interview, which facilitates coordination among people involved in the interview and ensures flow of accurate information from the client to the psychiatrist defining treatment plans and new development during diagnosis. More so, in any interview setting, interviewers depend on the information given to formulate their course of action (Stoker et.al, 2016). Furthermore, the nature of an interview and its underlying reasons normally assessed through effective questioning and ability to form reasonable opinions that later assist in attaining the objectives of the interview, in this case diagnostic information. In summary, interviews critically investigate the negative life routines on the daily lives of the people and management of personal activities and mechanisms that may later lead to an imbalance and cause sleep deficiency. In addition, the interview structure helps look into communication tactics required to make a client open up more about their situation.

In order to convey facts and a solid treatment plan, it is compulsory for the interviewer to frequently access personal details at all times and confirm with the client. Partners and other people of interest may need information about progress of the situation after the interview and it is up to the psychologist to unveil the information from a neutral perspective (Stoker et.al, 2016). Examples of information a psychologist must have are underlying reasons for the sleep deficiency, conditions that causes headaches, client’s personal needs, and construct a timeline pattern for the sleep condition. Therefore, based on past researches, interviews help the both parties adhere to objectives mitigate misunderstanding or misinformation and interruptions, which may lead to failure of the project. From my standpoint, a team managing a project may comprise of people from various backgrounds hence communication streamlines processes, actionable causes and levels every team players’ understanding so that no one remains behind schedule.

 How to obtain headache and sleep deficiency symptoms

The flow of the interview, reaction of the client to each question will unveil if the client has the right question (Stoker et.al, 2016). Furthermore, flexibility while questioning the client builds up concepts and understandings on the dynamic changes that sleep deficiencies causes on their bodies. Consequently, the information help the psychologist identify the right symptoms as stated by the client.

Communication Management and Ensuring the client participate fully in the interview

In respect to interactions during an interview, a client can speak more if the psychologist allows it (Kohansieh, & Makaryus, 2015). On the other hand, information should be consistent and builds up to a strategic plan within falling along the lines of sleep deficiency and headaches. In the end, it boils down to socialization and integration between the psychologist and the client that will make the interview move forward without any query. Each person should share their opinion and prevent dominance from either men or women.

Based on past journal and resonating during any interview, communication is the only means through which psychologists can support a client mission and vision (Kohansieh, & Makaryus, 2015). It is good to note that visionary pertains questioning style and elements of the strategy and effective communication. More so, clients must be collaborative and willing to find a solution to their problems.

 Management of the interview

Communication management builds up concepts and later converts information into duties and defined works (Kohansieh, & Makaryus, 2015). Consequently, the information is no longer something abstract but an element utilizable throughout the interview. In other words, communication management transfer knowledge and demonstrates the mannerism of alleviating sleep deficiency problems into achievable tasks.

There are various communication styles. The first is assertive where one exerts total control over others but not in a dictatorial manner. The guy may try to inspire others to some extent. This type of interview style can succeed in closed environments that need output only and where the roles are repetitive (Ghobadi, & Mathiassen, 2016). The only advantage of assertive is that it gives out good results. However, it does not inspire loyalty, openness, and creativity sustainably. The second style is active and manipulative where psychologist needs charisma and an effective approach to give out results. Most used in easy surroundings. This style is a hands-on style that encourages the spirit of teamwork and needs dedicated people to carry out the duties.

Stimulating the client to think freely during the interview

The capability to think or integrate thoughts makes the team to suppress unnecessary divergent thoughts and move as one force to achieve one goal and beat the time limit. This can only occur due to intentional desire to achieve the main goal (Ghobadi, & Mathiassen, 2016).Communication management boils down to relationships and attitude of group members among themselves. The relationships and reaction toward roles and duty affect behavior, which in turn metamorphoses into the group results. Relationship between client and psychologist affects work culture. Efficient communication forms good relationship shapes work ethic and input within a group. Therefore, effectiveness within a group and output is molded by the behavior, reaction, and attitudes of the client.

In summary High, stake conversations such as interviews need a positive attitude and a courageous heart to tackle the issue at hand rather than brush over the situation with sugarcoated words. During interview conversations, an experienced communicator considers his or her objectives especially when the situation spirals out of hand. Simply put objectives of a crucial conversation consequently lead to better outcomes for the project and conclusive decision-making while building teams, which pushes the objectives of the project forward. The scope of an interview that would define and give direction to the entire objective had to do with generating information from the client that later corresponds to headache and sleep deficiency. Tailoring the needs according to what they disclosed and not speculation would cater for any future challenges that arose.

References

 Ghobadi, S., & Mathiassen, L. (2016). Perceived barriers to effective knowledge sharing in agile software teams. Information Systems Journal, 26(2), 95-125.

Johns, R. E., & Gorrick, J. (2016). Exploring the behavioural options of exit and voice in the exit interview process. International Journal of Employment Studies.

Kohansieh, M., & Makaryus, A. N. (2015). Sleep deficiency and deprivation leading to cardiovascular disease. International journal of hypertension, 2015.

Stoker, M., Lindsay, P., Butt, J., Bawden, M., & Maynard, I. (2016). Elite coaches' experiences of creating pressure training environments for performance enhancement. International Journal of Sport Pyschology.

The Effects of Globalization on the Level of Hospitality in Different Countries across the World

Introduction and Research Significance

Globalization is the current way of life, which is characterized by the world becoming smaller. A major consequence of the phenomenon is that many countries are continuously becoming more dependent on one another economically. The need to remain competitive economically in a more open and integrated world economy has seen countries their level of hospitality, especially through the tourism and hospitality industry. Hospitality has become an important part of business interests across the world with different countries showing the need to develop or diversify their activities.  With the onset of globalization, hospitality became one of the spheres where business and social cross-continental shifts could be observed due to its innate global nature. The research on the globalization has affected the hospitality level across the world is important for a wide understanding of the growth and change in the hospitality and tourism industry.  Understanding the global orientation of hospitality among countries is also important in predicting the future possible outcome of the industry.

Critical Reflection on the Existing Literature

Globalization has been driven by international politics, social aspects, economic changes including markets, firm strategy, capital and trade flows. It is a phenomenon that can be explained through global citizenship social theory especially in relation to cognition. The theory relates to the need for knowledge acquisition, critically thinking and understanding of local, national, regional, and global issues and interdependency of various populations and countries (Pittman, 2017, 3).  From economic perspective, globalization relates to increasing level of interdependency of production and the market in different countries, and also, media communication that provide information in for of a trade good (Barnett & Sikkink, 2008,6).  The globalization process has brought about creation of international tourism market.

The tourism markets are expected to have fair competition irrespective of the nation of origin, and destinations normally function interactively (Sheel, A., 2007, 7). In order to remain competitive, countries had to improve their level of hospitality in order to attract investors and customers. The improving level of hospitality is indicated by the quality of services provided to customers, and an enabling environment that foreigners to visit specific countries. Hospitality was perceived to have multiplier effect, so that a boom in the hospitality industry leads to opportunities for other kinds of businesses (Zaitseva et al.2016, 7181). The flow of foreign investment also increased when firms improved their level of hospitality.

Theoretical Framework

It is important to have an overall understanding of how the onset of globalization lead to increased level of hospitality in different countries in the world.  Globalization involves internationalization of markets, expansion of economies, and delivery of goods and services in the foreign markets. Over the years hospitality became an important aspect of business in countries, which was seen in their desire in developing and diversifying their activities. Globalization increased the level of competition, and countries endeavored to increase the hosting service level, and eventual network of business organization within the hospitality industry (Bang & Markeset, 2011, 238). The globalization process impacted the organizational capital of services industries including hotels through the emergency of enhanced management technologies, organizational culture, leadership, tools of management.

The globalization process is the independent variable, while the level of hospitality is the dependent variable. The expansion of markets due to full exploitation of local markets, internalization of economies, and increased competition contributed to the notion that enhancing the hospitality level of a country would have multiplier effect. The major assumption is that countries viewed hospitality as the major sphere of business, which would affect the entire economy.

Research Questions or Hypotheses

Research Questions  

• What are the factors that led to the process of globalization?
• To what extent does the level of hospitality influence the business environment of countries?
• How did globalization influence the level of hospitality in countries across the world?
• Were the effects of globalization on hospitality experienced across the entire world?

Research hypothesis

• The need for business expansion to increase growth and profitability, improved technology, reduced barriers to facilitate global trade and improved infrastructure specifically transport systems largely contributed to the process of globalization across the world.
• Hospitality has been viewed as a major sphere of business so that an increase in the level of hospitality is associated with a multiplier effect, leading to growth in other businesses.
• Countries understood that to remain competitive in a globalized, and thus, open economy, they had to enhance their hospitability.

The effect of globalization was felt by almost all countries, except the ones that continued to enforce barriers to external trade.

Research objectives

The research aims at achieving the following objectives:

• Investigating the effects of globalization on the level of hospitality across the world; the aim is to have an insight on the extent to which countries become hospitable after the onset of globalization process
• To analyse the factors that drove the process of globalization and why hospitality became a sphere of business in countries; the essence is to understand how these factors  informed countries to embrace hospitality as a competitive aspect for their economies
• To examine whether the impacts of globalization were felt in the entire world; it includes examining whether there are countries that remained unaffected by the process.

Research Methods

 The data needed for this research will be gathered from different published research journals and articles touching on globalization and its effect on hospitality. Since this research is qualitative, the aim is to carry out a study that offers in-depth insight and hence, the effect of globalization on countries’ level of hospitality.  The data collection technique will involve examining the existing data from various documents and records.  The technique entails examining various information and research from databases since relating to the globalization, growth in hospitality industry, and how the two interconnect. The data collected will involve how the hospitality of chosen countries changed due to the phenomena. Hence, by search different data bases, it will be possible to gather sufficient information for the completion of this study.

The sampling method to be used in this case is typical case sampling. Typical case sampling involves a purposive sampling method applied when one is interested in the normality of settings, contexts or events (Palinkas et al. 2015, 536). In this case, “typical” implies that study will involve the capacity to compare or contrast findings from a research by use of “typical case sampling” with other related samples (BARAN & JONES, 2016, 118). With this sampling technique, the sample focuses on data related to the level of hospitality of some selected countries, and viewing the sample as demonstrating other similar samples.  Other than the research article and journey available through online platform, any report or records will be accessed by seeking permission from relevant bodies.

Research Methodology

The research will apply qualitative data analysis, which entails descriptive data that relates to concepts on globalization and hospitality. The analysis will provide an understanding of the research objectives through a revelation of themes and patterns of the information collected.  The analysis will aim at identifying common themes, relationships and patterns within the sample of the data collected. The analysis will also employ both primary and secondary comparison of data, where findings of the documented information will be compared with the literature review findings. The differences between the primary and secondary data and literature review will also be discussed in the data analysis.  The analysis will also involve a discussion about any aspects of the effect of globalization on level of hospitality that will not be mentioned in the available studies, even though they should be mentioned.  The analysis will also involve linking the research findings to the research objectives and hypothesis.

Ethical Considerations

In research, ethical consideration is very important and involves various standards of conduct expected from the researcher. Ethical standards help in preventing against falsification or fabrication of data and hence, enhance the pursuit of truthful knowledge as the major aim of the research (KULAKOWSKI & CHRONISTER, 2006, 525). A major ethical consideration is adherence of laws and that govern the research process including acknowledging and protection researchers of documents used. Also, the research will ensure there is no fabrication or falsification of data. In addition, care will be taken to prevent presenting other researchers’ work or taking credit for other people’s work through failure to cite relevant sources.

Potential Contribution to Knowledge (and Practice, for Professional Doctorates)

Essentially, the research will help professionals in developing and polishing their research skills. It will enable them conduct substantial research, while reflecting upon individual’s practice. The paper follows the expected research standards and guidelines, and relevant principles. The research can be viewed as ethnographic, where the goal is to explore the degree to which the researcher who is undertaking the professional doctorate improved in terms of knowledge. The completion of the research on globalization and its effect on hospitality will have impacted an individual’s level of understanding, and their professional development and practice. It is expected that the analysis of the findings will help the student to have a personal reflection on how their professional development will be altered or impacted by the research.

With increased understanding of how the globalization process affected hospitality, the student can pursue their professional career on the basis of greater insight in their relevant field.  Moreover, the research can help the student in improving from mere learners to researchers, having understood the framework of the research and its significance in improving the level of knowledge. Hence, undertaking the research and acquiring the required qualification is an important aspect for the students. It empowers the individuals and opens up various opportunities in the field of research and hence, enhances their competitiveness. The completion of professional doctorate involves development of one’s knowledge, their understanding, and improved writing skill, presenting by way of research and exploring practice.

Research Plan

The plan will help in allocating sufficient time for every task that has to be completed. The resources needed in the completion of various tasks include enough hours, the various databases from which data will be collected.  Access to some of the databases will be booked in advance.

Alignment of Proposed Research with Research Interests of The Faculty of Business

The research focuses on different areas that the Faculty of business emphasizes including international business management, consumer behavior, marketing, business strategy, and leadership. The research areas of the Business Faculty aim at providing the PhD students with access to a wide range of expertise. The research interests also cut across a number of disciplines, and working with the required support of its high quality faculty. The research on effect of globalization on the level of hospitality across the world touch on a wide range of disciplines including micro and macroeconomics , strategic management , marketing management and international relations. The aforesaid are the major aspects that have greatly contributed to the improvement of the level of hospitality for most countries in the world. The concepts of business environment and macro-economics are important in this research because attempt to explain the changes in the world economics.  This research aligns with the faculty need to equip the leaners with enough knowledge whose application can produce a well-rounded and competitive professional. The research also improves the research skills of the learners, and thus, aligning them with the research interest of the faculty.

References

Pittman, J., 2017. Exploring global citizenship theories to advance educational, social, economic and environmental justice. Journal of Tourism and Hospitality, 6(6). Pp. 3-6

 Sheel, A., 2007. Globalization, Tourism and Hospitality–A Reflection. Journal of Hospitality Financial Management, 15(2), p.7.

Zaitseva, N.A., Larionova, A.A., Yumatov, K.V., Korsunova, N.M. and Dmitrieva, N.V., 2016. Assessment of the Impact of Globalization on the Introduction of Innovative Technology Companies in the Hospitality Industry. International Journal of Environmental and Science Education, 11(14), pp.7176-7185.

Barnett, M.N. and Sikkink, K., 2008. From international relations to global society. In The Oxford Handbook of Political Science. Pp. 5-7

Bang, K.E. and Markeset, T., 2011, September. Identifying the drivers of economic globalization and the effects on companies’ competitive situation. In IFIP International Conference on Advances in Production Management Systems (pp. 233-241). Springer, Berlin, Heidelberg.

Palinkas, L.A., Horwitz, S.M., Green, C.A., Wisdom, J.P., Duan, N. and Hoagwood, K., 2015. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), pp.533-544.

KULAKOWSKI, E. C., & CHRONISTER, L. U. (2006). Research administration and management. Sudbury, Mass, Jones and Bartlett, Pp.525

BARAN, M., & JONES, J. (2016). Mixed methods research for improved scientific study. Hershey, PA : Information Science Reference, an imprint of IGI Global,pp 117-119. Retrieved from:http://search.ebscohost.com/login.aspx?direct=true&scope=site&db=nlebk&db=nlabk&AN=1203149.

Is NQO1 a suitable target for chemotherapy in Lung Cancer?

Introduction

Small Cell Lung Cancer (SCLC) represents about 13% of all lung cancer issues and continues to become a significant clinical health concern globally (American Cancer Society, 2019). The core reason for focusing on this type of cancer is based on the fact that it is a subtype of lung cancer that has no available effective treatment. Moreover, patients with the disease have a survival rate of about 16-24 months when exposed to chemotherapy and other concurrent thoracic radiations (Tsoukalas, et a. 2018 p. 145 & O’Brien, 2006 p. 5443). Under such conditions, it is crucial to understand its pathogenesis and whether NAD(P)H: quinone oxidoreductase 1 (NQO1) could emerge can be regarded as being the suitable target for chemotherapy in lung cancer.

Globally, the manufacture of effective and targeted diagnostic (theranostic) and therapeutic and chemotherapeutic agents is considered a highly accurate and dependable curative and diagnostic approach of lung cancer. As highlighted by Shin, Han, Verwilst, Kumar & Kim, (2016 p.  1419), NAD(P)H: quinone oxidoreductase 1 (NQO1) a common obligatory two-electron reductase that is reflected an excellent anti-cancer enzyme. In detail, NQO1 is an important cytosolic flavoenzyme that aid in the catalysis of the quinone 2-electron into simple hydroquinones that are then expelled out of the body. The human body cell has two core but, competing quinone metabolism pathways. In case one, quinones are passed through the one-electron reduction procedure that is catalyzed by enzymes such as P450 and b5 reductase. The outcome of the process is alkylating species and other free radicals. It is important to note that the metabolite semiquinone gets into an automatic oxidation process under the present aerobic conditions.  

In addition, NQO1 is thought to protect the cells from any unpredicted oxidative damage by blocking or barring quinones from infiltrating the one-electron reduction process. As a result, it results in less toxic hydroquinones that are readily excreted from the cells (Shin, Han, Verwilst, Kumar, & Kim, 2016 p.  1421). In vitro it has been proven that NQO1 have the potential of lowering the development of benzo(a)pyrene quinone-DNA that are produced by cytochrome P450 reductase. For that reason, NQO1 has been reflected as a dependable anti-cancer enzyme.  More evaluation by Begleiter, et al. (2009 p.3) showed that more levels of NAD(P)H:quinone oxidoreductase 1 were present in some lines of a variety of cancer cells when compared with other healthy cells. Resultantly, it has been depicted as an exceptional target for some of the drug delivery systems for cancer. With this understanding, this paper strives to explore whether NAD(P)H:quinone oxidoreductase 1 (NQO1) is indeed a suitable target for chemotherapy in lung cancer.

            During cancer therapy, the selective targeting of the cancerous cells as compared to other normal cells is its main goal. Unfortunately, some of the chemotherapeutics have been found to destroy rapidly dividing cell indiscriminately.  Despite the fact that some of these drugs can be effective in a certain environment, the inability to specifically target cancerous cells is the one which leads to dose limiting toxicities. Therefore, the best proven means of avoiding these toxicities entails targeting the aspects of the cancer a person has that cannot be shared with other normal cells (Ma, 2015 p.2)

            Although in normal cells its expression is quite low, it has been realized that it is greatly over-expressed in solid tumor including lung cancer (Guang-Zhi Dong, 2009 p.478). It is because of this over-expression that is regarded as being the main reason as to why NQO1 increases the progression of tumors.  Therefore, it implies that the NQO1’ over-expression as well as its association with the patient’s poor outcome is what equally makes it to be an intriguing agent (Kung, 2014 p.1). Although the inhibition activity of the NQO1 enzyme is regarded as being an anticancer strategy, it has never been successful.

Method

Epidemiologic studies examining the targeting NQO1 in lung cancer were obtained through searching the databases offered by ISI Web of Knowledge and PubMed database. The core keywords utilized in the search include ‘NQO1’, ‘NAD(P)H:quinone oxidoreductase 1’, ‘NAD(P)H:quinone oxidoreductase 1 targeting’, ‘’NQO1 targeting’, and ‘NQO1 target for chemotherapy in lung cancer.' The search gave about 21 articles with relevant keywords. However, to get the most updated information regarding NQO1 suitability as a the main target for lung cancer chemotherapy, all articles and journal older than five years were excluded from the study. From a total of 21 articles, the research was left with 11 articles. Another exclusion criterion included removal of all articles that were not written in English. After the exercise, four articles were removed leaving the study with seven articles. However, for accurate diagnostic and exploratory needs of lung cancer, the research reviewed the abstracts to all the seven articles to check the eligibility of their titles and the topic of study. The exercise cut off two articles from the study as they were more inclined towards other forms of cancer as opposed to lung cancer. In totality, five articles were left for study purposes.

            A large number of the curative medicines that are used for the purpose of repairing end up failing because of the absence of tumor-selectivity. In the process of using β-lapachone and polymerase PARP inhibitors, it has been noted that the synergistic antitumor mainly evolves from unrelenting NAD (p) H levels that aid in refueling the recycling activity of the NQO1 (Guang-Zhi Dong, 2009 p.480). The synergistic antitumor effectiveness as well as the continued survival is the one that expands the use and effectiveness of the PARP inhibitors for the treatment of lung cancer in human (Lienhart, 2014 p.4692).

In summary, the values and arrangement of articles and journals reflect their ability to support the study question. The findings by each source are then compared with the results from the articles to ensure that accurate examination of whether NQO1 is a suitable target for lung cancer chemotherapy is achieved. It is crucial mentioning that the methodology showed that one sustainable way of preventing cancer development and spread is the suppression or clampdown of all carcinogenic metabolic activation processes. As a result, it works in preventing the production of the ultimate carcinogens. The findings and keywords as depicted in the above table show that NQO1 inhibits tumorigenesis in lung cells hence a good target for chemotherapy as it prevents carcinogenesis. 

Results

As revealed by the articles, NQO1 has biochemical roles that include protection, initiation, and promotion of cancer. Analytically, its roles could be categorized into four primary functions. They are detoxification of all quinone substrates through two-electron reduction, scavenging superoxide anion radicals, sustenance of endogenous antioxidants and finally stabilization of p33/p53/p73 proteins. While considering whether NQO1 is a suitable target for chemotherapy in lung cancer, it is crucial highlighting that its activities are easily up-regulated by dietary or chemical inducers. Consequently, having it as a suitable target for chemotherapy offers a dependable platform for lung cancer prevention.

In a normal environmental situation, exposure to quinones originate from the oxidizing metabolites of benzo(a)pyrene [benzo(a)pyrene 3,6-quinones] readily available in tobacco. As highlighted above, NQO1 catalyzes the single-step of two-electron reduction that works in reducing the quinones to hydroquinones. Hydroquinones are then conjugated and excreted from the body cells. In the specific process, NQO1 prevents the generation of free radicals throughout the redox cycle which means that it prevents the body cells from carcinogenesis. With the ability to inhibit such processes, NQO1 can reduce a wide range of substrates including quinone-imines, quinones, and nitro compounds present in events such as smoking. In totality, its performance and capacity to reduce carcinogenicity and toxicity of various quinones proves that it is a suitable target for chemotherapy in lung cancer cells. Reason being, it will help the chemo drugs to reach different quinones zones that have the potential to promote, initiate, or spread cancer cells in the lungs (Srijiwangsa & Na-Bangchang, 2017).

According to Oh & Park (2015), NQO1 has showcased the ability to scavenge superoxide available in NAD (P) dependent state. Structurally wise, vasculature cells where NQO1 is easily expressed are directly connected to the lungs. Therefore, the detoxification activity of NQO1 against superoxide anion radicals that are produced by cardiovascular tissues and NAD (P) H oxidases would help prevent the initiation and spread of cancer cells in the lungs. In totality, its detoxification ability reconfirms its capacity as an appropriate target for chemotherapy in lung cancer as it fits the toxins right from their source.

                                                            Discussion

            Furthermore, taking into account the targeted quinones, it is evident that the reduction of quinones by the NQO1-mediated 2-electron can either be one of the chemotherapeutic, detoxification or chemoprotection responses in the lung cancerous cells.  In the process of reducing toxic quinines using NQO1, such toxic substances end up being conjugated with glucuronic or glutathione acids before they are being excreted from the affected cells. Considering the protection the NQO1 provides, recent research indicates that the continued use of the dietary compounds for the purpose of reducing the expression of NQO1 is one of the successful means of preventing the development of lung cancer in human.

            Nevertheless, the reducing effect of the NQO1-mediated 2-electron is has the ability of converting compound of quinone to cytotoxic compounds hence resulting to cell death. Research indicates that the expression of NQO1 is large percent of human lung cancers is relatively high as compared to its expression in normal tissues. Therefore, this means that these tumors can be easily damaged using cytotoxic drugs relative to the normal tissues (Guang-Zhi Dong, 2009 p.479). It is important to review some of the biological role/roles of the NQO1 compounds in cancer and its potential curative target for lung cancer treatment.

            Despite the fact that the absence or the lowering of the activities of the NQO1 with the increased vulnerability of the development of cancer, medical research have proven that NQO1 is highly up-regulated in such cells. For the case of lung cancer chemotherapy, the increased expression of NQO1 has been noted to be highly connected with the late medical stage of differentiation (Lienhart, 2014 p.4694). The high expression of NQO1 in patients suffering from lung cancer, for instance, reveals low rates of disease free survival (DFS) as well as overall survival (OS) unlike in individuals with low NQO1 expressions. This implies that in lung cancer chemotherapy, the role played by NQO1 enzyme is relatively high as compared to the effect to induce in some of the adjacent normal tissues. 

            The modern medical research has proven that the reduction of quinones using NQO1 is one of its widely accepted and best described function. Ideally, environmental and endogenous quinones are some of the most reactive molecules that have the potential of reducing the development of cancer or its treatment. After reducing quinones into hydroquinones, it becomes easier for that compound to be removed from the body. As a result of that, it has been realized that the detoxification of the redox recycling of quinones using NQO1 also assist in protecting human cells from some of the oxidative stresses as well as preventing carcinogenesis.

            The reduction of menadione using NQO1 also has the ability of enhancing the formation of stable hydroquinone that can be easily conjugated as well as excreted from the human body in the process of treating lung cancer. Because of the number of times NQO1 is modified in transcriptomic and genomic level, the effect of its modulation on cancerous cells during chemotherapy places it as the main link connection between lung cancer redox resistance and alterations (Li, 2015 p.2). This means that one of the possible means of preventing the development of cancer entails suppressing the carcinogenic metabolic activations so as to prevent the production of carcinogens   (López, 2018 p.33).

            Likewise, studies have proven that the induction of these phase II enzyme mainly compares with the inhibition of the chemical mediated tumorigenesis and its promotion in the initiation stage. This implies that amongst all the phase II enzymes, it has been realized that NQO1 have the ability of inhibiting carcinogenesis.  Equally, when enhancing protection against the promotion as well as the development of lung cancer, the biochemical and the multiple roles of this enzyme can be categorized differently (Guang-Zhi Dong, 2009 p.478). The first category involves the use of its 2-electron reduction activity to boost the detoxification of the quinone molecules or substrates. The second one involves promoting the scavenging of the superoxide anion radicals (SOD).  The third role involves maintaining endogenous antioxidants for instance α-tocopherol and ubiquinone. The last role entails assisting in stabilizing suppressor proteins (Ross, 2004 p.643)

            Nevertheless, it has the realized that the use some of the chemopreventive agents to stimulate ARE/KEAP1/Nrf2 signaling pathway, resulting to the rise of its gene expression, has been perceived as being the main strategy of preventing lung cancer. For instance, during the bio-reduction of MMC using NQO1, it has been realized that the NQO1 levels is the one assists in predicting its sensitivity. Although other bio-reductive enzymes can be used in activating MMC, the polymorphism and expression levels of NQO1 aid in determining it medical response to MMC treatment.

Finally, tumor suppressor proteins such as p53 are well-known for their ability to suppress tumorigenesis by arresting growth as a response to DNA damage. According to Oh & Park (2015), p53 protein is regulated by modifying the interactions that affect its stability and half-life. Under normal conditions, p53 is gradually degraded as it interacts with chemicals or enzymes that induce proteasomal degradation. However, as discovered by Oh & Park (2015 p.14), NQO1 has proved its ability to stabilize the functions and ability of tumor suppressor protein (p53). It does that by inhibiting the proteasomal degradation process hence improving the performance of p53 thereby protecting the cell against carcinogenesis. Similarly, placing NQO1 as a target for chemotherapy in lung cancer would ensure that the drugs reach the specific cells without facing any inhabitation by enzymes in the body cells (Parkinson & Hergenrother, 2015).

Comparison of this research with previously published research

            Some of the accumulating evidence obtained from the previously published research regarding the adaptable cyto-protective roles of this substance particularly the prevention of lung cancer also proves how NQO1 is vital in treating cancerous cells. In addition to that, the role played by NQO1 polymorphism assists in explaining the generation of cancerous cells (Li, 2015 p.3). It should be noted that some of the compounds that are used also end up becoming cytotoxis because of the reduction activities that are accelerated by NQO1. In the process of damaging cancerous cells in lungs, previously published research suggests that it becomes easier to over-express NQO1 in those cells using some of the bio-reductive anticancer medicines (Benhamou, 2001 p.441). As a result of that, it is possible to induce the activities of NQO1 in cancerous cells for continues effectiveness of bio-reductive anticancer medicines.

Limitations

            Our research had various limitations. One of these limitations is that retrospective analysis of the effects of this enzyme on lung cancer chemotherapy was not properly done. The reason for that is because it was not possible to detect its curative effects. Another limitation is that although some of the p53 was highly assessed in exons 5-8, it was not easy to identify specific mutations using SSCP. As a result of that, the effect it induces on the expression of these proteins as well as its interactions with NQO1 is unknown. Furthermore, the findings of this research suggest that the study did not have the ability to utilize information from other multi-institutional trials. Finally, the data obtained from patients having various conditions that were linked with NQO1 polymorphism ended up weakening the results obtained from this research.

            During chemotherapy, the mechanisms of this enzyme, therefore, are the ones that aid in explaining the anti-tumor effects of these drugs. As compared with other previously published research, information obtained from Lap studies also suggest that the activated redox cycle of this enzyme does not have the ability of inducing a unique pathway for cell death, hence inhibiting the development of anti-tumor drugs (Song, 2008 p.162). The activation of NQO1 substrates after reduction is what makes them to be one of the promising strategies for enhancing lung cancer chemotherapy. Despite that, another publication bias discovered is that although NQO1 can be used to activate a number of the anti-tumor drugs, the truth is that they lack enough specificity and selectivity to NQO1.

Conclusion

The review has utilized five scholarly articles published in the last five years. From the analysis, it is evident that NQO1 has a vital role to play in reducing carcinogenesis. Moreover, the study has discovered that higher levels of NQO1 are available in cancerous cells as compared to normal cells. This then implies that it is an outstanding target which supports the creation and targeting of lung cancer chemotherapy drugs. The targeting is accurate and more focused on ensuring that carcinogenesis within the body cells is reduced. Following the above discoveries, it is essential concluding that, YES; NQO1 is a suitable target for lunch cancer chemotherapy.

            To enhance the treatment of cancer, some of compelling mechanisms of suicide substrates or NQO1 inhibitors have been developed. During lung cancer chemotherapy, the suggested mechanisms of cell death come as a result of the activation of the futile recycling of the anticancer drugs. In most cases, the death of the NQO1 expressing cells can also prevented using NQO1 inhibitors as well as cells having low resistance to NQO1 (López, 2018 p.30). For instance, to akylate the protein irreversibly, it becomes possible to inhibit the growth of cancerous cells in human hence suggesting its potential function for this compound as a curative agent.

References

American Cancer Society. (2019). What Is Small Cell Lung Cancer?. Retrieved from https://www.cancer.org/cancer/small-cell-lung-cancer/about/what-is-small-cell-lung-cancer.html

Begleiter, A., El-Gabalawy, N., Lange, L., Leith, M. K., Guziec, L. J., & Guziec, F. S. (2009). A Model for NAD(P)H:Quinoneoxidoreductase 1 (NQO1) Targeted Individualized Cancer Chemotherapy. Drug target insights, 4, 1-8

Benhamou, S. et al. (2001) ‘Role of NAD(P)H:quinone oxidoreductase polymorphism at codon 187 in susceptibility to lung, laryngeal and oral/pharyngeal cancers’, Biomarkers, 6(6), pp. 440–447. doi: 10.1080/13547500110057399.

Guang-Zhi Dong et al. (2009) ‘Heat shock increases expression of NAD(P)H:quinone oxidoreductase (NQO1), mediator of β-lapachone cytotoxicity, by increasing NQO1 gene activity and via Hsp70-mediated stabilisation of NQO1 protein’, International Journal of Hyperthermia, 25(6), pp. 477–487. doi: 10.1080/02656730903049836.

Kung, H.-N. et al. (2014) ‘Sulindac Compounds Facilitate the Cytotoxicity of β-Lapachone by Up-Regulation of NAD(P)H Quinone Oxidoreductase in Human Lung Cancer Cells’, PLoS ONE, 9(2), pp. 1–15. doi: 10.1371/journal.pone.0088122.

Li, Z. et al. (2015) ‘NQO1 protein expression predicts poor prognosis of non-small cell lung cancers’, BMC Cancer, (1). doi: 10.1186/s12885-015-1227-8.

Lienhart, W. ‐ D. et al. (2014) ‘Collapse of the native structure caused by a single amino acid exchange in human NAD(P)H:quinone oxidoreductase1’, FEBS Journal, 281(20), pp. 4691–4704. doi: 10.1111/febs.12975.

López, L. C. et al. (2018) ‘Combined molecular modelling and 3D-QSAR study for understanding the inhibition of NQO1 by heterocyclic quinone derivatives’, Chemical Biology & Drug Design, 91(1), pp. 29–38. doi: 10.1111/cbdd.13051.

Ma, X. et al. (2015) ‘Nanotechnology-enabled delivery of NQO1 bioactivatable drugs’, Journal of Drug Targeting, 23(7/8), pp. 672–680. doi: 10.3109/1061186X.2015.1073296.

O’Brien ME, Ciuleanu TE, Tsekov H, et al. (2006) Phase III trial comparing supportive care alone with supportive care with oral topotecan in patients with relapsed small-cell lung cancer. J Clin Oncol 2006;24:5441-7. 10.1200/JCO.2006.06.5821

Oh, E. T., & Park, H. J. (2015). Implications of NQO1 in cancer therapy. BMB reports, 48(11), 609-17

Parkinson, E., & Hergenrother, P. (2015). Deoxynyboquinones as NQO1-Activated Cancer Therapeutics. Accounts Of Chemical Research, 48(10), 2715-2723. doi: 10.1021/acs.accounts.5b00365

Ross, D. (2004) ‘Quinone Reductases Multitasking in the Metabolic World’, Drug Metabolism Reviews, 36(3/4), pp. 639–654. doi: 10.1081/DMR-200033465.

Shin, W., Han, J., Verwilst, P., Kumar, R., & Kim, J. (2016). Cancer Targeted Enzymatic Theranostic Prodrug: Precise Diagnosis and Chemotherapy. Bioconjugate Chemistry, 27(5), 1419-1426. doi: 10.1021/acs.bioconjchem.6b00184

Song, C. W. et al. (2008) ‘Anti-cancer effect of bio-reductive drug β-lapachon is enhanced by activating NQO1 with heat shock’, International Journal of Hyperthermia, 24(2), pp. 161–169. doi: 10.1080/02656730701781895.

Srijiwangsa P, Na-Bangchang K (2017) Roles of NAD (P) H-Quinone Oxidoreductase 1 (NQO1) On Cancer Progression and Chemoresistance. J Clin Exp Oncol 6:4. doi: 10.4172/2324-9110.1000192

Tsoukalas, N., Aravantinou-Fatorou, E., Baxevanos, P., Tolia, M., Tsapakidis, K., Galanopoulos, M., Liontos, M., … Kyrgias, G. (2018). Advanced small cell lung cancer (SCLC): new challenges and new expectations. Annals of translational medicine, 6(8), 145

Zeekpudsa, P., Kukongviriyapan, V., Senggunprai, L., Sripa, B., & Prawan, A. (2014). Suppression of NAD(P)H-quinone oxidoreductase 1 enhanced the susceptibility of cholangiocarcinoma cells to chemotherapeutic agents. Journal Of Experimental & Clinical Cancer Research, 33(1), 11. doi: 10.1186/1756-9966-33-11

 PRACTICE ON QUANTITATIVE CRITIQUE: LITERATURE REVIEW AND STUDY DESIGN

Article title: “Health-related quality of life and antihypertensive medication adherence among older adults”

Authors: Elizabeth, W.H, Paul M, Cara J.J, Larry W, and Marie, A. K.W

            Hypertension is one of the prevalent and symptomatic ailments that have the ability of affecting thousands of adults. Despite the effective curative treatments as well as the evidence-based treatment guidelines that are used for the purpose of managing or controlling high blood pressure, the truth is that uncontrolled hypertension is one of the challenges facing modern therapeutic procedures.  Taking into consideration the views of the author, it is evident that low antihypertensive clinical attention has been perceived to be one of the important barriers that limit the control of hypertension.

             Moreover, behavioral, treatment, clinical, and demographic factors are also some of the agents that are ultimately associated with its medication adherence. The reason for that is because this study suggests that some of the psychosocial factors are the ones which assist in determining the extent of antihypertensive therapeutic adherences in aging individuals.  Despite that, the effects that it induces on the mental and physical quality of life of an individual is one of the mechanisms that are used to access the manner in which their psycho-ability have the potential of managing their chronic diseases. 

            According to this article, it is clear that some of the results obtained from the subgroup assessment indicate that the association between antihypertensive medication and HRQOL adherence remain to be consistent across gender, race, and age groups.  Furthermore, the modern research carried concerning this ailment indicates that individuals with low MCS and PCS HRQOL scores have the propensity of having medium o low antihypertensive medication adherences, even after making adjustments for education, race, age, marital status, and gender. This then implies that the association that exists between these factors is perceived to be consistent and persistent in subgroup examinations. On the other hand, the authors suggest that the information obtained reveals that there is a consistent relationship which exists between mental and physical measures of antihypertensive and HRQOL medication adherence in aging individuals. Regardless of that, some of the researches that aid evaluating such a relationship have ended up producing extensive conflicting results. Taking into account the sample of geriatric patients who were used in assessing this claim, it is evident that there was no any relationship that can be detected between self-reported and HEQOL antihypertensive individuals with an age ranging from 35-80 years. The reason for that is because weak negative link can easily be indentified between HRQOL and the self-reported treatment. With respect to the views of the author, it is logical to say that aging individuals having low MCS scores have the potential of showing minimal adherences to their antihypertensive treatment or medication.

            Nevertheless, as far as hypertension in adults is concerned, it is evident that HRQOL that is ultimately associated with lower antihypertensive treatment adherences ought to take into account the attitudes of the patients towards accepting the medical attention given as well as their psychosocial wellbeing.  This means that the exact mechanism that assists in associating HRQOL with the medication provided to such individuals still remains unknown. Despite that, it has been proven that HRQOL is one of the complex web of psychosocial characteristics that have the ability of negatively impacting the aptitude of the patient o manage some of their chronic diseases.

            Taking into account the results obtained from patients suffering from diabetes, it has been found that HRQOL can also be associated with a variety of factors. This is because these factors have been regarded as being the main precursors to therapeutic adherences, including the beliefs of the patients that they can have the ability of controlling their self-efficacy or behaviors, their knowledge and attitude towards disease management, their competence levels, as well as their optimism or outlook of life. Thus, other than what the article suggests, it is important to carry out extra researches which assist in understanding all the mechanisms HRQOL uses in affecting the adherence to antihypertensive treatments as well as in cardiovascular health.

            According to this article, the result obtained from the research conducted suggests that mental and physical measures or scores of HRQOL are ultimately linked with its medication adherences, especially in emotional, social, and mental domains. Although these results comply with the information that was obtained from the previous studies, it is important to first identify some of the medical depressions a person has. Ideally, it is these assumptions that can aid in evaluating some of the depressive symptoms that examine how antihypertensive treatment adherence correlates in patients suffering from chronic disease.

            From the information collected using patients who acknowledged that they always felt worn out and tired most of the time, implied that they have frequent interferences with their normal societal activities. The main cause of that is because of the emotional and depression problems and the feeling of nervousness that they develop. As a result of that, they end up increasing the odds of low antihypertensive therapeutic adherence. This then implies that older individuals suffering from hypertension as well as having worsening emotional wellbeing might have low adherences to antihypertensive medication.

            As the authors continue to express their views, they suggest that aging individuals having low mental and physical HRQOL have the likelihood of having low adherences to such treatment, whether such an adherences was measures using pharmacy or self-reported means. Despite that, it is logical to say that HRQOL is one of the important factors that can assist in understanding an individual’s adherence to antihypertensive medications, with social, emotional, and mental domains generating the greatest impact. In order to make this possible, it is important to clarify the longitudinal relationship that exist between antihypertensive treatment adherences, health outcomes, and HRQOL in aging individuals. The reason for that is because it will aid physicians to assess whether improvement in an individual’s quality of life has the ability of increasing adherence to antihypertensive medications as well as improvement in cardiovascular health results.

            Nevertheless, the effective prevention and management of cardiovascular events in individuals suffering from hypertension mainly require optimal control of their blood pressure levels. Regardless of the advances in its management and prevention, poor antihypertensive medication adherences are also one of the factors that attenuate its treatment efficacy. This implies that medication adherences are one of the self-regulatory behaviors in an individual. As the authors continue to explain in this article, the majority of people always strive to understand their disease or ailment through creating their personal model. Because of that, it becomes possible to conceptualize it as a disease representation.

            There are five main key elements that can be used for the purpose of representing illness. these components include what the disease or the ailment is, the causal factors of such a disease, the effects it has to the daily life of an individual, the duration it takes, as well as whether it is possible to control it. Conversely, the representation of hypertension in adults can also be fostered through using previous symptoms and disease experiences. All this have to be based on the data obtained from different cultural and social associations. Therefore, the uniqueness of its representation is based on the intrinsic beliefs of a person.

            Additionally, the representation of hypertension in an individual is perceived to be dynamic hence has the ability of changing over the course of the ailment.  This means that is the responsibility of an individual to have the ability of determining his or her coping strategies which in return assist in regulating or minimizing their health challenges. A person has the option of either choosing to adhere to the available medication regime by taking into account what they believe to be absolutely true about hypertension. These will have to take into account some of the connections that exist in the process of seeking medical attention to disease management.  As the article suggests, it is evident that it is the continued utilization of the available coping strategies that can assist in appraising its therapeutic outcomes in older people.      Preferably, in case a person feels that these coping strategies do not have the potential of managing hypertension; it implies that they have the likelihood of terminating the medical attention they receive. In the process of ensuring that each person has been informed about the treats of hypertension, it becomes possible to predict its medication adherence. This should also take into account providing education strategies that can assist older adults to cope up with hypertension.

                                                             Introduction

            Health care industry has been encountering substantial restructuring. The reason behind that entails understanding the manner in which the industry has the capacity of aiding understanding some of some of the changes which have been encountered in the same industry (Hammaker & Knadig, 2018). Nevertheless, the amount of the cost expenses which the organization receives from the private and other governmental organizations is the one which has the capacity of influencing or enforcing the health care providers to the extent of moving fee-for-service so has to enhance their health care services. The idea behind this is because it is the one which assists them in consolidating their everlasting corporate organizations (Penner, 2013). 

                                    Risk analysis and capital structuring

            From the perspectives of the healthcare organizations, it implies that any changes which might have been encountered will have to take into account some of the changes non-profit organizations could have encountered.  From the information collected, it implies that some of the not-for-profit hospitals like the Louisville hospital are the ones which have been always involved in acquisitions and mergers. Although other organizations could have entered in the same deal, it implies that they could have entered in the losing end (Li & Fei, 2017).  Regardless of the fact that health care information to be provided by each hospital varies, it implies that there is the need of ensuring that have followed the same protocol. The reason for that is because it is the one which have the influencing as well as evaluating some of the strategies and partnership needed to enhance their survival. Conversely, there is the need for understanding the ideas that outline some of the processes such a hospital organization utilizes to enhance their health care services (Wong et al., 2013).

            Conversely, the cost management and containment health care pressure are some of the factors which hospitals try to consolidate. The reason for that is because some of the affliction proposals obtained from the for-profit and not-for-profit partners are the one which will provide some of the fundamental solutions to economics and governance issues that impacts health care organizations.  In order to make this strategy a key goal, it is important to ensure that free proposal and open process have been integrated in understanding the impacts such conversion has to financial wellbeing of such a merger. This is important because the good understanding of the peoples’ values is one of the key ingredients which will enhance successful transaction.  Such an approval will ultimately take into account some of the political interests aimed at enhancing its environmental conversions (Hammaker & Knadig, 2018).

            Additionally, the above considerations imply that such conversions that is currently washing through the modern hospital industry is always driven by the financial and strategic pressures that is generated by the health care organizations. Taking into account the double-digit inflation found in the health care expenses, it means that the donors of this organizations have the motives of controlling some of the health care expenses to be encountered (Penner, 2013).  The modern health care information collected suggests that it the managed care which ends up doubling some the health care impacts it has on hospitals. Regardless of that, some of the incentives which were included were specifically developed for the purpose of maximizing the utilization of skilled and outpatient nursing facilities. 

            Some of the various strategies that have been adopted by the hospital boards are aimed at sheltering such organizations from affliction storms generated by other hospitals or neighboring hospital systems. Because of that, it implies that that hospital should have the capacity of realizing some of the key goals which will enable them to achieve organizational survival (Li & Fei, 2017). Taking such strategies into account, it means that the first mechanism will entail measuring what the hospital will be gaining. The reason for that is because it is the ability of organization that takes into account the means they use in partnering with the HMOs (health maintenance organizations).

            Nonetheless, in the process of partnering with the Louisville as one of the non-profit organization, it is important to ensure that its management authority have had the capacity of achieving the economies of scale through spreading fixed expenses. The idea behind this will entails streamlining the health care services that they offer. For some of the buyer who might be ratcheting down payments, it implies that the kinds of individual who will be surviving are the lowest income earners (Hammaker & Knadig, 2018). It is the demand for lower expenses invariably which ends up resulting for the push for size. The reason for that is because the lower medical purchasing power is the one which enhances lower cost capital, purchasing power, as well as the general access to production through enhancing the potential of the production systems (Penner, 2013). 

            The strategic rationale which necessitates a hospital to seek affiliation will mainly take into account some of the health care services they provide to satisfy the requirements of their clients. Although it is not an easy task, it is the responsibility of the hospitals’ boards of directors to ensure that they are emotionally connected to the needs of their co-workers and their community at large (McCue et al., 2015). Additionally, in order to evade such financial risks, the hospital organization should ensure that they have become protective in the manner in which they share their healthcare information.

            Despite the fact that it is it is highly appropriate and accepted that the decision made by the board to affiliate any health care decision, the truth is that at times the board do not end up receiving any considerable attention. The reason for that is because several participants have been noted to be ill-served by some of the health care organizations which have been long served by need of resisting the market pressures. In the process of seeking a financial partner, what happens is that the non-profit hospital strategic options and values is what end up diminishing. As this scenario continues, the truth is that such a hospital will be left with the responsibility of handling any health care partner who might be willing to meet its financial needs. This means that it is a truism in the hospital’s affiliation process which enables it to enhance as well as renegotiate some of the nonfinancial issues that ultimately impacts its vision (Hammaker & Knadig, 2018). It is because of this delayed hospital fiduciary roles which end up delaying the actions its management authority takes.

            The type of proposal that the not-for-profit and for-profit hospitals come up with is the one that represents a scenario in which previous competitors tries to rejuvenate fierce rivalry aside so as to come together in improving the interests of their community. The main objective behind this entails reducing costs through the process of rationalizing their health care services as well as increasing market clout (McCue et al., 2015). Furthermore, the combination of the hospital thwart HMO’s is the one which attempts to induce rivalry amongst each other. Regardless of that, the truth is that it is the modern health care system that has the capacity of improving its services through reducing non-patient and management care services.

            This will be mainly achieved through eliminating a certain percentage of its management team as well as merging back some of its office functions for instance, billing and accounting. Despite that, such transaction has been found to be difficult to implement (Wong et al., 2013). The reason for that is because in most cases the hospitals’ board of directors has been found to be resistant in streamlining any means which one organization can use to take over the other.

            On the same note, it should be understood that this kind of merger is the one which end up faltering the selection of CEOs (chief executive officers). The reason for that is because one of the largest barriers is the resistance developed to the notion of rationalizing their clinical services. As a result of that, it implies that the need of concentrating hospital tertiary services is the one which inflames competition amongst powerful medical practitioners as well as arousing jealousy between management and the board of members (McCue et al., 2015).

                                                            Conclusion

            Recent research indicates that antitrust law is one of the challenges that health care organizations do experience. Basically, as the two hospital tries to improve their financial base as a joint venture, their initial statements ought to be taken into account. It is this law which has been found to be frustrating the board of directors because it does not consider them to be in the profit-oriented organization. It is this scenario which always chafes them from the returns to be made by the physician groups or for-profit payers at the expense of the community health care organization. Since health care payers are the main customer of the health care organizations, it implies that the merger with for-profit and not-for-profit hospitals is the one which can be constructed as anticompetitive. It is this concept that always imbues the whole idea of the not-for-profit organization.

                                                            References

Hammaker, D. K., & Knadig, T. M. (2018). Health care management and the law. Jones & Barlett Learning Press

Li Han, & Fei Ren. (2017). Risk Assessment and Management in Hospital Merger and Acquisition. Journal of Commercial Biotechnology, 23(2), 31–36. https://doi.org/10.5912/jcb782

McCue, M. J., Thompson, J. M., & Tae Hyun Kim. (2015). Hospital Acquisitions Before Healthcare Reform. Journal of Healthcare Management, 60(3), 186–203. https://doi.org/10.1097/00115514-201505000-00007

Penner, S. J. (2013). Economics and financial management for nurses and nurse leaders. Springer Press

Wong-Hammond, L., & Damon, L. (2013). financing strategic plans for not-for-profits. Hfm (Healthcare Financial Management), 67(7), 70–76. Retrieved from http://165.193.178.96/login?url=http%3a%2f%2fsearch.ebscohost.com%2flogin.aspx%3fdirect%3dtrue%26db%3dbth%26AN%3d88970823%26site%3deds-live

Appendix

                               Louisville Hospital income Statement

                             Annualized data for twelve months

HR IN SMALL BUSINESS: Babies Welcomed at T3

Question 1

Creativity of the workforce is achieved when the working environment allows enough flexibility in employees’ timings and proper work-life balance. The employee benefits that allow for a flexible working environment includes bringing babies to work, paid-for holidays and vacations, and brining employees’ dogs at the work place. The female employees who bring their babies to work are able to manage their parental role without a disruption in the roles they have been performing. In their effort to make the arrangement a success, the employees learn ways of handling different tasks simultaneously. The culmination of this arrangement is the capacity for the employees to handle their tasks any disruptions that arise in the process. Moreover, the new mothers are not distracted by too much worry about their babies, which gives them enough space to concentrate on their work once the babies are asleep. They extra flexibility needed to take care for their babies while working affords them an opportunity to embrace the principle in their tasks. The paid-for holidays allows employees to relax and refresh mentally since their minds are diverted away for normal work and routines. Employees vacation allows for a period of lowering stress level and preventing burnout, while the psychological detachment enables employee to divert their conscious attention away from normal tasks, which is important for creative thinking (Daft, 2011). Additionally, by bring their dogs to the work place, employees are also able to divert their focus from their normal tasks, and enhance creativity.

The T3 and Under Policy enhance flexibility, creativity, and productivity in the business. Flexibility is achieved when employees are given a chance to engage in different activities at a go, and this eventually facilitates creativity in the business. Improved creativity ensures that the level of productivity among the employees increases. However, risks that may arise include a possible neglect on important aspects of the job for the mothers, or employees misusing the granted flexibility to serve their personal interests. The company can address the risks by putting in place boundaries on the freedom accorded to employees, and thus, ensure that they remain focused to the goal of the organization.

The policy of “bringing your baby to work” can also be applicable to companies that allow employees to undertake their maternal-care roles and job-related tasks at the same time. Hence, firms such as Financial Institutions, banks, and other services related company can employ the policy, especially if mothers are given enough space to be flexible.

Question 2

The policy of “bringing your baby to work” has continued be embraced by many organizations after the implementation of “T3 and Under”. More mothers are extolling the various benefits that comes with bringing along their babies to workplaces, and increased number of employers are allowing them. The policy is consistently being seen as a way of lowering stress for the parents and infants. The extent of adoption of the policy can be seen by its acceptance even among the political class as people become more knowledgeable about the place and significance of family relations to individuals and the society. However, there are issues that the case does not highlight, in terms of the varying reasons for allowing the policy. Business organizations perceive the policy from a work point of view, while an employee is concerned with the interest of the baby and that of hers. The organization is weary of losing crucial employees and the incurring huge costs to train and retain others for replacement. On the hand, the employee may be weary of high cost of employing caregivers for the babies. Hence, the policy should be adopted in accordance with specific need of the organization. It is important of employers to harmonize their own interest and that of employees in order to have mutual benefits.

Reference

Daft, R. L. (2011). Understanding management. Mason, OH: South-Western Cengage Learning. 419-421

 Ovarian Cancer

Human ovaries can be described as the small, almond moulded tissues that are situated on both sides of the female uterus. Ovarian cancer comes about when abnormal cells in the ovary start to multiply out of control where they end up forming a tumour (Gajjar et al., 2012). This tumour when left untreated can spread to the other body parts and this is what is commonly known as metastatic ovarian cancer.  Ovarian cancer is the fifth most frequently detected malignance amongst women all over the globe (Gajjar et al., 2012). This type of cancer causes more deaths per year than any other malignancy of the female reproductive structure, with a projected count of 22,000 new cases every year in America. The life risk of a woman developing this type of cancer is 1 in 75 and her chances of dying of the illness are 1 in 100 (Gajjar et al., 2012). The syndrome stereotypically presents at the late phases when the five year comparative subsistence rate is only 29%. There are rare cases, about 15%, that are normally diagnosed with localized tumour when the five year comparative subsistence rate is only 92% (Lanceley et al., 2011). This strikes the general 5 year virtual survival rate to commonly range amid 30%-40% across the sphere (Lanceley et al., 2011).

The cancer of the ovaries can come about in numerous altered fragments of the ovary; it can begin in the ovary’s germ, epithelial cells or even the stromal.  There are three common types of ovarian cancer

• Epithelial tumours that form in the coating of matter on the outer side of the ovaries and roughly 90% of ovarian tumours are normally epithelial tumours.
• Stromal tumours, they develop in the hormone making cells and they description for around 70% of all the ovarian malignancies.
• The germ cell malignant tumours, they progress in the egg generating cells and they are very infrequent (Gajjar et al., 2012).

The precise source of ovarian cancer is not really known, though there are some risk factors that are associated with the epithelial ovarian cancer. As one gets older, there is higher risk of developing ovarian cancer. The cancer is infrequent among women that are younger than forty years and most of the ovarian malignancies are normally developed after menopause. It is estimated that half of all ovarian malignancies are prevalent among women who are 63 years of age and older (Gajjar et al., 2012). The women that get their first pregnancy after the age of 35 years and those that have never had a full term pregnancy have higher risks of developing ovarian cancer. Child bearing women are projected to have a 30 – 60% lower threat for ovarian malignancy and increasing births have a tendency to to reduce the risks even further (Gajjar et al., 2012). Breastfeeding is also a factor that affects risks of developing the cancer, breastfeeding supresses the emission of pituitary gonadotropins, hence causing anovulation. An increasing period of breastfeeding declines the threat of developing ovarian malignancy (Gajjar et al., 2012).

Obesity is highly associated to advanced risks of developing many malignancies. Obese women tend to have a higher threat of acquiring ovarian malignancy, though not necessarily the destructive categories. Obesity also greatly affects the overall survival of the women that has developed ovarian cancer (Gajjar et al., 2012).

Smoking of cigarette also upsurges the threat of mucinous and borderline ovarian malignancies and the longer one has smoked the greater the risks (Gajjar et al., 2012). Exposure to talcum powder is also associated with ovarian cancer, talc contains a substance that is known to cause cancers around the lungs and when it is inhaled (Gajjar et al., 2012). Women that use talcum powder in their genital areas have increased risks of developing ovarian cancer (Lanceley et al., 2011). The more years the talcum powder is used, the higher the risks.

History of the family is one of the most noteworthy risk factor of ovarian malignancy, the mutation of the genes that are involved in DNA reparation increases risks of cancer in some individuals. Ovarian malignancy can route in families and the threat increases if a parent, sibling or offspring has had ovarian malignance. The threats get higher with the number of relations that have the malignancy within the family (Gajjar et al., 2012). The history of other types of cancers such as breast cancer within the family can also be linked to an increased risk of ovarian cancer. This is because they can be instigated by a congenital transmutation in certain genes that source a family malignancy syndrome that upsurges the menace of the ovarian malignancy.

Ovarian malignancy comes about when there are faults in the standard cell development in the ovaries. This normally happens when the cells get old or broken and they die and fresh cells are developed to take their habitation. The malignancy starts to develop when these new cells form and they are not needed and the old cells fail to die as they are supposed to (Lanceley et al., 2011). These whole processes cause an accumulation of additional cells which form mass of soft tissue that become known as a tumour. The anomalous malignance cells often have inherent anomalies that cause them to grow excessively and this cause the cancer to be aggressive (Lanceley et al., 2011).

The diagnosis of ovarian malignance normally begins with a corporeal inspection which includes;

• A pelvic check,
• A blood exam or
• A transvaginal ultrasound

 A biopsy can be done to determine the presence of cancer, where by a small tissue sample is acquired from the ovaries to look for malignance cells. Imaging tests are also done to help detect any alterations in the ovaries and the other structures that may be instigated by the tumour (Koldjeski et al., 2005). The imaging includes CT scan, M.R.I and PET scan.

The early stages of the ovarian malignance may not have any defined signs and they may be difficult to detect but they include;

• Bloating
• Trouble eating
• Recurrent impulse to urinate
• Agony and distress in the pelvis
• Pain during sex
• Changes in menstrual periods for instance heavier bleeding

The cancer has four stages, the lower the number the lower the spread of the cancer. The highest number four means that the cancer has widely spread and hence requires intensive treatment (Lanceley et al., 2011). Three factors are used to stage the cancer including the size of the tumour, the spread to the adjacent lymph nodules and the spread to the distant spots. Stage I cancer is normally confined to one ovary, stage II cancer is normally restricted to the pelvis, stage III is the tumour that has spread into the stomach and the stage IV cancer is the one that spread outside of the stomach and also to other tissues (Lanceley et al., 2011).

The management of the ovarian malignance is dependent on the category, the phase, and whether one wants to have offspring in the future. Surgical procedure is normally conducted to help sanction whether one truly has cancer, the stage it is at, and to hypothetically eradicate the cancer (Koldjeski et al., 2005). During the surgical procedure, the surgeon attempt’s to eliminate all the tissue that comprises the cancer and they might also take a biopsy to perceive if the malignance has spread. The degree of this surgery is normally dependent on whether one wants to be pregnant in the future, where an individual that wants to get children in the future and has stage 1 cancer will have the affected ovary removed and a biopsy is done on the other ovary. The surgery may also include the removal of fatty tissues that are connected to some of the intestinal organs or even the elimination of intestinal and pelvic lymph nodes (Koldjeski et al., 2005).

Surgery for people that do not want to have children in the future can be more extensive. And more surgery may be required for the individuals that have stage 2, 3, and 4 cancer. This surgical procedure may comprise the elimination of the uterus, the elimination of both ovaries and fallopian ducts, and basically the elimination of as much tissue that has tumour cells as possible (Koldjeski et al., 2005).

Chemotherapy is what follows after the surgery. The medications in this case are given intravenously or through the abdomen and this is what is commonly known as intraperitoneal treatment (Koldjeski et al., 2005). Other oral medications may be given to help reduce the side effects of the chemo, most of which include painkillers and antibiotics.

References

Lanceley, A., Fitzgerald, D., Jones, V., Miles, T., Elliott, E., Darragh, L., & Peck, L. (2011).

Ovarian cancer: symptoms, treatment and long-term patient management. Primary Health Care, 21(7), 31–38. https://doi.org/10.7748/phc2011.09.21.7.31.c8689

Gajjar, K., Ogden, G., Mujahid, M. I., & Razvi, K. (2012). Symptoms and Risk Factors of

Ovarian Cancer: A Survey in Primary Care. ISRN Obstetrics & Gynecology, 1–6.

Koldjeski, D., Kirkpatrick, M. K., Swanson, M., Everett, L., & Brown, S. (2005). An Ovarian

Cancer Diagnosis-Seeking Process: Unraveling the Diagnostic Delay Problem. Oncology Nursing Forum, 32(5), 1036–1042. https://doi.org/10.1188/05.ONF.1036-1042

 Claim: One way to assure the health of a discipline is to nurture contrasting perspectives

Introduction

A perspective is a way of thinking to a group of people who share a common role. Today, there is a fundamental change in how people organize, produce and interpret knowledge.  In the production of academic knowledge, professionals from different areas of expertise are implementing various perspective to solve problems. Frontiers of academic knowledge from different disciplines such as sociology, law, psychology, history and other areas bring different disciplinary perspectives and employ integrative approaches to offer synergistic solutions to the problems. The purpose of this paper is to focus on the interdisciplinary work and the major concern is exploring whether contrasting disciplinary perspectives assures the health and credibility of a discipline.  In order to  understand  how  multiple perspectives and  intellectual diversity  may  assure  the health of discipline, the paper will  be guided by the  following   general  knowledge questions and real-life situations:

• To what extent do the contrasting perspectives strengthen the areas of knowledge of a discipline?
• Can the credibility of discipline be falsified by the experts’ different perspectives and disagreements?
• What shapes the experts' distinct perspectives?
• What drives the conflicting claims?

  The hypothesis of the paper is that professionals should use an interdisciplinary approach and contrasting perspectives as this approach will enable them to apply knowledge from a different background, interpret knowledge using opinions, life experiences and personal observation. Accordingly, contrasting perspective and subjectivity judgment are the important ways that should be used to maintain the credibility of discipline and draw a conclusion concerning the areas of knowledge.

            Concerning the areas of knowledge, the perspectives concept would help the experts to generate valuable knowledge by using empirical evidence rather than theory (Dilworth, 21). The theory contains a sentence which might be true and false and thus, the experts need to understand the discipline using empirical facts. Note that in formulating a theory or rather understanding phenomena, authors encounter incommensurability problem due to lack of competing paradigms. In other words, the problem arises when scientists analyze a problem using a similar description (Dilworth, 21). However, the scientific revolution has helped the scientists to understand that a good formulation of the theory requires different concepts and different views. It is important to understand that the scientific revaluation did not only develop the scientific knowledge but it brought great advances in the areas of knowledge.  In addition, there were conceptual changes and this means that the older concepts in defining and solving problems were modified. The conceptual changes mean that the theoretical terms are used refer to different things with reference to the type of theory (Dilworth, 23). Today, various disciplines or areas of knowledge require the discovery of new facts and new theoretical principles. It is true that scientific disciplines have unique basic principles, specific perspectives, specific concepts and intended object that helps investigate the scientific reality and come up with a conceptual paradigm.  In order to find the reality and assure the credibility and the health of discipline, there must be an empirical-scientific agreement. In studying an area of knowledge, experts set a subject matter and come up with more advanced theories. In order to satisfy the subject matter, experts offer contracting perspectives toward creating a common reality (Cents, 20). In other words, experts create different theories that have different meaning about the discipline's subject-matter. The main point is that with the scientific revolution and scientific advance, contracting perspectives are needed to interpret the universal theories. 

  Personal and shared knowledge are two important elements that form a knowledge framework in the area of knowledge.  In the area of knowledge, individuals offer their personal knowledge which is gained through experience, formal education or academic research (Miller & Mansilla, 2). In the area of knowledge, personal knowledge play a significant role as it guides on the procedures of doing things.  On the other hand, shared knowledge comes from individual contributions and it plays a significant role in the area of it changes the common way of doing things by applying new experiments, new theories, and advances. It is also important to note that in the area of knowledge, people's perspective is influenced by their cultures, beliefs, and values (Miller & Mansilla, 4). Individuals involved in the area of knowledge differ in nationality, ethnicity, class, gender, race and more. The assortment of distinct groups allows international-mindedness where people offer different perspectives and share knowledge. The purpose of introducing the concepts of personal and shared knowledge is to support the claim that combination of contracting perspectives from individuals and groups from different background allows the experts to apply the differences in finding the scientific reality. 

 Hutchinson & Oltedal support this claim by arguing that today, a professional domain is made up of systematic and specialized knowledge. The author uses the social work academic discipline as an example of an area of knowledge and argues that the health of a social work discipline is derived from the combination of knowledge fields like geography, psychology, sociology, and history (Hutchinson & Oltedal, 2). All these domains are applied since the social work field demands a holistic approach in order to analyze the problem and offer solutions.  For example, the experts in the social work field are interested in understanding the problems affecting a group of people and the material needed to combat the issues. However, social workers derive other knowledge from the sociology field in order to understand the nature and pattern of society. This means that the social work field cannot fully implement the necessary changes as a single entity but it needs other sociology perspectives in order to understand the situation efficiently (Hutchinson & Oltedal, 4). Thus, there is a need for applying a contextual diversity to the social work Discipline in order to effectively and efficiently solve the societal issues and improve the living condition and the well-being of people.

            In the area of knowledge, experts develop a scientific theory which is either approved or disproved with a minimum claim. Thus, multiple contrasting perspectives are needed to formulate the theory, arrive at the final results and draw a conclusion. For example, in the social work discipline, there must be interactional perspectives. The purpose of this perspective is to create a linkage between the traditional social-political climate and modern organizational structure. The social work field supports the claim and draws the assumption that contrasting perspectives are an integral part of the credibility of a discipline.  Experts need to apply the new perspectives to the existing knowledge in order to compare the knowledge and come with credible research (Hutchinson & Oltedal, 230).  Another perspective is the psychodynamic perspective and it focuses on personality development at the individual level and the relationship between the individual and the surroundings.  For example, the learning theory provides a perspective that the environment controls human behavior and thus, the social worker focus on problematic behavior and its consequences (Hutchinson & Oltedal, 232). Another perspective is the conflict perspective that helps the social worker understand that in the society, people have different interests that leads to conflict and oppression, especially on women. Thus, the social worker may concentrate on the issues affecting a particular group of people such as the black people and address social issues (Hutchinson & Oltedal, 233). These different perspectives support the claim that for a discipline to be credible, it needs contrasting perspectives in order to connect and synthesize knowledge from different settings. 

             Grusec & Davidov support the claim by arguing that experts of psychological development employ different perspectives in order to understand the socialization discipline. They affirm that in every area of study, integration of knowledge is important since the knowledge from other relevant domains possess a special mechanism. For example, in the socialization field and in specific the study of caregiver-child interactions, it is important to employ contrasting perspectives since there are distinct domains that explain the child-caregiver interaction (Grusec & Davidov, 687). Each domain that talks about the social relationship employ unique principles and mechanism, rules, behavior change, and different outcomes. Thus, it is important to consider the interconnectedness of different aspects and articular different areas before arriving into the conclusion. Mazzei (216) also supports the use of contrasting perspectives by saying that in the Business field, experts who want to understand the knowledge of corporate communication can derive information from other fields like public relations, business communication, and marketing. These domains defer and overlap in various ways but the combination would help the expert in corporate communication to produce a better understanding.  In addition, the contrasting perspectives from different domains offer an integrative approach where experts examine the interrelationships and benefits from the cross-fertilization (Mazzei, 219). The different perspectives help the experts employ the most important approach in conducting research and the approach will increase credibility.  Contrasting perspectives add value to the area of study since the experts incorporate specific connotations and concepts from each domain and thereby generates valuable knowledge.

Conclusion

 Contrasting perspectives yields powerful ways of addressing questions. The integrative disciplinary perceives allows the experts to use analogical thinking and as a result, they are able to relate the concepts from another domain with the discipline thereby strengthening the credibility of the discipline. The research has also confirmed that the can assure the health of discipline in that the experts introduce compound concepts that promote integrative understanding. In other words, there are terms that when derived from another domain and applying to one domain,  they create a  relationship between the two different fields and the relations helps in linking the cultural and genetic factors and more important formulating a new approach of understanding the area of knowledge.  The research has shown that in order to assure that discipline is well researched, there must be multiple perspectives,  complex explanation of the area of knowledge, different concepts and findings, a complex line of inquiry such as culture,  and beliefs, values and experiences. Contracting perspectives will enable the experts to create mutual scrutiny and apply knowledge from other fields and as a result, the perspectives will yield action-oriented leverage. The paper has confirmed that the area of knowledge and the different disciplinary perspectives play a significant role in forming a dynamic relationship in defining the problem and applying tools from other relevant domains thereby strengthening the credibility of a discipline.

Work cited

 Cents, Michel HG. Intra-Value Conflicts and Nietzsche's Perspectivism: Multiple Perspectives

of Values and Tackling Grand Challenges. MS thesis. University of Twente, 2017.

Hutchinson, Gunn Strand,  & Oltedal, S. "Five theories in social work." (2014).

Miller, Matthew, and Mansilla B. V. "Thinking across perspectives and

disciplines." Harvard Graduate School of Education (2004).

Mazzei, Alessandra. "A multidisciplinary approach for a new understanding of corporate

communication." Corporate communications: an international journal 19.2 (2014): 216-

230.

 Grusec, Joan E., &  Davidov, M. "Integrating different perspectives on socialization

theory and research: A domain‐specific approach." Child development 81.3 (2010): 687-

709.

Dilworth, Craig. "The Perspectivist Conception of Science." Science Between Truth and Ethical

Responsibility. Springer, Cham, 2015. 21-25.

Social Cognition and Attitude Towards Depression

Abstract

The overall aim of this proposal is to investigate whether the attitudes towards depression affects the social cognition of students from Louisiana State University Alexandria (LSUA).  Research has found that social cognition is important in cognitive functioning as it enables individuals with depression to identify, infer information about intentions and feelings and comprehend information.  The research finds that social cognitive performance is impaired when people have stressful encounters. The background information about the proposal is that both traditional and non-traditional students experience mental health problems as they join the university.  Traditional students encounter various challenges such as social problems, homesickness, time management, adjusting to the new environment and school-life balance. Similar, non-traditional students suffer from school-life balance, financial challenges, family responsibilities, and time management. The research has also found that among these students, some may be suffering from remitted depression while others may be suffering from current depression.  Patients' whose cognitive functioning has been affected have problems in paying attention, negative attitude and memory loss.  The main problem that the research has found is that despite the fact that some patients have remitted depression while others have current depression, there is no difference between the two individuals in measuring social cognition.  For this reason, Lip service is only given to patients who engage in university activities such as social life pressure, extracurricular activities, relationships and more. The research on social cognition and depression has been ignored especially on areas based on types of medications, gender, and other factors. It is important to examine the social cognition and attitude towards depression since there are many factors that may contribute to low performance in social cognition. The hypothesis of the study is that attitudes towards depression are linked with low social cognition among LSUA students.  To accomplish this hypothesis, the study will use 50 participants from LSUA students' community where twenty-five are male and 25 are female.

 Social cognition can be defined as one’s ability to detect, process, and comprehend information that is of social importance. The information can be about a place, a situation, or a person and its relevance to the individual (Baune, Air, & Weightman, 2014). Social cognition is an important element for personal functioning, wellbeing, and development. Depression is a mental state that negatively affects the way one feels about oneself. For college and university going students, college life can be stressful at time. From adjusting to the new environment, academic pressure, and fulfillment of personal tasks, some students have stressful encounters during their college time. The encounters lead to a student’s first mental health problems and eventual downfall if not countered (Pedreli et al., 2015). It is these encounters that lead to depression and cause a student to have low performance in social cognition. Baune, Air, and Weightman (2014) researched on social cognition and depression as a review on the role of the latter in major depressive disorder. Ladegaard (2013) investigated major depression and social cognitive ability.  Villate, Marcotte, and Potvin (2017) examined the correlates of depression in college students. 

            Mental health problems are common among university students. This can be attributed to university life being a challenging time to both traditional and non-traditional undergraduate students. Depending on one’s financial support, the traditional student may join university after clearing high school studies. Traditional students are usually young, require a parent’s financial support, may have part-time work, and don’t have the experience to handle the root harsh nature that life is. Coupled with academic pressure, taking up adult-like duties, being in relationships, and interacting with different people from different backgrounds, the life of a university student may be stressful. Non-traditional students may also have mental health problems due to chances of having dependents that do not include their spouses. They may have to make time for work, meeting deadlines, family responsibilities, and meeting the demands for academics (Pedreli et al., 2015). This continuous loop of life has caused an increase in the number of students, both traditional and non-traditional, having mental health problems. These numbers include the students who may have suffered from depression and have recovered- remitted patients, and students who are currently suffering from depression-current patients. 

            The connection of social cognition and the attitude towards depression is abstruse. Patients who suffer from depression have been reported to impairments in cognitive functioning. These functions include paying attention, loss of memory, and psychomotor functioning (Douglas & Porter, 2009). Harkness et al., (2011) and McDermott and Elbeimer (2009) found out that depressed individuals show extensively reduced social cognition when paralleled to healthy control individuals. Also, depressed people are more likely to have negative attitudes and interpretations to neutral expressions when compared to healthy control individuals. The have a grander passion of emotion than the healthy control group (Harkness, et al., 2011). Nevertheless, there is no difference between healthy control individuals and depressed (current and remitted) individuals on measures of social cognition, visual perception, prosodic stimulant, and affect recognition. This lack of link could be due to the connection between social cognition and individual cognitive processes not being expansively studied.

            A majority of the study showing the relationship between social cognition and the attitude towards depression have been concentrated in patients who are beyond teenage hood and early youth. Lip service has been given to the executive function and information processing of depressed individuals who are participating in activities that university students do. These activities include enduring academic pressure, social life pressure, engagements in sports and co-curricular activities, part-time works, and or, relationships. This void in the study has left a disparity in findings go from research on social cognition and depression in university. Also, gender, symptoms severity, types of medication, and recurrence of depressive episodes have been used as variables in most of the studies, ignoring individual factors that may lead to depression and eventual low performance in social cognition of individuals. There is need for study of social cognition and attitude towards depression, their association and prevalence in university students, such as the LSUA. These voids have created an avenue for this research to center on social cognition attitude towards depression in LSUA. This paper will investigate whether the attitude towards depression affects social cognition of LSUA students. With this goal in mind, the investigation will aim to address two hypothesis.

1. Attitude towards Depression is linked with low social cognition among LSUA students.
2. Social cognition performance is affected by current and remitted depression.

Participants

            A total of 50 participants are expected to take part in the study. The participants will be recruited from the LSUA student community. This project will be conducted via online survey. Of the 50 patients, the researcher will expect 30 to know an individual with remitted depression patients and 20 to know an individual with current depression patients. Twenty-five patients will be male and 25 will be female. The 50 patients will be compared to an equal number of people who know healthy control individuals. The healthy control individuals will be the selected by the researcher through individual interviews. The researcher will get participants of ages 17 to 56. The researcher will not factor in the race as a variable in recruiting patients for the study or the healthy control individuals. The type of students, whether traditional or non-traditional will be factored in when selecting the patients. The course studied, extracurricular activities engaged in, and use of substances will be factors when recruiting the patients for the research.

Materials and Measures.

            In an effort to reveal the relationship between social cognition and attitude towards depression in LSUA students, factors such as age, gender, family dynamics, course studied, part-time or fulltime student etc. will be addressed.  Attitudes toward symptoms of depression, sociodemographic factors, friends’ support, adjustment to college, and existence of a romantic relationship will be used to consider eligibility. In this study, we will stay away from measuring diagnosis and only measure attitudes about diagnosis. In addition, we will create our own survey measuring attitudes towards depression. Some example questions assessing attitudes about depression could be: Do you think that Depression should be considered a real disorder?  Do you think that individuals with depression should be given special accommodations?  These types of questions can allow you to determine if people have a negative view of depression or a sympathetic view of depression. All these tests will be made into a flowing questionnaire that the patients will respond to.

Procedures

            The researcher will go to the professor and once the survey is approved, the professor will upload it to Survey monkey.  Once approved, the professor will then distribute the link to LSUA students for participation.  Survey monkey will provide the avenue for the online questionnaire. The 50 participants will get wind of the research through emails and participation is voluntary.  Special effort will be put by the professor to get the information to majority of the students in the university. The researcher will introduce the project to the recruited participants and healthy control group through survey monkey.  Ethical issues will be addressed and the recruited patients will be given resources for depression as whether it is severe, current, remitted.  This will aid in not losing sight of the scope and aim of the study. Through the survey monkey questionnaire we will be able to provide answers to the whether or not an individual’s attitude towards depression is linked with low social cognition among LSUA students. In addition, the survey will answer if social cognition’s performance is affected by attitudes about current and remitted depression.

Call to action

            The purpose of this article is to inform the reader on essential skills that would assist minimize infant mortality, define infant feeding norms, and evaluate underlying reasons how infant development ensues in terms of the feeding skills.

 Skills needed to minimize infant mortality

 Protection commences before the mother gives birth. An expectant mother needs to under vaccination against sicknesses such as influenza (Iams et.al, 2008). During pregnancy, these diseases can also affect the child through the placenta that is in contact with the mother’s blood stream.

 Apart from immunization, breastfeeding a child from birth makes the infant healthier. Breast milk contains rich nutrients, which strengthens the immune system of the child hence increasing their survival rate (Delaney, & Arvedson, 2008).

Infant feeding behavior

After six months, a baby can consume simple solids with milk hence the baby needs to be responsive every time it is fed (Delaney, & Arvedson, 2008).. When it gets hungry, it can cry out and the mother can take the chance to feed it more food.

Infant development progress

            In terms of physicality after a few months, an infant moves from being helpless to an energetic infant. After a year, a mother must note these changes in her baby. Infants grow at an alarming rate and each month a new alteration occurs (Delaney, & Arvedson, 2008). In order for the changes to take place, there are certain skills a mother should adhere to notice healthy progress.

Feeding skills development

An infant needs to feed on healthy foods at particular times. The mother should lay the toddler in a partial inclined position while feeding and the baby should identify the feeding bottle (Iams et.al, 2008). The baby should utilize hands during breast-feeding and show a good and awareness of synchronization as he or she swallows and sucks.

Reference

Iams, J. D., Romero, R., Culhane, J. F., & Goldenberg, R. L. (2008). Primary, secondary, and tertiary interventions to reduce the morbidity and mortality of preterm birth. The lancet, 371(9607), 164-175.

Delaney, A. L., & Arvedson, J. C. (2008). Development of swallowing and feeding: prenatal through first year of life. Developmental disabilities research reviews, 14(2), 105-117.

        Chapter 3

Methodology

3.0. Introduction

       3.0.1. Study Location 

3.1 Research Paradigms                                                                         

3.2 Research Design and Methodology

3.3 Philosophical and theoretical basis for the study

3.4 Population, Sample and Sampling

3.5 Data Collection

3.6 Pilot Test/Pilot Interview

3.7 Data Analysis

3.8 Reliability and Validity

3.9 Ethical Considerations

3.10 The Summary

Figures:

Figure 1

Appendices:

Appendix 1: Information Sheet

Appendix 2: SE-PSCS Questionnaires 

Appendix 3: RCSI Approval

Appendix 4: RCSI Final amendment Approval

Appendix 5: Permission Emails

Appendix 6: MRC/IRB Approval

Appendix 7: Flyer

Chapter 3

Methodology

3.0 Introduction

The methodology chapter provides information on the procedures and instruments that are used to answer the research questions. This chapter is divided into the following sections and sub-sections: Introduction, Research Paradigms, Research Design and Methodology, Philosophical and theoretical basis for the study, Population Sample and Sampling, Data Collection, Pilot Test/Pilot Interview, Data Analysis, Issues of Reliability, Ethical Considerations and Summary.

In this study, the researcher is studying the factors that contribute to nurses’ self-efficacy level in offering cigarette smoking termination amenities among mentally-ill smokers in a psychiatric hospital. Specifically, the research answers the following question: “How does an Arab mental health nurse rate their self-efficacy in providing cigarette smoking cessation for mental health in- patient?” The study aims to assess the attitudes, beliefs and current practices of Arab mental health nurses in providing cigarette smoking cessation and their sense of self –efficacy’ in promoting free smoking policy in mental health services.

The objectives of this study are:

1. To assess Arab nurses’ attitudes and beliefs towards cigarette smoking use in Mental Health Services.
2. To assess the perceived self-efficacy of Arab nurses in promoting cigarette smoking cessation in mental health Hospital (Male/Female inpatient units, Outpatient department, community adult , Psychogeriatric, Child and Adolescent Mental Health Psychiatric Services(CAMPS).
3. To make recommendations to the psychiatric hospital on staff educational preparation approaches to cigarette smoking cessation.
4. To determine the best research approach prompts frequent debates, as all methods have their strengths and limitations (Crotty, 1989).

            Although there are many valid research paradigms, methodologies and strategies used in nursing research, none are universally recognized as superior to the others (Cordeiro V et al., 2016). Nursing research seeks, through application of a systematic processes, new knowledge that will benefit the population as a whole, across a continuum of healthcare services addressing the needs of all age profiles (Boswell&Cannon, 2012).  Fundamentally, undertaking research entails choosing which paradigm and methodology that best answers the research question (Welford et al. 2011, Jones 2014). The Quantitative descriptive cross-sectional survey design will be discussed in this chapter. The research study is formulated upon a confirmatory and predictive nature, using a positivism paradigm. The researcher explains all necessary ethical considerations in choosing the participants for the research.

            HMC was selected for the study for a number of reasons. Primarily, it is the only first provider of smoking cessation in Qatar. Secondly, it receives the highest number of tobacco smoke patients in the Gulf region (Hamad Medical Cooperation., 2018). In 2015, the smoking cessation center received over 3,600 patients seeking cessation services. The statistics show 52% of the patient’ Nationalities are south Asian, Iranians and Arabs.The pervasiveness of cigarette smoking in the Qatari populace was projected in a past study  by World et al., (2018) to be 36.5%.

            Approximately 40% of patients at HMC are heavy smokers consuming more than 30 cigarettes per day (Lasser et al., 2000, Hamad Medical Cooperation., 2018) The significant rise in the number of schizophrenic patients is 44%. A cross sectional survey of psychiatric patients found that 61% respondents were smokers and 18% were heavy smokers(Schroder et al., 2003).  The number of psychiatric patients attending cigarette smoking cessation is due to policy of the facility and the country in prohibiting the smoking at public places, indoor offices, hospital premises and restaurants.  However, smoking is still allowed on acute psychiatric wards but will be banned from 4^Th March2019 (Hamad Medical Cooperation., 2018). The Mental Health Service in Qatar provides an institutional collaboration among mental health facilities with smoking cessation that can support inpatient units. The mental health clinic works with the HMC tobacco control center to help patients with mental health problems quit tobacco smoking. The center expects to expand its cigarettes smoking cessation services from a current   800 to 1200 patients annually for the next 5 years. Therefore, the research findings of this study will be helpful for the organization in service planning and expansion (Hamad Medical Cooperation., 2018).

            The high number of smoking cessation service patients at the hospital emphasizes the nurses’ role and the need for their expertise. Psychiatric nurses at the hospital are expected to offer cigarette smoking cessation services by March 2019. Being in an Arab world, the organization has many Arab clinicians in different specialties (Abujaber&Katsioloudes, 2015). The research aims at assessing Arab nurses’ beliefs, attitudes and clinical practices in providing smoking cessation and free smoke policy by the hospital. The mental health services mainly offer cigarettes smoking cessation to resident and non- resident patients. Statistics show the percentage of Qatari patients is higher than non-Qataris.

            Finally, the researcher chose the location of this hospital because there is very limited research on this topic in the Gulf region. The selected location of the HMC in Qatar could also allow for applying study results to other facilities in the Gulf region.  Furthermore, the hospital was an accessible facility during submitting the IRB. The study permitted the use of descriptive cross –sectional survey design.

            3.0.1 Study Location

The research study was conducted at the Hamad Medical eCooperation (HMC) a govermental hospital located in Qatar. The facility is one of the largest not-profit premier healthcare facilities in the Gulf region. The healthcare facility (HMC) operates eight hospitals in Qatar; one of them is the Psychiatric hospital. The research took place at the Psychiatric hospital in Qatar which is part of  the largest Hamad General Hospital (HGH) in Doha. HMC receives  the highest rates of smokers among control tobbaco clinics in the country (Hamad Medical Cooperation., 2018).

3.1 Research paradigms

Healthcare related research is usually aligned with one of two main research paradigms, or theoretical perspectives. Paradigms described as “world views or ways of go through and thoughtful about the world”(Kuhn, 1974.p.55). According to Kuhn (1974) the term paradigm denotes “a research philosophy with a set of principles, morals, and conventions that a community of researchers has in common concerning the nature and manner of research”; a paradigm is a view of the world on how “things work”(Kuhn, 1974.P.87, Morgan, 2011). A paradigm is the conceptual framework that dictates all aspects of a research study (Kuhn, 1974). The choice of a research paradigm is strictly influenced by concepts of ontology (belief systems about social reality), epistemology (theoretical frameworks in place), axiology (ethics and values) and methodology (the best approach for systematic inquiry) (Kuhn, 1974, Crotty, 1989, Weaver&Olson, 2006).

 The researcher in this study adopted the positivism paradigms. This approach is associated with the self-assessment questionnaire and will answer the research question. According to (Guo et al., 2015), the same study was conducted between two different hospitals in southern and western are in Taiwan. The authors used quantitative approach with self- reported questionnaire. A positivistic paradigm commonly uses a quantitative methodology in research as it believes that a “single reality exists”, which can be known and measured and thus uses a quantitative model to measure and know this reality (Crotty, 1989.p.167). On the other hand, a constructivist paradigm observes that there is no single truth; making it necessary to interpret the reality.  Therefore, qualitative methods are used to measure these realities (Kuhn, 1974). 

3.2 Research Design and Methodology

This study utilized a expressive cross-sectional review design; employing questionnaires that were self-administered. The questionnaires were relatively quick and easy to complete by the participants Arab mental health nurses), but they did not show the differences between cause and effect (Denise&Cheryl, 2012). Descriptive research studies are often used when research questionnaire includes open questionnaire or conditions and events (Denise&Cheryl, 2012). Descriptive research involves credentials of traits of a certain phenomenon based on answers made or can involve exploring the association between two or more variable (Wahyuni, 2012).

 Nevertheless, the purpose of this descriptive design was to measure self-efficacy of Arab mental health nurses in different units (inpatient/outpatient male and female). In this case, the research design/methodology would give a snapshot of the frequency and characteristics of self-efficacy issues within the specified time period in order to allow for thorough analysis. The level of self-efficacy of Arab nurses that mental health services would be the measured rated among the population sample (Guo et al., 2015, Zhang et al., 2015, Barros et al., 2014).

3.2.1 Cross Sectional Studies  

The most significant benefit of cross sectional studies is they are fast and  fiscally affordable since there is no follow up, less resource are essential to run the study (Boswell&Cannon, 2012). Cross sectional studies are the best way to control occurrence and are valuable at recognizing relations that can be more meticulously studied using a regiment study or randomized controlled study (Cordeiro V et al., 2016). The most significant issue with this sort of study is distinguishing cause and result from simple association.

3.3 Philosophical and theoretical basis for the study

Figure 1; showing an example of a questionnaire that has been adopted in this study        

The theoretical basis for the study is Self-efficacy theory (Bandura, 1977). The basic foundation is that there is a positive relationship between self-efficacy and behavior change. The questionnaire that has been adapted and shown in the figure (2), has been used to quantify attitudes, opinions, behaviors, and other defined variables with demographic variables such as age, gender, level of education and experiences years, this can be viewed in Appendix2.

This study tried to assess the opinion of the nurses and also to find common reasons why people living with mental illness smoke and continue smoking as one of the attitudes and believes in the sub scale.

3.4 Population, Sample and Sampling

Appropriate selection of study subjects aids the vital purpose of guaranteeing that findings precisely characterize what is happening within the population of interest (Cordeiro V et al., 2016, Burns&Grove, 2009). A poorly selected sample may yield biased results which affects the external validity of the study, and as such, results cannot be applied to the wider population (Denise&Cheryl, 2012). The population refers to all subjects of interest to the researcher and the sample refers to the proportion of the population selected to participate (Cordeiro V et al., 2016).

Several aspects must be taken into consideration when designing the sample size in quantitative studies.  The main considerations are: 1) the population of the study,  2) type of the design 3) the measurement and 4) practicability (Boswell&Cannon, 2012). A descriptive design is used to examine characteristics of Arab mental health nurses as the sample. According to (Burns&Grove, 2009)  in  (Boswell&Cannon, 2012),a descriptive design helps the researcher to develop the clinical practices theory to find the rationale of practice, solving  problems between the variables (dependent/ independent) in the research question. A poorly selected sample may yield biased results which affects external validity of the study, and as such, results cannot be applied to the wider population (Denise&Cheryl, 2012). The population refers to all subjects of interest to the researcher and the sample refers to the proportion of the population selected to participate (Burns&Grove, 2009).

            The research population for this study was Mental Health Nurses (MHN) at HMC  (n=250), a sample size included all Arab mental health nurses is used for this study (n=103)  (Hamad Medical Cooperation., 2018). The expected response rate to the study questionnaire is 63% this is in reference to the population in this hospital

All the Arab nurses at the hospital were provided with the questionnaire package and that most especially those that have provided outpatient/inpatient services for more than 3 months.  The sample size of 103 nurses come from six departments as follows; Male/ female inpatient units, outpatients, adult male/ female community, adult/ older psychiatry, case managers, consultation and liaison.

Although purposive sampling is viewed as a non-probability method which is subject to researchers' judgment, it ensures a proper representation of the study population. These participants are selected based on inclusion and exclusion criteria such as Nationality and different job title in the work.

The inclusion criteria:

1. Only Arab licensed nurses working in the psychiatry hospital.
2. The individuals must be over 18 years old and citizens of any country within the Middle East and North Africa
3. The nurses should have received the license three months training prior to the recruitment.

Exclusion criteria:

1. Non Arabic nurses
2. Individuals who are currently on leave for more than three months
3. Unlicensed nurses for instance the student nurses and the new graduates

3.5 Data Collection

The data pertaining to each Arab nurse was collected weekly for the duration of the study over a four week period in psychiatry hospital.

The researcher reviews all the potential individuals who can participate in the study as per the inclusion and exclusion criteria. After selection, all the individuals will be contacted through their Head Nurses units’ emails and a visit to their department to inform them. The individuals will later read the information sheet as consent form before enrolment into the study see Appendix (1). Participants will complete the survey and return it in a closed envelop to the secretary office

Two nurses returned the survey empty in the pilot phase and completed survey is (n=7) and actual study phase are (n=103). The returned survey in the actual study was (n=12) some none Arab nationality nurses answering the questionnaire and some not completed. The participants’ kept them in the return box.

 The data collected included demographic details obtained from the nursing answers including

• Age
• Gender
• Nationality
• Educational levels
• Present job
• Experience years
• Smoking history
• Graduation years
• Unit/ work area.
• Country where obtained the professional license

 See Appendix (1). 

3.5.1 Data collection protocol

Data collection phase of the research question is carried out in two stages: The first phase includes acquiring the participants and this included getting a list of the Arab mental health nurses from which were obtained from the secretary management. The research will begin with the collection of the data from nurses. If the expected response rate is not reached after 2 weeks, the researcher will extend the participation period for two more weeks.

The list of Arab nurses that fits the inclusion / exclusion criteria was reassessed by two research assistants and a management nurse, to ensure that all included Arab nurses maintained the needed capacity for participation this study. After the completion of this step, no disagreement occurred and all nurses who fit the inclusion / exclusion criteria were approached by one of the two research assistants that were helping with this study whose main role was to ensure that everything about this study was effective and going according to plan and invited to participate in the study. Participants information sheet are provided with the survey to all participants.  Those nurses who agreed to participate were invited to complete the questionnaires with the assistance of the researcher.

The researcher did not offer any opinions to the participantsroughout the completion of the questionnaires which helped ensure validity of the exercise. A stamped MRC- HMC and a return envelope is also attached. Contact details for the PI and the research supervisor were also included in the information sheet. Participation packages were numbered in order to assess response rates and also to avoid interference with confidentiality. 

3.5.2 Instrument

This study adopted similar research questionnaire used in a different study and permission was granted by the original study author (Guo et al., 2015). The questionnaire in this study was previously used in a study in Taiwan to examine self-efficacy in smoking cessation services for psychiatric nurses (Guo et al., 2015).  The questionnaire was designed by (Zapka et al., 2000), (Sarna et al., 2001) and later developed by (Johnson et al., 2009) then (Guo et al., 2015). The research questionnaire was divided into four parts;

1. Attitudes and Beliefs

Part two collects information on nurses’ attitudes and beliefs when offering the clinical services. It includes a total of four questions with subsections testing different notions as reasons why people smoke, and barriers to receiving cessation services. Such information can assist in identifying the nurses' perception of how they deal with mental health patients in need of smoking cessation services.

2. Smoke-Free Policies

Part three of the questionnaire asks questions on the work place smoke-free policies in the institution. The section is divided into other sub-sections assessing different self-efficacy practices in the clinic. Sub-section one has questions A to M each measuring clients experience to smoke free policies in the institution. The second subsection examines nurses’ response to the same policies. The third section measures the interaction between patients and healthcare providers.

3. Cessation Practices

The final part of the questionnaire sets out to evaluate the interventions of the nurses based on the cessation policies in the facility. The part has four questions that determine the type of services and how nurses offer them to clients. Some of the questions include whether nurses assess smoking patients, provide support and encouragement to those in need of quitting smoking, type of discussions with clients.

4. The Nurse Self-Efficacy Scale

The study used a self-efficacy scale that was first developed by Zapka et al. (2000) and later modified Johnson et al. (2009) during their research to examine attitude of nurses in a mental health care setting offering cessation services to tobacco smokers. The tool has five items, which measure different confindence levels as identification of clients level of smoking, discusion of strategies to minimize the strategy, patients preparedness of leaving the smoking behavior, knowledge of effects of smoking, and suggestion of other therapies. A higher score shows the participants have  high confidence.  

This questionnaire took around 20-30 minutes according to nurse’s skills to be completed.  The questionnaire included items like; attitudes and beliefs regarding smoking by a patient; implementation of smoking free policy at work; and clinical practices experience in providing smoking cessation services (SCS) . All research tools related to SE-PSCS nurse’s measure were adopted from the original English language questionnaire (Sarna et al., 2001, Zapka et al., 2000), which was modified in some parts by (Johnson et al., 2009).  For efficiency, the questionnaire is open ended in nature such that the participants after giving an answer have the chance of explaining these answers. This is effective because it helps these participants to offer more information that is beneficial for this study.

3.5.3 Demographic information

 Part one entails collection of demographic information of the research subjects. The data provides the demographic characteristics of research subjects such as i.e. Age , Gender, Nationality, Educational  levels, Present job, Experience years, Smoking  history ,Graduation years, Unit/ work area and  the professional license country, history of smoke ciggeratte and education history related smoking cessation .

 The three main parts of the questionnaire contain eleven sub divisions of sub scales and Yes/No-Agree/disagree Likert scale (Appendix2).

3.6 Pilot Test/Pilot Interview

Before the actual study, the researchers did a pilot test to ensure the research design was appropriate and the questions in the questionnaires were applicable and understandable to the study population. The strategy entailed administering the questionnaires to the selected individuals representing the study sample (n=10). After they answered the questions, researchers analyzed the data to ensure validity of the study.  The seven questionnaires response rate of ten 7/10 were included in the pilot on basis of purposive sampling. The pilot test was vital for the research as it helped in identifying questions in need of adjustment.

3.7 Data Analysis

Each survey was assigned a serial number so it could be used for correction and revision purposes. Statistical Package for the Social Sciences (SPSS Inc. Chicago, IL software, SPSS version 25.0 was used for statistical analysis of the data. All data was tested for normality using the associations between two or more qualitative variables (demographic variables, potential confounders, and self-efficacy for providing SCS among psychiatric nurses was assessed using Karl Pearson correlation and coefficient, t-tests and ANOVA. Descriptive statistics were generated to describe demographic data and the results of sample size outcome measures (n=61).

Quantitative data between the two independent groups (two different units within Arab mental health nurses) was analyzed using unpaired test or Mann Whitney U test as appropriate. Relationship between two quantitative variables will be examined using Pearson’s correlation coefficients. The relationship between correlates of self-efficacy in providing SCS among psychiatric nurses and main intrinsic and extrinsic risk factors (demographics and potential confounders) was compared and assessed using logistic regression models. The results were presented and reported in odds ratio (OR) and associated 95% CI. All P values presented were be two-tailed, and P values <0.05 were considered as statistically significant. Scale (Appendix 2) and the SE-PSCS.

 The researcher concurrently recorded SE-PSCS. The SE-PSCS questionnaire data was placed directly in SPSS version 25 and   all original papers kept in locked looker.

The researcher used the information sheet attached to the survey in addition to a flyer poster created by author for explaining the project. The researcher also explained any unclear sentences or questions in a very assertive and professional manner when communicating with participants. The opportunity to contact the primary investigator was voluntary and welcomed,

3.8 Reliability and Validity

According to (Gerrish&Lacey, 2010) reliability and validity are key concepts of research. Reliability in research is the ability to provide consistency in the measurement of an outcome. Equally, validity in research is described as the ability to measure what the study aimed to measure without bias (Gerrish&Lacey, 2010). Reliability is concerned with consistency, accuracy and stability (Boswell&Cannon, 2012).

Reliability and validity are imperative in research as results must be representative of the truth. New research cannot benefit clinical practice if reliability and validity cannot be proven (Denise&Cheryl, 2012). In order to ensure reliability and validity, researchers must be systematic in their approach to conducting research so that results can be replicated in future studies (Wahyuni, 2012)

There was no significant issue of the reliability and validity faces in the research questionnaire because all the questions used were open ended and thus allowed the participants to explain their answers further.  The researcher used the information sheet attached to the survey in addition to a flyer poster to explain the project to the participants to ensure that they understood what the study was all about, see Appendix 7. The researcher also explained unclear sentences or questions in a very assertive and professional manner when communicating with participants. The opportunity to contact the primary investigator was voluntary and readily welcomed. 

Some changes only done on demographic part and was in English language. The original version was also in English language and all participants can speak and understand the English Language. In each part of the questionnaire, the previous author determined the validity as the following titles;

• Attitudes and Beliefs

Individuals who are smokers and hold an attitude that smoking is right are mostly less active in offering the cessation services. The section has a total of 9-items measured on a 4-point scale. A higher score on the scale reflects fewer barriers to perception practices. (Guo et al., 2015)found that the framework is effective as it had a test– retest reliability at 2 weeks of 0.65 (P = 0.004) and Cronbach’s α was 0.85.

• Smoke-Free Policies

 (Guo et al., 2015)found the smoke free-policy framework valid as it had a reliability test of 0.80 in two weeks. .

• Cessation Practices

The section has 18 items with a reliability score of 0.77 when applied in two weeks (Guo et al., 2015)

3.9 Ethical Considerations 

An application for ethical approval was submitted to the Royal College of Surgeons in Bahrain’s Research Ethics Committee on the 04^th April 2018 (Appendix 3). Approval was granted on 29^th April 2018 (Appendix 4).  Some amendments were requested by RCSI research committee in regards the IRB (MRC) requirements, and final RCSI committee approval commenced on the 5^th August 2018 (Appendix 5). Recruitment commenced on 11^th September 2018 after IRB date approval 12^th August 2018. Permission was granted by mail from the Chief  Medical Officer of the psychiatric hospital and Nursing director in question to conduct the study on-site on 28^th  May2018 (Appendix 6).

            Arab Mental health nursing participants were provided a Leaflet in each unit (Appendix 7) where the aims and objectives of the research were explained at this time. The aims and objectives of the study were explained to the study population at the hospital regardless of whether they are in the sample target or not. Any members who wished to participate in the study were provided with a participation pack to take home and complete at their leisure. The participation pack contained the information sheet (Appendix1), SCS survey and returned envelop (Appendix 2), which participants were asked to complete and return to the PI or return box in the secretory office in the included stamped, white envelope.  No identifiable information was included in the data collection forms. Every participant was assigned a Number / serial number used for data entry purpose in the program. Hard copies of all data collection forms were kept in a locked cabinet format. Data was electronically transferred to the researcher’s unique project folder in a computer secure drive. Where data analysis had to be carried out away from the main server for practical reasons, an encrypted USB key was utilized to ensure data security.

            The storage and use of participant data was carried out in adherence with the Data Protection Acts (Harriss&Atkinson, 2015, Moulton&Hamilton, 2004), and in accordance with the Royal College of Surgeons in Bahrain (RCSI) Data Protection Policy Guidelines (Kassim et al., 2016). Data will be stored for a period of five years, in accordance with these guidelines. 

3.10 Summary

The purpose of the study was to assess the relationship between the attitudes, beliefs and current practices of Arab mental health nurses towards cigarette smoking and tobacco use, and their sense of self -efficacy in promoting cigarette smoking cessation in mental health services. This was performed using a prospective, descriptive cross-sectional research design. This design was chosen as the writer wished to follow participants over a four week period and assess nurse’s attitudes towards the cigarette smoking cessation as determined by the self-efficacy psychiatric smoking cessation services (SE- PSCS) survey. A positivist, quantitative method was used as the researcher wished to extract data regarding the tool of SE-PSCS (survey) and examine any association between the variables. This data was analyzed to assess the presence or absence of a relationship.

Non-probability, purposive sampling was used as the writer wished to study Arab mental health nurses which would be representative of the target population. Participants had to be confident in their abilities to deliver treatment and health services to mentally ill patients. For this reason, a minimum work of period of three months and a valid license were the only inclusion criteria for the study.

Those participants who did not return envelops to participate were excluded from the study. No other exclusion criteria were applied. Arab nurses who met the inclusion criteria were invited to participate. A sample size of 61 from 103 participants was determined through power analysis.  The self-report questionnaire SCS was collected and the data was analyzed. Data was analyzed using a Statistical Package for Social Sciences (SPSS) programmer version 25. Correlation between tools was determined chi-square (χ2) test, Fisher Exact test or Yates corrected Chi-square as appropriate was used to determine the relationship between subscales.

Significance was determined through the calculation of p-values. Coded data was entered in the system then frequency showing the variables’ relationships was extracted for interpretation. With the procedures and instruments in place, the study will get accurate and reliable results. After analyzing the results, the researcher made recommendations to the psychiatric hospital on staff educational preparation approaches to cigarette smoking cessation.

Reliability and validity were ensured through the use of validated tools. The researcher was the only person assessing participants therefore eliminating unethical issues such as privacy and confidentiality concerns. The study was designed and conducted in a strict accordance with the IRB in (MRC- HMC).

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Appendices

Appendix (1): Information Sheet

Appendix2: SE-PSCS Questionnaires 

Appendix3: RCSI Approval

Appendix4: RCSI Final amendment Approval.

Appendix5: Permission Emails.

Appendix6: MRC/IRB Approval

Appendix7: Flyer

Examination of the United State National Care Delivery Model

  According to Ammatuna & Gaul (2018), U.S healthcare facilities have employed a new model that is enabling the facility to offer quality and efficient health care access. The U.S healthcare system has employed the model of value-based care- a customer-focused and patient-centered model designed to eliminate unnecessary interventions (AMMATUNA & GAUL, 2018). All healthcare organizations in the U.S are obligated to provide reimbursements through Medicaid and Medicare. The Organization for Economic Cooperation and Development reports that in a year, U.S spends almost $10, 000 on health expenses and despite the high costs, there is a high rate of mortality rate which occurs due to lack of profession's performance (AMMATUNA & GAUL, 2018).  Thus, there is a need to improve patient safety, reduce health costs and improve professional performance. VBC is the best technology as it will reduce medical errors, build a coordinated care team, provide proactive care and promote health improvements.

 Buttigieg, Rathert & Eiff (2015) affirm that healthcare management practices show a disparity between local and international health care system. It is true that the United State healthcare model differs from international delivery models in international healthcare system has a wealth of innovations and this means that the system moves beyond the comfort zone and employs significant models that brings greats results and conclusions (Buttigieg, Rathert & Eiff, 2015). Since the international health care system encompasses diverse healthy systems and focus on providing international best practices, the system has employed the model of healthcare management research.  According to my own opinion, this is the best model since its implications are far-reaching. In other words, increasing efforts in healthcare research is the best decisions as it encompasses many areas that are needed to improve the healthcare system (Buttigieg, Rathert & Eiff, 2015). Today, the world is spending a lot on diseases such as obesity, cancer, chronic hypertension among many. To address these issue, the international healthcare system employs the model of management experiments models that focus on promoting growth and innovation in the sector of healthcare.

 Both the U.S healthcare delivery model and the international healthcare model relate since their main objective is to improve the quality of care and improve the population's health.  For example, the organization perspective of U.S is to implement a new healthcare payment method and the major forces toward this initiative are building a connection with health organizations, ensure every individual has access to quality care and improve the professional skills. The international organization perspective is based on research efforts to come up with good management practices. The two perspectives show that the organizations have a similar aim of providing quality healthcare. However, they differ in that the international perspective is based on improving skills and knowledge to improve managerial standards (Buttigieg, Rathert & Eiff, 2015). In contrast, the U.S focus on local issues which are aimed at improving the payment method rather than research. The management experiment model that the international system executes is the best model as it investigates the problems,  the solutions, knowledge, and skills and implements new technology to promote healthcare worldwide.

Response 1

  I disagree with your stand that the U.S healthcare system is complex and that it should adopt the compulsory healthcare insurance like the Canadian healthcare system.  It is important to deal with out-of-pocket payments and private health insurance as the U.S has been doing.  The private sectors in the U.S are doing well in this field since they are managing the medical and surgical costs and have also led to the growth of the insurance markets. The private schemes are providing high coverage since half of the population is already enrolled in private health insurance (Preker, Scheffler & Bassett, 2007). The Voluntary Health Insurance has enabled patients to access quality care in terms of medical checks, emergency care, outpatient services, and other services through paying monthly premiums.  Note that the compulsory Health Insurance will affect the vulnerable group since not all U.S citizens will able to pay insurance premiums.

 Response 2

I agree with your opinion that the U.S healthy system payment model is the best.  Thank you to the private health insurance organizations since they have dramatically changed the lives of many. The private companies have protected people from illnesses since they can access medical check, see a specialist and receive quality care any time needed. The U.S model has not only improved hospital care but it has also brought significant improvements in facilities, physician training, funding mechanism, and technology (Preker, Scheffler & Bassett, 2007). The government should continue to support and regulate the private health insurance and insurers to maintain the quality care.

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