Effects of a Prenatal Yoga Programme on the Discomforts of Pregnancy and Maternal Childbirth Self-Efficacy in Taiwanâ„¢, Midwifery Essay Example

Effects of a Prenatal Yoga Programme on the Discomforts of Pregnancy and Maternal Childbirth Self-Efficacy in Taiwanâ„ ¢, Midwifery Essay Sun, Y.C. Hung, Y.C. Chang, Y. and Kuo, S.C. (2009) Effects of a Prenatal Yoga Programme on the Discomforts of Pregnancy and Maternal Childbirth Self-Efficacy in Taiwanâ„ ¢, Midwifery. [Online] DOI: 10.1016/j.midw.2009.01.005 (Assessed: 9 April 2010) In this 21st century, people are more educated and are more aware on products they are using or services that are provided. When they purchase a product, they will demand for evidence which proves the effectiveness of the item. Not only that, people are more health concern, they will consume food that are proved to benefit the body, for example, oranges are proved to eliminate flu and etc. As we can see, we live in a world flooded with evidence. As compared to many years before, nurses practice through experience, tradition, culture or patientsâ„ ¢ need and yet they value the clinical experience, patientâ„ ¢s experience, local culture as evidence (Rycroft-Malone et.al., 2004). As today, we are being instilled on evidence-based practice. Even that, nurses must be clear of the basis of practice despite knowing that the practice is not evidence-based to provide a sensible care to the patients (Zeitz McCutcheon, 2003) We will write a custom essay sample on Effects of a Prenatal Yoga Programme on the Discomforts of Pregnancy and Maternal Childbirth Self-Efficacy in Taiwanâ„ ¢, Midwifery specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Effects of a Prenatal Yoga Programme on the Discomforts of Pregnancy and Maternal Childbirth Self-Efficacy in Taiwanâ„ ¢, Midwifery specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Effects of a Prenatal Yoga Programme on the Discomforts of Pregnancy and Maternal Childbirth Self-Efficacy in Taiwanâ„ ¢, Midwifery specifically for you FOR ONLY $16.38 $13.9/page Hire Writer In health care, many of our practices are evidence-based. The policies and procedures, medications and treatment, included nursing care are practiced base on the evidence shown. By practicing evidence-based practice, we need to search for the best evidence available from research done recently (Sackett et.al., 1996) and evidence-based practice should not be argue and should not be any disagreement as the practice is proved (Goding Edwards, 2002). Once we practice with evidence, we can surely observe the outcomes from patients as in the piece of research. However, Scudder (2006) states that it is difficult to practice based on evidence as patients in this modern world would prefer to make their own treatment methods which might not have evidence to prove the effectiveness. When we evaluate our own practice, are all of the practices that we are following still the safest or still the most effective way in promoting health and preventing diseases This is in doubt. As health care personnel, it is important to keep ourselves updated with latest evidence-based practice to improve our care to patients. In order to do that, the most effective way is to search for research articles to compare and evaluate the findings. Hence, we can improve or initiate new practices based on the research done. Nurses have to take the lead in initiate new practices and to perform effective leadership to improve nursing care. The top management of an organization should take the lead to transform research knowledge into real practice and change the culture of the hospital (Stetler, 2003). There are five steps leading healthcare workers to evidence-based practice, we must be able to question what practice is good, nurses must be able to structure the information provided and critically appraise the information found also nurses be able to search for research articles and evaluate critically, then to implement the new practices (Cleary-Holdforth Leufer, 2008). However, in selecting research articles, we need to critically analyse the validity and reliability of the researchers and the research process before adapting the practice. Nurses should not follow blindly with orders and policies that are being set except that nurses need to critically analyse the strength and weakness of current practice, policies and procedures and theories that we have learn (Timmins, 2006). At times, we notice that some research has insufficient data to conclude the results and some has no definite findings (Aveyard Sharp, 2009). It is a good practice that nurses form a group in a ward to seek for better practices and discuss new policies which is supported by evidence. With this practice, it will not only build up leadership in every staff and also will improve the standard of care in the ward. I am a Staff Midwife working in a 10 bedded delivery suite in a private hospital in Malaysia as well as a part time pregnancy yoga instructor. I have a great interest in womenâ„ ¢s health and promoting healthy pregnancy. Most of the pregnant mothers in Malaysia prefer to stay home and refuse to perform any form of exercise throughout their pregnancy. They think it is a taboo for pregnant women to be active as this will cause miscarriage or preterm labour. Moreover, there are limited exercise can be done during pregnancy and most of the pregnant ladies in Malaysia are not exposed to information regarding exercise during pregnancy. Hence, they are afraid to exercise without guidance as well as support from health care workers and this is supported by the research of Duncombe et.al. (2009) shows that majority of the pregnant women thinks that exercise specially designed for pregnant mothers are the safest and they are more willing to learn those exercise. During pregnancy, yoga is one of the safest exercises to stay healthy and fit. On top of that, yoga relieves stress and promotes relaxation to eliminate mood swings. When the pregnant mother has pain or other discomfort during pregnancy, it will encourage mood disorders (Beddoe et.al., 2009). This is supported by the research of Furlow et.al. (2008) and Beddoe et.al. (2009) said that yoga is widely practice in pregnant mothers in obstetrics and gynaecology condition as well as meditation and it is one of the top choices of physicians in providing alternative care to the patients in the United States. With yoga practices, most of the mothers are able to cope with stress and have a healthier body as there is a link between our mind and body, when our mind is relaxes and calm, our body will follows; hence reduces stress not only in our mind and also in our body. By practicing yoga postures, chanting om, breathing exercise and yoga nidra (deep relaxation) will improve physical stre ngth and flexibility, improve self-awareness and also calm the body and mind (Chuntharapat et.al., 2008). In addition to that, when the level of stress hormones in the motherâ„ ¢s body is high, it will affect the health of the mother and the baby (Tiran Chummun, 2004). Wadsworth (2007) noted that exercises can relief minor discomfort and have lower incident of gestational diabetes, preeclampsia, preterm labour and etc. Pregnancy is a natural process and it is not a type of disease. Hence, many doctors or midwives do not prescribe medications to pregnant mothers if there are no medical conditions such as diabetes or hypertension and etc. because by consuming unnecessary medications will cause complications not only to the mother and also to the baby. Tiran Chummun (2004) commented that the use of drugs must be prevented in making sure that the side effects of the drugs will not affect the fetusâ„ ¢ wellbeing. For this reason, complementary therapies such as yoga, meditation, relaxation, reflexology and etc are the recommended techniques to promote healthy pregnancy. Thus, as a midwife and a certified pregnancy yoga instructor; I would like to discover some information from research regarding exercises during pregnancy and the effectiveness in practicing yoga during pregnancy. With this information, I would like to promote pregnancy yoga including relaxtion in my practice area especially in antenatal classes that are conducted in the hospital in order to maximize the health of pregnant mothers. Tiran Chummun (2004) and Satyapriya et.al. (2009) agreed that promoting relaxation in antenatal class helps mothers stay in more relaxed state when they preparing for labour. This piece of research that I have chosen is from a journal named Midwifery and it is published by Elsevier, the leading publisher of science and health. Midwifery is a journal that publishes all information regarding midwifery to enhance the knowledge, skills and attitudes of all midwives. Hence, this is a reliable source for the research article that I have chosen. This research article is regarding the outcome and the experience of pregnant mothers in terms of minor discomforts and the outcome of handling the labour process after the practice of yoga. As stated clearly in the title of this research, the words used attract readers and readers are be able to form an outline on what is the focus of this research from the title. However, as this is a quantitative research, the title should emphasize on the population of pregnant mothers was benefitted on the yoga programme as the format of a quantitative research focus much on the quantity or frequency of the study (Aveyard et.al., 2009). There are four researchers in this research study. They come from different field of work, including nursing division, midwifery, social culture and welfare, and an instructor for exercise and health science. This mixture of different discipline can enhance the flow of the research as they have different opinion and experience irrespective of nursing point of view, social culture or in the view of exercise. With this, the research can only proceed with a correct direction and then the study objective can be met. There is an abstract for this research article. The objective of the research, the design, place, participants, intervention, measurements, conclusions and implications are clearly identified. Readers can have a clear outline regarding this piece of research article by studying the information in the abstract of this paper. Yoga has been proving to relieve tension and improve health in practitioners and to promote relaxation, improves flexibility and relieves some minor discomfort, for example, backache and cramps etc. has shown in the wide range of the primacy source of literature reviews by the researchers ranging from the year 1991 till year 2008 included a research conducted in India regarding yoga on pregnancy outcome was clearly been evaluated. The aim of the researchers is to find out the incidence of minor discomforts occur during pregnancy and the self efficacy in labour and by practicing yoga during antenatal period by seeing that there are no studies conducted regarding this subject in Taiwan. The aim and objectives are clearly identified in the introduction of this piece of research article which leads the readers into the research findings. This is a qualitative research using a non-randomised controlled experimental study, the researchers chose participants who had antenatal checks and decided to deliver in the study hospital. The researchers used statistical power analysis to calculate the sample size which was around 41 participants per group. The sampling process conducted in the antenatal clinic in an urban hospital in Taiwan. There are few inclusion and exclusion criteria while choosing the participants. The inclusion criteria includes primigravida 18 years old at the 26-28 gestational weeks with a singleton pregnancy who are be able to listens and speaks in Chinese and has no experience in practicing yoga before, besides that, she had not been exercising for at least a year. The exclusion criteria includes pregnant mother who experienced premature labour or used epidural anaesthesia as the form of pain relieve and caesarean section is the delivery method. The researchers select the participants for control group from January to March 2004 while the participants in experimental group from April to June 2004. After the fine selection, the total of 96 participants was allocated into 2 groups â€Å" the control group consists of 45 participants and the experimental group consists of 51 participants. After the allocation of the participants, a double-blind procedure is used to avoid bias during the selection procedure to ensure that the researchers will not select the desire samples. Along this sampling process, participants were provided a written and informed consent in maintaining the confidentiality of democratic data and questionnaires during this research process. Researchers are advice to consider ethical issues in research to prevent discomforts in participants; hence, the findings are more authentic (Robson, 2007). According to Guillemin Gillam (2004) reflexivity in research not only helps researchers to reflect on the research process and construct the whole research and also to maintain the ethics in the research. Both the control group and the experimental group received the standard obstetric care and usual antenatal information including information on yoga practice in pregnancy. But only the experimental group receive a yoga programme which prepared by professionals. Throughout the research study, 2 participants from control group and 6 participants from experimental group was removed by the researchers due to various reasons such as unable to contact participant while follow up procedure; participants had preterm labour during the research period and etc. Therefore, only 43 participants in the control group and 45 participants in the experimental group participate in this research study. With total number of 88 participants is not a good sample size to conclude the research findings. There is only small percentage of urban pregnant ladies in Taiwan being studied which unable to conclude the results for most pregnant women in Taiwan which has different culture background and educatio n level in the rural area. There is no power calculation done to ensure the reliability of the sample size. Power calculation is very important in determining sample size. if the sample size is too big, researchers will waste their time and resources to conclude the data which normally will have minimal gain; whereas if the sample size is too small, the reliability of the findings to determine the research questions is suspicious (Hill Lewicki, 2007). This yoga programme in experimental group was evaluated by 5 experts using the context validity index (CVI) to ensure the content validity. The CVI is a measurement measured by content experts for a particular tool used in a research is appropriate in collecting data and conducting the research to ensure the objective of the research is met (Polit Beck, 2006). As stated in the research article, the CVI of this yoga programme was 0.96 which is a good validity. Participants were given a 10-pages booklet and a 30-minutes videotape yoga workout to practice at home and the researchers will make phone calls to all participants every week in the first 2 weeks then every 2 weeks till delivery. The researcher learnt the yoga exercise from a yoga instructor after which the researcher will teach the participants by following the videotape which consists of 9 exercise and meditation. Participants were asked to practice at home for an hour at least 3 times a week for 12 to 14 weeks. Noneth eless, Yoga is an art to improve health; it is best practice from the pregnancy yoga instructors. Participants might interpret the information wrongly by practicing from the videotape. Injuries could happen when there is no guidance during the practice. Although follow up phone calls was made, the compliances to the practice were unknown. In the study of Chuntharapat et.al., (2008), noted that the participants who can fulfill the research process are mostly housewife who can practice consistently in the yoga center in Thailand. Participants might have inconsistency in practice which will affect the research findings. For these reasons, it is best to have participants to attend yoga classes 3 times a week for 12-14 weeks instead of videotape practice. There are 2 methods used by the researchers. They are the discomforts of pregnancy questionnairesâ„ ¢ and childbirth self-efficacy inventoryâ„ ¢ (CBSEI). The discomforts of pregnancy questionnaires consists of 20 questions that reviewed by antenatal experts. Each question in this questionnaire was scored by five-point scale. The scale was composed as very severe (5 points) to none (1 point). The higher the score for this questionnaire indicates that the more discomfort of pregnancy occurs. As indicated by the researchers of this research article, the CVI value for this questionnaire was 0.92 shows that the questionnaires have a fine validity. CBSEI was the diagnostic tool to assess the self efficacy in pregnant mothers during labour. There are 4 measurements needed to conclude the results for CBSEI. The self-efficacy expectancy during active phase of labour; the outcome expectancy during labour; the self-efficacy expectancy during second stage of labour and the outcome expectancy during second stage of labour. It is measured by a 10-point likert scale. In self efficacy expectancy scale, 10 points indicates very sure to 1 point indicates not at all sure. Whist in outcome expectancy scale, 10 points indicates very helpful to 1 point indicates not at all helpful. Before the questionnaires was distributed and before videotape with booklet was hand out to participants, pilot tests was conducted to make sure that participants understand the video content and the booklet also be able to practice the yoga exercises alone at home. Pilot test allow researchers to test the public before the real data collection and to make amendment on any uncertainties (Robson, 2007). Three sets of data collection were done. Demographic information and discomforts of pregnancy questionnaires was collected during 26 weeks to 28 weeks for pre test, this procedure was carry out when the researchers distribute and explain the consent once the participants agreed to participate in this research. The 2nd time of data collection for discomforts of pregnancy questionnaires was during 38-40 weeks gestation (post test) before delivery. The third data collection was during active phase of labour (when the participant having a contraction in 3 to 5 minutes) that participants were asked to complete the CBSEI along with another CBSEI data was collected 1 to 4 hours after second stage of labour. Data was evaluated by researchers after collection. All data ware analyse using Mann-Whitney U-test. The researchers used a statistical package in assisting them to get an accurate result. It is important for the researchers to know and be familiar with the statistical test to analyse the data collected. Robson (2007) thinks that the researchers must seek help if they are not an expert in using the statistical test in order to interpret results accurately. A research cannot contribute evidence to guide clinical practice if the findings of the research are not accurate, biased or fail to accurately represent the experiences of the experimental group, for example, the scale given to evaluate the discomfort of pregnant women must be clear and understandable to participants so that the participants answer accurately. The findings of this research presented clearly by the researchers. The differences between control group and experimental group clearly stated. The p values of this research are less than 0.5. This shows that the reliability of this research is high. Besides that, the questionnaires and the methods used were evaluated by experts. Hence, the reliability, validity and trustworthy of this research was maintain. However the analytical process was not clearly identified. From the research findings, there are no significant differences in birth weight of baby in control group and in experimental group. The findings for pregnancy discomfort in control group were increase during the post test compare to pre test; whereas in experimental group, there is not much difference in pregnancy discomfort. Participants from experimental group had increase in self efficacy in childbirth. In addition to this, there are extra findings regarding physical responses after each yoga session such as chances of pregnant women experience contractions while practicing yoga and feelings of pregnant women after the yoga programme in experimental group. Most of the participants have no contractions during the practice of yoga, but experience sweating and slight panting after practice. However, most of the participants felt yoga ease discomforts in pregnancy and meets their needs by practicing yoga. The limitations of this research are clearly stated. For example, the sample size is small, it is unable to conclude the population in Taiwan and the participants are primigravidas also a further research needs to be done on multigravida mothers too. Furthermore, the timing of data collection for CBSEI is varies between participants; for instance that some participants need longer time to have a close contractions while the other do not; Some participants fill up the CBSEI 1 hour after delivery while the others complete the CBSEI at 4 hours after delivery. This will cause some difference in the findings as the timing was not fixed. From this research, it shows the benefits of practicing yoga during antenatal in helping pregnant ladies to cope with stress, relieves discomforts during antenatal and also increases the coping mechanism during labour through the practice of breathing exercise and relaxation techniques. As a midwife and a yoga instructor, I have witness some cases which the mother had learned yoga during antenatal and have a positive outcome in coping labour contractions. As in a study done by Chuntharapat et.al. (2008), the result shows by practicing yoga or three times a week for 30 minutes a day will decrease discomfort during pregnancy, decrease pain during labor and shorten the labor process due to the enhancement of coping mechanism. As in Malaysia, most of the women do not exercise during pregnancy. From this assignment, I would like to propose to the hospital management to encourage yoga programme as one of the programme in antenatal class to build awareness in pregnant mothers and the public in this country, bringing from good care of the hospital to excellent care! However, the hospital that I am practicing is a catholic hospital, most of the Muslims and Catholics in my country do not practice yoga as their perception on yoga is a religious practice and it is related to meditation. Hence, to respect different religions in a multiracial country, I would like to look for more evidence on this matter to clarify the uncertainties, so that the Muslims women and Catholics women can also beneficial on this programme. In order to implement new practices, a clear vision, a good leadership and sufficient evidences are needed to help change the culture of practice. Hockenberry et. al. (2008) noted that if there is no incorporation of the hospital environment, there will be no significant changes in practice. On top of that, audit on current practices is important to ensure the quality in current practice; audit need to be done to encourage quality improvement. When an organization need to change a practice, evidences are needed to encourage change and audit is to decide which evidence to follow will benefit the patients most as well as to monitor the staff compliances to the new practices. Audit need to make sure that the hospital staff are trained and accreditated by experts before commencing new practices to guarantee safe practice. Research, audit and quality improvement work hand in hand to provide quality care to patients (Hill Small, 2006). In conclusion, as a healthcare worker, we are encouraged to update our knowledge constantly not only by reading evidence based research and also to analyse the content critically whether it is valid and reliable before turning it to the new practice in our practice area and it is supported by Haynes et. al. (2002), he thinks that there is no purpose of an excellent research done but there is nobody to implement the research findings into practice. In line with this, nurses must be able to evaluate the strength of the research findings before implementing in order to provide a safe evidence based practice to patients (Nolan Bradley, 2008). Reference Aveyard, H. and Sharp, P. (2009) A Beginnerâ„ ¢s Guide to Evidence Based Practice in Health and Social Care Professions. Maidenhead: Open University Press. Beddoe, A.E. Yang, C.H.P. Kennedy, H.P. Weiss, S.J. and Lee, K.A. (2009) The Effects of Mindfulness-Based Yoga during Pregnancy on Maternal Psychological and Physical Distressâ„ ¢, Journal of Obstetric, gynecologic and Neonatal Nursing, 38, pp.310-319. Chuntharapat, S. Petpichetchian, W. and Hatthakit, U. (2008) Yoga during Pregnancy: Effects on Maternal Comfort, Labor pain and Birth Outcomesâ„ ¢, Complementary Therapies in Clinical Practiceâ„ ¢, 14, pp.105-115. Cleary-Holdforth, J. and Leufer, T. (2008) Essential Elements in Developing Evidence-Based Practiceâ„ ¢, Nursing Standard, 23(2), pp.42-46. Duncombe, D. Wertheim, E.H. Skouteris, H. Paxton, S.J. and Kelly, L. (2009) Factors Related to Exercise over the Course of Pregnancy including Womenâ„ ¢s Beliefs about the Safety of exercise during Pregnancyâ„ ¢, Midwifery, 25, pp. 430-438. Furlow, M.L. Patel, D.A. Sen, A. and Liu, J.R. (2008) Physician and Patient Attitudes towards Complementary and Alternative Medicine in Obstetrics and Gynecologyâ„ ¢, BMC Complementary and Alternative Medicine, 8(35). [Online] doi: 10.1186/1472-6882-8-35 (Assessed: 9 April 2010) Goding, L. and Edwards, K. (2002) Evidence-Based Practiceâ„ ¢, Nurse Researcher, 9(4), pp. 45-57. Guillemin, M. and Gillam, L. (2004) Ethics, Reflexivity, and Ethically Important Moments in Researchâ„ ¢, Qualitative Inquiry, 10(2), pp.261-280. Haynes, R.B. Deveraux, P.J. and Guyatt, G.H. (2002) Physiciansâ„ ¢ and Patientsâ„ ¢ Choices in Evidence Based Practiceâ„ ¢, British Medical journal, 324, pp.1350. [Online] doi:10.1136/bmj.324.7350.1350 (Assessed: 20 April 2010) Hill, T. and Lewicki, P. (2007) Statistics Methods and Applications. Tulsa: Statsoft. Hill, S.L. and Small, N. (2006) Differentiating between Research, Audit and Quality Improvement: Governance Implicationsâ„ ¢, Clinical Governance: An International Journal, 11(2), pp.98-107. Hockenberry, M. Walaen, M. Brown, T. and Barrera, P. (2008) Creating an Evidence-Based Practice Environment: One Hospitalâ„ ¢s journey, Journal of Trauma Nursing, 15(3), pp.136-144. Nolan, P. and Bradley, E. (2008) Evidence-Based Practice: Implications and Concernsâ„ ¢, Journal of Nursing Management, pp. 388-393. Polit, D.F. and Beck, C.T. (2006) The Content Validity Index: Are You Sure You Know Whatâ„ ¢s Being Reported Critique and recommendationsâ„ ¢, Research in Nursing Health, 29, pp.489-497. Redman, B.K. (2003) Measurement Tools in Patient Education 2nd Edition. 2nd edn. Broadway: Springer Publishing Company. Robson, C. (2007) How to Do a Research Project: a Guide for Undergraduate Students. Cambridge: Blackwell Publishing. Rycroft-Malone, J. Harvey, G. Seers, K. Kitson, A. McCormack, B. and Titchen, A. (2004) An Exploration of the Factors that Influence the Implementation of Evidence into Practiceâ„ ¢, Journal of Clinical Nursing, 13, pp.913-924. Sackett, D.L. Rosenberg, W.M.C. Gray, J.A.M. Haynes, R.B. and Richardson, W.S. (1996) Evidence Based Medicine: What It Isnâ„ ¢tâ„ ¢, British Medical Journal, 312(1), pp. 71-72. Satyapriya, M. Nagendra, H.R. Nagarathna, R. and Padmalatha, V. (2009) Effect of Integrated Yoga on Stress and Heart Rate Variability in Pregnant Womenâ„ ¢, International Journal of Gynecology and Obstetricsâ„ ¢, 104, pp.218-222. Scudder, L. (2006) Using Evidence-Based Informationâ„ ¢, The Journal for Nurse Practitioners, March, pp. 180-185. Settler, C.B. (2003) Role of the Organization in Translating Research Into Evidence-Based Practiceâ„ ¢, Outcomes Management, 7(3), pp.97-103. Timmins, F. (2006) Critical practice in Nursing Care: Analysis, Action and Reflexivityâ„ ¢, Nursing Standard, 20(39), pp.49-54. Tiran, D. and Chummun, H. (2004) Complementary Therapies to Reduce Physiological Stress in Pregnancyâ„ ¢, Complementary Therapies in Nursing Midwifery, 10, pp. 162-167. Wadsworth, P. (2007) The Benefits of Exercise in Pregnancyâ„ ¢, The Journal for Nurse Practitioners, May, pp.333-338. Zeitz, K. and McCutcheon, H. (2003) Evidence-Based Practice: To Be or Not To Be, This is the Question!â„ ¢, International journal of Nursing Practice, 9, pp.272-279.

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Visual technology - Assignment Example The artist creates this dimension. Therefore, art becomes unique as it comes to be the product of the artist’s imagination. Literally, reproduction of arts means to recreate art, a camera mimicking the way eye sees the object is an example of it. By introducing the term â€Å"politics† Benjamin referred to the manipulation of art for personal gains. It is similar to discovering nuclear energy but if it was going to be used to destroy Hiroshima and Nagasaki it was certainly not the intention of the scientist that discovered it in the first place. The politics of arts allows the images to be reused and modified with the use of text and sound and soft fares to produce the desired results. It is hard to come to a conclusive perception when I look at this painting. To me, this artwork is by far the most elegant and extraordinary work by Picasso. The simplicity in the play of color is exquisite. It should look unbalanced and smudgy with this unusual play of colors yet it is extremely balanced and has a serene effect on the emotional state of mind. Physically, I feel alive and liberated when I look at this artwork. The immediate impact on the physical state is the acknowledgement that this ‘renegade’ dimension exists and speaks directly to me. Intellectually, this painting does not fall into the conventional realm because it seems off-the-cuff or a deviation from the monotonous lifestyle. To me, it is the difference between listening to the symphonies of Mozart and hip-hop music. I instantly think about my childhood when I look at this artwork. Without a doubt, this painting triggers nostalgia in me. I start relating how I always wanted to be different, the way this painting seems different from the others. If Picasso could paint this today it would be a messy room of a teenager who plays guitar and loves football. The newness of this image is the comfort in knowing that something exists with which

Cloud Computing Research Paper Example | Topics and Well Written Essays - 1000 words

Cloud Computing - Research Paper Example The only requirements for a person to access the applications include a computer system and an internet connection. â€Å"As long as a computer has Internet access it will be able to use the application† (Cheow 2010). Categories of Cloud Computing Cloud computing falls into three major categories, which include utility computing, web services, and Software-as-a-Service. SaaS SaaS is the simplest way of computing because it is a single application. Cheow (2010) states, â€Å"Because there is only one application it is very easy for the company to maintain†. SaaS model helps companies save their expenses on buying hardware and software. This model also removes the maintenance costs of the computer systems and applications. â€Å"This type of cloud computing delivers a single application through the browser to thousands of customers using a multitenant architecture† (Knorr & Gruman, n.d.). Utility Computing If we talk about utility computing, we can say that it is, at present, a supplemental kind of computing because it is used for the fulfillment of such needs that are not very critical in nature. â€Å"Early enterprise adopters mainly use utility computing for supplemental, non-mission-critical needs, but one day, they may replace parts of the datacenter† (Knorr & Gruman, n.d.). Web Services The third type of cloud computing .i.e. ... Importance of Cloud Computing Unlike traditional business applications, cloud computing eliminates the issues of hardware and software failure for its users. In traditional settings, companies need to install, configure, test, and run every application on their own. However, with cloud computing, companies run their business processes in the form of clouds where they do not need to worry about any technical failure or information misuse. Using cloud-computing system, an industry can experience a considerable amount of workload shift because many of the tasks are performed online. Strickland (n.d.) states, â€Å"Local computers no longer have to do all the heavy lifting when it comes to running applications†. Disadvantages of Cloud Computing Along with a number of advantages of cloud computing, there also exist negative aspects of using cloud-computing services. Two of the drawbacks of cloud computing include security and privacy concerns and loss of control due to increased de pendency. Security is the biggest concern because users of cloud computing services usually do not feel safe while sending their private data to the cloud service providers. Moreover, increased dependency on cloud service providers is also a negative aspect of cloud computing. Companies Providing Cloud-Computing Services In traditional settings, companies need to design, configure, implement, and maintain the business applications. They need to hire experts who can perform the role of application development but with cloud computing, companies run their business processes in the form of clouds where they do not need to worry about any technical failure related to hardware and software. There exist some cloud-computing services providers, which provide management services, such

Service Quality Dimensions That Affect Customer Satisfaction Commerce Essay

Service Quality Dimensions That Affect Customer Satisfaction Commerce Essay The objective of this chapter is to formulate the research question and develop the conceptual framework for the study. A detailed overview of how the research was conducted, the operationalisation of the variables, hypothesis formulation and the research methodology used which covers data collection methods used, sample selection and method used for data analysis are discussed. 3.2 Research Question Based on the review of literature and the research problem, the following question has been formulated in order to determine the relationship that exists between the various dimensions of customer expectation and the service quality by the insurance companies for motor insurance policy holders. It is important to understand this relationship as it would enable the companies in the insurance sector to improve their service quality and to match and to exceed customer expectations and create a knowledge base in order to stay ahead in the market. The following research questions were derived from the research problem and the review of the literature. What are the Service Quality Dimensions that affect customer satisfaction in the Motor Insurance industry in Sri Lanka? What is the extent to which customers are satisfied with the services received from the Motor Insurance Industry? What are the gaps between customer Service Quality and Customer Satisfaction of Motor Insurance policy holders? 3.3 Conceptual Framework Service Quality Dimensions Dependant Variable Independent Variables [Source: Developed by the Researcher] 3.3.1 Rationalization of the conceptual framework Conceptual framework was replicated based on Zeithaml, Parasuraman Berry (1991), to test this study in the Motor Insurance Industry in Sri Lanka. On the detailed literature review, the research identified five factors that impact value delivery to customer of Motor Insurance services. These five service quality dimensions of SERVQUAL Model by Parasuraman and Berry et el (1985), have been derived as independent variables. These variables fall under Service providers Perspective in the conceptual framework. The dependent variable was identified as Customer satisfaction. The gaps in quality of service will be identified by using these five dimensions. This is the gap between the Customers expectation and experience of the Motor Insurance service delivery, which will subsequently have an impact on customer satisfaction. Rust Oliver (1994) and the Nordic Model (Gronoos, 1992) too emphasizes the importance of meaning of the gap between expectations and the experience in service industry. Hence all these have been included in the conceptual framework. 3.3.2 Definitions for Variables Tangibles Modern Equipment and Technology, Visually appealing physical facilities neat appearing employees and agents, visually appealing materials associated with services. Appearance of physical facilities, equipment personnel and communication material (Parasurman et.al,1998 and 1990). Reliability Keeping promises when promises to do something by a certain time , offering products and services of utmost quality, issuing contracts with clear, transparent and non ambiguous terms, settling customers claims with no unnecessary delays, ,showing sincere interest when solving customers problems, offering services right the first time without unnecessarily discomforting customers, providing services within the specified contract time limits, issuing error free bills, statements, receipts, contracts, claims and other documents. Ability to perform the promised service dependably and accurately (Parasurman et.al,1998 and 1990). Responsiveness telling customers exactly when the services will be performed, doing their best to give prompt service to customers, always willing to help customers, never being too busy to respond to customers requests . Willing to help customer and provide prompt service (Parasurman et.al,1998 and 1990). Assurance Customers feeling safe in their transactions, behavior instilling confidence in customers, being consistently courteous with customers, having employees and agents with the necessary knowledge to give professional services to customers. Knowledge and courtesy of employees and their ability to convey trust and confidence (Competence, courtesy, creditability and security of the service), (Parasurman et.al,1998 and 1990). Empathy Giving customers individual services, operating hours convenient to all customers, giving customers personal attention, having the customers best interest at heart, understanding the specific needs of customers. Caring, individualized attention the firm provides its customers (Access to organizations representatives, communication and understanding the customer), (Parasurman et.al,1998 and 1990). As presented in the above conceptual model, the independent variable of dimensions of service quality will be studied. Price is also a relevant variable. However, the focus of this study is on service quality attributes and therefore is not within the scope of this study. Theoretical research has presented several different service quality definitions. However, Parasuraman et al. (1985) definition of service quality, which has been used in many industry studies before, was adopted. Service quality is defined as the degree of discrepancy between customers normative expectations for the service and their perceptions of the service performance. The SERVQUAL model developed by Parasuraman et al.(1998), is therefore used for this study. Hypotheses Formulation Hypothesis is a testable speculative statement delineating the relations between all the elements of a theory (Page Meyer, 2000). The development of hypothesis was categorized into two sections based on insurance companies customers. Accordingly five hypotheses were developed. The source for all hypothesis development was based on the conceptual framework. Furthermore, the hypotheses based on insurance companies were primarily related to the importance of each expectation. The hypotheses developed for customers were based on the service quality of obtaining Motor insurance policies. When developing hypothesis, Literature review under section 2.18, according to the study carried out in Greece and Kenya by Rand, (2006), it was proved that there is a relationship between service quality dimensions and expected and experienced service quality by the customers in the insurance industry. 3.5 Hypothesis Rationalization Expected Experienced Service Quality in relation to Reliability dimension in motor insurance According to Parasuraman et al (1985) Reliability dimension measures the ability to perform the promised service dependably and accurately. As per the research carried out by Rand (2006) , it says that the Reliability has a huge impact on the service quality in service industry. Especially in a industry like Motor insurance it has a huge effect. Consumers satisfaction choice of service provider and service quality evaluation are influenced by the expectations of the consumer, (Trinh et al.2000). As mentioned above in the research carried out in Kenyan Insurance industry by Rand (2006), it is noted that most of the researchers (Rand, 2006; Trinh, 2000) have identified that Reliable service always has a positive impact on the service quality provided by the company. Therefore it is worthy to investigate the relationship among Expected Experienced Service Quality in relation to Reliability dimension in motor insurance. It could be hypothesized that, H 1 0 There is no relationship between Expected Experienced Service Quality in relation to Reliability dimension in motor insurance H 1 There is a relationship between Expected Experienced Service Quality in relation to Reliability dimension in motor insurance Expected Experienced Service Quality in relation to Responsiveness dimension in motor insurance The Dimension Responsiveness explains about willingness to help customers and provide prompt service. Responsiveness factor significantly has a positive effect on Customer satisfaction. Quality service provision, customer satisfaction and customer loyalty has recently been emerging as important parameters for both researchers and practitioners in turkey. This has been proved through a research carried by Yale University in Turkey (2009) on Service Quality in healthcare. This research was also based on the service quality. To provide superior service quality responsiveness is a very important factor since service providers should always willing to help customers. Especially in an industry such as insurance it is a very decisive factor since the customer is expecting a prompt action for their problems. So responsiveness factor effectively contributes to reduce the gaps between the Expected Experienced Service quality by the motor insurance policy holders. Therefore it is worthy to identify the relationship between the Expected Experienced Service Quality in relation to Responsiveness dimension in motor insurance. So it could be hypothesized that, H 2 0 There is no relationship between Expected Experienced Service Quality in relation to Responsiveness dimension in motor insurance H 2 There is a relationship between Expected Experienced Service Quality in relation to Responsiveness dimension in motor insurance Expected Experienced Service Quality in relation to Assurance dimension in motor insurance Assurance dimension is all about, the knowledge, competence, and courtesy of service employees and their ability to convey trust and confidence. Ducker (1991) defines service quality as What the customer gets out and is willing to pay for rather than what the supplier (of the service) puts in? Hence, service quality is often conceptualized as the comparison of service expectations with actual performance perception (Bloemer, Ruyter et al. 1999; Kara, Lonial et al. 2007). Service science literature often relies on SERVUQAL as an instrument to measure quality of service provided. SERVQUAL scale was developed based on a marketing perspective with the support of the Marketing Science Institute (Parasuraman, Zeithaml et al. 1986). It is very important to keep the assurance on the agreement made the company to their customers. Specially in the insurance industry, it is crucial factor to offer the assurance of the services provided. Therefore it is worthy to identify the relationship betwee n the Expected Experienced Service Quality in relation to Assurance dimension in motor insurance. So it could be hypothesized that, H 3 0 There is no relationship between Expected Experienced Service Quality in relation to Assurance dimension in motor insurance H 3 There is a relationship between Expected Experienced Service Quality in relation to Assurance dimension in motor insurance Expected Experienced Service Quality in relation to Empathy dimension in motor insurance Empathy dimension is about caring individualized attention provided to customers. According to the expectancy disconfirmation model, customers satisfaction is a function between his/her service performance perception and expectation (Pizam and Ellis, 1999), and illustrated as Satisfaction=f (Perception-Expectation). It is very important to offer individual attention to the customers specially in the service industry. Trustworthiness is one of the critical factors in any industry for the customers. Empathy factor defines that. Keeping the customer complaints and criticisms is very important in the motor insurance industry as the competition is very high. If the organization looses one policyholder that may affect the organization immensely. Therefore it is worthy to identify the relationship between the Expected Experienced Service Quality in relation to Empathy dimension in motor insurance. So it could be hypothesized that, H 4 0 There is no relationship between Expected Experienced Service Quality in relation to Empathy dimension in motor insurance H 4 There is a relationship between Expected Experienced Service Quality in relation to Empathy dimension in motor insurance Expected Experienced Service Quality in relation to Tangibility dimension in motor insurance Tangibility is all about appearance of physical facilities, equipment, ambience, personnel and communication materials. The rewards to firms that establish a loyal customer base have been well documented (Armstrong and Symonds, 1991: Heskett et al. 1994: Reichheld amd Sesser, 1990). In general, increased loyalty leads to lower cost of servicing the firms customers, reduced marketing expenditure, increased business from the existing customer base and greater profits. The internal appearance and the facilities is also affecting the service quality. It in turn helps the company to retain their customer and reduce the unnecessary costs such as saving costs. Therefore it is worthy to identify the relationship between the Expected Experienced Service Quality in relation to Tangibility dimension in motor insurance. So it could be hypothesized that, H 5 0 There is no relationship between Expected Experienced Service Quality in relation to Tangibility dimension in motor insurance H 5 There is a relationship between Expected Experienced Service Quality in relation to Tangibility dimension in motor insurance 3.6 Operationalization Based on the SERVQUAL scale and using five service quality dimensions. Concepts Variable Indicator Measure Reliability Price/Premium Reasonable Premium rates In order to evaluate customer expectation and experience , a 5 point scale was used. To measure customer perception the rating scale , for 1 Not important and 5 Very Important . And to measure customer experience the rating scale, for 1 Not Experienced at all , to 5 Experienced at a high level Product Range Range of products offered, to suit individual requirements Physical Access Availability and convenience of facilities and branch network Electronic access Availability of Telephone and online facilities Service delivery Level of service as expected/promised Responsiveness Waiting time Average time taken to process a claim after an accident In order to obtain data on average time spent with the Insurance providing company to get an service rating scale from 1 to 5 was used . for 1 Not Experienced at all , to 5 Experienced at a high level . In order to evaluate customer expectation and experience , a 5 point likert scale was used. Level of responsiveness of the Insurance staff Time taken to respond to an issue Assurance Stability The guarantee of safety when making a claim In order to evaluate customer expectation and experience, a 5 point likert scale was used. Safety of the investment Making the actual cost Convenience to the holder Confidentiality Maintenance of confidentiality Product Knowledge The knowledge of the product/features by the staff members Empathy Benefits Special benefits and features for the customer In order to evaluate customer expectation and experience, a 5 point likert scale was used. Attention Personal attention to customers and recognizing regular customers Caring Helping customers in a pleasant and caring manner Approachability Easy to approach staff members Tangibles Environment Pleasant ambiance inside the company In order to evaluate customer expectation and experience, a 5 point likert scale was used. Facilities Facilities provided to the policy holders Parking Availability of adequate parking at the Insurance company Number of repair centers in Sri Lanka Directional signs and information Availability of adequate instructions and directions of counters and procedures and easy directions when filling forma and other documents Appearance of Staff members Staff members are dresses appropriately Layout Convenient layout of the company interior Customer Satisfaction Level Satisfaction Level of satisfaction of the insurance company in relation to each service quality dimension A 5 point likert scale was used to measure the likelihood of these indicators ranging from Very Likely to Highly Unlikely. In Order to measure the time length of the relationship the respondent has with the Insurance provider , 5 time slots were presented where by the respondent could select his/her most relevant time slot. Study was carried out to ascertain the validity and Reliability of the Questionnaire. This was done as the instrument to use collected data was not tested previously. 3.7 Research Methodology The Research methodology is the way research is conducted. Research methodology refers to the theory of how research should be undertaken (Saunders, et al 2005). The first step of the study is to assess the service quality gaps in relation to the customer expectations and experience among five leading Insurance Companies which deals with Motor insurance in Sri Lanka and with each of the five SERVQUAL dimensions. This study helps to determine the average service quality gap score (between customers expectations and experience) for each service quality dimensions and how it affects the overall customer satisfaction. The second step each Insurance companys gap scores for each service quality dimensions. This is to examine the differences within each insurance company when providing services to the customers and to compare the differences of the overall satisfaction of customers in each insurance company. Stage three measured the level of satisfaction of the customers and the fourth stage examines the relationship between the expected and experienced service quality gaps by the customers for each dimensions. The final Stage integrates the data obtained from the five insurance companies and conclusions were prepared in accordance to the findings. Based on research problem, preliminary data was the main source of data used in this research. Consistent with the deductive research method, data collection through questionnaires has been a long proven method to collect valid and reliable data (Page Meyer, 2000). The deductive method refers to the use of a theory to generate prepositions or hypothesis that can be tested. Thus, the research method has been chosen for this study is based on deductive method. 3.7.1 Method of Data Collection In this study the primary data was collected through a self completion questionnaire from customers of the selected five Insurance companies. The study followed the Quantitative method to gather and analyze the data. The secondary data was collected from secondary source such Government publications (IBSL Annual Report 2010 Central Bank Annual Report 2010), Company Annual reports and from other publications. 3.7.2 Selection of Sample For the purpose of gathering data on customer expectation and customer experience, a total number of 250 questionnaires were distributed, from which a total of 224 valid Reponses were received and selected for data analysis. Individuals within a sample are chosen by chance rather than by the researcher or by being self-selected (Page and Meyer, 2000). A simple random sampling technique was used for this study, so that each unit of the population will have a known and equal chance of being selected. The sample was spread across Motor insurance policy holders of Five different Motor insurance providing companies in Sri Lanka. A brief description of selected five companies are given below, Aviva NDB Insurance PLCPLC Aviva NDB Insurance PLCtook wing as a leading player within Sri Lankas insurance landscape in the late 1980s. Over the years, the Companys good governance practices, ethics and innovation have helped it to soar to new heights. The dynamism and creativity of the Aviva NDB Family has been the engine of its evolution into a superior entity in the insurance and financial services sector. The Company has recorded a Consolidated Revenue of Rs. 7, 265 million with an impressive growth rate of 23.7% over the previous year. The Revenue reported for the current year includes Rs. 171.2 million being the gross-up of tax withheld at source on Government Securities. Excluding this, the growth for 2010 stands at 20.8%. Union Assurance PLC Union Assurance is a composite insurer transacting both Life and General business including personal insurance, in operation since 1987. A Public Quoted Company, UA entered the insurance arena at the time the private sector was permitted to set up in insurance, following the enactment of the Control of Insurance (Amendment) Act No. 42 of 1986. Committed to pursuing the highest standards of service and security, UA is backed by the corporate might of blue chip companies John Keells and Carson Cumberbatch. UAs reinsurers are world leaders, chosen for their dependability and total security. In short, they are the best in the business. The companys paid up capital as at 31 December 2009 is Rs 250 million and net asset base, Rs 1.6 billion, also indicates the companys  Ã‚   financial stability and strength, and places it firmly at the apex off private insurance service providers in Sri Lanka. Asian Alliance Insurance PLC Within a very short time period, Asian Alliance Insurance PLC has achieved what every company yearns for; it has touched the hearts of its customers with outstanding levels of professionalism and service. Asian Alliance commenced operations in December 1999 with 50 employees. Today the company has grown from strength to strength to become one of Sri Lankas leading players in the insurance industry. The company caters to an ever-growing client base that consists of corporate and individual clients. The secret behind the Asian Alliance Insurance success story lies in its ability to offer tailor-made insurance solutions to its customers. Sri Lanka Insurance Cooperation Sri Lanka Insurance Corporation which was established in 1962 as a State Owned Corporation was converted to a Limited Liability Company for a brief period of 6 years and was re-instilled in the state sector on the 4th June 2011, further strengthening the Corporation as the strongest and the largest Insurer in the Country. Sri Lanka Insurance is now backed by government protection and service excellence on par with the best in the private sector. At present Sri Lanka Insurance has over 120 Branches Island with an unparalleled assets base under management of over Rs.64.8 billion with a Life fund of over Rs.39 billion and over one million policies in force. The Motor Insurance Department has branched off into unrelated areas such as Theft only, Fire Only, Fire and Theft, 3rd Party Fire and Theft and Act only; once again, offering covers aimed at satisfying their clientele to a maximum. Ceylinco Insurance PLC From a solid and innovative start in 1939, Ceylinco Insurance Company Limited has faced numerous changes and challenges and has successfully weathered them all. Registered as Ceylinco Insurance Company Limited in 1987 and commenced business on the 14th of January 1988, in the spheres of Life and General Insurance, we have grown from strength to strength. Today, they have become the leading insurance company in Sri Lanka, with the largest network of branches and agents in the insurance industry. Their goals include becoming the leading provider of protection and financial security in Sri Lanka and in select international markets. 3.7.3 Structure of the Questionnaire Part one of the questionnaire focuses on demographic features of the respondents. Part two focuses on the dimensions. Questions from 1.14 entail in Reliability dimension and thereafter, based on Operationalisation, 10 questions focus on Responsiveness dimension 16 questions represents the Assurance dimension and 9 questions on Empathy dimension. Final dimension which is Tangibility has 10 questions. Each dimension has 2 columns to rate expected and experienced using a likert scale of 1.5, not important at all being No.1 and Very important being No.05. For the study, questionnaire was designed in accordance with the research objectives. The Questionnaire is based on the five SERVQUAL dimensions presented by Parasuraman et al (1985) and the Gap 5 which is also known as the Customer gap (the gap between customer expectation and experience) of the SERVQUAL mo del presented by Parasuraman et al (1985) , modified and tailored to specific service quality requirements of the Motor Insurance industry. Table 2: Structure of the Questionnaire Questionnaire Variables Measurement Items Section 1 Personal details Section 2 Measure Service quality perceptions of five insurance companies in general from individuals Section 3 Measure Service Quality dimensions separately to find out Expected Experienced service quality by each customer. 3.1 Reliability 3.2 Responsiveness 3.3- Assurance 3.4 Empathy 3.5 -Tangibility 3.7.4 Method of Data Analysis The Data was collected through a Questionnaire. The study was carried out using Descriptive statistics as well as Inferential Statistics. Under Inferential statistics an ANOVA analysis and paired sample two test were carried out. Descriptive Statistics Descriptive statistics  are used to describe the main features of a collection of  data  quantitatively. Inferential Statistics Inferential statistics are used to draw inferences about a  population  from a  sample. T-Test This test is used to compare the means of two samples (or treatments), even if they have different numbers of replicates. ANOVA test The Analysis Of Variance, popularly known as the ANOVA test, can be used in cases where there are more than two groups. The following methods have been used to analyze the data obtained from the study. Gap technique The gap technique will be used to analyze and identify the service quality gaps between expectation and experience of customers. Comparative Analysis A comparative analysis will be conducted in relation to the gap technique between the five Insurance companies using graphs and tables. Relationship Analysis Under Inferential Statistic analysis paired sample two test will be conducted to analyze the relationship between Expected service Quality and Experienced Service Quality by the customers. 3.7.5 Pilot Study Pilot study was carried out to ascertain the reliability and validity of the questionnaire. The instrument used to gather data in a research should be valid and reliable (Page Meyer, 2000). 3.8 Summary The purpose of this chapter was to explain and formulate the research questions and to provide a conceptual framework. The research question was formulated and thereafter the conceptual framework was designed using Service Quality as the independent variable and Customer Satisfaction being the dependent variable. Thereafter, the operationalization for the study was designed in accordance with the features/qualities of motor insurance industry. Given this, the methodology for the researcher was presented which included methods of data collection, selection of the sample, the questionnaire design and the methods of data analysis. Finally the limitations of the study were mentioned.

HIV Treatments and Reducing Drug Resistance Essay -- Biology Medical B

HIV Treatments and Reducing Drug Resistance Abstract HIV is a retrovirus that will constantly attack human’s immune system once an individual is infected and will eventually develop to AIDS, often a deadly sexually transmitted disease. Currently, there are different kinds of antiretroviral treatments available for patients who are tested to be HIV positive as well as patients with AIDS. HIV can easily develop resistance to its treatment through mutation each generation, which leads to ineffectiveness in treatment. The only way to continue to fight off HIV is to change treatment that is still available. Patients have to cooperate with experienced doctors by adhering to their professional recommendations, while doctors are responsible for closely monitoring the patient’s conditions through test results and their body’s response to treatment, as well as helping them to live healthily without serious damage to their immune system over a long period of time. Human Immunodeficiency Virus, commonly known as HIV, is the retrovirus that causes a desperate worldwide epidemic that afflicts human beings – Acquired Immunodeficiency Syndrome, abbreviated as AIDS. When the body is infected with HIV, the immune system will respond by making antibodies to fight against this particular infection (AIDS.org, 2003). As a result, to determine whether a person is infected, a sample of blood is extracted and the test will look for antibodies fighting against HIV. This kind of blood test is known as HIV testing. Even though HIV is the actual cause of AIDS, a person who is positive in the HIV Testing does not necessarily mean that the person has AIDS (AIDS.org, 2004). When a person is infected with HIV, the virus will gradually damage the immune sys... ...s.org/factSheets/102-HIV-Testing/html AIDS.Org. (2004, August). Immune Restoration Overview. Information Fact Sheets. July 17, 2005: www.aids.org/factSheets/470-Immune-Restoration-Overview.html AIDS.Org. (2004, September). Opportunistic Infections. Information Fact Sheets. July 17, 2005: www.aids.org/factSheets/500-Opportunistic-Infections.html AIDS.Org. (2004, March). Viral Load Tests. Information Fact Sheets. July 17, 2005: www.aids.org/factSheets/125-Viral-Load-Tests.html AIDS.Org. (2003, November). What is AIDS?. Information Fact Sheets. July 17, 2005: www.aids.org/factSheets/101-What-is-AIDS.html Avert.Org. (2005, July). Continuing Antiretroviral Treatment. Continuing HIV Treatment. July 21, 2005: www.avert.org/couttrt.htm The Body. (2003, April). Living with HIV/AIDS. Center for Disease Control and Prevention. July 17, 2005: www.thebody.com/cdc/living.html