Glucose Tolerance Tests Accuracy In Diagnosing Diabetes

Glucose Tolerance Tests Accuracy In Diagnosing Diabetes According to the World Health Organization (WHO), more than 220 million people worldwide have diabetes. An estimated 1.1 million people died from diabetes in 2005, and almost half of diabetic deaths occurred in people under the age of 70 years of age. WHO projects that the number of diabetic deaths will increase to 366 million by the year 2030 (8). Diabetes Mellitus Type 2 is a prevalent disorder that causes one to have high blood sugar, or hyperglycemia. This hyperglycemia can be the result from one or a combination of 1) decrease production of insulin from beta cells of the pancreas; 2) increase sugar production from the liver; 3) decrease sugar uptake by cells secondary to insulin receptors. Symptoms of DMII are excess urination, excess thirst, dizziness, blurred vision, sweating, and fatigue. Patients presenting with these symptoms should be screened by a finger stick, where a blood sample is taken from a quick prick of the finger, to be tested for hyperglycemia. Normal blood sugar should range from 70-100mg. If one has a fasting sugar of >126mg or an after eating sugar level > 200mg, then an oral glucose tolerance test (OGTT) should be performed. During an OGTT, a patient consumes a 150-200g carbohydrate diet for three days and fasts from midnight prior to test date. The morning of test, the patient consumes 75g sugar mixe d with 300ml of water within a 5 minute period. The patients blood sugar level is be measured at baseline, and then again at 120 minutes. A diagnosis of DMII is made if the baseline level is >126 mg and the 120 minute level is >200mg. These guidelines are set by the American Diabetic Association (ADA) and the World Health Organization (WHO) (1,8). Another option for obtaining a blood sugar level is measuring the percent of glycosylated red blood cells, or the percent of sugar attached to a RBC. RBCs live for approximately 90 days in the human body. By measuring this percentile one can observe the patients blood sugar level over the previous 3 months and not just at the moment an OGTT is performed. Today, HbA1c is a main tool for following metabolic control in persons with diabetes(5). A HbA1c > 6.0 percent should permit a diagnosis of DMII, but is not at this time a definite diagnostic tool. Diabetes can cause complications of multiple organ systems. WHO defines consequences of diabetes as follows: Diabetes increases the risk of heart disease and stroke. 50% of people with diabetes die of cardiovascular disease (primarily heart disease and stroke). Combined with reduced blood flow, neuropathy in the feet increases the chance of foot ulcers and eventual limb amputation. Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. After 15 years of diabetes, approximately 2% of people become blind, and about 10% develop severe visual impairment. Diabetes is among the leading causes of kidney failure. 10-20% of people with diabetes die of kidney failure. Diabetic neuropathy is damage to the nerves as a result of diabetes, and affects up to 50% of people with diabetes. Although many different problems can occur as a result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or weakness in the feet and hands. The overall risk of dying among people with diabetes is at least double the risk of their peers without diabetes (8). Previous studies have showed that better control of plasma glucose levels reduced the risk of developing long-term complications pertaining to diabetes (4). A higher HbA1c correlates well with the likelihood of developing chronic complications such as the ones listed above. This study is designed to explore if a HbA1c be used to diagnose diabetes. Observations suggest that a reliable measure of chronic glycemic levels such as HbA1c, which captures the degree of glucose exposure over time and which is related more intimately to the risk of complications than single or episodic measures of glucose levels, may serve as a better biochemical marker of diabetes and should be considered a diagnostic tool (2). As for the current gold standard for diagnosing diabetes, the oral glucose tolerance test (OGTT) has its limitations (2). These include high interindividual variability, low reproducibility compared to FPG, poor compliance with the conditions needed to perform the test correctly, and is cumbersome and time-consuming for medical staff and patients (4). Due to these factors one may ask, Is a HbA1c or an OGTT more accurate at diagnosing new onset diabetes mellitus type 2 in a patient presenting with hyperglycemia? By exploring this question and answering it from an evidence-based approach, the answer may help clinicians advance to an easier and less time consuming way to diagnose diabetes mellitus type II. CLINICAL CASE A 57 year old African American male presented to the outpatient office with symptoms of dizziness, blurred vision, polydipsia, and polyuria. He has a significant history of hypertension and hyperlipidemia. The patient was unclear when his symptoms started. Upon evaluation in the office, the patient was noted to have a marked glucose elevation of 420. An in-house HbA1c was also noted at 13.0. Upon further questioning, the patient has not been taking any medications for diabetes, and is currently taking Lisinopril and Zocor for his other medical conditions. Due to the presenting symptoms and lab results, the patient was admitted to the hospital for hyperosmolar nonketotic hyperglycemic state. METHODS A PubMed search was performed by using the Clinical queries and Diagnosis filters. The terms A1c AND diagnosis AND diabetes and glycosylated hemoglobin AND diagnosis AND diabetes were used to search the site for relating articles. With these search terms, a total of 176 hits revealed articles pertaining to the requested information. Articles that met all inclusion criteria for the research were evaluated and assigned a type/level of evidence. In order to be included in this evidence-based study, articles had to meet the following inclusion criteria: Articles must be cohort studies. Studies must not be > 6 years old. Articles must have participants with impaired glucose levels or symptoms of impaired glucose. Studies must include evidence of OGTT or FPG and HbA1c. Studies must have a significant number of participants to produce a significant result (n > 375). Any articles that did not specifically relate to diagnosing DMII with a HbA1c were excluded. Articles that were not cohort studies, were older than six years, did not have participants with impaired glucose, or did not have a significant amount of participants were excluded. Certain articles that appeared in the PubMed search were strictly review articles. These papers were reviewed, and if applicable, may be used to provided supporting factors about pathophysiology/ epidemiology of diabetes type II and its diagnostic criteria. Articles that met all inclusion criteria were evaluated and assigned a level of evidence using the Oxford Centre for Evidence-based Medicine Levels of Evidence worksheet. RESULTS Study #1: Diagnosing Type 2 Diabetes Mellitus: in Primary Care, Fasting Plasma Glucose and Glycosylated Hemoglobin Do the Job Study Design: This study was performed at the Raval Sud Primary Care Center in Barcelona, Spain and was begun in 1992. The purpose of this study was to determine the validity of glycosylated hemoglobin values as a method to diagnose type 2 diabetes mellitus in a population at risk seen in primary care. Four hundred fifty four subjects were selected to participate in the study. The population served by the Raval Sud Center is characterized by it low evonomic level, high rate of immigration, and high rate of morbidity and mortality for certain diseases and disorders. Inclusion criteria for eligible participants had at least on e of the risk factors for developing DMII described in the ADA guidelines. These included family history of DMII, personal history of carbohydrate intolerance or gestational diabletes, prolonged use of a drug able to raise glucose levels, obesity with a body mass index > 30, hypertension, HDL-cholesterol levels 250 mg/dL. Persons who did not wish to take part in the study were excluded. For the purpose of this particular study, data was recorded from the time the patient was included in the Raval Sud Care Center. The study then used a cross-sectional analytical design to validate a diagnostic test. (4) Study Conduct: Subjects were interviewed and variables were recorded for each participant. These included sociodemographic characteristics such as age and sex, clinical characteristics such as BMI and blood pressure, and laboratory values including fasting plasma glucose in a venous blood sample, oral glucose tolerance test after a 75g glucose overload, and a HbA1c measured by high pressure liquid chromatography. To standardize the results for the HbA1c, the absolute values were recalculated in terms of the number of standard deviations above the mean. FPG and OGTT values were based on the WHO criteria as having normal, impaired, or DMII glucose levels. (4) Study Results: The distribution of demographic characteristics and laboratory findings are shown in Table 1. The study found that plasma glucose levels were significantly lower in normal subjects than in subjects with abnormal glucose levels (IFG or OGTT) and even lower in subjects with abnormal glucose levels than in patients with diabetes (P 5.94% (mean, +3SD), the diagnosis of DMII is reliable and accurate in 93% of the cases. Table 4 shows the diagnostic validity of a combined strategy of FPG and HbA1c values: patients were considered to have DMII when FPG > 125 mg/dL, or when FPG >110 mg/dL and HbA1c was greater than the cutoff value. Maximal efficacy (93% GV) was found for HbA1c > 5.94% (x +3SD), with a sensitivity of 92.2% and a specificity of 95.1%. (4) Study Critique: It has been confirmed that the relationship between circulating glucose values and the onset of chronic complications exists. Thus, it is logical for the diagnosis of DMII to be based on glucose values. One of the main problems in this particular study was to define and establish a cutoff point for this continuous quantitative variable. This study analyzed different cutoff points for the whole sample of patients at risk for DMII. When HbA1c values > 5.51% (x +2SD), were used for the cutoff point for diagnosis of DMII, the sensitivity (76%) and specificity (85%) were acceptable. However, when a higher cutoff point was used, specificity increased, but only at the expense of reduced sensitivity. Due to this situation, the study designed a strategy for diagnosis based on the FPG values and the validity of HbA1c. (4) Level of Evidence: 1c Study #2: Comparison of A1c and Fasting Glucose Criteria to Diagnose Diabetes Among U.S. Adults Study Design: This study included participants from the 1999-2006 National Health and Nutrition Examination Survey. Participants included 6,890 adults (>20 years of age), without a self-reported history of diabetes. The subjects attended a morning examination, fasted for > 9 hours at the time of their blood collection, and had valid plasma glucose and HbA1c values taken. Participants were categorized into one of the four groups by presence or absence of fasting plasma glucose > 126 mg/dL and HbA1c > 6.5%. The distribution of the population into these groupings was determined and the K statistic value was calculated. Also, the distribution of U.S. adults by fasting glucose and different HbA1c cutoff points (6.0-6.7%) were calculated. The objective for this study was to compare A1c and fasting glucose for the diagnosis of diabetes among U.S. adults. (6) Study Conduct: Data was collected through questionnaires (demographics, medical history), a physical examination (blood pressure, BMI, and waist circumference), and blood collection (lipids, plasma glucose, HbA1c). The plasma glucose was measured by using a modified hexokinase enzymatic method and the HbA1c using a high-performance liquid chromatography. (6) Study Results: This study concludes that an HbA1c of > 6.5%, along with a FPG >125 mg/dL demonstrates reasonable agreement for diagnosing diabetes. 1.8% of the participants were classified as having diabetes with a HbA1c > 6.5% and a fasting glucose >126 mg/dL. Among participants with a HbA1c 125 mg/dL, 45% had an A1c value > 6.0% but less than 6.5%. According to A1c guidelines, this value poses an elevated risk for diabetes. Table A1 shows a distribution of adults by fasting glucose and different HbA1c cutoff points. From this table, the lower the HbA1c cutoff points results in higher sensitivity and lower specificity. (6) Study Critique: In this study, certain participants had discordant results such as a HbA1c > 6.5% and a fasting glucose of Study #3: A1c and Diabetes Diagnosis: The Rancho Bernardo Study Study Design: The Rancho Bernardo Study included 2, 107 participants without known DMII, who had an OGTT and a HbA1c between 1984 and 1987. This cross-sectional study of community dwelling adults was provided written informed consent and laboratory data was performed. (3) Study Conduct: HbA1c was measured with high performance liquid chromatography using an automated analyzer. Ophthalmologic evaluation was also performed on the subjects. This was done by using nonmydriatic retinal photography. Sensitivity and specificity of HbA1c cutoff points for DMII were calculated, along with K coefficients which were used to test for agreement between A1c values and diabetes status. The objective for this study was to examine the sensitivity and specificity of HbA1c as a diagnostic test for DMII in older adults. (3) Study Results: For this study the HbA1c cutoff value was 6.5%. This value had a sensitivity of 44% and a specificity of 79%. A lower A1c cutoff point of 6.15% yielded the highest sensitivity at 63% but a lower specificity at 60%. If one were to use this cutoff value, it would miss one-third of those with DMII by the American Diabetes Association guidelines. It would also misclassify one-third of those without DMII. Using the HbA1c value of 6.5% as the cutoff point, the agreement with DMII diagnosis was low (K coefficient was 0.119). In order to compare A1c and ADA criteria with DMII complications, the study looked at participants with some degree of retinopathy. Of the participants who had retinopathy, 40% had and A1c > 6.5% and none had DMII by ADA criteria. This study concluded that the limited sensitivity of the A1c value cutoff may result in missed or delayed diagnosis of DMII, whereas the use of current OGTT criteria will fail to identify a high proportion of individuals with hi gh A1c values, which correlate with long term complications of DMII. (3) Study Critique: This study was performed on a much older population than the other studies examined in this paper. It has its benefits and disadvantages for surveying a population in which there mean age was 69.4. The advantage is that the U.S. elderly population has the greatest current burden and is expected to have the greatest increase in the prevalence of DMII. On the other hand, the disadvantage to having such an older subject population is that it limited the HbA1c cutoff values to that particular population. In a previous critique of an article one of the concerns was the fact that there are different aspects of glucose metabolism. It would have been supportive if the article addressed the age of their participants and compared them with the study results. (3) Level of Evidence: 1c Study #4: Diagnostic value of glycated haemoglobin (HbA1c) for the early detection of diabetes in high-risk subjects Study Design: This study was performed by collecting data from the Bundang CHA General Hospital database. A total of 392 subjects who had an abnormal random plasma glucose, a history of gestational diabetes mellitus, a macrosomic baby, or a severe obesity were selected to participate in the study. Exclusion criteria included a previous history of diabetes of other endocrinopathies, pregnancy, abnormal liver or renal function tests, a history of major surgery, severe illness, blood transfusion within the previous 6 months, and weight loss > 3kg during the past three months. After an overnight fasting, blood samples were drawn from all participating subjects to include FPG and HbA1c values. (7) Study Conduct: Glucose concentrations were measured using the glucose oxidase method on a autoanalyzer. The HbA1c values were measured by the high-performance liquid chromatography method. All statistical analysis was performed and the best predictive cutoff values for FPG and A1c for detecting patients with new diabetes were identified using the optimal sensitivity/specificity values determined by the receiver operating characteristic curve. (7) Study Results: Figure 1 shows the ROC plot representing the sensitivity and specificity for the HbA1c and the FPG in detecting undiagnosed DMII. From this study, the optimal cutoff value for HbA1c was 6.1% and for FPG was 6.1 mmol/l. The sensitivity/specificity for the HbA1c cutoff value was 81.8% and 84.9% respectively. Table 1 shows the results from the combination of using FPG and HbA1c. This study demonstrated that HbA1c was very useful to screen for diabetes in high-risk patients and the combined use of HbA1c and FPG made up for the lack of sensitivity in FPG alone. (7) Study Critique: This studys subjects were only Korean, therefore making the population very ethnically limited. It would have been beneficial to have seen the population more diverse and to notice the change in results. Also, the study stated that an OGTT was performed, yet a confirmation status of repeat testing was not recorded. This would have been beneficial to have in order to compare results to the FPG and HbA1c values obtained for cutoff for diagnosing DMII. (7) Level of Evidence: 1c DISCUSSION The purpose if this study was to assess if a HbA1c was sufficient enough to make a unknown diagnosis of diabetes mellitus type 2. From these studies one can gather that a HbA1c is adequate for making a new diagnosis for DMII. The following chart compares the specificity and sensitivity of each HbA1c from each study critiqued in this study. Also, each study uses a different HbA1c cutoff that they gathered from their cohort or cross-sectional study which is also included in the chart below. Study Sensitivity Specificity HbA1c used for Diagnosis Diagnosing Type 2 Diabetes Mellitus: in Primary Care, Fasting Plasma Glucose and Glycosylated Hemoglobin Do the Job 63.3% 93.4% 5.94% Comparison of A1c and Fasting Glucose Criteria to Diagnose Diabetes Among U.S. Adults 72.5% 96.5% > 6.0% A1c and Diabetes Diagnosis: The Rancho Bernardo Study 44% 79% 6.5% Diagnostic value of glycated haemoglobin (HbA1c) for the early detection of diabetes in high-risk subjects 81.8% 84.9% 6.1% Study #1 discussed the option of performing a combination of HbA1c and a FPG test. This exhibited to be most the most poignant result with a specificity/sensitivity of 92.2 and 95.1, respectively. In study #2, it also agreed that a HbA1c and a FPG level provided the most assured diagnosis for DMII. However, this study had the most discordant results and was probably due to the fact of its subject population. It stated that the results may have been due to the fact that assessment of different aspects of glucose metabolism was present (6). Study #3 was performed on a much older population, and focused on the importance of following HbA1c levels to help prevent long term complications of DMII. However, it also stated that a HbA1c would also have a higher sensitivity and specificity if it were performed along with a FPG test. Finally, study #4 agreed on the fact that a HbA1c was very sufficient for screening for DMII, and that it provided much support for diagnosing DMII along with a FP G. CONCLUSION This study provided that a HbA1c of approximately 6.0% is a great support to help making the diagnosis of DMII along with a FPG > 125. Some studies have suggested that a HbA1c of this value is suggestive of a diagnosis, however, the studies above advocate that FPG levels should also be obtained to solidify the actually diagnosis of DMII. However, in a recent publication from the JAAP, it states thatan A1c value of 6.5% higher as diagnostic. This value appears to be the level at which a person is at risk for developing the complications of diabetes. A diagnosis should be confirmed with a repeat A1c test, unless clinical symptoms and a glucose level higher than 200 mg/dL are present (5). From this statement one can confer that the patient described above in the clinical case portion of this paper, does indeed warrant the diagnosis of DMII on the basis of a HbA1c of 13.0%, the presence of clinical symptoms, and the glucose elevation of 420 mg/dL.

Faulty economics Essay

Based on Neoclassical economics, this statement is faulty because the employees provide their marginal unit of service by providing the kind of labor that their companies need to their loss of leisure. Almost all CEOs are the most stressed out employees of a company because they carry the burden to run the company. 2. This statement is faulty because the consumers are maximizing their utilities and the producers are maximizing their profits. In this statement, the demand for bottled water is greater than the demand for gasoline. Therefore, the production cost of the bottled water is greater than the production of gasoline. 3. Neoclassical economics focuses on the satisfaction of the consumers. Consumers have the preferences on whether they will stop smoking or continue to smoke. Therefore, their addiction to nicotine has no direct relationship with the increase in taxes. 4. This statement is not true because the firms will only employ people when the cost for hiring them is balanced with their outputs. 5. This statement is not true because the law for supply and demand does not apply to everyday lives. When there is a shortage in parking lots, the university will then put a price in the parking area as the solution to the problem. The students will then â€Å"bid† for their spaces in the parking lots. This is because the university will strive to optimize their market interdependence and to achieve economic equilibrium.

Definition of the Triangle Trade (Rum and Slave Trade)

In the 1560’s, Sir John Hawkins pioneered the way for the slave triangle that would take place between England, Africa, and North America.  While the origins of the slave trade from Africa can be traced back to days of the Roman Empire, Hawkins voyages were the first for England. The country would see slave trade flourish through more than 10,000 recorded voyages up through March 1807 when the British Parliament abolished it throughout the British Empire and specifically across the Atlantic with the passage of the Slave Trade Act. Hawkins was very cognizant of the profits that could be made from the slave trade and he personally made three voyages. Hawkins was from Plymouth, Devon, England and was cousins with Sir Francis Drake. It is alleged that Hawkins was the first individual to make a profit from each leg of the triangular trade. This triangular trade consisted of English goods such as copper, cloth, fur and beads being traded on the African for slaves who were then trafficked on what has become to be known as the infamous Middle Passage. This brought them across the Atlantic Ocean to then be traded for goods that had been produced in the New World, and these goods were then transported back to England. There was also a variation of this system of trade that was very commonplace during the  colonial era in American History. New Englanders traded extensively, exporting  many commodities  such as fish, whale oil, furs, and rum and followed the following pattern that occurred as follows: New Englanders manufactured and shipped rum to the west coast of Africa in exchange for slaves.The slaves were taken on the Middle Passage to the West Indies where they were sold for molasses and money.The molasses would be sent to New England to make rum and start the entire system of trade all over again. In the colonial era, the various colonies played different roles in what was produced and used for trade purposes in this triangular trade. Massachusetts and Rhode Island were known to produce the highest quality rum from the molasses and sugars that had been imported from the West Indies.  The distilleries from these two colonies would prove to be vital to the continued triangular slave trade that was extremely profitable. Virginia’s tobacco and hemp production also played a major role as well as cotton from the southern colonies.   Any cash crop and raw materials that the colonies could produce were more than welcome in England as well as throughout the rest of Europe for trade. But these types of goods and commodities were labor intensive, so the colonies relied on the use of slave for their production that in turn helped to fuel the necessity of continuing the trade triangle. Since this era is generally considered to be the age of sail, the routes that were used were chosen due to the prevailing wind and current patterns. This meant that is was more efficient for the countries situated in Western Europe to first sail southward until they reached the area known for the â€Å"trade winds† before heading west towards the Caribbean in lieu of sailing a straight course to the American colonies. Then for the return trip to England, the ships would travel the Gulf Stream and head in a Northeast direction utilizing the prevailing winds from the west to power their sails. It is important to note that the triangle trade was not an official or rigid system of trade, but instead a name that has been given to this triangular route of trade that existed between these three places across the Atlantic. Further, other triangle-shaped trade routes existed at this time. However, when individuals speak of the triangle trade, they are typically referring to this system.

The Pros And Cons Of High School Students - 1155 Words

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Clifford Olson Canadian Serial Killer Essay - 1005 Words

Clifford Olson: Canadian Serial Killer Clifford Olson is one of Canadas well known serial killers. He showed no sign of sympathy for the public all throughout his life and would eventually end up killing many innocent people and spending a good portion of his life in jail. Clifford Olson was born on January 1st 1940, in Vancouver, British Columbia. While he was growing up he was always in trouble. Even as a child in school her was referred to as a bully and not a nice kid. Then as he grew up things didnt change for the better the just got worse. As a teenager and young adult Olson found himself in trouble with the law quite frequently. From the year of 1951 to 1981 ( ages 17-21) he had 94 arrests. He was put in jail for some of†¦show more content†¦This time the victim was 13 year old Colleen Daignault. Like Christine she also lived in Surrey . Sixteen year old Darren Joshrud disappeared from the mall In Vancouver within the same as Colleen went missing. He was found On May the 2nd, 1981. He had been killed by severe blows to the head which had shattered his skull. Two weeks after Darrens body was found, Clifford Olson got married. HE married the mother of his son and the woman he had been living with since he got out of jail. But again, this didnt change the nature of Clifford Olson. Four days after his marriage, Sandra Wolfsteiner became Olsons next victim. She was 16 years old and had been hitchhiking in Langley when she went missing and was eventually killed. When she didnt show up at home from a baby-sitting job on June 21st 1981 Ada Court was reported missing to the police by her parents. She was 13 years old when she fell victim to Clifford Olson. A little over a month after Ada was reported missing the body of Judy Kozma was found mutilated in Lake Weaver, near Agassiz, in Fraser Valley. Judy had gone missing 16 days earlier on July 9th. On July the 15th the police in British Columbia held a Law Enforcement Conference. At this conference it was discussed that Olson may be responsible for the murders of all the above children. Since he was suspected the police placed Olson under their watch, in hope of preventing more murders on innocent people. HoweverShow MoreRelatedThe Case Of Clifford Robert Olson1241 Words   |  5 PagesIn this paper I will be explaining the case of Clifford Robert Olson, who was arrested for the murder of 11 children in 1982.To start off, I will be giving you a quick summary about the case. Clifford Olson had a substantial criminal record. He was arrested on August 12, 1981, with the suspicion of attempts to abduct 2 girls. Just 13 days later on August 25th, he had been charged with the murder of Judy Kozma. Clifford had killed 11 children between the ages 12-18 and he refused to confess unlessRead MoreWilliam Pickton Anthropology1495 Words   |  6 Pagestheory from psychology, sociology, an d anthropology. Using each perspective, write a one page analysis of the behaviour of William Pickton. Write a perspective for each social theory (three pages in total). 2. Write a hypothesis to research a serial murderer using the following social science theories: Psychoanalysis, Functionalism, and Feminism. For example, a Marxist could look at the economic inequalities as a means of promoting a feeling of helplessness. This helpless feeling could promoteRead MoreProject Mgmt296381 Words   |  1186 PagesWhy ERP? First Edition Larson and Gray, Project Management: The Managerial Process, Fifth Edition Leenders, Johnson, Flynn, and Fearon, Purchasing and Supply Management, Thirteenth Edition Nahmias, Production and Operations Analysis, Sixth Edition Olson, Introduction to Information Systems Project Management, Second Edition Schroeder, Goldstein, Rungtusanatham, Operations Management: Contemporary Concepts and Cases, Fifth Edition Seppanen, Kumar, and Chandra, Process Analysis and Improvement, FirstRead MoreQuality Improvement328284 Words   |  1314 PagesWalker, and Mr. John Belvins, the Coca-Cola Company; Mr. Bill Wagner and Mr. Al Pariseau, Litton Industries; Mr. John M. Fluke, Jr., John Fluke Manufacturing Company; Dr. Paul Tobias, formerly of IBM and Semitech; Dr. William DuMouchel and Ms. Janet Olson, BBN Software Products Corporation. I would also like to acknowledge the many contributions of my late partner in Statistical Productivity Consultants, Mr. Sumner S. Averett. All of these individuals and many others have contributed to my knowledge

Bad Credit Can Hurt Your Job Seekers Free Essays

Monica Cotallat, Hudson Community College Professor Sakina Laksimi-Morrow English 102 March 17, 2013 BAD CREDIT CAN HURT JOB SEEKERS I am a student majoring in Graphic/Web Design. This is my 4th semester at Hudson Community College. A large number of employers use credit checks to make employee selections. We will write a custom essay sample on Bad Credit Can Hurt Your Job Seekers or any similar topic only for you Order Now A study made by the Society for Human Resource Management (SHRM) in 2010 reported that 47 percent of respondents only use credit background checks for job applicants in certain types of positions, for example, positions with fiduciary and financial responsibilities (SHRM, 2010). Thirteen percent of those surveyed conducted credit checks on all candidates while 40 percent in the SHRM study reported that they did not utilize credit checks on any job candidates (SHRM, 2010). Almost half of employers are running credit checks. What are they looking for? Is it an invasion of privacy? Is it fair? What can be done about? Are people with a blemished financial past scarred for life? The purpose of my paper is to understand why this is happening, examine its reasons and what one can do to help themselves in a competitive work force. There is an array of tools employers use to examine and decide on job applicants and employee job promotions. Typically they will contact references, verify educational and/or professional history, request a criminal history report and in certain situations obtain an individual’s credit history. For some this can create a barrier in the search for employment. A study made by the Society for Human Resource Management (SHRM) in 2010 reported that 47 percent of respondents only use credit background checks for job applicants in certain types of positions, for example, positions with fiduciary and financial responsibilities (SHRM, 2010). Thirteen percent of those surveyed conducted credit checks on all candidates while 40 percent in the SHRM study reported that they did not utilize credit checks on any job candidates (SHRM, 2010). This showing almost half of employers are using credit checks on job applicants which economic downturn has made it harder for some people to get a job due to bad credit. It’s a catch 22. You need a job to pay your debit down but because of your bad credit you can’t land a job. There is also the question of invasion of privacy. Many job applicants have concerns with employers asking questions or requesting an explanation on why they are behind on their bills. Whether tarnished credit is due to medical bills or a messy divorce is it really necessary to explain personal matters to an employer? Is this a violation of rights? From my readings it appears NOT to being a violation. Under the Fair Credit Reporting Act (FCRA), employers are allowed to obtain and use employee’s credit report. However there are guidelines for requesting this information. An employer must inform the applicant about checking into their background and the applicant must sign giving permission to the employer to access the credit/background check. One has the right to refuse such a background check but most likely a spot for candidacy will go out the window. Employers use it as a measure of character. Poor credit history may cause a potential boss to question your dependability, decision making skills, constancy and follow through abilities. Also presumably this helps employers prevent theft or embezzlement for fear of lawsuits. However, there is no concrete evidence connecting people’s credit histories to their on the job performance or productivity. In 2010, Eric Rosenberg, director of state government relations for Trans Union, one of the country’s largest reporting companies told Oregon legislators â€Å"At this point we don’t have any research to show any statistical correlation between what’s in somebody’s credit report and their job performance or their likelihood to commit fraud. † Oregon since then is one of 7 states who had passed a bill prohibiting/limiting the use of credit histories in job screening with certain exceptions. Other states who share this law are: Washington, Connecticut, Hawaii, Illinois, California and Maryland. But some of the laws still need reinforcement and exemptions slimmed. For example Illinois allows employers to continue to do credit checks on managers and minor retails workers. Sixteen other states are considering legislation to limit employer use of credit checks: Georgia, Indiana, Louisiana, Michigan, Missouri, Minnesota, Missouri, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, South Carolina, Vermont, Wisconsin and District of Columbia. While these states propose limiting the use of credit check none of the statutes imposes an out right ban. Besides the question of violation rights there is also the question of discrimination. The Equal Employment Opportunity Commission says, â€Å"Employer credit checks are legal, but can be discriminatory if they disproportionately exclude minorities, women or people older than 40 and are not essential to a hiring decision. A 2007 report conducted by the Federal Reserve Board found out that African-American and Hispanics had considerably lower credit scores than non-Hispanics whites. The last 10 years attractive lending schemes zeroed in on communities of color who lacked in wealth and assets. During the housing boom, minority borrowers were lured into subprime (high interest) loans when in reality they qualified for prime loans. In result after the crash, African Americans, Latinos and Asian-Americans lost half of their family wealth. Employment credit checks are hitting these f amilies hard. This is why organizations like the Lawyers Committee for Civil Rights, National Council of La Raza and the National Association for the Advancement of Colored People (NAACP) have publicly opposed the use of employment credit checks. Another factor is age discrimination. Perhaps an elderly person carries poor credit due to medical bills. As I mentioned earlier, it can be an invasion of privacy by feeling obligated to explain reasons for unpaid bills but to explain bills due to health issues can make the job seeker uncomfortable discussing personal medical histories. This brings fear of losing a job opportunity to a younger, healthier credit worthy applicant. Contrary to Americas strong belief in a right to privacy of their medical histories and an amended act in 2003 to the Fair Credit Reporting Act that requires medical debt to be masked on credit reports and the Americans with Disability Act, which prohibits employers from inquiring about medical history prior to making a job offer. Courts have recognized the discriminatory impact of employment credit screening. The Department of Labor won a verdict against Bank of America stemming in part from the bank’s use of credit checks to hire entry-level employees, which had a discriminatory impact on African-Americans. The country’s challenges with constant layoffs and mortgage foreclosures leave many Americans struggling with maintaining healthy credit. As of April 2010, one-quarter of U. S. consumers, nearly 43. 4 million people, had poor credit. These people should not be omitted from the chance of recovery. Laws need to be tightened and screening should only be applied depending on the nature of the job. Even if hired with a less than desirable or acceptable credit post-employment credit checks can be used to facilitate promotions and transfers. If one has signed the credit consent document when started employment, the employer does not need your signature again. As per the Federal Trade Commission (FTC), if an employer denies you employment or promotion due to credit they must give you a copy of the report used to determine your worthiness and a document called A Summary of Your Rights Under the Fair Credit Reporting Act before taking adverse action. Of course for companies to be forth coming is different story. They can easily say they opted for a different more qualified candidate. Nevertheless, I have listed below steps and tips to help with the job application and interview process. Until those states without credit screening laws pass a bill to protect job seekers we must learn to deal with the issue and voice our rights. †¢ Request your report from the three reporting agencies: Experian, TransUnion and Equifax. You may request a free annual credit report by visiting www. nnualcreditreport. com or you may call 1-877-322-8228. Review your credit report to ensure its error free. Dispute any errors if found. It takes seven years to remove negative credit off your report but to improve a credit score the sooner you start improvement immediately shows. This is a good way to sell your self to employers as you can promote yourself as one who is aware of mistake and imperfection but you have taken steps to rectify and reestabli sh yourself. †¢ Do not be afraid to confess immediately. Not as quickly as stating it in your cover letter but when meeting face to face. This may eliminate you from consideration but in early process the company is still looking for reasons to eliminate candidates. Better to be forthcoming in the front to avoid 5 interviews down the road and having to hit that credit history bump. †¢ If you avoid mentioning early regarding your credit usually one knows the final stages of the interviewing process. At this point inform them about your credit. Most people do not like surprises especially companies ready to make an offer. This will add value and removes the surprise. †¢ Also how you address it influences how the information will be received. The bigger the deal you make of it, the more attention they’ll give it. Share the information with a smile and positive outlook off-handedly. You are communicating that it’s no big deal. May use this approach for example â€Å"I wanted to let you know that during my time unemployed I was juggling my bills and ruined my credit. Since you will be running a credit check I wanted to alert you. Will my temporary bad credit be an issue? In short words you have given them the â€Å"why† which would have put them on edge and eased them with the problem being â€Å"temporary†. In my opinion if credit screenings for employment is a must then only allow looking partial history. Perhaps just for the last 12 months. Companies should only be allowed to view history once at the hiring point and not during the life of the employed at the company. If a position is rejected to a candidate for credit reasons the company must be required to confess this to the unemployed. This gives the job seeker awareness to the issue. Fraud happens often in many institutions. Just because one hold bad credit does not make them a poor employee. In turn they maybe a superior employee as they need and value their job which helps pay their debit. Chris Ball, operations manager for the Jackson, Miss. , branch of Express Employment Professionals said â€Å"he understands that hiring managers who use credit scores are trying to protect their companies from people who might be desperate and turn to embezzlement or theft to cover their bills. But he also says he’s not sure that using credit reports is all that useful: â€Å"In this day and age, it’s hard to find anyone with perfect credit† I completely agree with the above statement. We have done just fine with regular criminal background checks. I do not find the need to also use credit screening with the exception of finical institutions. I ask the question â€Å"Did Bernie Madoff have bad credit? S urely not but was he not responsible for the largest financial fraud in U. S. history? Did someone run a credit background check on him? † I am sure NASDAQ did but did this prevent embezzlement? How to cite Bad Credit Can Hurt Your Job Seekers, Papers

Long Test in Philippine Literature in English Sample Essay Example For Students

Long Test in Philippine Literature in English Sample Essay Modified True or False: Read the undermentioned statements. If the sentence is true. write Thymine on the infinite provided. If the sentence is false. underscore the word or phrase that makes the sentence incorrect and compose the right reply on the infinite provided. ( 20 points ) 1. Literature is the contemplation of History because the inside informations it gives to historical events are literally meaningful. 2. The history of a state can be learned in its fundamental law. in its Torahs. and in its political statements. But to cognize the history of a nation’s spirit. you must read its literature. For through it. you can detect how the people of a state have reacted to the events around them. 3. Nick Joaquin’s The God Stealer illustrates the battle a modern native Ifugao and his ways of get bying with the challenges and demands of civilization and modernisation. 4. The Aroma of Apples shows that Filipinos go and live abroad because the Philippines is a state without hope. 5. Aida Rivera Ford’s Hunger characterizes how the Filipino society is both hapless and promising. 6. Francisco Icasiano’s The God Stealer uses the construct of cultural disaffection to conscienticise the Filipinos as respects their excessively much sense of colonial outlook. 7. For Aida Rivera Ford. wealth and comfort in life are non plenty to rise up up a kid as it was reflected in her short narrative. Hunger. 8. That Bienvenido Santos is the false supporter in The Scent of Apples emphasizes the truth that a literary piece can non get away reflecting the author’s life and surroundings. 9. Esa. in The Chieftest Mourner. is a Feminist. 10. Miss Noel. an idealistic English instructor from Pugad Lawin. decided to go forth the school after she saw the world of the instruction system upon the trial of the school supervisors. Modified Multiple Choices: Choose the missive of your reply for the undermentioned points. Each of the options is right. nevertheless with matching points ; 5 for highest and 1 for the lowest. ( 50 points ) 1. The dead poet’s niece is the chieftest griever because she. A. lost her favorite uncle B. did non hold a opportunity to be mentored by her uncle C. is the incarnation of the dual criterion society D. is enchanted by the enigma of Esa. the fancy man E. is sad for her widowed aunty 2. Miss Noel’s being idealistic is. A. baseless B. hopeless C. hapless D. principled E. baronial 3. For F. Sionil Jose. success and modernness. A. are evil B. can non be achieved unless cultural individuality is wholly disregarded C. may still be achieved without needfully burying one’s roots D. cause the Westerners to be attracted to alien objects E. imperil cultural roots due to their imperialistic nature 4. Wendy’s unfixed shoe strap shows that. A. her parents do non love her B. she is all entirely C. irresponsible parentage is across socio-economic position D. rich childs have their ain portion of jobs E. hapless kids are better than rich 1s 5. The God Stealer pictures the important human experience which says that. A. blood is thicker than H2O B. the ground for the hunt of individuality is guilt and confusion C. success can non compare the benefits of true individuality D. the past is like a shade that will forever hangout anyone who tries to abandon it E. one can non get away the roots of his/her cultural individuality 6. â€Å"The Chieftest Mourner† . â€Å"Hunger† . and â€Å"The Visitation of the Gods† portion the subject. . A. Filipino young person needs extreme counsel and way .u9207b71be5d9dec045446902a906b01b , .u9207b71be5d9dec045446902a906b01b .postImageUrl , .u9207b71be5d9dec045446902a906b01b .centered-text-area { min-height: 80px; position: relative; } .u9207b71be5d9dec045446902a906b01b , .u9207b71be5d9dec045446902a906b01b:hover , .u9207b71be5d9dec045446902a906b01b:visited , .u9207b71be5d9dec045446902a906b01b:active { border:0!important; } .u9207b71be5d9dec045446902a906b01b .clearfix:after { content: ""; display: table; clear: both; } .u9207b71be5d9dec045446902a906b01b { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u9207b71be5d9dec045446902a906b01b:active , .u9207b71be5d9dec045446902a906b01b:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u9207b71be5d9dec045446902a906b01b .centered-text-area { width: 100%; position: relative ; } .u9207b71be5d9dec045446902a906b01b .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u9207b71be5d9dec045446902a906b01b .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u9207b71be5d9dec045446902a906b01b .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u9207b71be5d9dec045446902a906b01b:hover .ctaButton { background-color: #34495E!important; } .u9207b71be5d9dec045446902a906b01b .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u9207b71be5d9dec045446902a906b01b .u9207b71be5d9dec045446902a906b01b-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u9207b71be5d9dec045446902a906b01b:after { content: ""; display: block; clear: both; } READ: Years of Journalism EssayB. Philippine society is comparatively immature in footings of managing delicate societal issues C. Filipino mind is like a kid that looks for its parents for function mold D. Filipinos suffer jobs from different degrees and gravitations E. immature people are ever present in the Philippines 7. Wendy is the prototype of a. A. fatherless coevals B. motherless coevals C. coevals that needs counsel and attending D. coevals that is ever discontented E. clip when people have to work harder to last 8. The name Philip Latak is symbolic of. A. the continuity of the native tradition B. the insisting of the western civilization C. the ambiguity of the modern Filipino individuality D. the mixture of civilizations E. the loss of Filipino individuality 9. The lines â€Å"Surely all these old ages. he must hold held on to certain thoughts. certain beliefs even semblances peculiar to the expatriate. † illustrate. A. haughtiness B. realisation C. disaffection D. understanding E. empathy 10. â€Å"At that minute before fled. I saw what I had waited to see. The mascara had so run down her cheeks. But somehow it wasn’t amusing at all† . Above are the concluding lines of the short narrative â€Å"The Chieftest Mourner† . which reveal a major feature of the storyteller being. A. empathetic B. childish C. funny D. concerned E. scoffer Enumeration: Give what each of the undermentioned points asks for. Incorrect spelling is incorrect. ( 15 points ) 1-2. Genre of Literature 3-7. Elementss of Fiction 8-12. Partss of a Plot 13-15. Definition of Stream of Consciousness