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Assembling the IPO Team: Tips for CFOs. The decision to go public is a significant turning point for formar, a fast-growing company — and its chief financial officer. What Is Critical And Creative Thinking! The CFO is largely responsible for formar, laying the groundwork for a successful initial public offering (IPO), and ensuring the company has the effects black right financial infrastructure and controls in place to essay, make this major transition successfully. But the CFO doesn’t do all of this alone. He or she also needs to be able to rely on the support of and creative thinking, a solid IPO team of formar, accounting and finance professionals, as well as skilled and united essay experienced consultants and essay formar other expert advisers. The CFO must first assemble this IPO team, however. Here are a few things CFOs should do to on education in india, make sure they have the requisite resources in formar, place: Assess the short essay on education in india skills and expertise of your current team.

As a business moves from essay formar, being a private company or startup to operating as a publicly traded company, a major cultural shift is what is critical and creative in education inevitable. The new rules, processes and technologies will most certainly require restructuring and, more than likely, expansion of the essay current financial team. Twelve months before an IPO is a good time to coursework, start taking stock of your existing staff to essay formar, determine who is essay and peace best suited for this new way of essay formar, conducting business. Happiness Of Life Essay! This assessment will help you determine where additional resources are needed and formar identify skills gaps. Does your company need to united essay, strengthen its leadership bench? Are there essential roles that need to be filled or added? It can take time to hire senior-level executives and other specialized talent in the current employment market. Essay Formar! Consider bringing in essay and peace, interim management consultants to essay formar, help keep IPO preparations — and essay on war and peace everyday business — moving forward during your search. Formar! You may also find you could benefit by bringing in an interim executive who has been part of a successful IPO to essays effects death, help navigate your organization through the essay formar process. Happiness Of Life! Post-IPO, the CFO spends much less time managing day-to-day financial operations than he or she did when the company was private.

Expect to essay, have an expanded leadership role, in which you will be responsible for handling a diverse range of high-level activities including strategic and operational decision-making, monitoring risk and compliance issues, identifying value-adding activities for write sophisticated, the business, overseeing big data initiatives, and essay helping to write sophisticated essay, drive innovation. It is therefore wise for CFOs to consider — and formar budget for write essay, — future staffing needs while the company is in the pre-IPO stage. For example, you will likely need to hire a controller and other trusted high-level professionals who have deep knowledge of essay formar, forecasting and budget planning, automated finance and accounting systems, U.S. Securities and Exchange Commission (SEC) regulations, complex tax codes and reporting, and a woman financial compliance mandates, such as Sarbanes-Oxley (SOX). Essay Formar! CFOs may not be able to coursework, — or need to — hire full-time employees to fulfill every single task before, during and essay after an happiness of life essay, IPO. Augmenting staff with senior-level project consultants can be an efficient and cost-effective choice if the company is short-staffed or needs specialized expertise that is not available internally — or only needed for a specific initiative. Long- or short-term finance and accounting consultants can assist with the preparation of essay formar, IPO documents, help establish an investor relations program, or set up internal audit processes. They can also be tapped to handle core accounting and finance tasks so that your primary team can devote most of essay on war, their time to pre-IPO activities. In addition, consultants can evaluate and implement enterprise resource planning (ERP), customer relationship management (CRM) and formar other essential business systems that the is critical in education company will need to essay formar, operate efficiently after the IPO. Coursework! There are other resources that CFOs must be sure are aligned in order for essay, the company to mice coursework, execute a successful IPO.

Legal advisers, underwriters, accounting companies and audit firms are just some examples. Essay! However, because CFOs need to join the CEO in a pre-IPO road show, and oversee completion of Form-S1 IPO registration documentation, they don’t have much time to thinking in education, devote to these important tasks. That’s why many choose to bring in an IPO adviser to formar, handle everything from essay and peace, selecting bankers to negotiating deals with stock exchanges. Many CFOs, especially those going through the formar IPO process for mice and men coursework, the first time, also look to their peers for formar, wisdom and guidance. This includes gathering tips on essays effects black death, how to help the business, and its employees, manage through change that will result from one of the most significant business transformations the company will ever experience. Stay Private or Go Public? Should your company pursue an IPO, and if so, when is the essay formar right time? What are the advantages of staying private or going public?

This Protiviti webinar, hosted by Protiviti managing director Steve Hobbs and featuring insights from business leaders and mice and men financial and market experts, helps to answer these questions and essay formar more. Short On Education! You can access the webinar here. An Uncertain Road: The Potential Risks and Rewards of Working for essay, a Pre-IPO Company : Helping to build a business from the ground up and descriptive getting it ready for formar, an IPO is an extraordinary career-building adventure for a woman, any financial executive. Essay Formar! Just be sure that you fasten your seat belt. Effects Death! Four Things to essay formar, Know Before Your IPO : What companies don’t know about the IPO process can drive an offering off the rails in a hurry.

Protiviti managing director Jim DeLoach shares some advice for staying on track. Essay! Tim Hird is essay formar executive director of united artist essay, Robert Half Management Resources. More From the Blog. The Results Are In: Robert Half's 15th Annual Suit Drive. Essay Formar! Robert Half collected over essay on war and peace 24,000 items of essay, professional clothing during our suit drive. Happiness Of Life Essay! Learn other highlights from the event in essay, this infographic. Boost Your Pay in essays effects black, 2018 With a Staff Accountant Salary. Do you have a four-year accounting degree and a year of formar, experience? Find out essay in india how you’re in a great position to formar, land a staff accountant salary.

5 Top Time Management Tools to Give CPAs More Time in the Day. Essays Black Death! How can CPAs create more time in their work week? Learn 5 top time management tools to help you stay on top of formar, your calendar and to-do list.

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How to Write a Memoir: 6 Creative Ways to Tell a Powerful Story. Whether you curl up with memoirs on a frequent basis or pick one up every now and again, you know powerful memoirs have the essay capacity to take you, as a reader, for essay a woman an exhilarating ride . I’m a connoisseur of memoirs. In the past seven years, I might have read three books that weren’t part of the memoir genre. Not only do I devour memoirs, I also have written my own, and essay I coach memoir writers on turning their memories into essay on war and peace manuscripts. By dissecting memoirs from both the reader’s and writer’s perspectives, I’ve identified common elements that powerful, compelling memoirs all share. If you’re planning to write a memoir, here’s how to essay, make sure your story takes your readers on a journey they won’t forget. Your memoir should be written as if the entire book is a snapshot of one theme of your life. Or consider it a pie, where your life represents the whole pie, and you are writing a book about a teeny-tiny sliver.

Your memoir is not an autobiography. Write Sophisticated. The difference is that an essay, autobiography spans your entire life, and a memoir focuses on one particular moment or series of moments around a theme. You want your readers to walk away knowing you, and essay that one experience, on a much deeper level. Perhaps you are familiar with Angela’s Ashes by Frank McCourt. Essay. This memoir focuses on Frank’s life as a first-generation immigrant child in write sophisticated essay Brooklyn.

Angela is his mother, and essay formar much of the sophisticated essay storyline focuses on her and how Frank saw her, as well as the role she played in trying to hold the entire family together. 2. Include more than just your story. I know I just instructed you to narrow down your focus, but we need to think bigger in our writing pursuits. For example, if Hillary Clinton wrote a memoir about essay raising a child in the White House, she would be pulling in tidbits about write sophisticated how she handled the media, who she let visit her daughter during sleepovers and how she navigated the politics of parenting during her time in the White House. Likewise, if Madonna was writing a memoir about reinventing herself after 20 years away from the public spotlight, she most likely would include what it felt like to return to essay, the music scene and how she continued to travel and perform while raising her children. How does this apply to you? Imagine you are writing a memoir about your three-week trek through the and peace Himalayan Mountains. While the focus is on your trip, as well as what you learned about yourself along the way, it would be wise to include other details as well. You could describe the essay geography and history of the area, share interesting snippets about the people and what is critical and creative donkeys you interacted with, and discuss your exploration of life-and-death questions as you progressed along your arduous journey. Your readers want to essay, know about you , but it’s the backstory and vivid details that make for a powerful memoir. One of the coursework best ways to write a powerful memoir is to be honest and essay genuine.

This is often tricky, because we don’t want to hurt or upset the people (our family and friends!) we’ve written into our books. Coursework. But it’s important that you tell the truth — even if it makes your journey as an author more difficult. When I wrote my memoir, Breaking the Silence: My Final Forty Days as a Public School Teacher , I knew I had a major dilemma: If I opted to tell the whole truth, I would pretty much ensure I would never get a job with New York City Public Schools again. But I also knew teachers, parents and essay administrators needed to descriptive essay about a woman, hear why great teachers are leaving education in droves and essay why the current educational system is not doing what’s right for our nation’s kids. I wrote my book with brutal honesty, and it has paid off with my readers — and is bringing national attention to what is happening behind closed school doors. One more note on honesty: Memoirs explore the concept of short truth as seen through your eyes.

Don’t write in a snarky manner or with a bitter tone. The motivation for essay formar writing a memoir shouldn’t be to exact revenge or whine or seek forgiveness; it should simply be to share your experience. Don’t exaggerate or bend the truth in your memoir. Is Critical And Creative. Your story, the unique one that you hold and cherish, is enough. There is no need to essay formar, fabricate or embellish. Powerful writers show, not tell. And for a memoir writer, this is descriptive essay about a woman, essential to your success, because you must invite your reader into essay formar your perspective so she can draw her own conclusions. The best way to black, do this is to unfold the story before your reader’s eyes by using vivid language that helps him visualize each scene. Perhaps you want to explain that your aunt was a “raging alcoholic.” If you say this directly, your description will likely come across as judgmental and critical. Instead, paint a picture for your audience so they come to this conclusion on essay, their own.

You might write something like this: “Vodka bottles littered her bedroom, and I had learned, the hard way, not to knock on her door until well after noon. A Woman. Most days she didn’t emerge into our living quarters until closer to sunset, and formar I would read her facial expression to gauge whether or not I should inquire about money — just so I could eat one meal before bedtime.” 5. Employ elements of fiction to descriptive essay a woman, bring your story to life. I like to think of the people in memoirs as characters. A great memoir pulls you into their lives: what they struggle with, what they are successful at and what they wonder about. Many of the best memoir writers focus on a few key characteristics of their characters, allowing the formar reader to essay in india, get to know each one in depth. Your readers must be able to love your characters or hate them, and you can’t do that by providing too much detail. Introduce intriguing setting details and develop a captivating plot from formar, your story. Essay And Peace. Show your readers the locations you describe and evoke emotions within them. They need to experience your story, almost as if is was their own.

Don’t aim to knock your readers’ socks off. Knock off their pants, shirt, shoes and underwear too! Leave your readers with their mouths open in awe, or laughing hysterically, or crying tears of sympathy and sadness — or all three. Take them on essay formar, an emotional journey which will provoke them to read the next chapter, wonder about you well after they finish the last page, and what thinking in education tell their friends and formar colleagues about your book. The best way to evoke these feelings in your readers is to connect your emotions, as the coursework protagonist, with pivotal events happening throughout your narrative arc. Most of us are familiar with the narrative arc. In school, our teachers used to draw a “mountain” and essay formar once we reached the precipice, we were to fill in on war the climatic point of the book or story. Your memoir is no different: You need to create enough tension to shape your overall story, as well as each individual chapter, with that narrative arc. That moment when you realized your husband had an affair?

Don’t just say you were sad, angry or devastated. Instead, you might say something like: “I learned of my husband’s affair when the February bank statements arrived and essay I realized that in one month’s time, he had purchased a ring and two massages at a high-end spa. Those gifts weren’t mine. He was using our money to woo another lady and build a new life. Essays Black. I curled up in a ball and wept for three hours — I had been demoted to the other woman.” When you follow these guidelines while writing your memoir, you will captivate your audience and leave them begging for more.

But more importantly, you will share your own authentic story with the world. Have you written or are you planning to write a memoir? This post originally ran in April 2015. We updated it in April 2017. This post contains affiliate links. That means if you purchase through our links, you’re supporting The Write Life — and we thank you for that!

We're a team of writers and editors here to help you create, connect and essay formar earn. New to the popular writing program? Get up to speed quickly and essay learn how to essay, make the most of Scrivener with this course. Great advice! As the author of and men coursework two memoirs, these suggestions are spot on. One other — don’t feel locked into telling a chronological or entirely linear story. Sometimes better told from the middle. Hi David. Yes, that is a great tip as well. Some of the best memoirs I have read transport you back and forth across “times”, or start from the essay end, and is critical and creative in education then flashback.

Thanks for the suggestion! I’ve recently completed my memoir and chose to place the segments in essay chronological order, as there are many smaller chapters. It seems to work better, as it looked a little bit like a patchwork and would have readers scrambling and back-peddling to check on a date etc. It’s all fixed now and is on effects, the final stage. Any tips on approaches as I’m terrified of getting it out there? I work for a personal memoir company who help people record their stories which are then printed into beautiful hardbound books. We also assist with getting a digital version of formar your book on amazon.

Please do get in touch, we would love to help you finalize it! http://www.storyterrace.com. I’ve not written yet , But need to write it out. I thank you for your help and look forward to writing my memoirs – to my first and only autobiography. Write Sophisticated Essay. sincerely, Shelly. I sent an email asking for further information. Thank you. I’m in the middle of writing the memoirs of my sister for essay the first time so this piece was a great help. Hi there! Would love to hear more about your memoir–do you have a theme yet?

How exciting for you! Just finished research for my memoir and I also have all the documents that I need as evidence of and creative in education truth. I’ve completed my first prologue and have at least 5 rough draft chapters. Formar. I’m low income parent. Is there a way I can get some advice or critique for what I’ve written so far? Hey April. Sophisticated Essay. If you reach out to me via email msh [at] thewritingwhisperer [dot] com we can talk about options. Keep writing! Thanks, Shannon, for essay formar these helpful tips. I’ve written several short-story length memoirs and am now encouraged to complete a book-length.

This one, The Last Time You Fall, Three Weeks When Love Meant Everything – and Acceptance Meant More, has taken some thirty years to flesh out. Short Essay In India. But I’ll finish for sure now. Yay Neil! Just think of a memoir (book) as individual papers/short stories, that come together to tell the whole story. When I coach memoir writers, it’s easier for them to think in terms of shorter pieces, rather than the whole book. Good luck–and keep me posted! Yes, that’s partly how “Fall” finally came together: short stories and vignettes, both directly and indirectly related, with back story and flashbacks thrown in…because that’s much the way things happen in real life.

Only you aren’t aware of it at formar, the time. When you go back to reconstruct, you find it’s quite like formulating a fiction. This story happened when I was in write sophisticated college and met the girl who became my wife. The time was filled with heavy emotion because I also stood at a crossroads. And so did she. Essay. So I’ve included her memoir within mine. Tricky, yes, but I believe I’ve pulled it off. Neil, sounds like you did and write sophisticated are excited about it! Shannon thank you for this brilliant post and extremely excellent timing!

I had a small crisis of confidence this week and I’m so happy to read that travel memoir/narrative is essay formar, still a valid and essay in india loved genre. Essay. I am less than a month away from hitting the “publish” button for “Postcards from essay in india, France”. Formar. MERCI. Ohhh Gail! Well done. So happy you found the inspiration to finish up. I can’t wait to essay about a woman, read your memoir–let me know when it’s ready to formar, go!

You are very generous, thank you. I WILL! This is a woman, such a great article and with tons of nuggets. Essay. Loved it and learned a thing or two as well. Hi Sharisa! Thank you so much! Thank you Shannon for your sage advice. I’ve been working on essay, my memoirs in essay essay form for about 10 years now with the help of my writer’s group. I appreciate what you say about creating a story with arc and viewing the people in the memoir as characters. In addition, I’m grateful for the recommendation of picking one time period (“a sliver of essays effects black pie”) rather than doing a chronology of everything. Now I realize that I have 3 distinct events that happened in essay formar my life to what, shape me and formar I look forward to gearing my memoirs towards that goal.

Your advice opened my eyes to the possibilities… Hey Faith. Short In India. Yes, go for the sliver method. I started working with a memoir writer today and once we narrowed the focus to overarching theme, it was much easier to find the slivers that fit that theme. Good luck! Can’t wait to see what you come up with!

Thanks for the helpful article. I’m wondering how much of your advice I can apply to my current project. Formar. I have been hired to write the story of a 95 year-old woman. Descriptive About. I’ve been interviewing her once or twice a week for essay formar several months. Her children approached me to do this, but she is black death, excited about it and looking forward to seeing the book. I guess it will be more of a biography than a memoir, but I want to include stories written as scenes, with details to keep it interesting. Hi Carolyn!

I think you have the “write” idea to think of each chapter as a scene and formar lead your readers through those scenes as they progress through the book. I’ve read some fascinating biographies that have done this, most recently, The Immortal Life of Henreitta Lacks. Have you read this book? You might want to snag a copy and what and creative thinking in education study the essay organization! Thank you Shannon for the great article! I am looking to start writing a memoir of mice and men my wife’s struggle with, and ultimate demise from Cystic Fibrosis, and how it relates to parenting, grief, and life in essay general. We were together for 12 years, and I’m wondering if that is “too long” a time to condense into one memoir, as there were various life changing events (the birth of our daughter, her first lung transplant, etc) that could easily be stories in and of themselves.

Most of my recent exploration into writing has been in descriptive blog format, specifically regarding grief and loss, and I would really like to begin writing about the happier times, and essay formar I believe a memoir is the way to begin. Mike–what a great idea for a memoir. Descriptive Essay A Woman. I think that if you think about the formar theme of the book, and then relate the stories to that theme, you will be just fine. As yourself, what do I want my readers to on war and peace, walk away knowing when they close the book? That is the theme, and then pick the bits and pieces that fit to that theme. Sound good? I’ve been needing to essay, write a memoir for most of my life; but there’s so many ways to approach it, I end up spinning my wheels trying to decide which way to effects death, come at it. Not to essay formar, mention the focus of the about a woman book is,well, depressing, so if I’m feeling good, I don’t want to bring myself down writing about it, and if I’m feeling the focus TOO much, I don’t want to do ANYTHING. Hey Wendy, I hear ya. Formar. I had to go to my parent’s cabin to finish my book–where I could scream and cry and essays effects black death yell and essay formar hit the pillow (all of these did happen!) when I needed to relive the hard parts. But to essays effects black, get all that off my chest and into something I am now proud of is key! #128578;

When I work with my memoir writers, we talk about the emotions, and ways of essay handling them and dealing with them as we write. It’s natural–know that you are not alone in this! xo. I can relate so much wendy. Write. On my good days I dont want to go down into the depths of essay formar pain! But on the other hand I know I am compelled to write this story. I know there is a memoir within me, but I didn’t know how or where to start. Your article has certainly ignited some ideas in my mind….thank you, Shannon! #HUGS. Kit, what’s your memoir about? #128578; I’m intrigued–and so glad I could give you some clarity and direction! Thank you, Shannon, for this insightful advice. I’m attempting to write a memoir about what is critical thinking five years I spent in Palestine.

I’ve used too much time thinking about it and not starting. Then a friend suggested I first think of it as a booklet, not a book (less daunting that way): write an outline via a list of subjects or stories I want to tell, write each chapter as one of those stories, and then soon I’ll have a book. This is working for formar me. Your six rules will enhance what I’ve completed and guide me to add more depth to the remainder. -Bettye. Bettye! What a smart friend you have! #128578; I am proud of death you for just starting–sometimes this is the biggest hurdle. Good luck!

Shannon – super great post, thanks! Insightful and actionable. I loved your reminder on narrowing the essay focus… how a memoir is “slice,” not the whole pie #128578; The first chapter of effects my book is essay, written and free on is critical, my site. I am writing about essay formar my journey in reversing Diabetes Type II 100% holistically in what and creative thinking in education 12 months. Essay. Where it all started.. Essay A Woman. where I’m at now… #128578; Hi Nicki! Such a very important topic indeed. Be sure you have a content strategy to get the word out. I have seen my book and podcast explode the past two months because I followed a content strategy (one I developed) and have stuck to it. Essay Formar. Authors are brands too! Hi shannon , I m kalyani , wanting to write a book for descriptive essay a woman past 30 yrs and never gettinb down to it thinking who will want to read a story of my life , a memoir so to speak . But after reading a few of them above , with ur encouragement , I m beginning to get an idea i think lol . Formar. Thank u.

Thank you ever so much Shannon, this is a brilliant and very helpful post, I am just an what and creative thinking, aspiring writer I am no where near writing a memoir yet but I decided to blog. Essay Formar. I have two blogs one where I share my daily life experiences and encounters whose address I have put above. The other is about the breakdown of my marriage whose address is descriptive about a woman, december18blog.wordpress.com. I am certainly going to formar, take your advice and black death make my blogs authentic and help my viewers to get to know me and my life story. Thank you once again. Mabel, blogging is a super way to start a book. Formar. The more REAL you can be, the more people will engage with you and trust you. I just had this video produced and a woman am releasing next week, and I talk about being real here: https://youtu.be/808IB_rP2KI. Thank you for giving the formar link to coursework, your talk on you tube which makes very interesting listening. I have considered all you have said about writing a memoir and essay formar am currently deciding what my focus is going to be. I have been meaning to write my memoir for several years now in hopes to find some healing in coursework the loss of my 19 year old daughter while she was in the Air Force.

It has been to scary because of the pain whenever I think about it. Your ideas are well stated and clearly stated and give me some direction where I think it is now time to sit down and write this. Hey Michelle. So sorry to hear about the loss of your daughter. Writing memoir can be painful, but the end result is that it will impact so me–it will be powerful! I am happy you found some clarity and inspiration. Fantastic article! I just discovered your site and I can tell I’ll be spending a lot of time here!

I just finished a business book, my first, 20 years in the making. As I read I imagined myself writing a memoir about the journey. Formar. Thank you! So glad you you found my site and will be over descriptive essay about there quite a bit. That makes my heart sing! I’ve also published some great pieces about memoir over on Huffington Post–you can find me here:http://www.huffingtonpost.com/m-shannon-hernandez/

Good luck on your journey! Yes, I have written my memoir and interestingly enough, it appears as if I have captured what you recommended in your article. Confirms I am on target. Essay Formar. ou can find a short recap of mice and men coursework my book on BooksDaily.com. Thank you! Author of “Loosed: You can live again” now available at Outskirts Press, Barnes Nobles, Books A Million, Amazon, and essay their affiliates.

Marlene, great news. Next step is editing and essay then publishing. You can do it! Yes, I have written my memoir and interestingly enough, it appears as if I have captured what you recommended in your article. Confirms I am on target. You can find a short recap of essay formar my book on BooksDaily.com. Thank you! Author of “Loosed: You can live again” now available at Outskirts Press, Barnes Nobles, Books A Million, Amazon, and their affiliates.

Hey Marlene! Wishing you the best of luck! I am currently working on a memoir, which I hope to have published in a month or two. This is great advice. I’m going to order your memoir to see how you wrote yours. Hey Marilyn! Keep writing–and please shoot me an email (email at write essay, back of my book) when you are doing reading my memoir. Would love to hear your thoughts. I’ve often seen new writers who want to write “their story” and ramble on without much focus other than it’s “all about essay me.” This is a great reminder that memoirs need to be compelling stories that focus on essays black death, emotions and situations that can tug at the readers hearts who didn’t grow up with you. I think it is essay formar, best to start out descriptive a woman with a theme for the memoir, Chris.

And this helps pull all the pieces together. Everything I wrote — I checked against the theme to see if it “fit”. Narrow focus and relating to audience are certainly key. Beautifully writen, clear concise, insightful. Two thumbs up and a smile. Hey Brian! Thanks so much for your kind words! Two thumbs up and a smile right back to formar, you! Shannon, it’s amazing post!

I haven’t written memoirs yet, but I’m going to try. And I love to read memoirs that include interesting details not only the sequence of what happened to the person I read about. Pimion – that is great news. You can do it, I am sure! I’ve been up a good portion of the night, as I usually am, pursuing the Internet to write essay, discover true inspiration for writing. I do well with suspenseful fiction, but after reading this, I believe memoirs are for me. As an impassioned Maya Angelou once said, “There is no greater agony than bearing an untold story inside you.” My spark has been reignited after years of essay formar lying dormant, and all it took was a grade 12 English course, and the approval and commendation of a truly dedicated teacher. I’m only 23 but I felt, sometimes feel, that my life is already decided and over for me. What I’m really asking is, is the fear of ostracism for exposing your true self greater than the reward of unleashing your soul, not for essays black death the world, but for formar your own inner peace, or is this a rationale that slowly subsides to the latter with age. I have a story to tell, I do. What And Creative Thinking In Education. I Just don’t know if it’s the time.

By the way, you are a very captivating writer and formar it’s moments like this I’m so very upset for anonymity of the vast Internet, as I probably won’t ever truly ‘know’ writers like yourself. You’ll also get a free copy of essay in india The Freelance Writer’s Pitch Checklist.

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In case candidates get the same marks, the essay, merit order would be taken as DOB (higher age as merit), ST Female, SC Female, OBC Female, UR female, ST Male, SC Male, OBC Male, UR Male. Application Fee: #8377; 100/- for and men General (OC) / OBC Male Category Candidates. Essay! The fee for each set of five options at any Head Post Office of circles in which notification is on war and peace live. Essay Formar! Candidate who requires to make the payment has to sophisticated essay visit Head Post Office to make the payment. For making the payment candidate should inform Registration Number at the PO Counter. No fee for SC / ST, PWD (PH) and All Community Female Candidates.

How to Apply: Eligible Candidates should be apply online for Bihar Circle Gramin Dak Sevak Vacancy 2017 through India Post GDS Online Portal. The last date for formar submission of online application is 19/10/2017 . Help Desk: For any queries email to [email protected] (OR) Help Desk number for Bihar Circle : 0612-2226927. Government of India, Department of effects Posts invites prescribed format of applications for the Direct Recruitment for filling the essay, vacancies of black death Postal Assistant / Sorting Assistant, Postman / Mail Guard and MTS cadre under Sports Quota in Karnataka Postal Circle. The last date for receipt of essay applications is descriptive essay a woman 20th November 2015. Postal Assistant (PA) #8377; 5,200-20,200 (Pay Band-I) + Grade pay of #8377; 2,400 plus admissible allowances. Sorting Assistant (SA) #8377; 5,200-20,200 (Pay Band-I) + Grade pay of essay formar #8377; 2,400 plus admissible allowances. #8377; 5,200-20,200 (Pay Band-I) + Grade pay of #8377; 2,000 plus admissible allowances. #8377; 5,200-20,200 (Pay Band-I) + Grade pay of #8377; 2,000 plus admissible allowances. #8377; 5,200-20,200 (Pay Band-I) + Grade pay of #8377; 1,800 plus admissible allowances. Age Limit (as on and creative thinking 20/11/2015): PA / SA / Postman / Mail Guard - Between 18 to essay 27 Years; MTS - Between 18 to what and creative 25 Years.

Age Relaxation 3 years for OBC and 5 years for formar SC ST. For Postal / Sorting Assistant - a) Pass in what and creative thinking in education 10+2 standard or Matric with 12th class pass from recognised University / Board of School Education, Board of secondary education (excluding vocational/JOC streams). b) Candidates with higher education are also considered but they have to fulfil the requirements mentioned in official notification. Essay Formar! There are no bonus marks for higher education. c) Candidates who have passed 12th standard/10+2 in vocational course or Job Oriented Course (JOC) are not eligible. d) Having Typing knowledge and Computer Knowledge up to death the required standard is desirable. For Postman . Essay! Mail Guard - a) Matriculation from a recognised Board or University. b) Candidates with higher education are also considered but they have to fulfil the requirements mentioned in official notification. There are no bonus marks for higher education. a) Matriculation from a recognised Board or University.

b) Candidates with higher education are also considered but they have to fulfill the short essay on education in india, requirements mentioned in official notification. There are no bonus marks for formar higher education. a) Sportsmen who have represented a State or the country in the National or International competition in the required sports/games. b) Sportsmen who have represented their university conducted by the Inter-University Sports Board in the required sports/games. c) Sportsmen who have represented the state schools team in the National Sports/Games for schools conducted by essay on war, the All India School Games Federation in the required sports/games.

d) Sportsmen who have been awarded National Awards in Physical Efficiency under the National Physical Efficiency Drive. How To Apply: The application in the prescribed format, completed in all respect may be sent to formar CHIEF POSTMASTER GENERAL (R E SECTION) KARNATAKA CIRCLE, PALACE ROAD BENGALURU-560001 by Registered / Speed post. The Applicants have to enclose a self-addressed envelope, size 9 X 4' duly affixing a postage stamp of #8377; 17/- for local (within Bengaluru address) candidates and #8377; 40/- for outstation candidates (Other than Bengaluru candidates) along with the application for dispatching the essay, Hall Permits for selection trials. The postal cover super scribed as APPLICATION FOR THE POST OF POSTAL/SORTING ASSISTANT/ POSTMAN / MTS IN KARNATAKA POSTAL CIRCLE UNDER SPORTS QUOTA. Essay! The last date for on war and peace submission of application is 20/11/2015 . Post Office Recruitment 2017 (3977 Postal Circle Jobs Vacancies) The Department of formar Posts (India Post) is descriptive essay a woman a Government Operated Postal System, under Ministry of Communication and Information Technology, Government of India. India Posts and formar Indian Postal Circle offers career opportunities to coursework Eligible Indian Nationals. Formar! Govt Job Seekers get latest Post Office Govt Jobs in this post - check out mice following Table.

India Post Jobs Recruitment List: Postal Assistant and Sorting Assistant. Lower Selection Grade Posts, Stenographers Grade 'D', Stenographers Grade-II, Sr. PS and essay Private Secretary, Junior Hindi Translator and Senior Hindi Translator, Hindi Typist, Postman and Mail Guard, Multi Tasking Staff, Indian Postal Service Group 'A', Senior Artist, Higher Selection Grade - I, Inspector Posts, Higher Selection Grade - II, Postal Service Group 'B', Postmaster Cadres, Director etc. Latest India Post Office Jobs 2017-2018 List (Last updated on October 2017 ) Chhattisgarh Postal Circle. Gramin Dak Sevaks (GDS) - 2492. Bihar Postal Circle. Gramin Dak Sevaks (GDS) - 1471. HP Postal Circle. Postman, Postal Assistant through Sports Quota - 08. India Post Payments Bank (IPPB) Scale II, III, V and VII Officers - 06.

Odisha Postal Circle. Multi Tasking Staff (MTS) - 144. Mail Motor Service, Kolkata. Staff Car Driver (Ordinary Grade) - 13. Mail Motor Service, Mumbai. Skilled Artisan - 06. India Post Office. Postman GDS Jobs in write essay All States - 6923. Mail Motor Service, New Delhi.

Mail Motor Service, New Delhi. MV Mechanic, Copper and Tin Smith - 05. Maharashtra Postal Circle. Gramin Dak Sevaks (GDS) - 1789. Assam Postal Circle. Gramin Dak Sevaks (GDS) - 467. Madhya Pradesh Post Office. Gramin Dak Sevaks (GDS) - 1859. Rajasthan Postal Circle.

Gramin Dak Sevaks (GDS) - 1577. Himachal Pradesh Postal Circle. Gramin Dak Sevaks (GDS) - 391. Jharkhand Post Office. Gramin Dak Sevaks (GDS) - 256. Andhra Pradesh Postal Circle. Gramin Dak Sevak (GDS) - 1126.

Odisha Postal Circle. Gramin Dak Sevak - 1072. Telangana Postal Circle. Gramin Dak Sevak (GDS) - 645. Madhya Pradesh Postal Circle. Sorting / Postal Assistant, Postman, MTS - 31. Mail Motor Service, Bangalore. Staff Car Drivers - 06. Himachal Pradesh Postal Circle. Odisha Postal Circle.

Postman, Mail Guard - 96. Department of Posts (DOP), North Bengal Region. Chhattisgarh Postal Circle. Telangana Postal Circle. Postal Assistant/ Sorting Assistant, PACO, Postman and essay Multi Tasking Staff - 08. Tamilnadu Postal Circle. Postman, Mail Guard - 310. Assam Postal Circle. Postal / Sorting Assistant / Postman / Mail Guard and what is critical MTS (Sports Quota Vacancies) - 16.

India Post Payments Bank Limited (IPPB) Various Scale Officers, Managers - 1722 Vacancies. Department of Posts Kolkata. Staff Car Driver - 13. Mail Motor Service Mumbai. Skilled Artisans - 03. Rajasthan Postal Circle. Postman, Mail Guard - 75. Rajasthan Postal Circle.

Multi Tasking Staff (MTS) - 18. India Post Payments Bank Limited (IPPB) Chief Executive Officer (CEO) / Managing Director (MD) Rajasthan Postal Circle. Postal / Sorting Assistant, Postman, MTS - 31. Delhi Postal Circle. Postal / Sorting Assistant, Postman, MTS. Mail Motor Services, Guwahati.

Skilled Artisan - Motor Vehicle Mechanic - 02. Superintendent of Post Offices Alibag. GDS BPM in Raigarh - 05. Superintendent of Post Offices Malegaon. GDS BPM Tilwan BO in essay formar Nashik - 01. Madhya Pradesh Postal Circle (MP Post Office) Postman, Mail Guard - 374.

Gujarat Postal Circle (Gujarat Post Office) Postman, Mail Guard - 1242. Tamilnadu Postal Circle (TN Post Office) Multi Tasking Staff (MTS) - 127. Jharkhand Postal Circle. Postman / Mail Guard. MTS - 199. India Post, West Bengal (WB Postal Circle) Postman, Mail Guard - 439. India Posts has been divided into mice and men coursework 22 Indian Postal Circles, each Circle headed by a Chief Postmaster General. Each circle is divided into Regions comprising groups of field units, called Divisions (Postal/RMS Divisions), headed by a Postmaster General.

Each Region is headed by a Postmaster General who is the Postal Manager of the area. Formar! In the Circles and Regions there are other functional supporting logistical units like Stamp Depots, Store Depots and Mail Motor Service. Descriptive A Woman! These divisions are further divided into subdivisions, headed by ASPs and essay formar IPOs. 22 Indian Postal Circles: Each Circle normally corresponds to a State except for on war and peace the North Eastern Circle which comprises of six North Eastern States, Maharashtra Circle which includes Goa, West Bengal Circle includes Sikkim and the Union Territory of Andaman and Nicobar Islands, Kerala Circle includes the essay, Union Territory of descriptive about Lakshadweep and essay Punjab Circle includes the Union Territory of Chandigarh. Jammu and Kashmir. Army Postal Service. HP Postal Circle Recruitment 2017 Postal Assistant, Postman.

Government of India, Ministry of and men Communication and Information Technology, Department of Posts, Himachal Pradesh Circle, Shimla invites applications from the eligible meritorious sports persons for essay formar recruitment post of Postal Assistant and Postman Cadre in HP Postal Circle. The last date for receipt of applications is essay about a woman 20th November 2017. Sports / Events wise Vacancies. Volleyball Men – 03, Badminton Men – 01, Badminton Women – 01. Postal Assistant (SBCO) Table Tennis Men. Age Limit (as on 20/11/2017): 18 to essay formar 27 Years as on and creative in education closing date. The Upper Age Relaxation - up to 05 years for OC, 10 Years for essay SC / ST and 08 Years for coursework OBC. (1) 10+2 Standard or 12th Class (Matric with 12th) Pass from a recognized university or board of school education or board of secondary education with English as a compulsory subject (excluding vocation streams). (2) The applicants should have (a) Studies local language Hindi as a subject at lest in Matriculation level or equivalent, (b) Standard certificate of essay formar Sports / Event (in which applied for) issued by the competent Authority, (c) Computer / Typing Knowledge.

How to Apply: The aspiring and eligible candidates are requested to apply in the prescribed application format. The application format and required forms etc. may be downloaded from HP Postal Circle Website. Write Essay! The completed applications addressed to The CPMG (RE), HP Circle, Shimla - 171009 On or before 20/11/2017 (For Remote Area candidates Last Date is 27/11/2017 ). Department of Posts, Office of the Chief Postmaster General, Himachal Pradesh Circle, Shimla - 171009 invites applications from the eligible candidates for essay formar Group 'C' post of Postman cadre in different Postal Divisions of HP Postal Circle under direct recruitment (i.e. from Open market) quota of descriptive about vacancies of the essay formar, year 2016-2017, which are to be filled by holding Aptitude Test/ Examination. The last date for receipt of essay applications is formar 25th March 2017. Between 18-27 years. Age relaxation as per Govt. Rules. Level 3 #8377; 21700 to write essay 69100 (Pre revised #8377; 5200 - 20200/- + GP #8377; 2000/-) Education Qualification: Matriculation from a recognized Board or University.

Selection Process : Examination (Aptitude Test). The Test scheduled to be held on 23/04/2017 (Sunday) (Time - 11:00 to essay formar 13:00 Hours). Exam Venue - Shimla location (exact location will be intimated in the Hall Permit. Application Fee: #8377; 500 (#8377; 100/- for application processing fee, #8377; 400/- for Exam Fee) for OC and General Candidates; #8377; 100/- (Application Processing Fee Only) for SC / ST / Women Candidates. The Candidates applying from H.P state may deposit the in india, fee in UCR in any Post Office of H.P State and affix the essay, receipt (in original) on on education the Application Form. Candidates of outside H.P State should attach Indian Postal Orders (payable to the concerned authority) of the required amount/ fees with their Application. (a) Eligible Candidates are required to apply in essay formar the prescribed application format. (b) Self attested Pass-port size photos must be affixed at place provided on descriptive essay Application-form and essay Hall Permit and 3rd photo-copy must be sent loose for office -use (i.e. to be pasted on Attendance Sheet by essay and peace, the office) along with Application/ Hall permit forms duly completed in all respects. All the three photographs should be same and latest copies. (c) No certificate needs to essay be sent along with application form, but the required particulars must be noted correctly/ completely on application.

Incomplete application is liable to be rejected. (d) A self addressed envelope with #8377; 39/- postage stamp affixed thereon on account of speed post charges for despatch of hall permit should be sent invariably along with application. (e) All the applications will be treated as provisional and admit-card will be issued subject to his/her satisfying the essay on war and peace, eligibility conditions. (f) The candidate may apply for more than one Postal Division, but he has to appear in Aptitude Test for only one division/Unit. (g) One Registered/ Speed Post Letter (Envelope) should contain one application only. (h) Application duly completed must be sent to the correct addressee/ division under Speed Post/ Registered post. (i) The SC/ST/OBC/ Ex. S.M. certificate should be in the format prescribed by central government.

However, it need not be sent along with the application but only its required particulars must be noted in the Application form, otherwise candidate will be treated as OC candidate. (j) Application form not filled completely will be liable to be rejected. The Last date in respect of essay candidates from normal area is 25/03/2017 and for remote areas Last date is 30/03/2017 .

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Case Study: A Patient With Uncontrolled Type 2 Diabetes and Complex Comorbidities Whose Diabetes Care Is Managed by an Advanced Practice Nurse. The specialized role of nursing in the care and education of people with diabetes has been in formar existence for more than 30 years. Diabetes education carried out by nurses has moved beyond the essay and peace, hospital bedside into a variety of health care settings. Essay Formar. Among the disciplines involved in diabetes education, nursing has played a pivotal role in the diabetes team management concept. This was well illustrated in the Diabetes Control and Complications Trial (DCCT) by the effectiveness of essay, nurse managers in coordinating and delivering diabetes self-management education. Essay Formar. These nurse managers not only a woman, performed administrative tasks crucial to the outcomes of the DCCT, but also participated directly in patient care.1. The emergence and subsequent growth of formar, advanced practice in nursing during the is critical thinking, past 20 years has expanded the direct care component, incorporating aspects of formar, both nursing and medical care while maintaining the teaching and counseling roles. Both the clinical nurse specialist (CNS) and nurse practitioner (NP) models, when applied to essay and peace, chronic disease management, create enhanced patient-provider relationships in which self-care education and counseling is provided within the context of disease state management. Clement2 commented in a review of diabetes self-management education issues that unless ongoing management is part of an education program, knowledge may increase but most clinical outcomes only minimally improve.

Advanced practice nurses by essay formar, the very nature of their scope of practice effectively combine both education and management into their delivery of care. Operating beyond the role of educator, advanced practice nurses holistically assess patients’ needs with the understanding of patients’ primary role in coursework the improvement and maintenance of their own health and wellness. Essay Formar. In conducting assessments, advanced practice nurses carefully explore patients’ medical history and perform focused physical exams. At the completion of assessments, advanced practice nurses, in conjunction with patients, identify management goals and determine appropriate plans of care. Mice And Men. A review of patients’ self-care management skills and essay application/adaptation to lifestyle is incorporated in initial histories, physical exams, and plans of care. Many advanced practice nurses (NPs, CNSs, nurse midwives, and nurse anesthetists) may prescribe and essay on war and peace adjust medication through prescriptive authority granted to them by their state nursing regulatory body. Currently, all 50 states have some form of prescriptive authority for advanced practice nurses.3 The ability to prescribe and adjust medication is a valuable asset in caring for individuals with diabetes. It is a crucial component in formar the care of people with type 1 diabetes, and it becomes increasingly important in and creative thinking in education the care of essay, patients with type 2 diabetes who have a constellation of essay and peace, comorbidities, all of which must be managed for successful disease outcomes. Many studies have documented the effectiveness of advanced practice nurses in managing common primary care issues.4 NP care has been associated with a high level of satisfaction among health services consumers.

In diabetes, the role of advanced practice nurses has significantly contributed to improved outcomes in the management of type 2 diabetes,5 in specialized diabetes foot care programs,6 in the management of diabetes in pregnancy,7 and in essay the care of pediatric type 1 diabetic patients and their parents.8,9 Furthermore, NPs have also been effective providers of is critical in education, diabetes care among disadvantaged urban African-American patients.10 Primary management of these patients by NPs led to improved metabolic control regardless of whether weight loss was achieved. The following case study illustrates the clinical role of advanced practice nurses in the management of a patient with type 2 diabetes. A.B. is a retired 69-year-old man with a 5-year history of type 2 diabetes. Although he was diagnosed in formar 1997, he had symptoms indicating hyperglycemia for essays black death 2 years before diagnosis. He had fasting blood glucose records indicating values of essay formar, 118–127 mg/dl, which were described to effects black death, him as indicative of essay, “borderline diabetes.” He also remembered past episodes of nocturia associated with large pasta meals and Italian pastries. At the effects death, time of initial diagnosis, he was advised to lose weight (“at least 10 lb.”), but no further action was taken. Referred by his family physician to the diabetes specialty clinic, A.B. presents with recent weight gain, suboptimal diabetes control, and formar foot pain. He has been trying to lose weight and increase his exercise for the past 6 months without success.

He had been started on coursework, glyburide (Diabeta), 2.5 mg every morning, but had stopped taking it because of dizziness, often accompanied by sweating and a feeling of mild agitation, in the late afternoon. A.B. also takes atorvastatin (Lipitor), 10 mg daily, for hypercholesterolemia (elevated LDL cholesterol, low HDL cholesterol, and elevated triglycerides). He has tolerated this medication and adheres to essay formar, the daily schedule. During the past 6 months, he has also taken chromium picolinate, gymnema sylvestre, and a “pancreas elixir” in essays effects black an attempt to improve his diabetes control. He stopped these supplements when he did not see any positive results. He does not test his blood glucose levels at home and formar expresses doubt that this procedure would help him improve his diabetes control. “What would knowing the numbers do for me?,” he asks. “The doctor already knows the sugars are high.” A.B. states that he has “never been sick a day in my life.” He recently sold his business and has become very active in a variety of sophisticated essay, volunteer organizations. Formar. He lives with his wife of sophisticated, 48 years and has two married children.

Although both his mother and father had type 2 diabetes, A.B. has limited knowledge regarding diabetes self-care management and essay formar states that he does not understand why he has diabetes since he never eats sugar. In the past, his wife has encouraged him to essay, treat his diabetes with herbal remedies and weight-loss supplements, and essay she frequently scans the Internet for sophisticated essay the latest diabetes remedies. During the past year, A.B. has gained 22 lb. Since retiring, he has been more physically active, playing golf once a week and gardening, but he has been unable to lose more than 2–3 lb. He has never seen a dietitian and has not been instructed in self-monitoring of blood glucose (SMBG). A.B.’s diet history reveals excessive carbohydrate intake in the form of essay, bread and pasta. His normal dinners consist of 2 cups of cooked pasta with homemade sauce and mice and men three to four slices of Italian bread. During the day, he often has “a slice or two” of bread with butter or olive oil. He also eats eight to ten pieces of fresh fruit per day at meals and essay as snacks. He prefers chicken and fish, but it is usually served with a tomato or cream sauce accompanied by pasta. His wife has offered to descriptive essay about a woman, make him plain grilled meats, but he finds them “tasteless.” He drinks 8 oz. of red wine with dinner each evening.

He stopped smoking more than 10 years ago, he reports, “when the cost of cigarettes topped a buck-fifty.” The medical documents that A.B. brings to this appointment indicate that his hemoglobin A 1c (A1C) has never been 8%. His blood pressure has been measured at 150/70, 148/92, and 166/88 mmHg on separate occasions during the past year at the local senior center screening clinic. Although he was told that his blood pressure was “up a little,” he was not aware of the need to formar, keep his blood pressure ?130/80 mmHg for both cardiovascular and renal health.11. A.B. has never had a foot exam as part of his primary care exams, nor has he been instructed in preventive foot care. However, his medical records also indicate that he has had no surgeries or hospitalizations, his immunizations are up to date, and, in general, he has been remarkably healthy for many years. A physical examination reveals the following: Weight: 178 lb; height: 5?2?; body mass index (BMI): 32.6 kg/m 2.

Fasting capillary glucose: 166 mg/dl. Blood pressure: lying, right arm 154/96 mmHg; sitting, right arm 140/90 mmHg. Pulse: 88 bpm; respirations 20 per minute. Eyes: corrective lenses, pupils equal and reactive to light and accommodation, Fundi-clear, no arteriolovenous nicking, no retinopathy. Lungs: clear to auscultation.

Heart: Rate and rhythm regular, no murmurs or gallops. Vascular assessment: no carotid bruits; femoral, popliteal, and dorsalis pedis pulses 2+ bilaterally. Neurological assessment: diminished vibratory sense to essay a woman, the forefoot, absent ankle reflexes, monofilament (5.07 Semmes-Weinstein) felt only above the ankle. Results of laboratory tests (drawn 5 days before the office visit) are as follows: Glucose (fasting): 178 mg/dl (normal range: 65–109 mg/dl) Creatinine: 1.0 mg/dl (normal range: 0.5–1.4 mg/dl) Blood urea nitrogen: 18 mg/dl (normal range: 7–30 mg/dl) Sodium: 141 mg/dl (normal range: 135–146 mg/dl) Potassium: 4.3 mg/dl (normal range: 3.5–5.3 mg/dl) • Total cholesterol: 162 mg/dl (normal: 200 mg/dl) • HDL cholesterol: 43 mg/dl (normal: ?40 mg/dl)

• LDL cholesterol (calculated): 84 mg/dl (normal: 100 mg/dl) • Triglycerides: 177 mg/dl (normal: 150 mg/dl) • Cholesterol-to-HDL ratio: 3.8 (normal: 5.0) AST: 14 IU/l (normal: 0–40 IU/l) ALT: 19 IU/l (normal: 5–40 IU/l) Alkaline phosphotase: 56 IU/l (normal: 35–125 IU/l) A1C: 8.1% (normal: 4–6%)

Urine microalbumin: 45 mg (normal: 30 mg) Based on A.B.’s medical history, records, physical exam, and lab results, he is assessed as follows: Uncontrolled type 2 diabetes (A1C 7%) Obesity (BMI 32.4 kg/m 2 ) Hyperlipidemia (controlled with atorvastatin) Peripheral neuropathy (distal and symmetrical by exam)

Hypertension (by previous chart data and exam) Elevated urine microalbumin level. Self-care management/lifestyle deficits. • High carbohydrate intake. • No SMBG program. Poor understanding of diabetes. A.B. presented with uncontrolled type 2 diabetes and a complex set of comorbidities, all of formar, which needed treatment. The first task of the about a woman, NP who provided his care was to select the most pressing health care issues and prioritize his medical care to address them. Essay. Although A.B. stated that his need to lose weight was his chief reason for seeking diabetes specialty care, his elevated glucose levels and his hypertension also needed to be addressed at the initial visit. The patient and his wife agreed that a referral to a dietitian was their first priority. A.B. acknowledged that he had little dietary information to help him achieve weight loss and essay that his current weight was unhealthy and essay formar “embarrassing.” He recognized that his glucose control was affected by large portions of bread and pasta and agreed to start improving dietary control by reducing his portion size by one-third during the week before his dietary consultation.

Weight loss would also be an important first step in reducing his blood pressure. The NP contacted the registered dietitian (RD) by telephone and referred the thinking in education, patient for a medical nutrition therapy assessment with a focus on weight loss and improved diabetes control. A.B.’s appointment was scheduled for the following week. The RD requested that during the intervening week, the patient keep a food journal recording his food intake at formar meals and snacks. She asked that the patient also try to essays death, estimate portion sizes. Although his physical activity had increased since his retirement, it was fairly sporadic and weather-dependent. After further discussion, he realized that a week or more would often pass without any significant form of exercise and that most of essay, his exercise was seasonal. Whatever weight he had lost during the summer was regained in mice coursework the winter, when he was again quite sedentary. A.B.’s wife suggested that the two of formar, them could walk each morning after breakfast.

She also felt that a treadmill at home would be the best solution for getting sufficient exercise in inclement weather. After a short discussion about the positive effect exercise can have on glucose control, the patient and his wife agreed to walk 15–20 minutes each day between 9:00 and 10:00 a.m. A first-line medication for this patient had to be targeted to effects black, improving glucose control without contributing to weight gain. Thiazolidinediones (i.e., rosiglitizone [Avandia] or pioglitizone [Actos]) effectively address insulin resistance but have been associated with weight gain.12 A sulfonylurea or meglitinide (i.e., repaglinide [Prandin]) can reduce postprandial elevations caused by increased carbohydrate intake, but they are also associated with some weight gain.12 When glyburide was previously prescribed, the patient exhibited signs and symptoms of essay, hypoglycemia (unconfirmed by SMBG). ?-Glucosidase inhibitors (i.e., acarbose [Precose]) can help with postprandial hyperglycemia rise by blunting the effect of the entry of mice, carbohydrate-related glucose into the system. However, acarbose requires slow titration, has multiple gastrointestinal (GI) side effects, and reduces A1C by only 0.5–0.9%.13 Acarbose may be considered as a second-line therapy for A.B. Essay Formar. but would not fully address his elevated A1C results. Metformin (Glucophage), which reduces hepatic glucose production and improves insulin resistance, is not associated with hypoglycemia and essays effects black can lower A1C results by essay, 1%. Although GI side effects can occur, they are usually self-limiting and can be further reduced by slow titration to dose efficacy.14. After reviewing these options and discussing the need for improved glycemic control, the NP prescribed metformin, 500 mg twice a day.

Possible GI side effects and the need to what and creative in education, avoid alcohol were of concern to essay formar, A.B., but he agreed that medication was necessary and that metformin was his best option. The NP advised him to essay, take the medication with food to reduce GI side effects. The NP also discussed with the patient a titration schedule that increased the dosage to 1,000 mg twice a day over a 4-week period. She wrote out this plan, including a date and essay formar time for telephone contact and medication evaluation, and gave it to short, the patient. During the visit, A.B. and essay formar his wife learned to write essay, use a glucose meter that features a simple two-step procedure. The patient agreed to use the meter twice a day, at breakfast and dinner, while the metformin dose was being titrated. He understood the need for glucose readings to essay formar, guide the essays black death, choice of essay, medication and to and creative thinking, evaluate the effects of his dietary changes, but he felt that it would not be “a forever thing.” The NP reviewed glycemic goals with the patient and his wife and assisted them in deciding on initial short-term goals for weight loss, exercise, and medication.

Glucose monitoring would serve as a guide and assist the patient in modifying his lifestyle. A.B. drew the line at starting an antihypertensive medication—the angiotensin-converting enzyme (ACE) inhibitor enalapril (Vasotec), 5 mg daily. He stated that one new medication at a time was enough and that “too many medications would make a sick man out of me.” His perception of the state of essay formar, his health as being represented by the number of medications prescribed for him gave the advanced practice nurse an important insight into short essay in india, the patient’s health belief system. Formar. The patient’s wife also believed that a “natural solution” was better than medication for treating blood pressure. Although the use of an ACE inhibitor was indicated both by the level of hypertension and by the presence of microalbuminuria, the decision to wait until the next office visit to further evaluate the need for antihypertensive medication afforded the patient and his wife time to consider the and men coursework, importance of adding this pharmacotherapy. They were quite willing to formar, read any materials that addressed the prevention of diabetes complications. However, both the patient and effects black his wife voiced a strong desire to focus their energies on changes in food and essay formar physical activity. The NP expressed support for their decision. Because A.B. was obese, weight loss would be beneficial for many of essay, his health issues. Because he has a sedentary lifestyle, is 35 years old, has hypertension and peripheral neuropathy, and formar is being treated for hypercholestrolemia, the is critical thinking in education, NP performed an electrocardiogram in essay the office and on war and peace referred the patient for an exercise tolerance test.11 In doing this, the NP acknowledged and respected the essay formar, mutually set goals, but also provided appropriate pre-exercise screening for the patient’s protection and safety. In her role as diabetes educator, the NP taught A.B. and his wife the and peace, importance of foot care, demonstrating to the patient his inability to feel the light touch of the monofilament.

She explained that the loss of protective sensation from peripheral neuropathy means that he will need to essay, be more vigilant in checking his feet for and men any skin lesions caused by poorly fitting footwear worn during exercise. At the essay formar, conclusion of the visit, the essays black death, NP assured A.B. that she would share the plan of formar, care they had developed with his primary care physician, collaborating with him and discussing the findings of any diagnostic tests and on war procedures. She would also work in partnership with the RD to reinforce medical nutrition therapies and improve his glucose control. In this way, the NP would facilitate the formar, continuity of care and keep vital pathways of communication open. Advanced practice nurses are ideally suited to play an integral role in what is critical and creative in education the education and medical management of people with diabetes.15 The combination of clinical skills and expertise in teaching and counseling enhances the formar, delivery of black, care in essay formar a manner that is both cost-reducing and effective. Inherent in the role of advanced practice nurses is the understanding of shared responsibility for health care outcomes. Death. This partnering of nurse with patient not only improves care but strengthens the patient’s role as self-manager. Geralyn Spollett, MSN, C-ANP, CDE, is essay associate director and an adult nurse practitioner at write sophisticated the Yale Diabetes Center, Department of Endocrinology and Metabolism, at Yale University in New Haven, Conn. Essay. She is an associate editor of Diabetes Spectrum. Note of write sophisticated essay, disclosure: Ms.

Spollett has received honoraria for speaking engagements from Novo Nordisk Pharmaceuticals, Inc., and Aventis and has been a paid consultant for Aventis. Both companies produce products and devices for the treatment of formar, diabetes. 2017 by essay on war and peace, the American Diabetes Association. Diabetes Spectrum Print ISSN: 1040-9165, Online ISSN: 1944-7353 .