Muscle Training Intervention in Heart Failure Article Review

Muscle Training Intervention in Heart Failure Article Review Principles of Research in Nursing Practice A Critical Appraisal of Padula, C. A., Yeaw, E. and Mistry, S. (2009) A home-based nurse-coached inspiratory muscle training intervention in heart failure. Applied Nursing Research, 22: 18-25. Guidelines by Burns and Grove (2011) form the basis of this appraisal. Statement of the problem purpose of the study Padula et al. (2009) begin by discussing the clinical problem that led to the research being conducted. Disabling dyspnoea in heart failure (HF) is affecting patients’ quality of life. Impaired inspiratory muscle function has been recognised as a potential source of dyspnoea in HF. The purpose of the research emerges logically from the clinical problem which is to determine the effectiveness of an inspiratory muscle training intervention (IMT) on dyspnoea and health-related quality of life (HRQOL). The purpose of the study is directly linked to the clinical problem because the experimental hypothesis; if upheld may facilitate improved therapies for HF patients. Literature Review This section is clearly defined and well organised. A review of the abstracts for the eight sources cited in the ‘IMT in HF’ section denotes that all are relevant primary data-based studies. There are only two sources cited within 5 years of the acceptance date for publication. Sources should be current (Burns Grove, 2011). The researchers fail to acknowledge whether a systematic search strategy was exercised (Moule Goodman, 2009). Furthermore, the investigators may have found additional sources if they had included theoretical literature. Padula et al. (2009) paraphrase the knowledge gleaned from each source and form a critique of the overall methodology used in these studies. Three of the studies did not employ a control group; this decision may have threatened their capacity to infer causal relationships. In the RCTs, sample sizes were small and effect sizes were not published. Consequently, the ability to detect differences in outcomes between groups was compromised (Seers Critelton, 2001). The literature review identifies gaps in the knowledge base which builds a case for the present study. Padula et al. (2009) report that further research is necessary to determine the precise intensity of IMT. Study Design Sample There is ambiguity regarding the study design as the researchers refer to the study as an RCT on two occasions. On closer inspection, the study does not meet the criteria for this classification as complete experimental control is not possible (CASP, 2014). The study is a two-group quasi-experiment with pre- and post-test design (Hek Moule, 2006). This design is appropriate to address the research question. Although participants are assigned to groups with equal probability, the method selected (i.e. coin toss) is not entirely appropriate for small sample sizes (i.e. n=31) because it may lead to imbalance between the size of the experimental group and control group. Schulz Grimes (2002) explain that when a succession of tails or heads is thrown, it is tempting for the researchers to modify the results. This may result in subtle differences between groups. A more sophisticated method would be to use computer generated random numbers (Crombie, 2005). RCTs are conducted in research units to ensure greater control over extraneous variability. The present study was conducted in patients’ homes. The research population was stable HF patients without coexisting pulmonary disease or cognitive impairment. The sampling method is nonprobability convenience because the researchers recruited participants by means of newspaper advertisements and physicians’ offices (Clark-Carter, 2001). This method may have excluded patients who did not visit their physician on a regular basis. The article fails to include a power analysis; a test to assess the study’s ability to detect significant differences. The researchers acknowledge that the sample was small (n=31). An effect size for IM strength was reported (d=0.48). Data Collection The data collection methods are appropriate for measuring the dependent variables (Padula et al. 2009). Test-retest reliability values are documented for the following measures: PI max, the Borg scale (1982), and self-efficacy. These values should be documented for all data collection methods (Burns Grove, 2011). This useful statistical test is a measure of the stability of the scores elicited over time (Sim Wright, 2000). A Chronbach’s alpha score was only documented for one of the measures. This statistical test measures internal consistency; i.e. how confident are we that the individual items in a scale are accurately measuring the same construct (Clark-Carter, 2001). The article reports that the research assistants followed a specified protocol, however this is not provided in the report. The article should document all the steps taken to reduce errors during the data collection process (Burns Grove, 2011). For example, it is unknown whether steps were taken to reduce user error in taking physiological measurements such as respiratory pattern. Measurements were taken at spaced intervals (i.e. weeks 1, 3, 6, 9 12); this design feature strengthens our confidence in the findings. Mention should be made here of the possibility of demand effects; the notion that participants may have modified their responses on the Borg scale to match the expectations of the study (McCambridge et al. 2012). Analysis The inferential analyses (ANOVA) conducted are appropriate for the type of data collected (Ratio/interval and ordinal; Dancey Reidy, 2011). Post hoc analyses were used to detect the location of the differences in two of the dependent variables; a best practice approach. A table showing all mean scores including significance levels for each dependent variable would be beneficial to the reader. A significant difference was detected for IMT strength in the experimental group (p Discussion The key findings are clearly stated and are consistent with previous literature. The researchers offer an alternative explanation to account for why a significant improvement in IM strength and dyspnoea in the IMT group was found. Participants may have become accustomed to the technique of generating high maximal inspiratory pressures; this is referred to as the training effect. This is a confounding variable that could compromise the internal validity of the study. The researchers account for why the secondary aim of the study was not met. The measurement for self-efficacy (the CSES) was inadequate for the purpose it was intended for. The researchers acknowledge the study’s limitations – the relatively small sample size (n=31). The strict inclusion criteria effects external validity as the findings cannot be generalised to patients with HF and coexisting COPD which is prominent in the population. This is acknowledged as a potential source of error. The study contributes to an evidence base for the use of IMT as an additional treatment for stable HF and provides recommendations for future research. Word count: 1100 References Borg, G. (1982). Psychophysical bases of perceived exertion. Science in Sports and Exercise, 14 (5): 377-381. Burns, N. and Grove, S. K. (2011) Understanding nursing research: building an evidence-based practice. 5th ed. Maryland Heights, MO: Elsevier Saunders. Critical Appraisal Skills Programme (CASP) (2014) CASP checklists [online]. Available from: http://www.casp-uk.net/#!casp-tools-chcklists/c18f8. [Accessed 1 June 2014]. Clark-Carter, D. (2001) Doing quantitative psychological research. East Sussex, UK: Psychology Press Ltd. Crombie, I. K. (2005) The pocket guide to critical appraisal. London: BMJ Publishing Group. Dancey, C. and Reidy, J. (2011) Statistics without maths for psychology. 5th ed. London: Prentice Hall. Hek, G. and Moule, P. (2006) Making sense of research: an introduction for health and social care practitioners. 3rd ed. London: Sage Publications Ltd. McCambridge, J., de Bruin, M. and Witton, J. (2012) The effects of demand characteristics on research participant behaviours in non-laboratory settings: a systematic review. PLoS One, 7 (6): e39116. Moule, P. and Goodman, M. (2009) Nursing research: an introduction. London: Sage Publications Ltd. Padula, C. A., Yeaw, E. and Mistry, S. (2009) A home-based nurse-coached inspiratory muscle training intervention in heart failure. Applied Nursing Research, 22: 18-25. Schulz, K. F. and Grimes, A. (2002) Blinding in randomised trials: hiding who got what. The Lancet, 359 (9307): 696-700. Seers, K. and Critelton, N. (2001) Quantitative research: designs relevant to nursing and healthcare. Nursing Times Research, 6 (1): 487-500. Sim, J. and Wright, C. (2000) Research in health care: concepts, designs and methods. Cheltenham, UK: Stanley Thornes. 1

Home Alarm Case Essay

1) What is the LTV (looking 8 years out) of a customer who used auto-pay? The Life time value of a customer who used auto-pay is $1670.69 (LTV net of acquisition costs= $1373.69) 2) 2)What is the LTV (looking 8 years out) of a customer who did not use auto-pay? The Life time value of a customer who did not use auto-pay is $1361.87 (LTV net of acquisition costs= $1064. 87) 3) What is the maximum amount that Home Alarm could spend on customer and salesperson incentives to convert a residential customer to auto-pay? The maximum amount that could be spent should be the difference between the Lifetime Value of customers that sign up for non-autopay service ($1064.87) and the LTV for the ones who opted for an autopay service ($1373.69); which is $308,82. So far, Home Alarm doesn’t assign any budget for marketing at the time of sign up, so it could be a good idea to invest this amount ($308,82), or less, for a marketing campaign during the acquisition period, emphasizing the convenience of the automatic payment contract. 4) What new pricing strategies and services should Home Alarm consider to sign up new customers with auto-pay? One strategy to push new customers to sign up with autopay could be offering them the installation for free. In this case the cost of acquisition for each new customer who signs up for the autopay service would be $492 instead of $297. With this option, the lifetime value of each customer who opts for the autopay service will be $1178.69, lower than the amount that could have  been earned had they chosen this solution anyway, but higher than the $1373,69 that the company would earn had they not chosen the autopay. The main problem for this option is that we don’t have any information about the percentage of people that would choose the automatic payment without any incentive; indeed if we assume that 50% of the customer would choose the automatic payment in any case, we would earn 113,82 dollars (1178.69-1064.87) on average for each customer who decides to choose the automatic payment over the non automatic one, but we would lose $195 for each customer that would have chosen this method even without incentives. (Table 1) It could be worthwhile to offer just a reduction of the installation costs. For instance, offering a discount of 50% on the installation cost would increase the LTV of customers that choose autopay over non-autopay by more than $200 and would create a loss of only $97,5 per customer that would have opted for autopay without further incentive. Another strategy could be offering the new customers who opt for an automatic payment service a fixed price for the first three years (not increased by the annual 3% rate). In this case the LTV net of the acquisition costs would be $1305,5, still higher than the one the company would earn whether the customer opts for a not automatic payment. Moreover, offering 8 years of fixed price ($480) is still more profitable than the case in which the chose a not autopay method, but it is, in my opinion, not recommendable, because of the negative effect that it could have on the customer that chose this option before. Indeed they could decide to resign the contract and try to get a new one with the more convenient conditions. (Table 2) 5) What new pricing strategies and services should Home Alarm consider to convert existing customers to auto-pay? Taking in consideration the attrition rate during the past nine years, it seems to be more convenient try to convert the customers as early as possible; indeed the peak of the churn rate is between the third and the fourth year. One solution could be offering discounts for the customers that are willing to switch method, maybe offering them a reduction in the general rate. For example, the customers that opt for convert their payment method  could see their price increase just by 2% per year instead of the 3%. For instance, if the conversion happens during the first year, the LVT net of acquisition costs would be $1243.17 (the retention rate for the first year would be the same of the non autopay situation), significantly higher than the basic case. This numbers are obtained in the optimistic scenario where the attrition rate in case of switch would be exactly the same of the ones who initially chose for the automatic payment. (Table 3) Another option could be offering couple of years with a fixed price, as explained for the new customers.

The Good, the Bad and Term Papers Help

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Create Structures And Styles And Use Them Essay - 1860 Words

Create structures and styles and use them to produce websites KU 1.1 Please see initial design folder 1.2 The main law I was concerned with while creating the site was the copyright, Designs and Patents Act. To ensure the site was in line with this act with regards to images I created the Background of the logo myself using GIMP2 I then converted the background of a Lion rampant to Alpha so I could place this image on top of the background image. I am also covered by the creative commons to take and change an image found on the web. Since there was work completed on the image the final logo can be claimed as my own intellectual property. ST 1.1 Planning involved consideration of navigation method, colour scheme, logo design, favicon design, font choice and site name. Once these had been decided upon I started to gather resources for the project. The first thing that was obtained was the site font, this was found by going to google fonts and searching for stencil. A stencil font was chosen as the website is for booking and finding out about airsoft (a sport like paintball but using plastic pellets instead of paintballs) and therefore this font gave the site a military-esque feel relating back to the military theme. The next consideration to deal with was colour scheme originally a black and brick red colour scheme was chosen but later seeing the site using this scheme it was deemed too dark, I, therefore, opted for an off-white and red colour scheme as this lifted the pageShow MoreRelatedThe Tolo House Designed By Portuguese Architect Alvaro Leite Siza1234 Words   |  5 Pages$150,000 budget and took the concept of sta irs to a whole new level. Inspired by influences of the works such as Piranesi, Escher, and Wright he was inspired to use lighting and space to create a house much in the style of Fishburn, working not to stand out but rather to fit closely within its site, making the site almost a part of the structure which Siza designs. In the preliminary sketches to the right, one truly gets a sense of what Siza was looking to accomplish in a simple concept. In figure 2Read MoreRomanesque Architecture versus Gothic Architecture Essay714 Words   |  3 Pagestheir buildings were often built for their leaders unlike in other towns where they were more for the town as a whole. The evolution from Romanesque architecture to Gothic architecture shows mans ability to grow and innovate and create new and better ways to build structures as well as the artistic brilliance of man. Romanesque architecture combines features of Byzantine and Roman buildings. The buildings often have very thick walls with large round arches in doorways and as supports. There areRead MoreLeadership Style That Changed Over The Years1716 Words   |  7 Pagesand processes. There are as many styles of leadership as there are industries who utilize them. 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Wednesbury IKEA is a large formal organisation and it is best suited to a hierarchical organisational Read MoreRoman Architecture : Greek Architecture1345 Words   |  6 Pagesinfluenced greatly by other cultures such as the Greeks and the Etruscans.This is demonstrated by the examples of other civilization’s architecture within the Roman Empire.The combination of the cultures led to new types and styles of architecture, helping to create a style of Roman architecture which showed influences of Greece and the Etruscans. Roman architecture has its own elements and techniques while reflecting the influence of other cultures architecture on their own. Roman architectureRead MoreE.E. Cummings and His Wondrous Works634 Words   |  3 Pagesintriguing poet that is known for many poetic ideas. Among them, Cummings was known for his ability to create meaning using structure and his avant garde approach towards language. 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Embedded Blended Learning Within An Algebra Classroom A...

Annotated Bibliography Smith, J., Suzuki, S. (2015). Embedded blended learning within an Algebra classroom: a multimedia capture experiment. Journal Of Computer Assisted Learning, 31(2), 133-147. doi:10.1111/jcal.12083. Retrieved from https://wgu.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true This article was published in the Journal of computer Assisted Learning. This is a peer-reviewed, scholarly journal that focuses on the multiple applications of information and communication technology in order to support learning and knowledge sharing. The article is based on a dissertation by the first author that was submitted to St. Mary’s College of California. The article employs the term â€Å"quasi-experimental study†, to describe the research method, however this study applies mixed methods research in a small, action research type setting. The purpose was to determine whether student engagement and academic performance would improve if multimedia content was embedded into instruction. The study comprised of two Algebra II classes, taught by the same teacher, in the same high school, to 9th through 12th grade, randomly selected, students. One academic unit was taught over a four-week period, using identical content. The teacher utilized screen recording software to develop video lectures for the test class. The control class only received direct instruction from the teacher. Pre-tests administered at the start of the study and post-tests administered

Racial Formations Reflection and Analysis Free Essays

I am, without a doubt, completely uncomfortable discussing race. In fact, it is among my least favorite things to do. I mostly feel as if I do not know how to discuss race without offending someone, using the wrong word, revealing my ignorance about many issues within the topic, changing my mind about a certain belief midstream, or just generally looking like a fool. We will write a custom essay sample on Racial Formations: Reflection and Analysis or any similar topic only for you Order Now I avoid these discussions at all costs because they put me in a place I am rarely ready to be. So, naturally, this reading struck a chord with me before it actually even began. I related instantly and wholeheartedly to the question raised in the introduction: â€Å"If race is not ‘real’ in a scientific sense, why can I look around my classroom or campus and see that someone is black or Asian or white? † This quandary has plagued me for years. It seemed to me that race had to be more than a social construction established centuries ago. It had never really made sense to me, and this question established a personal connection for me to Omi and Winant’s subsequent explanation of this perplexing notion. The authors’ explanation of the history of race consciousness certainly helped me in my quest for answers and gave me a much clearer understanding of the origins of race consciousness. I could imagine the European settlers’ surprise upon discovering theirs was not the only existing race, thus challenging essentially every religious belief they held about creation. They could not explain this difference, and, as human beings devout in their religion, that was unacceptable. They needed explanation, and they needed to find it in the Bible. It is not difficult to relate to the anxiety and uncertainty they experienced. People of all religions seem to spend much of their practice justifying what happens in their lives — both good and bad — within their particular religious texts. We take scripture, verses, lines, chapter, and so on and make it fit into what makes sense for us or, in many cases, make it work to our advantage so that we can cope with what we do not understand or agree with. Having established how race consciousness came to be in the first place, Omi nd Winant address how race became a social concept, the issue at the heart of my original conundrum. As I read about hypodescent and beliefs about racial intermixture, I started to understand. The authors’ use of Marvin Harris’ work further established this understanding, particularly Harris’ statement, â€Å"†¦ The rule of hypodescent is, therefore, an invention, which we in the United States have made in order to keep b iological facts from intruding into our collective racist fantasies† (11). That was it. This eighteenth-century way of thinking was a continuance of the European settlers’ need to justify certain behaviors. They may not have been using the Bible to do so, but the creators of hypodescent were merely creating a belief to help them get through the social structure they had established and accepted. Now that I have a much better understanding of race as nothing more than a social construct, I suppose my issue is not entirely with those European settlers and not with inventors of outlandish notions about â€Å"Negro blood† but rather with current society. We are now at a point that we should know better. We should know that no one race is superior. We should know that â€Å"white† is hardly â€Å"pure† and certainly does not equal â€Å"better† simply because it is â€Å"white. † We have more than enough information to move beyond these ways of thinking and into a new era in which we are able to, as Omi and Winant state at the end of the writing, â€Å"break with these habits of thought† (15). How to cite Racial Formations: Reflection and Analysis, Papers

Statistical Analysis Samples for Students †MyAssignmenthelp.com

Question: Discuss about the Statistical Quantitative Data Analysis. Answer: Introduction Quantitative data analysis is the investigation of the different claims or hypotheses by using numerical data which is collected by researchers. It is important to arrange the research study in a particular manner and avoid different types of biases during the research study. If the research study consists of different types of biases, errors or mistakes, then we will not get the unbiased and reliable results for the research study and we do not use these estimates or models for further investigation. In the process of investigation, we need to develop the research hypotheses, collect the data, then analyze this data by using different tools and techniques of statistical analysis. After this statistical analysis we can conclude different results for the hypotheses established for the given research study. Quantitative analysis becomes a very important in the every field for making effective decisions. In this era of competition, every industry or organization use the statistical anal ysis during the process of policy making. The use of optimization techniques is found very useful for making more profit. The qualitative methods of data analysis will be great value for attempting to draw the useful results from a large qualitative data. It is found very beneficial to analyze the data for making effective decisions in the industry or organizations. The statistical data analysis helps us in recognizing the data structure and identifying the different sources of the variation. The quantitative analytical approach is useful for reporting the summary results in the numerical terms within specific degree of confidence. The quantitative research is very useful for uncover the trends in though and opinions. The purpose of the quantitative data analysis is to discover the meanings, variations and patterns of the relationships between the different variables under study. The statistical data analysis is very useful in the analysis of the quantitative and qualitative data. There are so many tools and techniques for the analysis of the statistical data. Here, we want to analyze the given quantitative data by using the different tools and techniques of the statistical analysis. The use of quantitative analysis is very helpful in the process of decision making and employing the new policies. In different companies or industries, the use of statistical analysis is becomes mandatory. Also, for production department, the advanced use of statistical quality control is essential in the competitive environment. Also, statistical analysis found very useful in the research of medical science, environment science, pharmaceutical sciences, social sciences, etc. For this analysis, we need to use the different tools and techniques such as descriptive statistics, inferential statistics, and graphical analysis for the given data. We have to check some claims regarding the variables in the given data by using testing of hypothesis. Let us see this statistical analysis in detail. Description of Data set The process of the data collection is very important for statistical analysis of the variables under study. For this research study, about 50 subjects are selected for this study. Well prepared questionnaires are used for the data collection from the 50 subjects or respondents for this study. Information regarding the different ten variables by using the questions is collected for each person or respondent. For this research study, the information or data is collected for the different variables such as the gender of the respondents, education level of the respondent, region of the respondents, marital status of the respondents, age of the respondent, monthly earning of the respondent and monthly expense of the respondents. For this research study, the nominal scale is used for the variables gender, region and marital status of the respondents. The ordinal scale is used for the variable education level of the person while the ratio scale of measurement is used for the variables earni ng, expense and age of the respondents. Data is given in the separate excel file. Research Hypotheses For this research study, the research hypotheses or claims are established as below: There is a difference exists in the average monthly income for the persons based on education level. There is a difference exists in the average monthly expense for the persons based on education. Is there any statistically significant difference observed for the average income for the persons from the rural and urban area? Is there a difference in the income based on area of the person? Is there any significant difference between the expenses of the persons based on the area of the persons? Is the education of the person is independent from the area of the person? We have to check these hypotheses by using different tests of hypotheses. Descriptive Summary For the given data set, there are 26 males and 24 females. The proportion of the male participants is given as 52% while the proportion of the female participants is given as 48%. From the frequency distribution of the variable education, it is observed that there are 27 persons having education less than graduation while there are 23 persons with education graduation or more. The proportion of the persons with education less than graduation is given as 54% while the proportion of the persons with education graduation or more is given as 46%. It is observed that 29 persons are originated from the rural area while 21 persons are originated from urban area. In the given sample, it is observed that 30 persons are unmarried while 20 persons are married. From the analysis of the given data for the expenditure and earning, it is found that the mean income per month for the persons involved in this research study is given as $7763 approximately with the sample standard deviation of $1566 approximately. From the given data, it is observed that mean monthly expense for the persons in the sample is $4581 approximately with sample standard deviation of $862 approximately. From the given histogram and box plot for the variable monthly income, it is observed that the data for the variable monthly income do not follow normal or approximate normal distribution. The data for the variable monthly income is negatively skewed. Also, it is observed that the histogram for the variable monthly expense do not indicate the normal or approximate normal distribution. Also data for the monthly income is negative skewed. The histograms and box plots are given in the appendix section. Testing of Hypothesis By using testing of hypothesis we have to check different claims. We have to use different tests for checking these hypotheses. We will use two sample t test for checking the significant differences in the averages of the monthly income and expense. The significance level for this test is considered as 5%. Let us see the results for these tests as below: First Hypothesis: There is a difference exists in the average monthly income for the persons based on education level. For checking the statistically significant difference in the average monthly income for the persons based on education level, null hypothesis is not rejected (t = -1.4872, p = 0.1435) at the 5% level of significance. There is insufficient evidence to conclude that there is a significant difference exists in the average monthly income for the persons with education less than graduate and education with graduate or more. Second Hypothesis: There is a difference exists in the average monthly expense for the persons based on education. The null hypothesis is not rejected (t = -1.8399, p = 0.0720) at the 5% level of significance. There is insufficient evidence to conclude that there is a significant difference exists in the average monthly expense for the persons with education less than graduate and education with graduate or more. Third Hypothesis: There is a difference in mean monthly income for rural and urban persons. For checking the significant difference between the average income for the rural and urban area by using two sample t test, it is observed that there is no any significant difference (t = -0.5292, p = 0.5991) is found for the average monthly income for the persons in rural and urban area. Fourth Hypothesis: There is a difference in mean monthly expense for rural and urban persons. Using the same test, it is found that there is no any significant difference (t = 1.1226, p = 0.2672) in the average monthly expense for the persons in the rural and urban area. Fifth Hypothesis: H0: Education of person is independent from area of person. Ha: Education of person is not independent from area of person. There is sufficient evidence (Chi-square = 0.1440, p = 0.7044) to conclude that two variables are independent from each other. Confidence Intervals After using the analysis for confidence intervals for mean monthly income, we are about 95% sure that the mean monthly income of the person will be between $7318 and $8208 approximately. Also, we are about 95% confident that the mean monthly expense for the persons will lies between $4336 and $4826 approximately. The details calculations and results for these confidence intervals are given in the appendix section. Conclusions From the analysis of the given data for the expenditure and earning, it is revealed that the mean age of the persons involved in this research study is given as 24.62 years with sample standard deviation of 2.26 years. From the analysis of the given data for the expenditure and earning, it is found that the mean income per month for the persons involved in this research study is given as $7763 approximately with the sample standard deviation of $1566 approximately. From the given data, it is observed that mean monthly expense for the persons in the sample is $4581 approximately with sample standard deviation of $862 approximately. No sufficient evidence found for statistically significant difference between average incomes per month as per education levels of the persons in the sample data. Also, there is no any sufficient evidence for difference between mean expenses per month for the persons with different education levels. It is found that there is no any significant difference (t = 1.1226, p = 0.2672) in the average monthly expense for the persons in the rural and urban area. From the results of Chi square test for independence of two categorical variables, it is found that education and area of the person is independent from each other. References Dobson, A. J. (2001). An introduction to generalized linear models. Chapman and Hall Ltd. Evans, M. (2004). Probability and Statistics: The Science of Uncertainty. Freeman and Company. 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