Cardiovascular Disease With Vitamin D Deficiency - 2233 Words

Cardiovascular Disease with Vitamin D Deficiency Introduction Vitamin D is a fat-soluble vitamin. the primarily source of vitamin d is exposure to sunlight, and we can find the vitamin D naturally . Vitamin D2 is generally produced in humans from 7- dehydrocholecalciferol upon exposure to ultraviolet light. in addition vitamin D2 and D3 can metabolized by human body (Zhang Naughton, 2008). However, highly prevalent of deficiency of vitamin D in the orarld spicially in United State. Vitamin D deficiency are present in as many as one third to one half of healthy middle-aged to elderly adults. inadequate sun exposure inadequate intake of food that high of vitamin D may causes of low 25-OH D levels ( Autier, Boniol, Pizot, Mullie, 2013). Cardiovascular disease (CVD) is a most prevalent disease in world population that causes the death through since the 1970s. CVD, which involve with heart, blood vessels or both. Cardiovascular disease imply that any disease that affects the cardiovascular system, such as cardiac, vascular diseases and peripheral arterial disease. There are number of factors that leading the CVD such as hypertension, atherosclerosis, smoking and aging (Tomey windson, 2014). musculoskeletal system is the best characterized form of deficiency of vitamin, as well as cardiovascular system may affect by low vitamin D levels . Clinical studies suggest that there is a relationship between plasma renin activity and low vitamin D level (Holicki chen, 2008).Show MoreRelatedVitamin D plays an integral role in multiple systems in the human body, from its function in600 Words   |  3 PagesVitamin D plays an integral role in multiple systems in the human body, from its function in Calcium and Phosphorus metab olism, to modulation of the immune and reducing the risk of cardiovascular diseases (Grober et al. 2013). Unfortunately, factors such as diet, geographic position, and skin pigmentation are contributing to an increase of prevalence of Vitamin D deficiency around the world, consequently leading to a higher rate of associated illnesses. Namely, Cardiovascular Diseases such as CoronaryRead MoreSci/241 Final1537 Words   |  7 Pagesnutritional health has been a very important part of my life since 2001 when I discovered I have Crohn’s disease. The food I consume affects my life in serious and immediate ways. Throughout this course I have learned various ways to help improve my dieting and better my overall health with different foods, ways of cooking foods, and supplements to help provide nutrients my body needs. Having Crohn’s disease can often make eating fruits and vegetable very painful. Although I have a chronic illness, I planRead MoreHow Does Vitamin D Improves Th e Plyometric Performance878 Words   |  4 PagesResearch Question: Does Vitamin D improves the plyometric performance in young basketball athletes? Part 1 A fat-soluble vitamin D is an essential vitamin which works as precursor steroid in biological and metabolic processes happening in human body (1). Deficiency of Vitamin D has shown a verity of adverse psychological, skeletal and muscular health issues (2). Vitamin D deficiency rate has been increased remarkably from year 1994 to 2004. There are many factors responsible for this like sunRead MoreVitamin D and Athletic Performance Essay1486 Words   |  6 Pageswithin the body and from that how they can influence the body’s ability to perform while under duress. An example of such would be the stress of athletic performance. Vitamin D, which is also referred to as cholecalciferol, is one of the fat soluble vitamins that have been attributed to influencing athletic performance. However, vitamin D is not as much a â€Å"performance enhancing† nutrient in the sense that when taken in higher amounts it will aid athletic performance, but rather when in deficient amountsRead MoreHypertension And Vitamin D Supplementation2526 Words   |  11 PagesHypertension and vitamin D supplementation Cardiovascular disease is the most common cause of worldwide mortality and morbidity and accounted 30% of deaths around the world in 2003 (Vacek et al., 2011). Hypertension is a worldwide epidemic that has a strong association with age and life patterns (Wuerzner, Burnier Waeber, 2012). Hypertension has been considered as a major risk factor of myocardial infarction, stroke, heart failure, peripheral vascular disease, chronic kidney disease, mental healthRead MoreThe Truth about Vitamin D Deficiency Essay1642 Words   |  7 PagesVitamin D deficiency: In the event that you avoid the sun, experience the ill effects of milk anaphylaxes, or stick to a strict veggie lover diet, you may be at danger for vitamin D inadequacy. Known as the daylight vitamin, vitamin D is transformed by the body because of daylight. It is additionally happens characteristically in a couple of sustenance’s including some fish, fish liver oils, and egg yolks - and in sustained dairy and grain items. Vitamin D is key for solid bones on the groundsRead MoreVeganism and vegetarianism are becoming a growing trend both are advertised in grocery stores1300 Words   |  6 Pagesreduced risk of Cardiovascular Disease (CVD) and type 2 diabetes (Barnard, Katcher, Jenkins, Cohen, Turner-McGrievy, 2009). There are, however, a few possible negative side effects to these diets concerning inadequate vitamin and mineral intake, which could lead to deficiencies or possibly diseases. Cardiovascular Disease CVD prevails in America with 1 out of 4 deaths due to heart disease; that’s eighty million people living with at least 1 form of heart disease (â€Å"Heart Disease,† n.d.). ResearchRead MoreMultivitamin With Coq10 And Alpha Lipoic Acid1231 Words   |  5 Pagesideal product for adults who are looking for vitamin and mineral supplements with superior antioxidant support to minimize the oxidative stress to the cells. Today life style is very stressful and many have poor dietary habits; their diets contain processed and artificial food instead fresh meat/vegetables and fruit. This vitamin and mineral supplement with CoQ10+ALA is a great source for vitamins, mineral and antioxidants. Currently there is no vitamin and mineral supplement that containing bothRead MoreThe Sunshine Vitamin or Vitamin D Essay946 Words   |  4 Pages+Vitamin D and hair growth are inextricably linked, according to research. Vitamin D, otherwise known as the sunshine vitamin, is composed of a gro up of fat-soluble compounds that mainly shapes the development and sustenance of bone health. It primarily regulates the gastric absorption of magnesium, calcium, zinc and other minerals that fortify bone density, strength and structure. +Recent studies have mapped out the connection between vitamin D deficiency and diseases of the skin, heart and prematureRead MoreThe Importance Of Nutrition On Health, Health And Well Being Of Our Population Essay1093 Words   |  5 Pagesstages to the final stages of life nutrition plays a vital role in the life a person. Poor nutrition can be caused by over indulgence or deprivation of essential nutrients and can lead to a decreased immune system which increases susceptibly to other diseases, obesity, poor wound healing and decrease in essential development in young ages. Nutrition is an important aspect in the health and well-being of our population. Educating the public on the effects on health of poor nutrition is key in preventing

The Clash Of Ideologies During World War II - 1104 Words

Trevor Gloede Annucci English 102 9:30 30, April 2015 The Clash of Ideologies With the end of World War II and the decline of fascism, two super powers would fight it out for the next forty years. As the cold war progressed the ideological battled would span across the globe in many small, and mostly third world countries. On such country, located in Indochina known as Vietnam. Once controlled by the French now lay hast to the clash of two super powers that would wreak havoc onto the country. With the USSR’s sphere of influence growing, the United States were increasingly worried about the Domino Theory. Consequently, the US adopted a protectorate attitude of the world, trying to eliminate the spread of communism. Though the Vietnam War’s location was insignificant, its ideological value was significant for the US to support to the anti-communist forces in an effort to undermine the influence of the Soviet Union. With the USSR’s sphere of influence expanding and international pressure on the United States, the US wo uld be persistent in fighting a war to support democracy and eliminate communism. In Mark Lawrence’s book, â€Å"The Vietnam War: A Concise International History† he attributes the stage of this clash between the west and the east to be due from the openness to influence of Vietnam. This stems because of the troubled past of the country. In the late 1800’s while the US was gearing up for a civil war the French had gained control of Indochina, which was made up ofShow MoreRelatedEssay on Consequences of the World War II1306 Words   |  6 PagesIn the World War I individual rights and civil liberty have died. The wartime controls had replaced the free enterprise, exchange controls and import-export regulations had replaced the free trade. The inflation had undermined the sanctity of property. The war had shrunk the rights of individuals and enhanced the power of the State. 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That kind of subtleRead MoreFrancis Fukuyama s The End Of History985 Words   |  4 PagesLife of Ideology, Life of Conflict: Francis Fukuyama and Samuel Huntington In Francis Fukuyama s â€Å"The End of History?† published in 1989, he posits that with the end of the Cold War, humanity is reaching a point where Western liberal democracy and economic structure is the highest form of ideological development. Other ideologies (communism, fascism, etc.) are vestigial forms of thinking destined to fail and disappear in an inevitable progression towards a liberal system (Fukuyama 1989). In â€Å"TheRead MoreTo What Extent Was the Cold War Inevitable? Essay1178 Words   |  5 PagesExtent Was the Cold War Inevitable? With the end of World War II (WWII) in 1945 began the Cold War, an international conflict that lasted from 1947–1991 and plagued nations across the globe. As the post-war negotiations were deliberated by three of the strongest world powers, the United States (US), Britain, and the Union of Soviet Socialist Republics (USSR), disagreements arose that created tension between the US and the USSR and ultimately instigated the infamous â€Å"Fifty Years War† (Crockatt 64).Read MoreThe Cold War And The Soviet Union1814 Words   |  8 Pagesâ€Å"Every war is fought three times. First comes the political discussion over whether to start or enter it. Then comes the question of how to fight it. And, finally, there is consideration of what lessons should be learned from it.† -Richard N. Haass. The Cold War was the third major conflict of the 20th century, 1947-1991, and followed just these rules. All three phases can be identified, and all three triggered intense debate. The Cold War was located in the countries of the US, the Soviet UnionRead MoreThe Main Reasons Why Wars Start1856 Words   |  8 PagesWar has always been a part of humanity ever since the dawn of modern humans. Wars have started for various different reasons such as territorial disputes, showcase of power, or a struggle between powers. There are many causes of wars from the different levels of analysis examining the roots of the four levels such as individual, state, interstate, and global level. The main reasons why wars start are problems and conflicts in the state level of analysis. Problems within the state eventually createRead MoreThe Cold War Really Shaped History1983 Words   |  8 Pages The Cold war certainly shaped history in the 1900s as a major global threat due to vast political and military tensions. Historiographical studies have shown that the Cold War was primarily due to conflicting ideologies in the world, in addition to America and the USSR’s ulterior motive for global expansionism. The Americans feared Soviet expansionism across the world, and feared the outcome of Communism spreading. Likewise, the USSR feared a capitalist spread. This essay will outline the differingRead MoreFukuyama s The End Of History?882 Words   |  4 Pagesthat with the end of the Cold War, humanity is reaching a point where Western liberal democracy and economic structure is the highest form of ideological development. Other ideologies (communism, fascism, etc.) are vestigial forms of thinking destined to fail and disappear in an inevitable progression towards a liberal system. In â€Å"The Clash of Civilizations?† published in 1993, Huntington writes that the wor ld is divided into civilizations, based on culture (not ideology or economic factors), and thatRead MoreCompare and Contrast Ww1 Ww21058 Words   |  5 PagesThe World Wars were in some ways similar but also, different. The World Wars had similarities in the way the wars were caused, how the wars ended, in regards to who lost, and propaganda. The casualties, the cost, and the military tactics however, were some of their differences. World War I was caused by the assassination of Archduke Francis Ferdinand of Austria in June 1914. However, World War II was caused by the political and economic instability in Germany, along with the bad conditions ofRead MoreTaking a Look at the Cold War1243 Words   |  5 PagesCold war The cold war began in 1945 and last till 1990.It involved many nation but the two main opponents were the United States and the Union of Soviet Socialist Republics. 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Night World Daughters of Darkness Chapter 8 Free Essays

She waited another hour after he set off down theroad, heading east-doing what, she had no idea. There was nothing that way except two creeks andlots of trees. And her house. We will write a custom essay sample on Night World : Daughters of Darkness Chapter 8 or any similar topic only for you Order Now She hoped he was goingto try to walk into town, and that he didn’t realize how far it was. All right, he’s gone, now forget about him. You’vegot a job to do, remember? A slightly dangerous one. And he’s not involved. I don’t believe he knows anything about what happened to Mrs. B. She got the shovel and started down the road west.As she walked she found that she was able to put Ash out of her mind completely. Because all she could think of was what was waiting ahead. I’m not scared to do it; I’m not scared, I’m notscared†¦. OfcourseI’m scared. But being scared was good, it would make her careful. She would do this job quickly and quietly. In through the gap in the hedge, a little fast work with the shovel, out again before anybody saw her. She tried not to picture what she was going to findwith that shovel if she was right. She approachedBurdock Farm cautiously, going north and then doubling back southeast to come in through the back property. The farmland had gone wild here, taken over by poison oak, beargrass, and dodder, besides the inevitable blackberry bushes and gorse. Tan oaks and chinquapins were moving in. Sometime soon these pastures would be forest. I’m not sure I believe I’m doing this, MaryLynnette thought as she reached the hedge that surrounded the garden. But the strange thing was that she didbelieve it. She was going to vandalize a neighbor’s property and probably look at a dead bodyand she was surprisingly cool about it. Scared but not panicked. Maybe there was more hidden inside her than she realized. I may not be who I’ve always thought I am. The garden was dark and fragrant. It wasn’t theirises and daffodils Mrs. B. had planted; it wasn’t the fireweed and bleeding heart that were growing wild. It was the goats. Mary-Lynnette stuck to the perimeter of the hedge,eyes on the tall, upright silhouette of the farmhouse. There were only two windows lit. Please don’t let them see me and please don’t letme make a noise. Still looking at the house, she walked slowly, taking careful baby steps to the place where the earth was disturbed. The first couple of swipes with the shovel hardly moved the soil. Okay. Put a little conviction in it. And don’t watch the house; there’s no point. If they look out, they’re going to see you, and there’s nothing you can do about it. Just as she put her foot on the shovel, somethingwent hooshin the rhododendrons behind her. Crouched over her shovel,Mary-Lynnette froze. Stop worrying, she told herself. That’s not the sisters. It’s not Ash coming back. That’s an animal. She listened. A mournful maaaa came from the goat shed. It wasn’t anything. It was a rabbit. Dig! She got out a spadeful of dirt-and then she heardit again. Hoosh. A snuffling sound. Then a rustling. Definitely an animal. But if it was a rabbit, it was an awfully loud one. Who cares what it is? Mary-Lynnette told herself.There aren’t any dangerous animalsout here. And I’m not afraid of the dark. It’s my natural habitat. I love the night. But tonight, somehow, she felt differently. Maybe it was just the scene with Ash that had shaken her, made her feel confused and discontented. But just now she felt almost as if something was trying to tell her that the dark wasn’t any human’s natural habitat. That she wasn’t built for it, with her weak eyes and her insensitive ears and dull nose. That she didn’t belong. Hoosh. I may have rotten hearing, but I can hearthatjustfine. And it’s big. Something big’s sniffing around in bushes. What kind of big animal could be out here? Itwasn’t a deer deer went snort-wheeze. It sounded larger than a coyote, taller. A bear? Then she heard a different sound the vigorousshaking of dry, leathery rhododendron leaves. In the dim light from the house she couldseethe branches churning as something tried to emerge. it’s coming out. Mary-Lynnette clutched her shovel and ran. Nottoward the gap in the hedge, not toward the housethey were both too dangerous. She ran to the goat shed. I can defend myself in here-keep it out—hit itwith the shovel†¦. The problem was that she couldn’t see from in here.There were two windows in the shed, but between dirt on the glass and the darkness outside, Mary-Lynnette couldn’t make out anything. She couldn’teven see the goats, although she could hear them. Don’t turn on the penlight. It’ll just give awayyour position. Holding absolutely still, she strained tohear any thing from outside. Nothing. Her nostrils were full of goat. The layers of oat straw and decomposing droppings on the floor were smelly, and they kept the shed too warm. Her palms were sweating as she gripped the shovel. I’ve never hit anybody †¦ not since Mark and Iwere kids fighting †¦ but, heck, I kicked a strangerthis morning†¦ . She hoped the potential for violence would comeout now when she needed it. A goat nudged her shoulder.Mary-Lynnette shrugged it away. The other goat bleated suddenlyand she bit her lip. Oh, God-I heard something out there. The goatheard it, too. She could taste her bitten lip. It was like sucking on a penny. Blood tasted like copper, which, she realizedsuddenly, tasted like fear. Something opened the shed door. What happened then was that Mary-Lynnette Something unholy was after her. Something thatsniffed like an animal but could open doors like ahuman. She couldn’t see what it was-just a shadowdarkness against darkness. She didn’t think ofturning on the penlight-her only impulse was to smash out with the shovel now, to get ft before ft could get her. She was tingling with the instinct forpure, primordial violence. Instead, she managed to hiss, â€Å"Who is ft? Who’sthere?† A familiar voice said,†Iknew you were going to do this. I’ve been lookingeverywherefor you.† â€Å"Oh,God, Mark.† Mary-Lynnette sagged against wall of the shed, letting go of the shovel. The goats were both bleating. Mary-Lynnette’s earswere ringing. Mark shuffled farther in. â€Å"Jeez, this place smells. What are you doing inhere?† â€Å"Youjerk,†Mary-Lynnette said. â€Å"I almost brained you!† 0†³You said you were forgetting all this crazy stuff. You lied to me.† â€Å"Mark, you don’t †¦We can talk later†¦. Did you hearanything out there?† She was trying to gather her thoughts. â€Å"Like what?† He was so calm. It made MaryLynnette feel vaguely foolish. Then his voice sharpened. â€Å"Like a yowling?† â€Å"No. Like a snuffling.† Mary-Lynnette’s breath was slowing. â€Å"I didn’t hear anything. We’d better get out ofhere. What are we supposed to say if Jade comes out?† Mary-Lynnette didn’t know how to answer that. Mark was in a different world, a happy, shiny world where the worst that could happen tonight was embarrassment. Finally she said â€Å"Mark, listen to me. I’m your sister. I don’t have any reason to lie to you, or playtricks on you, or put down somebody you like. AndI don’t just jump to conclusions; I don’t imagine things. But I’m telling you, absolutely seriously,that there is something weird going on with these girls.† Mark opened his mouth, but she went on relentlessly. â€Å"So now there are only two things you can believe, and one is that I’m completely out of mymind, and the other is that it’s true. Do you really think I’m crazy?† She was thinking of the past as she said it, of allthe nights they’d held on to each other when their mother wassick, of the books she’d read out loud tohim, of the times she’d put Band-Aids on his scrapes and extra cookies in his lunch. And somehow, even though it was dark, she could sense that Mark was remembering, too. They’d shared so much. They would always be connected. Finally Mark said quietly, â€Å"You’re not crazy.† â€Å"Thank you.† â€Å"But I don’t know what to think. Jade wouldn’t hurtanybody. I justknow that. And since I met her , .†Hepaused. â€Å"Mare, it’s like now I know why I’m alive.She’s different from any girl I’ve ever known. She’s ____ she’s so brave, and so funny, and so †¦ herself.† And I thought it was the blond hair, MaryLynnette thought. Shows how shallow I am. She was moved and surprised by the change in Mark-but mostly she was frightened. Frightenedsick. Her cranky, cynical brother had found somebody to care about at last †¦ and the girl was probably descended from Lucrezia Borgia. And now, even though she couldn’t see him, shecould hear earnest appeal in his voice. â€Å"Mare, can’t we just go home?† Mary-Lynnette felt sicker. She broke off and they both snapped their heads to look at the shed window. Outside a light had gone on. â€Å"Shut the door,† Mary-Lynnette hissed, in a tone that made Mark dose the door to the shed instantly. â€Å"And be quiet,- she added, grabbing his arm and pulling him next to the wall. She looked cautiously out the window. Rowan came out of the back door first, followedbyjade,followed by Kestrel. Kestrel had a shovel. Oh. My. God. â€Å"What’s happening?† Mark said, trying to get alook. Mary-Lynnette damped a hand over his mouth.What was happening was that the girls were digging up the garden again. She didn’t see anything wrapped in garbage bags this time. So what were they doing? Destroying the evidence? Were they going to take it into the houseand burn it, chop it up? Her heart was pounding madly. Mark had scooted up and was looking out. MaryLynnette heard him take a breath-and then choke. Maybe he was trying to think of an innocent explanation for this. She squeezed his shoulder. They both watched as the girls took turns with theshovel. Mary-Lynnette was impressed all over againat how strong they were. Jade looked so fragile. Every time one of the sisters glanced around the garden, Mary-Lynnette’s heart skipped a beat. Don’t see us, don’t hear us, don’t catch us, she thought. When a respectable mound of dirt had piled up, Rowan and Kestrel reached into the hole. They lifted out the long garbage-bagged bundle Mary-Lynnettehad seen before. It seemed to be stiff-and surpris ingly light. For the first time, Mary-Lynnette wondered if it was too light to be a body. Or too stiff †¦ how longdid rigor mortis last? Mark’s breathing was irregular, almost wheezing.The girls were carrying the bundle to the gap inthe hedge. Mark cursed. Mary-Lynnette’s brain was racing. She hissed,†Mark, stay here. I’m going to follow them-â€Å" â€Å"I’m going with you!† â€Å"You have to tell Dad if anything happens to me-â€Å" â€Å"I’m going withyou.† There wasn’t time to argue. And something inside Mary-Lynnette was glad to have Mark’s strength to back her. She gasped, â€Å"Come on, then. And don’t make asound.† She was worried they might have already lost the sisters–it was such a dark night. But when she and Mark squeezed through the gap in the rhododendron bushes, she saw a light ahead. A tiny, bobbing white light. The sisters were using a flashlight. Keep quiet, move carefully. Mary-Lynnette didn’tdare say it out loud to Mark, but she kept thinking it over and over, like a mantra. Her whole consciousness was fixed on the little shaft of light that was leading them, like a comet’s tail in the darkness. The light took them south, into a stand of Douglasfir. It wasn’t long before they were walking into forest. Where are they going? Mary-Lynnette thought. She could feel fine tremors in her muscles as she tried to move as quickly as possible without making a sound. They were lucky–the floor of this forest was carpeted with needles from Douglas fir and Ponderosa pine. The needles were fragrant and slightly damp and they muffled footsteps. Mary-Lynnette could hardly hear Mark walking behind her except when he hurt himself. They went on for what seemed like forever. It was pitch dark and Mary-Lynnette very quickly lost any sense of where they were. Or how they were going to get back. Oh, God, I was crazy to do this-and to bring Markalong, too. We’re out in the middle of the woodswith three crazy girls†¦. The light had stopped. Mary-Lynnette stopped, holding out an arm thatMark immediately ran into. She was staring at thelight, trying to make sure it really wasn’t moving away. No. It was steady. It was pointed at the ground. â€Å"Let’s get loser,† Mark whispered, putting his lips against Mary-Lynnette’s ear. She nodded and began to creep toward the light, as slowly and silently asshe knew how. Every few steps she paused and stood absolutely still, waiting to see if the light was going to turn her way. It didn’t. She got down and crawled the last ten feet to the edge of the clearing where the girls had stopped. Once there, she had a good view of what they were doing. Digging. Kestrel had shoveled the pine needles aside and was working on a hole. Mary-Lynnette felt Mark crawl up beside her,crushing sword fern and woodfem. She could feel his chest heaving. She knew he saw what she saw. I’m so sorry. Oh, Mark, I’m so sorry. There was no way to deny it now. Mary-Lynnetteknew. She didn’t even need to look in the bag. How am I going to find this place again? When I bring the sheriff back, how am I going to remember it? It’s like a maze in one of those computer fantasy games-Mixed Evergreen Forest in every direction,and nothing to distinguish any bit of it from any other bit. She chewed her lip. The bed of moist needles she was lying on was soft and springy-actually comfortable. They could wait here for a long time, until the sisters left, and then mark the trees somehow. Takephotographs. Tie their socks to branches. In the clearing the flashlight beam showed a hand putting down the shovel. Then Rowan and Kestrellifted the garbage-bagged bundle-Jade must beholding the flashlight, Mary-Lynnette thought-and lowered it into the hole. Good. Now cover it up and leave. The beam showed Rowan bending to pick up the shovel again. She began quickly covering the hole with dirt. Mary-Lynnette was happy. Over soon, she thought, and let out a soft breath of relief. And in that instant everything in the clearingchanged. The flashlight beam swung wildly. Mary-Lynnette flattened herself, feeling her eyes widen. She could see a silhouette against the light-golden hair haloed around the face. Kestrel. Kestrel was standing, facing Mark and Mary-Lynnette, her body tense and still. Listening. Listening. Mary-Lynnette lay absolutely motionless, mouthopen, trying to breathe without making a soundThere were things crawling in the soft, springy needlebed under her. Centipedes and millipedes. She didn’tdare move even when she felt something tickle acrossher back under her shirt. Her own ears rang from listening. But the forest was silent †¦ eerily dent. All Mary-Lynnette couldhear was her own heart pounding wildly in herchest-although ft felt as if it were in her throat, too.It made her head bob with its rhythm. She was afraid. And it wasn’t just fear. It was something shecouldn’t remember experiencing since she was nineor ten. Ghost fear. The fear of something you’re not even sure exists. Somehow, watching Kestrel’s silhouette In the dark woods, Mary-Lynnette was afraid of monsters.She had aterrible,terrible feeling. Oh, please–I shouldn’t have brought Mark here. It was then that she realized that Mark’s breathing was making a noise. Just a faint sound, not a whistling, more like a cat purring. It was the sound he’d made as a kid when his lungs were bad. Kestrel stiffened, her head turning, as if to locate a noise. Oh, Mark, no. Don’t breathe. Hold your breath-Everything happened very fast. Kestrel sprang forward. Mary-Lynnette saw her silhouette come running and jumping with unbelievable speed. Toofast-nobody moves thatfast .. . nobody human†¦. What are these girls? Her vision came in flashes,as if she were under a strobe light. Kestrel jumping. Dark trees all around. A moth caught in the beam. Kestrel coming down. Protect mark†¦ A deer. Kestrel was coming down on a deer. Mary-Lynnette’s mind was filled with jumbled, careening images. Images that didn’t make sense. She had a wild thought that it wasn’t Kestrel at all, but one of those raptor dinosaurs she’d seen at the movies. Because Kestrel moved like that. Or maybe ftwasn’t a deer-but Mary-Lynnette could seethe white at its throat, as pure as a lace ruffle at the throat of a young girl. She could see itsliquid black eyes. The deer screamed. Disbelief. I can’t be seeing this†¦. The deer was on the ground, delicate legs thrashing. And Kestrel was tangled with it. Her face buriedin the white of its throat. Her arms around it. The deer screamed again. Wrenched violently.Seemed to be having convulsions. The flashlight beam was all over the place. Then it dropped. At the very edge of the light, Mary-Lynnette could see two other figures join Kestrel.They were all holding the deer. There was one last spasm and it stopped fighting. Everything went still. Mary-Lynnette could see Jade’s hair, so fine that individual strands caught the light against the background of darkness. In the silent Bearing the three figures cradled thedeer. Huddling over it. Shoulders moving rhythmically. Mary-Lynnette couldn’t see exactly what theywere doing, but the general scene wasf,miliar.She’d seen it on dozens of nature documentaries. About wild dogs or lionesses or wolves. The pack hadhunted and now ft wasfeeding. I have always tried†¦ to bea very good observer. And now, I have to believe my own eyes†¦ . Beside her, Mark’s breath wassobbing. Oh, God, let me get him out of here. Please justlet us get out. It was as if she’d been suddenly released from paralysis. Her lip was bleeding again-she must havebitten down on it while she was watchingthe deer.Copperbloodfear filled her mouth. â€Å"Come on,† shegasped almost soundlessly, wiggling backward. Twigs and needles raked her stomachas her T-shirt rode up. She grabbed Mark’s arm.†Come onl† Instead, Mark lurched to his feet. â€Å"Mark!† She wrenched herself to her knees andtried to drag him down. He pulled away. Hetook a step toward theclearing. No â€Å"Jade!† He was heading for the clearing. No, Mary-Lynnette thought again, andthen shewas moving after him. They were caught now, andit really didn’t matter what he did. Butshe wantedto bewith him. â€Å"Jade!† Mark said and he grabbed the flashlight.He turned it directly on the little huddle at the edgeof the clearing. Three faces turned toward him. Mary-Lynnette’s mind reeled. It was one thing toguess what the girls were doing; it was another thingto seeit. Those three beautiful faces, white in the flashlight beam †¦with what looked like smearedlipstick on their mouths and chins. Cardinal red, thimbleberry color. But it wasn’t lipstick or burst thimbleberries. It wasblood, and the deer’s white neck was stained with it. Eating the deer, they’re really eating the deer;oh, God, they’re really doing it†¦. Some part of her mind-the part that had absorbedhorror movies-expected the three girls to hiss and cringe away from the light. To block it out with bloodstained hands while making savage faces. It didn’t happen. There were no animal noises, nodemon voices, no contortions. Instead, as Mary-Lynnette stood frozen in an agonyof horror, and Mark stood trying to get a normal breath, Jade straightened up. And said, â€Å"What are you guys doing out here?† In a puzzled, vaguely annoyed voice. The way youwould speak to some boy who keeps following you everywhere and asking you for a date. Mary-Lynnette felt her mind spinning off. There was a long silence. Then Rowan and Kestrelstood up. Mark was breathing heavily, moving the flashlight from one of the girls to another, but always coming back to Jade. â€Å"What areyoudoing out here; that’s the question!† he said raggedly. The flashlight whipped to the hole, then back tothe girls. â€Å"What are you doing?† â€Å"I asked you first,† Jade said, frowning. If ft hadJust been her, Mary-Lynnette would have started towonder if things were so awful after all. if maybethey weren’t in terrible danger. But Rowan and Kestrel were looking at each other,and then at Mark and Mary-Lynnette. And their ex pressions made Mary-Lynnette’s throat close. â€Å"You shouldn’t have followed us,† Rowan said.She looked grave and sad. â€Å"They shouldn’t have beenableto,† Kestrel said.She looked grim. â€Å"It’s because they smell like goats,† Jade said. â€Å"What are you doing?†Mark shouted again, almostsobbing. Mary-Lynnette wanted to reach for him, butshe couldn’t move. Jade wiped her mouth with the back of her hand.†Well, can’t youtell?†She turned to her sisters.†Now what are we supposed todo?† There was a silence. Then Kestrel said, â€Å"We don’thave a choice. We havetokill them.† How to cite Night World : Daughters of Darkness Chapter 8, Essay examples

Physical Activity And Risk Of Coronary Heart Disease In India

Question: Discuss about the Physical Activity And Risk Of Coronary Heart Disease In India. Answer: Physical activity and risk of coronary heart disease in India The evidence presented in the paper The selected case-control study was carried out with an objective to know the relationship between physical exercise and coronary heart disease (CHD) in the urban areas of India i.e. Delhi and Banglore (Rastogi et al 2004). The urban hospitals of New Delhi and Bangalore were carefully chosen to draw a sample of 350 cases and 700 controls. The cases and controls were matched for age and gender. They were asked certain questions regarding socioeconomic status, smoking history, history of hypertension, diabetes, hypercholesterolaemia, family history of Cardio Vascular Diseases, dietary intake, types of fat or oils used in cooking, nutritional supplement use, and physical activity. The anthropometric measurments were also taken regarding height, weight, hip waist circumferences, body mass index (BMI) and waist to hip ratio. The data analysis was done using conditional logistic regression where confounders were controlled in the analysis. The results found that 48% of controls and 38% of cases participated in some kind of leisure-time physical activity. The participants who engaged in highest level of leisure-time physical activity had lowest risk of developing CHD. On the other hand; participants with comparatively increased levels of sedentary lifestyles, had higher risk of developing CHD. The paper concluded that leisure-time exercise had a protective effect on heart as compared to sedentary lifestyle. The recommendation of paper was that physical activities in daily lives should be promoted in urban India. Exposure or Intervention The exposure or intervention was leisure time exercise which was assessed with the help of physical activity questionnaire. The metabolic equivalents (MET) or intensity of the reported activities were assessed with the help of Compendium of Physical Activities (Rastogi et al 2004, pg 2, para 5). Outcome The outcome was acute Myocardial Infarction. Cases were the respondents having outcome. Controls were the respondents in which outcome was absent. Cases aged 2174 with a diagnosis of AMI were selected from eight urban hospitals in New Delhi and Bangalore between January 1999 and January 2000 (Rastogi et al 2004, pg 2, para 1). Study Design The study design was case-control study having 350 cases of acute myocardial infarction and 700 controls matched for age and gender. The study used conditional logistic regression for data analysis (Rastogi et al 2004, pg 1, Abstract). Study Population The study population was patients in urban hospitals of New Delhi and Banglore. Main findings of study People with exposure to highest level of leisure time exercise i.e. 145 MET-minutes per day, equivalent to 36 minutes of brisk walking per day, had relative risk of 0.45 (95% CI 0.31-0.66) as compared to non-exercise group. It means leisure-time exercise had a protective effect for the risk of AMI. On the other hand people with greater than 3.6 hours per day of sedentary activity had about 1.88 times (95% CI 1.09-3.20) higher risk of developing AMI, as compared to people with less than 70 minutes per day of sedentary activity per day. Extent to which the observed association between the exposure and outcome be attributed to non-causal explanations Non-causal explanations of the observed association could be attributed to selection and/or measurement bias, confounding, or chance variation. Following section explains all three in detail. Selection and/ or measurement bias The patients in both the groups were matched by age and gender; but there always remains risk of selection bias in the study as the controls were relatively healthy and their ailments were minor, as compared to cases having diagnosis of Acute Myocardial Infarction (AMI). The studies have shown selection bias to be a common cause of bias in case-control studies (van Rein et al 2014). The selection of controls could also be inappropriate. Also in the present study, the disease is very severe and the chances of pre-mature death are high. Thus the study selected only those patients who survived the condition of AMI and thus had comparatively less severe illness, which is again a major cause of bias (van Rein et al 2014). This is also called survivor bias in case-control studies (ibid). In the discussion section, the author has discussed that controls were chosen from seven different out-patient clinics and in-patient wards; and so there were chances of association being present in one particular group and not in other groups; and such a situation might induced bias in the results. Also the study interviewed only those cases who survived. Thus, although there were 25 cases that did not survive, but they could not be included in the study. Also the author himself has argued the possibility of only health conscious individuals participating in the study, which may have induced bias in the study. Moreover controls in the study were more educated and had lower incomes than cases; which might be the source of bias in the study. Confounding The study adjusted the following confounders: age, gender, cigarette and bidi smoking, BMI, WHR, alcohol intake, education, or income; but there might be other unknown confounding factors which might have introduced bias in the results. One such example is the use of chewing tobacco. Cigarette and Bidi smoking have been adjusted, but not chewing tobacco. There is also a possibility of introducing the bias by doing matching. However matching is supposed to remove bias but studies have shown that it may also introduce bias (Pearce 2016). The reason being; while attempting to match for the confounders; matching may also be done for exposure itself (ibid). Further matched case-control design must include matched analysis (ibid). In this particular research various potential confounders were controlled in the analysis. Thus every possible effort was done to remove confounding. The researcher has also reasoned that physical activity may also be protective for some of the ailments in control group, other than AMI, which may have induced confounding bias in the research. Chance Variation The researcher had set the level of significance at 95 percent, which left only 5 percent chances of chance variation. Chance Variation is inherent in any research based on statistical predictions. Chance variation is also called chance error or random error. It is the difference between the predicted value and actual value/ population value. In other words it is the probability by which the estimates differ from the true value/ population value. In a normal distribution curve, if we take a range up to 1.96 SD (standard deviations) above and below the estimated mean; then there are 95% chances that true value will fall in that range; which will leave only 5 percent likelihoods of any variation from this range, which is called chance variation. There will be 2.5% chances that true value/ population value will fall above this range and 2.5% chances will be that true value will fall below this range. (Sowey, Petocz, 2017) Internal Validity of the study The quantitative research is considered to be internally valid if it could minimise Systematic errors or bias. The researcher has to ensure that the cause-effect relationship is not a spurious one. There are several benchmarks defined by various epidemiologists from time to time; which authenticates the evidence of causal relationship between the exposure and the outcome; within the study. Some of these principles are as follows. The first principle is that the cause must precede the effect i.e. there should be temporal relationship between the cause and effect. The second principle is that covariation between cause and effect should be high. It means, by changing the one, there should be clear and visible change in the other. The third principle is that there should be a dose-response relationship between the cause and effect. It means higher the change in one, higher should be the change in the other or vice-versa (Neuman 2016). These conditions for internal validity of study are f urther deliberated in detail as follows. Temporal relationship Yes, the research have shown that there is a temporal relationship between exposure and outcome. It was a case-control study and the exposure or non-exposure to leisure-time exercise preceded the development or non-development of AMI. Strong relationship Yes, the relationship between leisure time exercise and AMI was very strong as the P value was less than 0.0001 for the relationship. Participants with 35-40 minutes of brisk walking had 55% lower risk of developing AMI as compared to controls who did not exercise. Dose-response relationship Yes, there was a dose-response relationship between exposure and the outcome. Participants in the highest level of physical exercise group had lowest risk of developing AMI and this observation was significant at p0.0001. Consistency within the study Yes, the results were consistent within the study. Age and Sex adjusted analysis showed that leisure-time physical exercise lowered the risk of AMI. After adjusting for confounders like cigarette/ bidi smoking, the leisure time exercise had protective effect on AMI risk. The results were also consistent in multi-variate analysis. Accordance with other evidence Yes, the findings are consistent with other evidence. The findings are consistent with evidence from some recent research. In 2014, Andersen and colleagues found that leisure time physical activity had a protective effect towards the risk of developing AMI and the benchmark of a dose-response relationship also got fulfilled (Andersen et al 2014). Similarly the INTERHEART study of China found a protective role of leisure-time physical exercise towards AMI as compared to sedentary lifestyle (Cheng et al 2014). Moreover in Copenhagen City Heart study, it was found that leisure-time physical exercise had a protective effect in post-MI patients (Saevereid et al 2013). A recent meta-analysis by Claes et al also revealed that home-based physical activity is protective for cardiovascular rehabilitation (Claes et al 2017). Some other studies around the world have also found that exercise-based rehabilitation helps in the improvement of quality of life and functional capacity of heart (Peixoto et al 2015). Also some studies have been mentioned in the article itself. The article talk about one prospective study from US on women that established that more than 3 hours per week of leisure time physical exercise had protective effect on heart. Another cohort study on US men determined that individuals who were doing more than 30 minutes per day of moderate-intensity physical exercise had 20 percent lower chances of developing CHD. The selected paper discusses another US-based prospective study on post-menopausal women, which determined that walking daily have a protective effect on heart. Biological Plausibility Yes, the results are plausible in terms of a biological mechanism. The leisure-time physical exercise results in lipid lowering in Atherosclerotic plaques. It also reduces thrombotic potential and increases fibrinolytic potential (Libby 2013). The study has also discussed underlying biological mechanisms due to which physical activity has protective effects on CVD risk. These include reduced blood pressure, increased HDL (High-Density Lipoproteins), increase in insulin sensitivity, improvement in endothelial function, and reduction in atherogenic cytokine production. External Validity The external validity of a research denotes the extent to which the results of the study could be generalised across heterogenous populations. The sampling bias may be a threat to external validity of research if the sample is not true representative of study population (Pearl 2017). In other words the results of the study could be generalised to whole population which is possible when the chosen sample is true representative of the study population. It is always important to reinforce the reporting of results on external validity so that the context of application of results could be understood i.e. whether the results are applicable to local settings or group settings or wider country settings. It becomes important to transform research in to practice as the interventions may also be applicable to similar context or settings (Steckler, McLeroy, 2008). Generalisability This particular research was conducted on hospital patients from the urban settings of Delhi and Banglore. Thus results of the study could be generalised to urban cities of India only, that too particularly Delhi and Banglore. If some other study is conducted by taking controls from general populations, the results might be different. Thus to conclude, the results of this research could be generalised to urban hospital patients of New Delhi and Banglore cities of India. Can the findings be applied to the source population from which the study population was derived? The study population was derived from urban hospitals of New Delhi and Banglore cities of India. The chosen sample was sufficient to generalise the findings to the source population; but as the research was conducted on patients selected from hospitals only, the generalisation of results to general population or whole population of a country or city is uncertain. Can the study results be applied to other relevant populations? The study results are specific to New Delhi and Banglore cities of India as the selected sample was representative of hospital patients of these two cities only; and thus the results could not be generalised to other relevant populations. References Andersen, K., Mariosa, D., Adami, H. O., Held, C., Ingelsson, E., Lagerros, Y. T., ... Sundstrm, J. (2014). Dose-response relations of total and leisure-time physical activity to risk of heart failure: a prospective cohort study. Circulation: Heart Failure, CIRCHEARTFAILURE-113. Cheng, X., Li, W., Guo, J., Wang, Y., Gu, H., Teo, K., ... Yusuf, S. (2014). Physical activity levels, sport activities, and risk of acute myocardial infarction: results of the INTERHEART study in China. Angiology, 65(2), 113-121. Claes, J., Buys, R., Budts, W., Smart, N., Cornelissen, V. A. (2017). Longer-term effects of home-based exercise interventions on exercise capacity and physical activity in coronary artery disease patients: A systematic review and meta-analysis. European journal of preventive cardiology, 24(3), 244-256. Libby, P. (2013). Mechanisms of acute coronary syndromes and their implications for therapy. New England Journal of Medicine, 368(21), 2004-2013. Neuman, W. L. (2016). Understanding research. Pearson. Pearce, N. (2016). Analysis of matched case-control studies. bmj, 352, i969. Pearl, J. (2017). The Eight Pillars of Causal Wisdom (Lecture notes for the UCLA WCE conference, April 24, 2017). Peixoto, T. C., Begot, I., Bolzan, D. W., Machado, L., Reis, M. S., Papa, V., ... Guizilini, S. (2015). Early exercise-based rehabilitation improves health-related quality of life and functional capacity after acute myocardial infarction: a randomized controlled trial. Canadian Journal of Cardiology, 31(3), 308-313. Rastogi, T., Vaz, M., Spiegelman, D., Reddy, K. S., Bharathi, A. V., Stampfer, M. J., ... Ascherio, A. (2004). Physical activity and risk of coronary heart disease in India. International journal of epidemiology, 33(4), 759-767. Saevereid, H. A. S., Schnohr, P. S., Prescott, E. P. (2013). Speed and duration of walking and other leisure time physical activity and the risk of heart failure: the Copenhagen City Heart study. European Heart Journal, 34(suppl 1), P3646. Sowey, E., Petocz, P. (2017). A Panorama of Statistics: Perspectives, Puzzles and Paradoxes in Statistics. John Wiley Sons. Steckler, A., McLeroy, K. R. (2008). The importance of external validity. American Journal of Public Health, 98(1), pp. 910. van Rein, N., Cannegieter, S. C., Rosendaal, F. R., Reitsma, P. H., Lijfering, W. M. (2014). Suspected survivor bias in casecontrol studies: stratify on survival time and use a negative control. Journal of clinical epidemiology, 67(2), 232-235.