Fiscal policy of the U.S Essay Example | Topics and Well Written Essays - 750 words

Fiscal policy of the U.S - Essay Example This would mean that there are measures put in place that ensure federal states have their budgets scrutinized well and that the debt nationally remains quite stable and ensuring that it is continually on a declining path. The Bowles-Simpson plan was set up with ideology of ensuring that they reduce the deficit and achieve the American fiscal goals outlined above. This plan is based on certain key fundamental components that would help in meeting the financial deficit. The Bowles-Simpson plan recommends for an enactment of a comprehensive tax reform. This plan focuses in reducing tax expenditure through what Bowles and Simpson described as â€Å"zero plan† which is intended to drastically cut not only the size but also the number of expenditures (Ghilarducci, 954). The main aim for America is to generate more revenue and direct that revenue to development and growth of the economy. These changes will ensure there is improvement in the tax equation that is both on the income an d expenditure. This would be achieved by applying several measures among them establishing tax policy. Implementation of a tax policy would ensure that there is a reduction in deficit especially on the federal states by making an attempt to raise more tax while cutting down on spending. This plan also aims at identifying possible areas of additional cuts on spending and revenue generations. Bowles-Simpson plan has various ways of achieving the goal that had been set out and adopted various options. As stated by Mathews et al (167), the† Zero Plan,† would work towards cutting off all unnecessary tax expenditures and save approximately eighty billion dollars yearly to cut on the financial deficit thus the revenue gains can be used to reduce tax rates. However there would be some exemption for instances in foreign tax credit, child credit and in earnings from income tax credit. There was less common preferencing especially on mortgage interest, retirement saving and on heal th insurance that is employer-sponsored. The plan also intends to ensure that expenditures on corporate tax are eliminated and that there is a reduction on the same. There was the Alternative minimum tax that also required elimination. The six individual bracket tax rates currently would be replaced with a schedule that has only three brackets and increase the same to higher percentages. Another major change would came in the wage base especially on the social security one which was to be increased with a two percent annually resulting to more than the average wage growth making it a more effective way. Gasoline which acts as a major source of income in federal states and increasing the excise tax on the same therefore would ensure that there is increase in income. While the proponents of Bowles-Simpson says that it is a remedy to ensuring that Americans reduce their debts and that there is economic revival the opponents of the same argue that this plan will reduce on net of safety programs such as Medicare and social security. According to Matthews et al (681), the Bowles-Simpson plan’s main strategy is cutting deep into benefits in order to restore solvency to the program while causing a number of serious and adverse changes. The fact the policy failed to protect the low income earners from these drastic reductions, low income workers are unlikely to support the program because of the reduced benefits. Moreover, this policy breaks the links between the relationship between their past earnings

History Assignment Example | Topics and Well Written Essays - 500 words - 1

History - Assignment Example The Palestinian partisans were funded and backed by the Arab neighbors. On May 1967, Nassar (Egypt's President) had the UN withdraw from Egypt. He then sent tanks and troops into the Sinai. Israel responded by moving troops as well. On June 5, 1967 Israel attacked the Egyptian air forces. With Israeli air planes protecting their troops and tanks, they easily took the Sinai. If the UN would not have stopped the war, Israel would have gone further into Egyptian territory. Israel also captured Jerusalem and Golan Heights during this war. Israel won the Six Day War. The Yom Kippur War led to Syria and Egypt to attack Israel again. This time after battles and negotiations, Israel gave back the Sinai and parts of other territory taken in the Six Day War. However this war lead to the Camp David Accords and led to Egypt recognizing Israel as a state. I.D. the following terms in paragraph format. Make sure you include ALL INFORMATION from the book: Do NOT just copy from the book. You must put these in your own words. (worth 5 points each) 1. Palestinian refugees Palestinian refugees are Arabs caught on Israeli land or in the Occupied Territories after the wars between Israel and their Arab neighbors. These individuals are waiting to be given citizenship by Israel or liberated by the country Israel took the land from.

Egypt vs Saudi Arabia Term Paper Example | Topics and Well Written Essays - 3500 words - 1

Egypt vs Saudi Arabia - Term Paper Example b. Egypt, it has a better history in political parties’ formation and practice, than Saudi Arabia. The existence of Liberation Rally, Nation Union, Arab Socialist Union and National Democratic Parties provided a better platform for the political leadership to introduce change in Egypt. a. Earlier networks of political groups and social formations that had carried traditions of resistance through the period of repression became mobilized beneath the surface of dictatorial order (Paulsen n.d.). 3. With the leadership of the country limited to one Royal family, there may lack instabilities in the governance, but active and talented leadership skills within the communities will always be left out. a. Most of the Middle East countries have large deposits of petroleum oil, and gases which attracts powerful nations, if not forcefully getting involved in the commotions of these Arab countries, in the name of providing a solution, but rather their intentions are to keep them closer for future reasons. a. The army leaders in Egypt realized that that their establishments could present a valuable role under new administration, and thus were willing to dare throwing out the old guard as they were not personal instruments of the ruler (Gause III 2011). A. The System and rule of governance between Egypt and Saudi Arabia’s leadership, international relations, countries’ security structure and role, and the law reform give the explanation for Saudi Arabia and Egypt divergence in outcomes. B. Egypt uprising was strongly supported by protestors in conjunction with political parties presence.

SEE BELOW FOR INSTRUCTION Research Paper Example | Topics and Well Written Essays - 500 words

SEE BELOW FOR INSTRUCTION - Research Paper Example This paper discusses the components of Betty Neuman’s theory and how they can be employed in the nursing practice Every system that deals with patients is an exceptional array instrument that responds to the environment. Ideally, the responses are covered in a structure that determines the relationship with the environment. Consequently, the theory assumes that there are stressors that have universal tendencies that have a potential of upsetting the stability of the patients. The theory also assumes that the line of defense should act as a caveat to environmental stressors (Meleis, 2011). Essentially, the assumption is that in the absence of a barrier enables the stressor to penetrate the line of defense effectively affecting the well-being of the patient. Every patient has the internal mechanisms that act as a resistance to any form of external aggression. It is essential that potential risks to patients are determined and appropriate measures taken to deal with the issues that may affect the stability of the clients. The theory also notes that clients in hospital environments constantly exchange energy with external surroundings. Moreover, the model intimates that there should be prioritization in terms of identifying the first line of action in so far as dealing with the stressors is concerned (Meleis, 2011). The treatments should be ranked as a consequence of making treatment effective. Neuman’s theory focuses on the extent to which an individual can interact and relate to the environment. Patients have a basic reaction to the environment, and the degree of response leads to the depletion of energy effectively leading to illness. The flexible line of defense is an important component that acts as a barrier to potential threats (Meleis, 2011). Stressors portend a number of negatives that may affect the stability of a patient. Prevention is critical in dealing with the stressors. The primary treatment is important and

Egypt vs Saudi Arabia Term Paper Example | Topics and Well Written Essays - 3500 words - 1

Egypt vs Saudi Arabia - Term Paper Example b. Egypt, it has a better history in political parties’ formation and practice, than Saudi Arabia. The existence of Liberation Rally, Nation Union, Arab Socialist Union and National Democratic Parties provided a better platform for the political leadership to introduce change in Egypt. a. Earlier networks of political groups and social formations that had carried traditions of resistance through the period of repression became mobilized beneath the surface of dictatorial order (Paulsen n.d.). 3. With the leadership of the country limited to one Royal family, there may lack instabilities in the governance, but active and talented leadership skills within the communities will always be left out. a. Most of the Middle East countries have large deposits of petroleum oil, and gases which attracts powerful nations, if not forcefully getting involved in the commotions of these Arab countries, in the name of providing a solution, but rather their intentions are to keep them closer for future reasons. a. The army leaders in Egypt realized that that their establishments could present a valuable role under new administration, and thus were willing to dare throwing out the old guard as they were not personal instruments of the ruler (Gause III 2011). A. The System and rule of governance between Egypt and Saudi Arabia’s leadership, international relations, countries’ security structure and role, and the law reform give the explanation for Saudi Arabia and Egypt divergence in outcomes. B. Egypt uprising was strongly supported by protestors in conjunction with political parties presence.

The Vietnam War Essay Example for Free

The Vietnam War Essay The Vietnam War is a conflict with Vietnamese against itself, North Vietnam or the Democratic Republic of Vietnam and the National Front for the Liberation of South Vietnam, wherein the Americans got involved mistakenly and honorably. (see Wikipedia) It is an effort to unify Vietnam into a single state. But then it is considered as false and dishonest theory. As per John Pilger, this war is an invasion of Vietnam’s homeland and lives. (see Global Issues) It is by far the longest war in the century of America against North and South of Vietnam. The Vietnam conflict with America is included in the Second Indochina dated 1954-1975 that grew out from the long conflict between France and Vietnam. (see Wikipedia) It is widely reflected in history and media that America lost this war because of the guerilla movement in Vietnam. (see Global Issues)   It is also believed that America lost this war due to the contribution of media that is against it. (see Global Issues) Actually, Vietnam approached US for assistance in building a nation from the Second Word War and mainly from French imperialism to achieved control for South Vietnam. (see Global Issues) It is believed that US supported Vietnam’s independence and determination. But then, US turned down the assistance that is why they turned to the other superpower at that time, the Soviet Union. (see Global Issues) Ho Chi Minh, communist leader, appealed to President Truman for assistance because Vietnamese wanted to pattern their constitution with the American government. (see Global Issues) But America declined to support their freedom and instead allied with the French. Vietnam was then forced to turn to China and the Soviet Union. (see Global Issues) United States is believed to give support to South Vietnam. They deployed personnel and US military advisers in 1956 to be responsible for training the army of South Vietnam. (see Global Issues) President Nixon purpose was to strengthen South Vietnam. US declined to support North Vietnam due to their communist belief to which US is not partaking. They came to aid the regime in the South who were said to be attacked by the North Vietnamese. (see Global Issues) The opposition said that America really lost the war. It is included in the criticism of the media. There are two most influential beliefs on why America lost this war. First, media undermined the military and political effort through media coverage, especially on television, in America. (see Global Issues) Second is that most of the journalists and broadcasters were against the war. It is on the whole of American media which resulted that war is a â€Å"failed crusade.† (see Global Issues) It has been reported that South Vietnamese had taken up arms to defend their villages and homeland. The North Vietnam Government was not recognized by the United States and the reason why US declined to assist because it is believe to be â€Å"improper† to acknowledge such correspondence. (see Global Issues) During the war, it is believed that it was the time where US dispatched its greatest ever land army and even offered the French two atomic bombs to use prior to its defeat in 1954. (see Global Issues) They pursued military strategies designed for people to abandon homes like usage of chemicals. Millions of people were killed and maimed, some were Americans and the rest are Vietnamese. The agreement to end the war included $3.25 billion of grant aid for 5 years to which was never paid. (see Global Issues) It is supposed to be for the postwar reconstruction but Vietnam did not reveal all the prisoners of the war who were supposedly part of the deal to aid. (see Global Issues) This is a tragic issue for Americans who have been unaware of the fate of their loved ones. (see Global Issues) The Vietnam conflict with the intervention of America is not really a war between the two countries. It is said that America lost this war. But America did not really lose it because in the first place, America was there to become an ally and just to support South Vietnamese for their fight against aggression from the North. Ineffectiveness is a more appropriate term. The way that Americans implemented their policy is ineffective in this conflict. America’s main goal is to unite Vietnam into one state. (see Global Issues) America failed to achieve that goal. The conflict highlighted more on the Cold War ideological battle. It reported and portrayed on the killings and tragedies that happened in the War. It focused more on the bad mistake. The good intentions were rarely questioned and carried out poorly. The media made coverage of America in an extremely one-sided story. (see Global Issues) It resulted to inaccurate reporting because only fragments were told. They mainly focused on the nature of the war. The atrocity of the war were mistakenly branded and blundered. Americans are on the side of South Vietnam that opposed the aggression from the communist, the North Vietnam. What really happened in this war was â€Å"internal aggression.† (see Global Issues) Wherein they invaded and attacked their own country and people. But then there were confusion on who really were â€Å"allies† on this war. The non-communist South Vietnam was said to be invaded by the communist, North Vietnam. (see Global Issues) United States therefore came to the side of the â€Å"democratic† regime in the South. But it was reported untrue. It is because Ho Chi Minh sent regular forces to assist the American attacks. (see Global Issues) He was persuaded to send regular armies to support the South in their opposition to American invasion. (see Global Issues) America lost the war in Vietnam. But millions of acres of forest were destroyed through herbicides poisoning, millions of people were slaughtered, rice fields were left with spots of bomb craters after â€Å"winning† its freedom. It is believed that in a war, no one really win or lose. Though they achieved what they are fighting for, they lose a great deal as well. Vietnam might have the independence and freedom they wanted but it caused them a lot before they achieved it. In contrast, America is still one of the most powerful countries in the world. They still aid and support other countries. But what is the measurement of victory? Is it shown in wealth or material possessions? Or is it measured by power? Or achieving what we really wanted though nothing was left afterwards? Winning does not end or achieve from a certain period of time. Victorious winning is seen on how you live after or if you were able to cope up with life after the battle. Fighting for what you desire and achieving it is a great reward for winning. On the process of achieving for these goals, you may lose some, but gain some as well. It really doesn’t matter if Vietnam conflict is a Winnable War. What matters most is the lesson learned from this war. The experiences happened, whether good or bad. Making things better and hoping that none of this will happen again in the future. To be able to have a peaceful world that can only be attained if we will not let selfishness rule over us. Most people believed that US lost the war. But Vietnam was destroyed to its core where it could be a pool of hope for the next generation and development option in Asia. If only plans were made and done effectively, things might have been different or it could be better than what happened. REFERENCES: Shah, Anup (29 December 2002). Media Propaganda and Vietnam. Retrieved October 15, 2006, from War, Propaganda and the Media Website: http://www.globalissues.org/HumanRights/Media/Propaganda/Vietnam.asp#ThemedialostthewarforAmerica Vietnam War Retrieved October 15, 2006, from Wikipedia Website: http://en.wikipedia.org/wiki/Vietnam_war#Richard_Nixon_and_Vietnam_.281969.E2.80.931974.29

Intervention to Reduce Progression of Diabetes

Intervention to Reduce Progression of Diabetes Developing an Intervention to Reduce Progression and the Development of Complications from Diabetes Mellitus in Adults in Glasgow. Introduction Type 2 diabetes is a serious medical condition that is increasingly prevalent in developed countries (International Diabetes Federation, 2013) and the most common variants of the condition are Types I and II. Type I patients have a deficiency in their pancreatic beta cells which leaves them unable to produce insulin. Thus in these individuals, some control over the condition can be achieved using insulin therapy (Schilling, 2007). Type II diabetics, have cells that have become resistant to the effects of insulin resulting in a delayed reduction in blood glucose (Skrha et al., 2010). There are additional types of diabetes; gestational, and a variety of Type III diabetes, however, the overwhelming majority of cases are of Type II with a significant minority of type I cases (Hardt et al., 2008). Complications of Diabetes Regardless of the underlying aetiology, the long-term complications of diabetes are similar. Excess blood glucose is thought to drive increases in oxidative stress both directly and via the derangement of mitochondrial energy pathways (Cade, 2008). Long term macrovascular damage will inevitably increase the risk of coronary heart disease (CHD), and ischaemic heart disease, with diabetics estimated as having a 3 and 5-fold increased risk of CHD mortality for men and women respectively (Loveman et al., 2008). Cerebrovascular disease is also a consequence of the chronic macrovascular damage with similar increases in stroke risk (Naci et al., 2015) Since each organ has its own microvascular supply, chronic hyperglycaemia also results in diffuse and widespread damage to a variety of body organs. As a result, diabetic complications include visual disability due to diabetic retinopathy; the leading cause of blindness in working age adults in the UK (Fowler, 2008; Kempen et al., 2004). In addition, patients suffer end stage renal disease from diabetic nephropathy (Adler et al., 2003), diffuse impairments of autonomic and somatic neural function, including pain perception, due to diabetic neuropathy (Stirban, 2014; Voulgari et al., 2013). Furthermore, the combination of microvascular damage, and reduced pain sensation, usually in the lower limb, results in many patients developing ulceration and necrosis of the inferior surface of the foot, the most common cause of non-traumatic amputations in the UK (Elraiyah et al., 2016). Costs of Diabetes In addition to the significant cost to the individual suffering with diabetes in terms of reduced personal health and quality of life, there are significant financial costs in treating the condition. In 2010-11, the total cost of diabetes to the UK was estimated at  £23.7bn (Hex et al., 2012). This was comprised of  £9.8bn in direct costs related to treating the disease, and  £13.9bn in indirect cost (e.g. lost productivity through absenteeism, early retirement or unemployment, (Hex et al., 2012)). More recently, the direct costs were estimated at  £13.7bn in 2012 (Kanavos et al., 2012). Within these direct costs, only around a quarter is directly spent on treating diabetes its self, and the remaining three quarters is spent on treating the complications following from the disease, (e.g. CHD, retinopathy, liver failure, diabetic foot, neuropathy (Kanavos et al., 2012)). Risk Factors for Diabetes There are a variety of factors that have been identified that places individuals at risk of developing type II diabetes, these include; having a family history of diabetes, obesity assessed using body-mass index, hypertension, visceral adiposity, adverse blood lipids, smoking, and impaired fasting glucose control (Lyssenko et al., 2008). Notably, several of these risk factors, including blood lipids, BMI, hypertension and visceral adiposity, are shared risk factors for CHD, which may in part explain the elevated risk of CHD in diabetics (Haffner et al., 1998). Indeed the clustering of these risk factors has been shown to be predictive of both CHD and diabetes (Haffner et al., 1998) and are collectively referred to as the metabolic syndrome. Moreover, these risk factors, appear to primarily be related to obesity in general, and excessive visceral adiposity in particular (Wozniak et al., 2009). Early work by West and colleagues (1978) demonstrated a strong positive association between rates of obesity and rates of diabetes with a variety of populations. Since then, the epidemiological link between excess body fat and risk of developing type II diabetes in particular has been repeatedly supported. For example, in the Nurses Health Study (Chan et al., 1994) females who had a BMI of greater than 35 kg.m-2 had a risk of diabetes 95 fold higher than those with a BMI of less than 21 kg.m-2 . Epidemiology of Diabetes The incidence and prevalence of diabetes have increased dramatically in the last two decades. Currently, the World Health Organisation estimates that diabetes effects around 9% of the adult global population (International Diabetes Federation, 2013) with variations in prevalence ranging from 26.4% in Kiribati to 1.54% of the population in Manin (International Diabetes Federation, 2013). Overall the UK ranks relatively favourably; in the same data from 2014, the UK had a prevalence of 3.9% (172nd out of 193 countries). Despite this relatively low ranking, the UK, in line with many developed countries, has experienced a rapid growth in the proportion of the population suffering with diabetes. Between 2007 and 2015 the number of patients diagnosed with diabetes increased by 75% from two to three and a half million cases (Diabetes UK, 2015). There are also an estimated half a million undiagnosed individuals at any one time. Indeed, the absence of overt symptoms in the early stages of the disease means that it is not uncommon for patients to have had the disease for several years prior to diagnosis, and confounds attempts to accurately calculate prevalence rates. Scotland has experienced similar increases, with the number of individuals diagnosed with diabetes increasing markedly over the last decade. The Scottish Diabetes survey (2014) demonstrated that the number of individuals with diabetes doubled from approximately 100,000 to 200,000 individuals between 2002 and 2007 despite a stable population of 5 million. Currently estimates for Scotland indicate that there are 276,500 diabetics in Scotland resulting in an overall prevalence that is a third higher than the UK average at 5.2% (NHS Scotland, 2014). Diabetes and Deprivation While the reasons that link indices of deprivation to diabetes are likely multifactorial, they undoubtedly exist. Individuals living in the most deprived areas of the UK are 2.5 times more likely to suffer from diabetes than those in the least deprived areas (Diabetes UK, 2006). Moreover the complications arising from diabetes such as CHD and stroke are more than three times higher in the lowest socio-economic groups and those with lowest educational achievement are twice as likely to have heart disease, retinopathy and poor diabetic control (Diabetes UK, 2006; International Diabetes Federation, 2006). The cause of the increased risk is not clear, however many of the risk factors such as obesity, smoking and physical inactivity, are also higher in those areas with the greatest degree of deprivation (Diabetes UK, 2006; International Diabetes Federation, 2006). From the data outlined above, the development of diabetes is a serious chronic medical condition that can result in early morbidity and mortality and is associated with significant personal and healthcare costs. Despite many of the risk factors for its development being modifiable, it remains a significant and increasing health risk that has a disproportional focus on the areas of greatest deprivation. Given that there is strong evidence that Glasgow has higher rates of both deprivation and type 2 diabetes than the rest of the UK, the aims of this paper are to discuss methods of describing the degree of the problem in Glasgow, as well as identifying, implementing and evaluating initiatives designed to reduce the burden of Type 2 diabetes within that area. Epidemiological Investigation of Diabetes in Glasgow The Centre for Disease Control defines public health research as consisting of four phases, public health tracking, public health research, health intervention programmes, and impact and evaluation (CDC, 2015). Thus before designing and implementing a diabetes focused health initiative, it is necessary to first establish that there is a public health need within Glasgow. This can be undertaken using primary or secondary data sources. Although secondary data sources are repositories of data that have been collected for some purpose other than the investigators main research question, Bailey et al. (2012) suggest that secondary sources also have several advantages. Typically, they are large data sets, and their use is highly cost efficient, as the data collection has already taken place. In terms of this investigation into Diabetes prevalence in Glasgow, there are a number of possible secondary data sources. The most directly relevant data is from the Scottish Diabetes Survey, the most recent data for which covers 2014 (NHS Scotland, 2014). In the most recent report, there is evidence that diabetes is a specific public health concern in Glasgow. For example, while it is not surprising is that Glasgow has the highest number of diabetics, around 22% of Scotlands diabetic population, since it is also the most densely populated region. However, this also translates to the region having the highest age adjusted prevalen ce of diabetes within Scotland at 5.8%. Furthermore the Greater Glasgow and Clyde (GGC) NHS board is criticised as falling behind other NHS health boards within Scotland, in its system of managing and screening its diabetic population in order to limit the progression of the disease. In addition, the Scottish Public Health Observatory (SPHO) provide a number of secondary data sources which may be valuable in triangulating conclusions and include; mortality rates, primary care information from GP practices, the Quality Outcomes Framework (QOF) detailing the performance of GP practices in dealing with key health issues, the Scottish Diet and Nutrition Survey, and the Health Education population survey (Scottish Public Health Observatory, 2015). In addition, both English and Scottish governments produce databases of indices of multiple deprivation (IMD), which can be useful when attempting to standardise the degree of a public health issue by deprivation level. This secondary data should be supported with primary evidence of the population of interest. While there are a number of research designs that could be used to collect primary data on Glasgow residents with diabetes, in this instance a cross-sectional observational design would be most useful. This method has several advantages, it is cost effective, requires only a single group, and each participant is only required to be assessed at a single time-point. This means that it becomes feasible to assess relatively large numbers of people (Bailey Handu, 2012). The limitations of this method are that it represents a single point in time and as a result, cannot be used to determine the sequence of events for a given set of exposures and outcomes. Therefore, it is not possible to infer causality from cross-sectional data. This type of research is most useful for determining prevalence rates for a specific condition (Bailey Handu, 2012).. An ecological study design might also be used, however, in this case, there are wide variations in income levels and deprivation levels within specific postcodes. Thus the possibility for the data to be affected by unknown confounding variables is significant. Similarly a case control study design has some additional control regarding possible confounders, but is again limited in being retrospective in nature and is predominantly used for rare diseases, which type 2 diabetes is not (Greenfield, 2002). Experimental designs such as prospective cohort studies or randomised control trials are the most internally valid designs to attribute causation of a condition to a specific exposure. However, they would not be appropriate in this instance, as they time consuming, expensive, and typically include far fewer individuals. Thus in order to use this type of study, the cost would be greater than the cost of any proposed intervention. In addition, while such designs are internally valid, they often lack ecological validity. That is, while the exposure and outcome can be linked in the study, at the population level, individuals may experience exposure to several predicating factors, and several protective factors. Thus, it is not always straightforward to transfer the findings from a highly controlled study to individuals (Peat et al., 2008). In order to undertake the cross-sectional survey, would require defining a series of areas (e.g. roads or school catchment areas) within specific post-codes to act as the sample frame. The survey data would be collected on these areas. The main problem with collecting this kind of data is a low response rate (Levin, 2006), and the possibility that individuals may responder or not due to the influence of some other factor introducing some systematic bias into the data. The main protection from this is to maximise the response rates. This is best done using face-to-face interviews with individuals in the sample frame (Levin, 2006). Diabetes Interventions The evidence for the type of behaviours that are useful in limiting the adverse complications of diabetes, have been the subject of several large scale epidemiological studies. In the UK the UK Prospective Diabetes Study (UK Prospective Diabetes Study, 1998) and its 10 year follow up (Holman et al., 2008) evaluated the effect of managing type II diabetes through diet alone, versus aggressive management aimed at restricting blood sugar concentrations. The data from the study indicated that while both the aggressive intervention only lowered blood sugar for one year, this translated into significantly lower rates of complications at the 10-year follow up. In the US, the Diabetes Control and Complications Trial (DCCT, 1993) and its 10 year follow up (the Epidemiology of Diabetes Interventions and Complications EDIC (Nathan et al., 2005)) also demonstrated that limiting increases in blood sugar, by maintaining concentrations within strict individualised limits, reduced the incidence of c omplications at the 10 year follow up by 57%. Similar reductions in adverse outcomes have also been found when diabetics have measures of blood lipids, blood pressure, nephropathy, retinopathy and diabetic foot complications assessed at regular intervals. It is also noteworthy that the Greater Glasgow and Clyde NHS region regularly performed in the lowest quartile of Scottish NHS authorities for implementing each of these evaluations (Scottish Diabetes Survey 2014). In long-term conditions such as Type 2 diabetes, the most appropriate strategies to control and manage the condition is for patients, to recognise themselves as stakeholders in their own treatment and to take ownership of the critical aspects of their care such as pharmacological treatment, dietary modifications and physical activity recommendations (National Institute for Health and Care Excellence, 2015). There have been several interventions that have aimed to use patient education to allow for a greater degree of self-management with a resulting closer control of risk factors for diabetic complications. Most recently Minet et al. (2010) evaluated the efficacy of 47 RCT studies aimed at improving diabetic patient education, and found that there was a significant reduction in the degree of hyperglycaemia experienced by the patients at the 6 and 12 month follow up time points. Similar meta analyses have supported the role of education in reducing the incidence of nephropathy and dia betic foot (Elraiyah et al., 2016; Loveman et al., 2008). Given that the UKPDS (1998) demonstrated that even short term reductions in blood glucose can reduce the numbers of patients who progress to sever complications, and given that the majority of the financial burden in treating type 2 diabetes is related to complications rather than the disease its-self. It seems clear that patient education could significantly improve the prognosis of diabetics as well as reduce the costs of future treatment. Implementing an Intervention in Glasgow Having identified a suitable educational intervention, the next stage is to ensure its faithful and appropriate replication within patients with Diabetes in Glasgow. A limitation of much of the available research is that interventions are predominantly applied in academic settings, and the effectiveness of interventions in community and primary care settings are frequently lower than anticipated from the scientific literature. This is a continuing challenge for implementing evidence-based strategies for public health issues. Kilbourne et al. (2007) recommend the REP framework, which although originally devised for faithful implementations of HIV educational programmes has been evaluated and found to help improve the effectiveness of other public health interventions. In order to use the REP framework for educational programmes aimed at Diabetics in Glasgow, the four stages of the REP framework would be developed. Pre-condition requires the identification of a suitable educational intervention. In this phase it is important that the chosen intervention is both feasible and appropriate for the setting in which it will be used. Pre-implementation requires that all staff involved in the intervention undergo training not only in the interventional educational curriculum, but also in the underpinning theories that shaped the original intervention. Implementation requires the educational programme is rolled out to diabetics within Glasgow, and that feedback is sought from stakeholders including patients undergoing the education. In this way it is possible to modify the intervention to better fit the situation, while still remaining faithful to the initial conceptual design. Finally, maintenance and evaluation requires further feedback regarding the effe ctiveness of the intervention, as well as ongoing support for partners who are delivering or helping ensure the continuation of the intervention. Monitoring an Evaluation For the proposed educational intervention, the evaluation would use the RE-AIM framework. This is the most widely adopted model for evaluation of public health interventions originally proposed by Glasgow and Colleagues (1999). This framework proposes the evaluation of five key elements of the intervention. Reach assess the number of individuals from the target population who received the interventions. Efficacy evaluates the degree to which the education intervention improved patients ability to manage their condition (e.g. better control of blood glucose, maintained or lowered blood pressure). Adoption would focus on the number of patients receiving the educational intervention whose behaviour was altered as a result. Implementation attempts to assess the degree to which the intervention was faithful to the evidence base upon which it was designed or was there pragmatic or other issues that meant the interventions was poorly delivered, or delivered in a manner not originally envisa ged. Maintenance attempts to quantify the degree to which the intervention becomes self-sustaining. This can be at an institutional level, i.e. does the health authority feel the programme is sufficiently successful to continue its development. However, it can also be at the individual level, were patients value the intervention and it becomes part of the persons habitual processes. Conclusion The aim of this paper was to investigate an intervention aimed at reducing the complications of type 2 diabetes in individuals diagnosed with the condition, living in Glasgow. It has established that in order to implement any such strategy, it is necessary to evaluate the degree of the problem using secondary and if required primary sources of data. In addition, any intervention should be evidence based, and attempt to replicate those interventions that have been demonstrated to be successful. This should be attempted in a strategic and structured manner in order to ensure high fidelity conversion from research evidence to intervention. The intervention its-self needs robust evaluation to determine if it was effective, and if not was it because of a failure of the underpinning theories or a failure in delivery. Unless they are well managed, individuals with Type 2 diabetes are at a significant risk of serious and life threatening complications. Educational interventions may be one wa y to provide effective strategies to enable better outcomes and reduced personal and financial costs. References ADLER, A.I., et al., 2003. Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). Kidney International. 63(1), pp. 225-232. BAILEY, S. and HANDU, D., 2012. Introduction to epidemiologic research methods in public health practice. Jones Bartlett Publishers. CADE, W.T., 2008. Diabetes-related microvascular and macrovascular diseases in the physical therapy setting. Physical Therapy. 88(11), pp. 1322-1335. CDC. 2015. Public Health Cycle [Online]. [Viewed 4th April 2016]. Available From: http://www.cdc.gov/ncbddd/hearingloss/publichealth.html. CHAN, J. M., RIMM, E. B. COLDITZ, G. A. 1994. Weight gain as a risk factor for clinical diabetes mellitus in women. Diabetes Care, 17, 961-9. DIABETES CONTROL AND COMLICATION TRIAL RESERCH GROUP, 1993. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl j Med. 329(14), pp. 977-986. DIABETES UK 2006. Diabetes and the disadvantaged: reducing health inequalities in the UK World Diabetes Day 14 November 2006. A report by the All Parliamentary Group for Diabetes and Diabetes UK. https://www.diabetes.org.uk/Documents/Reports/Diabetes_disadvantaged_Nov2006.pdf. DIABETES UK. 2015. Diabetes Facts and Stats November 2015 [Online]. [Viewed 20th March 2016]. Available From: https://www.diabetes.org.uk/Documents/Position statements/Diabetes UK Facts and Stats_Dec 2015.pdf. ELRAIYAH, T., et al., 2016. A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers. Journal of Vascular Surgery. 63(2), pp. 46S-58S. e2. FOWLER, M.J., 2008. Microvascular and macrovascular complications of diabetes. Clinical Diabetes. 26(2), pp. 77-82. GLASGOW, R.E., VOGT, T.M. and BOLES, S.M., 1999. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. American Journal of Public Health. 89(9), pp. 1322-1327. GREENFIELD, T. 2002. Research Methods for Postgraduates, London, Arnold. HAFFNER, S.M., et al., 1998. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. New England Journal of Medicine. 339(4), pp. 229-234. HANLON, P., et al., 2005. Why is mortality higher in Scotland than in England and Wales? Decreasing influence of socioeconomic deprivation between 1981 and 2001 supports the existence of a Scottish Effect. Journal of Public Health (Oxford, England). 27(2), pp. 199-204. HARDT, P.D., BRENDEL, M.D., KLOER, H.U. and BRETZEL, R.G., 2008. Is pancreatic diabetes (type 3c diabetes) underdiagnosed and misdiagnosed?. Diabetes Care. 31 Suppl 2 pp. S165-9. HEX, N., et al., 2012. Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabetic Medicine. 29(7), pp. 855-862. HOLMAN, R.R., et al., 2008. 10-year follow-up of intensive glucose control in type 2 diabetes. New England Journal of Medicine. 359(15), pp. 1577-1589. International Diabetes Federation 2006. Diabetes, deprivation and outcomes in a wealthy world. Diabetes Voice, 51, 37-40. INTERNATIONAL DIABETES FEDERATION. 2013. IDF Diabetes Atlas [Online]. [Viewed 20th March 2016]. Available From:https://www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf: IDF. KANAVOS, P., VAN DEN AARDWEG, S. and SCHURER, W., 2012. Diabetes expenditure, burden of disease and management in 5 EU countries. LSE Health and Social Care. KEMPEN, J.H., et al., 2004. The prevalence of diabetic retinopathy among adults in the United States. Archives of Ophthalmology (Chicago, Ill.: 1960). 122(4), pp. 552-563. KILBOURNE, A.M., et al., 2007. Implementing evidence-based interventions in health care: application of the replicating effective programs framework. Implementation Science. 2(1), pp. 1-10. LOVEMAN, E., FRAMPTON, G.K. and CLEGG, A., 2008. The clinical effectiveness of diabetes education models for Type 2 diabetes: a systematic review. Health Technology Assessment. 12(9), pp. 1-136. LYSSENKO, V., et al., 2008. Clinical risk factors, DNA variants, and the development of type 2 diabetes. New England Journal of Medicine. 359(21), pp. 2220-2232. MINET, L., et al., 2010. Mediating the effect of self-care management intervention in type 2 diabetes: a meta-analysis of 47 randomised controlled trials. Patient Education and Counseling. 80(1), pp. 29-41. NACI, H., et al., 2015. Rethinking the appraisal and approval of drugs for type 2 diabetes. BMJ Open. 351(h5260),. NATHAN, D.M., et al., 2005. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group: Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 353 pp. 2643-2653. NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE, N. 2015. Type 2 diabetes in adults: management: NICE guidelines [NG28] [Online]. [Viewed 20th March 2016]. Available From:https://www.nice.org.uk/guidance/ng28: NIHCE. NHS SCOTLAND 2014. Scottish Diabetes Survey 2014. Scottish Diabetes Survery Monitoring Group. PEAT, J., BARTON, B. ELLIOT, E. 2008. Statistics Workbook for Evidence-Based Health Care, Wiley-Blackwell. SCHILLING, J. A. 2007. Diabetes Mellitus: A guide to patient care, Ambler, USA, Lippincott. SCOTTISH PUBLIC HEALTH OBSERVATORY. 2015. Overview of Key data sources [Online]. [Viewed 4th April 2016]. Available From: http://www.scotpho.org.uk/publications/overview-of-key-data-sources/introduction. SKRHA, J., CERIELLO, A. GITT, A. K. 2010. Chapter 6 Microvascular and Macrovascular Complications. In: HALAN, P. (ed.) DIAMAP 1 : Roadmap for Diabetes Research in Europe. http://www.diamap.eu: European Union. STIRBAN, A., 2014. Microvascular dysfunction in the context of diabetic neuropathy. Current Diabetes Reports. 14(11), pp. 1-9. UK PROSPECTIVE DIABETES STUDY (UKPDS) GROUP, 1998. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). The Lancet. 352(9131), pp. 837-853. VOULGARI, C., PAGONI, S., VINIK, A. and POIRIER, P., 2013. Exercise improves cardiac autonomic function in obesity and diabetes. Metabolism. 62(5), pp. 609-621. WEST, K.M., 1978. Epidemiology of diabetes and its vascular lesions. Elsevier. WOZNIAK, S.E., GEE, L.L., WACHTEL, M.S. and FREZZA, E.E., 2009. Adipose tissue: the new endocrine organ? A review article. Digestive Diseases and Sciences. 54(9), pp. 1847-1856.