The Interpersonal Relationships On Customer Satisfaction Commerce Essay

The Interpersonal Relationships On Customer Satisfaction Commerce Essay Organisations today operate within a large competitive market so in order to maintain their current customers and gain further customers they must make their organisation attractive. Therefore they should focus on customer loyalty and the importance it plays within the organisation so creating and ensuring customer satisfaction is a very important factor. The general intention of this article is to explore the role played by interpersonal- relayed factors in gaining and developing customer loyalty to the company. Throughout the article we get to know how interpersonal relationships play a part in building customer loyalty and satisfaction towards the firm. We are able to appreciate the difference between customer-and-employee, and employee-and-employee relationships, and the impact they subsequently have on the organisation, both advantageous and otherwise. The customer-and-employee relationship is shown in the article to make a positive input to the firm, as interaction between the front line workers and the customer creates an overall perception of quality provided by the service provider. The article suggests that the social bonding between customer and employee makes the customer more committed and trust worthy of the firm, and consequently more loyal. It emphasises the importance of sales force skills and behaviour in gaining customer trust and developing long term buyer- seller relationships. This will not only develop the customers relationship with the employee but also with the firm thus achieving positive results. The article also highlights reasons why this relationship could have a negative effect on the firm, as the customers would become too loyal to the front line workers. This would have an impact when the employee left the firm as the customer would follow that employee or find another firm, as the relationship the customer had was directly loyal only to the employee. The other relationship which is portrayed within the article is customer-to-customer, which is said to contribute to the development of transactional satisfaction. This also plays a part in the development of long term relations within a firm, by their contact and interaction. Creating a strong bond, customers may interact at a regular basis and remain within their group of friends, this plays a positive effect on the intentional service. But again, same as the customer- to employee relationship, if one of the group of friends leave, they would follow and break their loyalty with that firm. This is a short summary of the main points in the article. It shows that customer satisfaction is a fundamental driver towards loyalty in the service market, and that monitoring the customers satisfaction levels should be a high priority for the service managers. There are tables within the article that help the ideas become clear about the impact of relationships on an organisation. Also the article points out how customer and employee relationships could be improved in order to be even more effective by such methods as personnel selection of front line workers, training to increase relation skills, reward systems based on fostering customer satisfaction and loyalty, and attention being paid to the design of facilities and layouts to develop the interaction between front line workers and customers. But on the other hand nothing can control the risk of a strong social link developing, thus the risk of losing the customers. Therefore it is also important to concentrate on employee sat isfaction in order to reduce turnover levels. Why I chose the article? I chose this article as I was intrigued as to how different relationships affect the customers perception of the company. As this article puts theory into practise we can see the effect it has on the firm. It is set on results collected within a gymnasium. It is interesting to get to know how the firm builds on social bonding with the customers, where the front line workers build friendships and get to know each other on a social basis. In return they gain each others trust and commitment hence the customer is not only loyal to the firm but also to the employee. This shows that customer service must be of a high standard within this particular firm, and I can imagine plays an important role in other organisations too. It contributes to the understanding of the customers and thereby maintains their loyalty. The essence of a salesmanship is the development of a social exchange relationship with buyers, such that economics and social benefits of mutual value can be traded (Tarn and Wong, 2001) The relationship creates a positive impact on the firm, both economically and sociably, and in return this makes customers loyal. Not only does the article show positive outcomes of the relationship, it also shows that problems can occur, thus making it realistic to read. Relationships can have a great impact on the social benefits of the firm, but can also backfire through employee loyalty rather than firm loyalty. Therefore, as shown in the article, if an employee would leave the firm the customer would follow them, as they have created a strong bond. This is interesting to know as it shows how relationships can have a beneficial impact on an organisation, but on the other hand can also be detrimental. This shows the dynamic effect a relationship plays on the firm, therefore firms must handle these situations very carefully and try to overcome the problem by making not only the customers satisfied with the firm but also the employees as well. The article shows that the firm has sat isfied customers as they have fixed membership fees, which they pay for frequent use of the service. But on the other hand it states in the article they found that, †¦the link between social benefits (which require the existence of a friendship relationship between a front- line employee) and the share of purchase in the point of sale is fully mediated by the overall customer satisfaction with the store (Reynolds and Beatty, 1999) This shows the importance of the customer satisfaction levels which generate their loyalty towards the firm. Important to always improve the firm by keeping up with the environmental changes within the industry which plays a competitive role against firms, where each tries to keep their existing customers and gain new ones by making sure they offer the best satisfaction levels of service and thereby enhance their loyalty. The articles role in marketing. Reading this article has enhanced my understanding of the importance that interpersonal relationships play within an organisation in relation to the satisfaction and loyalty of the customer. It has shown that marketing can be put into a very complex situation by the different environmental factors within the organisation and that customers change their way of living according to current trends in the market. The different relationships which develop within the firm have different effects on the performance of the company, which has been discussed within the article. Other authors such as Bolton and Lemon (1999) have likewise said:- Firms seek ways to manage customer relationship over the long term, understanding the dynamics of the service provider- customer relationship becomes a key priority. They believe that the customer relationship should be an important aspect for the organisation to develop and manage correctly in order to gain the best customer loyalty and create the best satisfaction standards. The organisation should understand how customers use the information and experience in deciding their level of usage, which inspires the organisation to use interpersonal relationships. This is especially important in service industries, Companies have begun to embrace the concept of customer life time value (CLV) and have begun moving towards devoting more dedicated resources such as formal and informal selling teams, to manage these precious customer relationships (Jones, E et all. 2005) This highlights the fact that customer satisfaction is important to maintain as it would also contribute to a positive word of mouth for free advertising for the firm, as the relationship which is established between the firm and its customer is critical its survival and success. The other important factor within relationship is communication between the customers and employees to enhance their understanding, Effective communication is seen in employees collaborating, interacting, and engaging with others in ways which help them understand the importance and meaning of that engagement, (Pace, R et all. 1989) This enhances my understanding again of the pressures which are placed on the organisation by dynamic competition, therefore creating a strong relationship with customers can play a very effective and positive role in the organisation. They affect the customers attitude positively towards the organisation, and the reliability and validity of the organisations performance. This is agreed by another author, Buendapudi and Berry (1997), the importance of interrelationship within a firm, they stated that, Relationship marketing has also expanded beyond its initial conceptualisation as a firms efforts to attract maintain and enhance relationships with its customers. This shows the importance of an organisation maintaining a strong relationship with its customers, and the best way of creating that bond is through the front line workers and the customers. This has been called a social bond within the article. It generates the organisations awareness of what the customers want to gain from the organisation and how it should be developed by more knowledge and understanding of the customers needs. This will give the organisation a strategic advantage within the market place. The customer- orientated firm is committed to relationship marketing and employees work together to solve customer problems. Employees morale is a critical success factor in the customer- orientated company, especially for employees who deliver some aspect of a products service bundle (Beatty et all. 1996) This shows that the organisations true mission is to establish an environment that creates value for the customer, employee and the investors. Therefore the importance of the orientation working within any organisation is the importance that the managers must be committed not only to the employees but also to their customers. This would therefore generate relationships within the organisation, and enhance interaction, which is a key variable to maintain the customers. Again this shows the advantage and importance of establishing a strong relationship with customers. The article also showed me that there are disadvantages in creating these strong bonds with customers and employees, and that they could have a negative economic effect on the organisation. If the employee decides to leave the organisation the customer might follow, as they have developed a customer and employee loyalty, not firm loyalty. This is also shown in research that Beatty, Mayer, Reynolds and Lee, (1996) undertook within sales, as they found that organisations lost their customers as they followed an associate who went to work for a competing organisation. The trust and honest relationship the customer had built with the employees within the firm had led the customer to depend on their Sales Assistant, which is a huge disadvantage for the company if the employee left, Firms engaging in relationship selling as a key strategy need to develop and implement specific policies and programs aimed at retaining their customers when successful relationship- building Sales Assistance choose to leave the firm. The strength of a relationship can be very powerful and create difficulties for an organisation to maintain their customers once an employee leaves. Further research is needed within this field, and also the issue of customers ability to maintain a relationship, either with a firm or employee. Not only does the fact that an employee leaving the company may remove the customers loyalty from the firm, but there are other factors that werent included in the article. The behaviour of another customer will affect another customers experience within an organisation. For example Grove and Fisk (1997) found that, standing in line is a serious challenge for many people, extended waits that often accompany many service encounters can put people in a bad mood, tempers can flare and disruptive behaviour can result. This could have a huge impact on a customers attitude towards the firm. But satisfying all customers is impossible as everyone has a different idea regarding what is appropriate in any situation. Therefore in this particular situation line managers were suggested to entertain customers while queuing to ensure that problems among customers didnt occur. To help recover from difficult situations such as these and to stabilise relationships, †¦ recruitment, subsequent training and appraisal methods should also be focused on the service works customer orientation (Bove et all, 2000). This brings together all the different ideas I have developed and understood about how important relationships can be within an organisation, but yet again, on the other hand, a disadvantage.

The Dead Fish Society :: Personal Narrative Essays

The Dead Fish Society It was a dark and stormy day. It the first day of class and Bletchley Boys School - a school rich in tradition, and rich in the traditional sense. I will never forget my first year at that school, for I met a teacher who changed my life forever. His name was John Flounder. He taught poetry - a class that was not exactly the most macho class, but one that was required. I sat in the classroom of Poetry 101 wondering what I was doing there. I looked around at the 30 other pimply faced boys who sat wondering the same thing. We were rich, we would be successful, and nobody ever needed poetry while holding a board meeting. I would soon change my mind. He entered the classroom through the front door, whistling a song vaguely familiar - the theme to "The Andy Griffith Show." I would later learn that its real title was "The Fishing Hole." He strolled through the class and out the back door. As we sat in wonder, he popped his head back in and said "Well, come on, then." We followed him out into the hall. "Men, I want to read something to you, " he said. "I gaze upon the still waters, my hair ruffles in the quiet breeze, the worm in my fingers squirms to be free, he does not like the hook. O worm, how many of those like me, didst thou consume before today ? a long dead fisherman perhaps are you ? to help me with my task." Flounder looked up for a moment and then at us. "What does this mean to you men ?" he asked. After a moment of completely blank stares he continued, "the author is trying to give you a message - 'Carpe Piscus.' Do any of you know what that means ?" Ralph Finkel did. Ralph always knew. "It means 'Seize the Fish!'" "Yes! Seize the Fish! It means that life is too short to spend your time in school. Go fishing, my boy! Look at the faces in these pictures, " he said as he pointed to one of the many pictures in the display case. "these are young men just like you. Can you hear them calling out ? They are saying 'Carpe Piscus - Seize the Fish.

Eminem :: essays papers

Eminem In â€Å"like Eminem says, why all the fuss?† featured in The Age journalist Shaun Carney defends Eminem and his lyrics. Carny stresses that Eminem winning the category should not be so controversial when Mathers is clearly depicting a role. His contention through out the article is to convince the reader to refrain from reaching to eminem, as a parody. Carny effectively seeks the neutral role during the story. He leans neither way. Carny signifies specific word choice and language devices to shock his audience and to create an underlying sense of non-prejudice, realistic view on society perhaps to open up the views of a small-minded prejudice race. Carny’s headline is very striking it creates tension and almost gives a sense of obligation to the audience to read on. Carneys headline is used as a device to capture the readers immediate attention. This foreshadows the final remark made by Carny, â€Å"so much for scandal,† now leaving the reader with a question , a parallel between start and finish tightly constructing the article. This clever technique leaves the reader open handed and open-minded to think about the actual topic of the article. Though Carny’s contention through-out the article is to suggest Eminem is â€Å"Just Joking’, he is not all, scared of presenting Marshall as ‘not so nice’ explaining him as â€Å"a 28 year old production of a peripatetic white-trash upbrining.† Then contradicting himself saying â€Å"Mathers all wounded and victimised by his sole-parent upbrining .† Is this not a slight use of sarcasm? putting himself in the biased head of an out reaged parent. Carney conveys his opinion in a very structured way. He uses Eminem song lyrics to show that he is a role player and only joking, â€Å"I’m just playin ladies. You know I love you.† Carney uses other examples to reassure people say the situations he raps about are â€Å"just clownin’.† Although readers may not realise, Carney these more realistic, human-like comments as a source of evidence to back up his contention that eminem are not real, Marshall Mathers is an actor playing a role, ultimately just doing his job. Carney’s clever style of writing indicates a strong point of view defending Eminem , but his style of writing has allowed the reader to make their own decision, giving a fair balance between good and bad. â€Å"Eminem deals in some very sick stuff, no doubt about it,† but again goes on to say, â€Å"Eminem is a skillfull storyteller and role player.

Tourette Syndrome Essay examples -- Biology Essays Research Papers

Tourette Syndrome Tourette syndrome is an inherited severe neurological disorder usually occurring before the age of eighteen and is associated with a degree of facial and body tics sometimes accompanied by random declarations of phrases or obscenities (2,3). The facial and body tics associated with the disorder can be painful and even embarrassing. Involuntary body movements such as jaw snapping, gyrating, hopping, and obscene gesturing are to name a few (1). Tourette Syndrome was named after a French neuropsychiatrist named Gilles de la Tourette who successfully assessed the disorder in the late 1800’s(3). Tourette Syndrome claims no specific race or ethnicity. The disorder generally can affect any ethnic group yet it does affect three to four times more males than it does females (3). Although just a mere decade ago Tourette Syndrome was frequently misdiagnosed as schizophrenia, Sydenham’s chorea, epilepsy, or nervous habits, its symptoms are now differentiated and specific case related. Tourette Syndrome is a case sensitive genetic disorder that varies from generation to generation. However, not everyone that carries the genetic make up of Tourette Syndrome will express those symptoms (1). Coined as the term autosomal dominate, when one parent is a carrier or expresses symptoms of having Tourette syndrome, there is a 50/50 chance the child will receive the gene from the parent (1,4). There are several behavioral and cognitive difficulties associated with the tics that many with Tourette Syndrome experience. Although Tourette Syndrome may present itself as a disorder of motor and vocal tics, it is much more complex. Commonly linked with Tourette Syndrome is attention deficit disorder with hyperactivity(A... ...r bodies just can’t control. While we think of behavior as a voluntary physical action, Tourette Syndrome reminds us that it is not. Without proper brain function our behavior can become totally involuntary and have a ‘mind’ of its own. Behavior is not a result of a physical bodily movement. Behavior may start in the brain and the type of behavior emitted is thus a result of the manner by which that brain functions. However it is also important to be opened minded and realize that sometimes our bodies can react without direct causation of the brain. Internet Sources: 1)htttp://www.mentalhealth.com/book/p40-gtor.html; Guide to the Diagnosis and Treatment of Tourette Syndrome 2)Dictionary.com/tourette syndrome 3)http://www.tsa-usa.org/; Tourette Syndrome Association, Inc. 4)http://members.tripod.com/~tourette13/; The Facts About Tourette Syndrome

My Understanding of Feminism Essay

My understanding of feminism has increased greatly due to the material and discussions in this course. When this course first started I had a small general idea of what feminism was. I always assumed it had to deal with women’s rights and movement, mostly about the African-American movements. I had no idea that feminism tied into so many different subjects throughout history and even the present day. This course also had a broad overview with many different types of readings. The readings, along with the discussions generated a more in depth view n particular topics. Although I had a general knowledge of some of the topics, other topics were completely new to me and I found them very interesting. For example, the topic about the native settlers that were forced from their native land by the Europeans, specifically about the Beothuck people of Newfoundland. One unit that really sparked my interest was Unit 1 1: Advertising Culture and the Commodification of the body. I think that this unit was very intriguing, as I have always wondered bout how and why the media portrays women the way they do. This idea of â€Å"Fat† women has become such a profitable topic in the media. The article by Lisa Ayuso â€Å"l look Fat in this† portrayed an excellent view from women who often feel ashamed of their body because it is not the â€Å"perfect body’ that is plastered all over the media. Another unit that I thoroughly enjoyed was Unit 8: Diasporas. I enjoyed reading other students posts on how they feel about Newfoundland culture and its traditional items. Many students registered in this course are from Newfoundland, so the shared culture among us with the different viewpoints, I found really interesting. This course has not changed my view or position on a particular issue. I have increased my knowledge and have broadened my views on many topics. One particular issue that came to a complete shock to me was about the forced sterilization of young black women. Especially about the doctor that tricked the mother into signing a waiver to do this to her daughters, I was in disbelief. Also, the trials and tribulations the young women had to go through to get an abortion. Abortion is still a sensitive topic today, but the views of it have changed a lot from the past. One thing that I don’t quite understand is Liberalism. It has come up in many of the readings, but I still seem to fully understand exactly what it is. Can anyone elaborate more on this for me? But overall this course has provided me with a deeper insight about feminism. My Understanding of Feminism By SexyNewfle

Morality Defined Essay

Legendary philosopher, Socrates once said, â€Å"A system of morality which is based on relative emotional values is a mere illusion, a thoroughly vulgar conception which has nothing sound in it and nothing true.† With this statement, Socrates argues that there are few people in this world who possess an absolute morality within themselves whereas most others have a relative morality which they stand by. Absolute morality is the belief that something is always right or always wrong while relative morality is the belief that something is right or wrong depending on the circumstances. The crucial difference between absolute and relative morality lies in the viewpoints of the people who possess each one. However, Socrates’ belief is that relative morality is nothing more than a mere illusion because it really has no guidelines that it stands behind; it is solely based on opinion. In his mind, it should not even be considered a morality. In essence, Socrates is arguing that you must believe in something to its extreme or not at all; there is no in-between. Cormac McCarthy’s novel The Road, tells the riveting story of a father and son’s survival in a post-apocalyptic world full of thieves and cannibals. The man and the boy travel the United States in search of food and shelter, while also attempting to flee from danger and the threat of death. All through the story, they consistently struggle with issues concerning their own morality, character, and conscience. They are forced to make life altering-decisions that ultimately define who they are as people. Throughout the novel The Road, McCarthy uses nature symbolism and apocalyptic imagery to criticize that many people’s ethics dissipate and their immorality consequently rises when they are immersed in an evil world. The desolate world that the boy, man, and others have to live in results in some people going to the extremes to survive. As the boy and man journey on the road, they encounter very few people along the way. However, one day, the man realizes there are people following him and the boy, so they hide out. Three men and a pregnant woman pass them on the road. A few minutes later they are met with a shocking sight, â€Å"Oh Papa, he said. He turned and looked again. What the boy had seen was a charred human infant headless and gutted and blackening on the spit. He bent and picked the boy up and started for the road with him, holding him close. I’m sorry, he whispered. I’m sorry† (McCarthy 198). The author deliberately describes the appearance of the burning baby using words that convey graphic imagery such as, â€Å"charred, human, infant, headless, gutted, and blackening,† eliciting a repulsive feeling and characterizing the ugliness of evil in the world. The sight traumatizes the boy evidenced when he gasps, â€Å"Oh, Papa,† and turns â€Å"and looked again [at the burning baby].† The man feels regretful for letting the boy experience such a horrendous sight and apologizes as he takes the boy back to the road. This gruesome imagery reveals the absolute social breakdown in humanity and society. The morality of the people in this apocalyptic world has completely faded because there are no governing rules or laws to keep them in line. This results in total chaos and turmoil as seen when the weakest and most helpless of human beings – an infant – is preyed upon by a group of insane man-eaters. The cannibals clearly symbolize the end of civilization and this passage represents the extremes of violence, hunger, and cruelty within the apocalyptic world. Every person in the story seems to be judged by the man and boy as either good and moral or evil and immoral. In his view, the man strongly believes he and the boy are moral and good because, as he tells the boy, â€Å"we’re carrying the fire† (McCarthy 83). This â€Å"fire† is symbolic of hope and human perseverance, despite the wicked world they are living in. The man assures the boy that they are the â€Å"good guys† who â€Å"carry the fire† within themselves to never stop trying to survive in the horrible world even amongst â€Å"bad guys† who kill and even cannibalize people in order to survive. As the story unfolds, the boy and the man encounter many potential threats to their existence and make questionable decisions in order to survive which sometimes violate their self-professed â€Å"good guy† virtues. Through his actions, the man subtly begins to show signs that he is heading towards immorality and evil. The man and the boy are awoken by the sound of a diesel truck not too far from them. They flee their camp site and listen quietly until the silence is broken by a guy stumbling through the woods. The guy wrestles the boy into his arms and the man fires his loaded pistol, â€Å"The man fell back instantly and lay with blood bubbling from the hole in his forehead. The boy was lying in his lap with no expression at all†¦covered with gore and mute as a stone† (McCarthy 66). The man’s quick reaction to save his son represents the very rare love bonds that still exist in this apocalyptic world. The author compares the boy to a â€Å"mute stone† after he obviously experiences another life-changing moment. Sickening imagery is also used in this passage, as seen through the words, â€Å"bubbling, hole, and gore.† These words portray the man’s heroic act to save his son; however, it comes at the expense of the brutal murder he committed. The man shoots the guy who threatens his son with the intention of ensuring the boy’s safety, yet it contradicts his own moral virtues. Because he did this out of love, the man can essentially justify the violent killing as being morally correct. Yet, what the man fails to realize, is what makes his choice more praiseworthy than the choices of the people who kill and even cannibalize others in order to survive. This clearly raises a contradiction which creates an ambiguity between immorality and morality. Although the man killed this guy to protect his son, his decision is still problematic because it only takes one bad decision like this to arouse the inner evil within himself and eventually drive him to immorality. After living in such a malicious world for such a long time, it is nearly impossible for the man not to succumb to immorality and evil. The boy and the man enjoy a nice walk on the beach until they come back to find their camp completely raided. Their entire shopping cart full of food and other survival necessities had been stolen and as a result, they set out to find the thief. They follow the tracks of the shopping cart and finally find the thief in front of the cart with a butcher knife. The man is enraged and pulls his pistol out and threatens the crook, â€Å"Take your clothes off. / What? / Take them off. Every goddamned stitch. / Come on. Don’t do this. / I’ll kill you where you stand. / He stripped slowly and piled his vile rags in the road. / Put the clothes in the shopping cart. / He bent and scooped the up the rags in his arms and piled them on top of the shoes. / Don’t do this, man. / You didn’t mind doing it to us. / You tried to kill us. / I’m starving, man. You’d have done the same. / You took everything. / Come on, man. I’ll die. / I’m going to leave you the way you left us† (McCarthy 256-257). The man clearly displays immorality by the way he treated the thief and how he reacted to the situation at hand. It is obvious he is incapable of any empathy for the guy who is trying to survive in the same hellish world he is trying to live in. The fact that he wanted to punish the guy by stripping him suggests he wants to make the crook suffer a horrible death because the world is too cold to live without any sort of clothing. The thief in this passage symbolizes the deterioration of the human race because he embodies the ugliness that has emerged in this new world where formerly common things are now extremely valuable. The man still believes he is a â€Å"good guy,† however, this controversial decision proves otherwise. Because the man is acting so cruelly in this scene, his viciousness can almost be compared to the brutality of the savages that roam the same barren world he lives in. Mark Twain’s novel The Adventures of Huckleberry Finn, set in the Pre-Civil War period, tells the story of young boy named Huckleberry â€Å"Huck† Finn, who ventures throughout the Mississippi River Valley. Huck travels with a run-away slave named Jim, meets many new people, and encounters frequent obstacles along the way. Throughout the novel, Huck constantly struggles with complex circumstances affecting his own conscience and morality, but ends up making a big decision that reflects his true character in the end. Due to the social environment in which Huck grew up, his racist outlook is displayed on occasion throughout the story. In one short exchange with Aunt Sally, Huck indicates that he doesn’t actually view blacks as real people. Huck tells his aunt that his boat ran ashore and she worriedly responds, â€Å"‘Good gracious! Anybody hurt?†Ã¢â‚¬Ëœ Huck replies, ‘†No’m. Killed a nigger,†Ã¢â‚¬Ëœ to which Aunt Sally answers, ‘†Well, it’s lucky; because sometimes people do get hurt’† (Twain 167). Huck’s conversation with his aunt vividly illustrates the deeply embedded racism within society. Not only does this exchange exemplify Huck’s own beliefs about blacks’ inferiority, but also proves his prejudiced outlook is primarily derived from the racist society in which he lives. The conversation suggests that both the aunt and Huck think of blacks only as â€Å"things† or â€Å"objects,† not actually human beings. When Huck informs his aunt that a â€Å"nigger† had died in the crash, she casually dismisses any loss of life. Instead, she responds by pointing out that â€Å"it’s lucky; because sometimes people do get hurt [in boat crashes],† therefore essentially revealing that she believes that blacks are not people. Both Aunt Sally and Huck offer no empathy or show any responsiveness to the death, which most people would do if another human had died. Although Huck views slavery as morally correct, he only believes this because it is customary during this time period. In essence, Huck’s moral nature has been misguided and distorted throughout his childhood, causing him to believe slavery and white superiority is ethically right. Sadly, his morality has been skewed so he believes something not necessarily because he actually believes it in his heart, but possibly because it is just what is socially accepted at the time. Bennett Kravits, author of the critical essay â€Å"Reinventing the world and reinventing the self in Huck Finn† reveals his criticism regarding Twain’s portrayal of whites’ perceptions of blacks. He specifically deals with the phrase that Huck uses to describe Jim, â€Å"white inside† (Twain 345).† He essentially explains that although that seems to be an overtly racist description, it actually has the potential to â€Å"undercut the prejudicial notions that whites held concerning blacks† (Kravits 6). It is clear Huck has a difficult time seeing Jim as an equal member of society, but he instead can view him as white inside. According to Kravits, the significance behind this depiction is that Huck discovers a way to see Jim as a fellow human being, just in an odd way. Huck’s morality has been molded throughout his childhood and he has an ingrained belief that blacks are just inhumane slaves that are property to white people; however, Kravits is actually arguing that Huck realizes black people deserve to be labeled as humans and not property. While journeying down the Mississippi River together, Huck and Jim begin to bond in a unique way. A friendship between them starts to develop and Huck’s compassion for Jim grows despite him being a black slave. Huck is faced with the particularly difficult decision of either turning Jim in or rescuing himself from the Phelps’. He struggles between standing up for Jim and what he believes is right or surrendering to the embedded racism he has grown up around. With Jim’s fate on his hands, Huck decides to save Jim instead of himself and rips up the letter to Miss Watson with the astounding exclamation, â€Å"‘All right, then I’ll go to Hell†Ã¢â‚¬Ëœ (Twain 162). During the moments leading up to this heroic decision, his mind runs wild with the thoughts of the harsh punishments Jim could possibly face. Huck recognizes that he has a power to give Jim something he has desired his entire life: freedom. Huck’s empathy is so strong at this point, that combined with his loyalty and morality, it causes Huck to have a significant epiphany. The epiphany illuminates Huck’s concern for Jim and shows another step in his moral development. The fact that Huck believes he is giving up his soul for Jim’s freedom demonstrates that Huck’s morality has truly developed over the course of the novel. This shows Huck’s incredible loyalty and his ability to put himself in Jim’s shoes in order to sacrifice his owns wants, needs and desires to save Jim. His empathy displayed in this scene supports the belief that although Huck is racist, he still possesses an enormous capacity to see Jim as a fellow human being. Every person acts in accordance with their beliefs, attitudes, and values, which consequently reflects that person’s ultimate identity. Many factors are responsible for determining the principles people value and respect, including familial, societal, and environmental influences. Throughout Mark Twain’s novel The Adventures of Huckleberry Finn, Huck is in the midst of moral development in his subconscious and his deeper feelings arise as the truer expression of his morality. He makes decisions in his adventures which demonstrate that not only does he possess morals, he possesses extraordinary ones. Huck’s moral maturity rings clear after he makes significant controversial decisions. Huck’s character progression shows that good scruples can be developed in anyone and a more empathetic part of people can triumph over heartlessness. . In the novel The Road, Cormac McCarthy describes the struggle between morality and immorality that exists within every person that walks the post-apocalyptic world. He demonstrates that some people give into the evil while others are able to remain good. McCarthy essentially concentrates on the man’s progression from the moral â€Å"good guy† to an immoral â€Å"bad guy.† â€Å"The fire† that the man truly believed he possessed slowly smolders and he begins to succumb to the immoral world he had faced for such a long time. Huck and the man serve as foils to each other by highlighting Huck’s progression towards a better morality as the man regresses and loses the morals he originally possessed. In essence, both Twain and McCarthy conclude that all people are faced with adversity and difficult decisions, but those people have the power to make certain choices which ultimately define who they really are. Works Cited McCarthy, Cormac. The Road. New York: Alfred A. Knopf, 2006. Print. Kravits, Bennett. â€Å"Reinventing the World and Reinventing the Self in Huck Finn.† Literature Resource Center. Gale, Winter 2004. Web. 22 May 2012. . Socrates. â€Å"Morality Quotes.† ThinkExist. Web. 22 May. 2012. . Twain, Mark. The Adventures of Huckleberry Finn. United Sates: Tom Doherty Associates, 1985. Print.

Nutraceuticals International Essay

1. â€Å"Beetroot juice ‘can beat blood pressure’. † Nutraceuticals International 13. 2 (Feb 2008). Summary/Critique Medications for hypertension can amount to a lot of money each year. This is the reason why many experts are trying to look at cheaper alternatives in producing medicines that could alleviate the upsurge of this dreaded disease. Cheaper medicines can come in a form of herbal remedies. In this report that appeared in a magazine Nurtaceuticals International (Feb.2008), it has been revealed that British researchers at Barts and The London School of Medicine found a new way of vitally reducing the blood pressure of hypertension patients. By taking 500ml of beetroot juice each, they might have a chance of being cured of their hypertension. The group of researchers, led by Amrita Ahluwalia and Ben Benjamin, identified that it is the â€Å"ingestion of dietary nitrate contained within beetroot juice† that does the trick. The effect can also be seen when people are eating green, leafy vegetables that ultimately results in decreased blood pressure. Because of the antioxidant vitamin content of vegetable-rich diet people can be protected against heart disease. This article is very informative because readers can learn the importance of having good diet can help everyone have a healthier life. Also, this article could encourage more experts in trying to find alternative ways of helping people with hypertension. Full Text Article: â€Å"Beetroot juice ‘can beat blood pressure’. † Nutraceuticals International 13. 2 (Feb 2008). Researchers at Barts and The London School of Medicine in the UK have discovered that drinking just 500ml of beetroot juice a day can significantly reduce blood pressure. The study, published on-line on February 5 in the American Heart Association’s journal Hypertension, could have major implications for the treatment of cardiovascular disease. Lead by Amrita Ahluwalia, professor at the William Harvey Research Institute at Barts and The London School of Medicine, and Ben Benjamin, professor at Peninsula Medical School, USA, the research reveals that it is the ingestion of dietary nitrate contained within beetroot juice – and similarly in green, leafy vegetables – which results ultimately in decreased blood pressure. Previously, the protective effects of vegetable-rich diets had been attributed to their antioxidant vitamin content. Effective one hour post ingestion Prof Ahluwalia and her team found that, in healthy volunteers, blood pressure was reduced within just one hour of ingesting beetroot juice, with a peak drop occurring three-four hours after ingestion. Some degree of reduction continued to be observed until up to 24 hours after consumption. Researchers showed that the decrease in blood pressure was due to the chemical formation of nitrite from the dietary nitrate in the juice. The nitrate in the juice is converted in saliva by bacteria on the tongue into nitrite. This nitrite-containing saliva is swallowed and, in the acidic environment of the stomach is either converted into nitric oxide or re-enters the circulation as nitrite. The peak time of reduction in blood pressure correlated with the appearance and peak levels of nitrite in the circulation, an effect that was absent in a second group of volunteers who refrained from swallowing their saliva during, and three hours following, beetroot ingestion. More than 25% of the world’s adult population are hypertensive, and it has been estimated that this figure will increase to 29% by 2025. In addition, hypertension causes around 50% of coronary heart disease, and approximately 75% of strokes. In demonstrating that nitrate is likely to underlie the cardio-protective effect of a vegetable-rich diet, the research of Prof Ahluwalia and her colleagues highlights the potential of a natural, low cost approach for the treatment of cardiovascular disease – a condition that kills over 110,000 people in England alone every year. Prof Ahluwalia concluded: â€Å"our research suggests that drinking beetroot juice, or consuming other nitrate-rich vegetables, might be a simple way to maintain a healthy cardiovascular system, and might also be an additional approach that one could take in the modern day battle against rising blood pressure. † 2. Zoler, Mitchel L. â€Å"Hypertension doubles female sexual dysfunction prevalence. † Family Practice News 36. 20 (Oct 15, 2006): 14. Summary Critique: We only know that hypertension affects the circulatory system of the human body. However, in this article by Mitchel Zoler (2006), it has been found that hypertensive women have double the risk of having sexual dysfunction than women with normal blood pressure. This proposition came after scientists have conducted a study of 417 women. As Dr. Michael Doumas reported in the annual meeting of the American Society of Hypertension, â€Å"women with controlled hypertension had a significantly lower prevalence of sexual dysfunction than did women whose hypertension failed to reach goal levels during treatment† (Zoler, 2006). In this particular study, all women were tasked to complete a â€Å"19-question form that has been validated as a way to evaluate sexual function†. The questions dealt with several domains of female sexual function: desire, arousal, lubrication, orgasm, satisfaction, and pain. The survey found out that among the women with hypertension, â€Å"42% had scores indicating sexual dysfunction†, which is far in statistically significant when compared with â€Å"19% among the normotensives†. Looking on how the researchers arrived at this conclusion can be doubtful because they merely based it on a survey, which can be a result of many other factors other than hypertension. Yet, this observation should not be taken complacently because hypertension is a common disease in the United States and its link to reproductive dysfunction in women should be established so that doctors will know how to alleviate the worsening problem of hypertension. Full Text Article: Zoler, Mitchel L. â€Å"Hypertension doubles female sexual dysfunction prevalence. † Family Practice News 36. 20 (Oct 15, 2006): 14. NEW YORK — Women with hypertension were twice as likely to have sexual dysfunction as normotensive women were, in a study of 417 women. The results also showed that women with controlled hypertension had a significantly lower prevalence of sexual dysfunction than did women whose hypertension failed to reach goal levels during treatment, Dr. Michael Doumas reported at the annual meeting of the American Society of Hypertension. But a third finding was that women who were treated with antihypertensive drugs had a higher prevalence of sexual dysfunction than did untreated women. Dr.Doumas speculated that this was caused by the effects of certain antihypertensive drugs, such as diuretics and [beta]-blockers. Treatment with other drug types, the angiotensin-receptor blockers and angiotensin-converting enzyme inhibitors, appeared to reduce sexual dysfunction, he said. â€Å"We need to treat hypertension because of its effect on adverse cardiac outcomes. But there is a hint that we can lower blood pressure with some drugs and also have good effects on female sexual function,† said Dr. Doumas, a physician in the department of internal medicine at the Hospital of Alexandroupolis in Athens. The study enrolled 216 women with hypertension and 201 normotensive women. Their average age overall was about 48, and all were sexually active. The women completed a 19-question form that has been validated as a way to evaluate sexual function. The questions dealt with several domains of female sexual function: desire, arousal, lubrication, orgasm, satisfaction, and pain. Among the women with hypertension, 42% had scores indicating sexual dysfunction, compared with 19% among the normotensives, which was a statistically significant difference. The prevalence of sexual dysfunction increased significantly with the duration of hypertension. Among women who had been hypertensive for fewer than 3 years, 16% had a score indicating sexual dysfunction; the rate rose to 33% among women with hypertension for 3-6 years and 79% among women with hypertension for more than 6 years. Age also showed a significant interaction with prevalence. Among women aged 31-40 years, the prevalence of dysfunction was 21%; the rate rose to 38% among women aged 41-50 and to 57% among women who were older than 50 years. The prevalence of sexual dysfunction was 48% among women treated for hypertension, compared with 33% among the untreated hypertensives, a significant difference. The average age was 48 years in both groups. But the prevalence was lower still among the hypertensive women who had their pressure controlled by treatment. With control defined as a pressure of less than 140/90 mm Hg, the prevalence of sexual dysfunction in women with controlled hypertension was 27%, significantly less than the 51% of women with uncontrolled hypertension who had dysfunction. It’s not yet known how antihypertensive drugs exert differing effects on sexual function. In general, drugs that cause vasodilation appear to improve sexual dysfunction, Dr. Doumas said. 3. â€Å"Liver linked to deadly disease. † USA Today (Magazine) 135. 2737 (Oct 2006): 10. The liver is important in the human body because it produces many enzymes that aid the digestion of our food intake. This is why it can be alarming to have liver disorders because it can affect our system from metabolizing food. For example, in the United States, many people consume an excessive amount of protein. The metabolism of excess protein, especially animal protein, can put a strain on the liver and kidneys in fats include dairy products, vegetable oils, and red meat. In this report from USA Today, it was found that liver disorders may trigger a deadly type of hypertension. As a physician from the University of Texas Southwestern Medical Center named Dan Rockey informed, this type of hypertension is called portal hypertension that â€Å"affects the blood flow into the portal vein, which feeds blood to the liver†. This report is alarming because the short-term mortality rate of having â€Å"portal hypertension is about 30%† (USA Today, October 2006). Dan Rockey and his colleagues are undergoing research to open new grounds for this disease and to find â€Å"possible clinical approaches†. Portal hypertension can trigger bleeding and development of fluid found in the abdomen. It is important to take more research on this type of hypertension because it can possibly become an epidemic if it is not treated. Also, we can take steps in taking care of our liver by reducing alcohol intake and eating healthy food. Full Text Article: â€Å"Liver linked to deadly disease. † USA Today (Magazine) 135. 2737 (Oct 2006): 10. Mechanisms causing a potentially deadly type of hypertension that result from liver damage have been identified by Don Rockey, a physician at the University of Texas Southwestern Medical Center, Dallas. Portal hypertension affects the blood flow into the portal vein, which feeds blood to the liver. Rockey identified the cellular activity that results in portal hypertension. He and his colleagues then took the research a step further, showing that, if the process can be interrupted, the hypertension subsides. â€Å"Portal hypertension is a deadly disease that complicates many forms of chronic liver injury,† he explains. â€Å"When this occurs, in its most severe form, the prognosis definitely becomes guarded,† often leading to the need for a liver transplant. The short-term mortality for patients with portal hypertension is about 30%. The latest research opens new ground and has implications for possible clinical approaches. â€Å"The end result of portal hypertension is bleeding and development of ascites [fluid in the abdomen]; so, if you could treat it early, you could prevent bleeding or the formation of ascites,† Rockey observes. Portal hypertension is similar to the widely known essential hypertension–which impairs blood flow to the heart systems–except it affects blood flow to the liver-related systems. The liver is an essential organ that washes the body’s blood of wastes and poisons. Cirrhosis of the liver occurs when the cells are damaged. Scarring often results, reducing blood flow and raising pressure on veins. The high pressure can cause veins to burst, resulting in internal bleeding and, potentially, death. Previous studies have shown that, at the cellular level, portal hypertension results from reduced production of needed nitric oxide, which regulates expansion of the blood vessels. Rockey’s research identifies how the nitric oxide production breaks down due to the effects of the protein GRK2. The protein attaches to another protein called AKT, interrupting the creation of nitric oxide. 4. Zoler, Mitchel L. â€Å"Hypertension diagnosis often missed in children. † Family Practice News 35. 11 (June 1, 2005): 15. We might not know it but children can develop hypertension too. Since the late 1980s, the rate of pre-hypertension and hypertension among U. S. children and teenagers has continued to increase. However, according to Zoler (June 1, 2005), experts miss 85% of these cases. In this article, Dr. Charlene K. Mitchell informed that â€Å"the problem with diagnosing hypertension in kids is that there are too many threshold pressures for most physicians to keep straight†. The guidelines for diagnosing children with the condition are different than those for adults. The point at which children are considered to have hypertension is determined by age, gender, weight and height, and young patients usually are not diagnosed until they have higher-than-normal readings for at least three visits. American Academy of Pediatrics guidelines require that blood pressure be taken at every doctors visit, but some physicians do not then calculate whether it is too high, especially if the child is healthy otherwise. This is why Dr. Mitchell suggested the researchers should be â€Å"aggressive† in finding a solution not to miss the diagnosis of hypertension in children. The impact of missing the diagnosis of hypertension in kids can be tremendous because it is a â€Å"killer† disease. Doctors missing to identify it could not suggest medications and this can be life-threatening for the children. More serious research should be conducted to identify what method is appropriate in determining the occurrence of hypertension in children. Full Text Article: Zoler, Mitchel L. â€Å"Hypertension diagnosis often missed in children. † Family Practice News 35. 11 (June 1, 2005): 15. New Orleans — A diagnosis of hypertension was missed in 85% of children with high blood pressure in a study of 287 youngsters who were examined at two university-based, pediatric clinics. The problem with diagnosing hypertension in kids is that there are too many threshold pressures for most physicians to keep straight, Charlene K. Mitchell, M. D. , said at the annual meeting of the Southern Society for Pediatric Research. Because the threshold for diagnosing hypertension varies by age, height, and gender, there are a total of 420 different diastolic and systolic pressures that determine whether a particular child has high blood pressure, said Dr. Mitchell, a pediatrician and internist at the University of Louisville (Ky. ). The total is 420 because there are 15 different age-specific threshold pressures for children aged 3-17 years, 7 different height-specific threshold pressures between the 5th and 95th height percentiles, different thresholds for girls and boys, and different thresholds for diastolic and systolic pressure. The threshold criteria for borderline hypertension would add another 120 pressure thresholds for diagnosing hypertension. â€Å"The numbers are chopped up too much. It’s far too complex for easy management,† Dr. Mitchell said. â€Å"If physicians must always look on a table every time they check a blood pressure, we’ll continue to see underdiagnosis. † Her solution to the number surfeit is to cluster several ages with a single diagnostic pressure threshold. However, eventually she would like to have study results establish pressure thresholds for diagnosing hypertension that are empirically derived, rather than based on statistics. If the diagnostic criteria are simplified, physicians will be much more likely to identify hypertension in children much more often, Dr. Mitchell said. â€Å"We need to be much more aggressive about recognizing hypertension in children than we are now,† she added. Her study was designed to assess physician accuracy at identifying hypertension in children aged 3-17 years being seen for routine, well-child visits from July 31 to Aug. 15, 2003. Of the 287 children examined, 90 (31%) had hypertension by current standards, and 35 (12%) had borderline hypertension. But only 15% of those with hypertension were diagnosed by their examining physicians. The results also showed that physicians were more likely to diagnose hypertension in children with a higher body mass index (BMI). The children who were correctly diagnosed as hypertensive were, on average, in the 92nd percentile for BMI. Those who had unrecognized blood pressure elevations were, on average, in the 76th percentile for BMI. 5. Bradbury, Jane. â€Å"The chicken and egg in hypertension†, The Lancet 349. 9059 (April 19, 1997), p. 1151. It is important to know where essential hypertension will trigger from because it can aid doctors to foresee the development of this dreaded disease. To wit, there is an ongoing debate of whether essential hypertension occurs when there is a perceived micro vascular abnormality or is when doctors see higher levels of blood pressure. In this article, UK clinicians found that males â€Å"with a familial predisposition to high blood pressure, a reduced number of capillaries and impaired microvascular dilatation precede hypertension†. In the research conducted by Professor David Webb and his team from the University of Edinburgh, they utilized the â€Å"four-corners epidemiological model† in predicting the triggering point of hypertension. Their study in 1977 determined the measure of blood pressure from 1809 married couples. In 1985, 864 of the 16–24 year-old children that came from the previous couples â€Å"had their blood pressure measured† too. Then, the researchers classified â€Å"four groups of offspring† by â€Å"combinations of personal (high or low) and parental (high or low) blood pressure†. Through these extensive studies, they determined that â€Å"microvessel characteristics which might be responsible for increased vascular resistance in essential hypertension†. Mostly, it is the males â€Å"with high blood pressure whose parents also had high blood pressure had significantly impaired dermal vasodilatation compared with the other three groups†. Also, they researchers observed they had â€Å"significantly fewer capillaries in the finger during venous occlusion†. This article can be helpful in the research of determining hypertension before it develops into a full-blown disease. Full Text Article: Bradbury, Jane. â€Å"The chicken and egg in hypertension†, The Lancet 349. 9059 (April 19, 1997), 1151. What comes first in essential hypertension-microvascular abnormalities or a rise in blood pressure? UK clinicians report this week that in men with a familial predisposition to high blood pressure, a reduced number of capillaries and impaired microvascular dilatation precede hypertension. Prof David Webb (University of Edinburgh, UK) and his team used the â€Å"four-corners† epidemiological model to unravel cause and effect in hypertension. In 1977, blood pressure was measured in 1809 married couples. 864 16–24 year-old offspring from 603 of the families had their blood pressure measured in 1985. Four groups of offspring were defined by combinations of personal (high or low) and parental (high or low) blood pressure. Microvessel characteristics which might be responsible for increased vascular resistance in essential hypertension were measured in 1993–95 for 105 men drawn from the four populations (J Clin Invest 1997; 99: 1873–79). Men with high blood pressure whose parents also had high blood pressure had significantly impaired dermal vasodilatation compared with the other three groups. They also had significantly fewer capillaries in the finger during venous occlusion. Factors which are associated with high blood pressure in offspring whose parent had high blood pressure are more likely to be causal than those that are associated with high blood pressure in the offspring irrespective of parental blood pressure, write the authors. The results suggest that defective angiogenesis may be an etiological component of hypertension, either environmental or genetic, and are consistent with the higher incidence of adult hypertension in people with a low birth weight. These findings, says Webb, should focus attention on the importance of early life factors in the programming of hypertension. 6. McCarron, David A. â€Å"Diet and high blood pressure – the paradigm shift. † Science 281. 5379 (August 14, 1998): 933-934. Doctors and nutritionists always exhort people to make a change to healthier diets because it can aid all of us in preventing deleterious diseases. According to McCarron (Aug. 14, 1998), â€Å"humans are nearly unique in their natural propensity to develop elevated arterial pressure, a fact attributed to both genetic and environmental factors†. Many experts point an accusing finger on salt being the one that can contribute to the occurrence of hypertension. However, McCarron (Aug. 14, 1998) revealed that the â€Å"importance of salt in the pathogenesis of hypertension† is still being debated and â€Å"remains undetermined†. Experts began to accuse the extreme use of salt as the one that causes hypertension â€Å"when early studies indicated that salt intake increased blood pressure†. However, McCarron (Aug. 14, 1998) indicated that â€Å"many of these studies have since been discounted for design and methodologic flaws. But even where the methodology is sound, sodium intake cannot be linked to hypertension or higher population-wide blood pressure†. In more conclusive studies, there existed a â€Å"compelling evidence that adequate intake of minerals, rather than restriction of sodium, should be the focus of dietary recommendations for the general population†. This article is enlightening due to the fact that it debunks the myth of salt being the primary cause of developing hypertension. The author suggests that we should limit our mineral intake and not just salt alone, in order to live a healthy lifestyle. We should not manipulate our diet to our own detriment, but we should shift it to become health-conscious because we are already armed with the knowledge of what’s good for us. Full Text Article: McCarron, David A. â€Å"Diet and high blood pressure – the paradigm shift. † Science 281. n5379 (August 14, 1998): 933(2). Hypertension–a serious health problem for industrialized societies–contributes significantly to the risk of coronary heart disease, congestive heart failure, stroke, and kidney failure. Among vertebrates, humans are nearly unique in their natural propensity to develop elevated arterial pressure, a fact attributed to both genetic and environmental factors. Only certain highly inbred strains of rodents and genetically engineered animals also spontaneously exhibit hypertension. Public policy has generally recommended that blood pressure can best be controlled by restriction of sodium chloride intake and with medication (1). Recent research has, however, emphasized the powerful role of total diet in the etiology and treatment of hypertension, suggesting that the focus of current public policy regarding nutrition and blood pressure is too narrow. Limitation of sodium chloride in food has historically been the dietary mantra of those who set nutritional policy for hypertension. Nevertheless, the importance of salt in the pathogenesis of hypertension has long been debated (2-4) and remains undetermined (5). The intense focus on sodium began when early studies indicated that salt intake increased blood pressure. These studies, many conducted decades ago, included epidemiologic surveys in primitive societies, clinical trials in patients with kidney disease, and animal investigations in which sodium intake levels cannot be realistically extrapolated to humans (6). Many of these studies have since been discounted for design and methodologic flaws. But even where the methodology is sound, sodium intake cannot be linked to hypertension or higher population-wide blood pressure (7). Two recent meta-analyses of randomized controlled trials–one examining the effects of sodium restriction (8) and the other of calcium supplementation on arterial pressure (9)–provide compelling evidence that adequate intake of minerals, rather than restriction of sodium, should be the focus of dietary recommendations for the general population. Assessing 56 trials of sodium restriction, Midgley et al. (8) concluded that individuals with normal blood pressure gained nothing from limiting sodium intake and that only older ([is greater than] 45 years) hypertensive people might benefit, a conclusion recently confirmed by other investigators (5). Midgley et al. also reported that the magnitudes of the blood pressure reductions were not consistently related to the amount of sodium intake, indicating that confounding factors were contributing to the changes in blood pressure. Indeed, in a meta-analysis of calcium supplementation trials, Bucher et al. (9) identified a small but consistent drop in blood pressure when normotensive and hypertensive persons consumed more calcium. They speculated that baseline calcium intake or increased biological need for minerals might be responsible for the blood pressure variability not otherwise accounted for in their analysis. These two reports presaged the outcomes of two large clinical trials from the NIH, published in 1997 (10, 11). The Trials of Hypertension Prevention (TOHP) II is the largest and longest study ever executed to test whether sodium restriction lowers arterial pressure and prevents the emergence of new hypertension cases (I0). No benefit was detected for the primary endpoint diastolic blood pressure. Systolic blood pressure decreased minimally (0. 7 mmHg), almost precisely the value that the Midgley (8) analysis projected. Furthermore, the TOHP II data demonstrated a dissociation between the extent of sodium restriction and the observed blood pressure reduction. The second large-scale study was the Dietary Approaches to Stop Hypertension (DASH) trial published in the New England Journal of Medicine (11). As would be predicted by Bucher et al. (9) in their meta-analysis of calcium studies, in persons whose intake of dairy products (and therefore calcium and other minerals) was well below currently recommended levels, blood pressure decreased significantly when the recommended amounts were included in their diets. In the DASH diet that was rich in dairy products, fruits, and vegetables and lower in fat (with sodium held constant), blood pressure decreased 5 to 6 mmHg in subjects with normal blood pressure; in those with mild hypertension, this blood pressure reduction was doubled, to 11 to 12 mmHg. Reductions of this magnitude have been observed previously only with antihypertensive medications. A second DASH diet, which included increased amounts of fruits and vegetables but did not include dairy products, produced more modest but still significant systolic blood pressure reductions, easily surpassing those observed with sodium restriction in TOHP II. DASH confirmed the meta-analyses as well as earlier indications from observational studies that dietary factors other than sodium markedly affected blood pressure (3, 12). For example, one of the earlier studies (12) identified inadequate calcium intake from dairy products as the dietary pattern most prevalent in individuals with untreated hypertension. Another study (3), in which nutrient intake was assessed from the first National Health and Nutrition Examination Survey (NHANES I), confirmed this dietary pattern in hypertensive individuals and identified the relative absence of fruits and vegetables in the American diet as the second best predictor of elevated blood pressure. These studies suggested that where intake of other critical nutrients is adequate, sodium intake at levels typically consumed in most societies might actually be associated with lower blood pressure. They also concluded that the absence of specific nutrients (calcium, potassium, and magnesium), resulting from low consumption of dairy products, fruits, and vegetables, is associated with hypertension in Americans (3, 12). The TOHP II study adds to the substantial body of literature that challenges the public health emphasis on sodium restriction as the primary nutritional means of improving blood pressure. The issue is further complicated by concerns raised in several recent reports (5, 13, 14) that the long-term effect of sodium restriction on cardiovascular morbidity and mortality may be the opposite of what has always been assumed. The DASH study provides a clear rationale for focusing our public health strategy on adequate intake of low-fat dairy products and fruits and vegetables. The consistency of the accumulated data is evident when the blood pressure changes seen with the DASH diet (11) are superimposed on the blood pressure profile of Americans as a function of calcium intake from (3) (see the figure). According to these data (3, 11), if the intakes of calcium and other nutrients obtained through low-fat dairy products, fruits, and vegetables were increased to the amounts readily achieved in the DASH study, the percentage of Americans with moderately severe hypertension (160/100 to 179/109 mmHg) would be decreased by nearly half, from approximately 9% to 5%. For the millions more with borderline elevations, the benefits are likely to be at least as great. Whether hypertension is genetic or environmental in origin, control of dietary mineral intake has a place in its management and prevention. As a society, we will not achieve the dramatic reversal in hypertensive heart disease that DASH and other studies clearly show is possible until we direct our efforts to the nutritional factors and dietary patterns that are actually relevant to this condition. In addition, diets low in fat but high in calcium, fruits, and vegetables are not prevalent in the subgroups of society at greatest risk for hypertensive cardiac disease–the elderly and African Americans. An added plus: A diet low in fat but high in calcium, fruits, and vegetables is also consistent with reduction of two other major public health problems, osteoporosis and cancer (15, 16). The emphasis on sodium as the single dietary culprit is counterproductive to our significantly reducing cardiovascular risk for most of us (5) and diverts attention from the issues we need to address (17). â€Å"Food products† such as snacks and soft drinks added to our diets in recent years have supplanted nutrient-rich foods such as fruits, vegetables, and milk. This shift in dietary patterns, and simultaneous suboptimal nutrient intake, is also far more likely to contribute to the prevalence of hypertension than salt, which has always been a component of the human diet. Humans may be unique in our propensity to develop hypertension simply because we are the only species with the capacity to manipulate our diets to our own detriment. References (1.) â€Å"The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure,† Arch. Intern. Med. 157, 2413 (1997). (2. ) G. Kolata, Science 216, 38 (1982). (3. ) D. A. McCarron, C. D. Morris, H. J. Henry, J. L. Stanton, ibid. 224, 139Z (1984). (4. ) J. D. Swales, Br. Med. J. 297, 307 (1988). (5. ) N. A. Graudal, A. M. Gallee, P. Gaffed, JAMA 279, 1383 (1998). (6. ) M. Muntzel and T. Drueke, Am. J. Hypertens. 5, 1S (1992). (7. ) Intersalt Cooperative Research Group, Br. Med. J. 297, 319 (1988). (8. ) J. P. Midgley, A. G. Matthew, C. I. T. Greenwood, A. G. Logan, JAMA 275, 1590 (1996). (9. ) H. C. Bucher et al. , ibid. , p. 1016. (10. ) Trials of Hypertension Prevention Collaborative Research Group, Arch. Intern. Med. 157, 657 (1997). (11. ) L. J. Appel et al. , N. Engl. J. Med. 336, 1117 (1997). (12. ) D. A. McCarron, C. Morris, C. Cole, Science 217, 267 (198Z). (13. ) M. H. Alderman, S. Madhavan, H. Cohen, J. E. Seatey, J. H. Laragh, Hypertension 25, 1144 (1995). (14. ) H. H. Alderman, H. Cohen, S. Madhavan, Lancet 351, 781 (1998).