STATE UNIVERSITY OF BOLIVAR

READING
GUARANDA – ECUADOR

NAME:

Jhennyfer Esthefania Escobar Pungaña

DATE:

Guaranda 07/01/2018

CLASS:

3F

TEACHER:

Lic. Cristhian Danilo Peñaloza Ulloa.

 STATE UNIVERSITY OF BOLIVAR
READING
GUARANDA – ECUADOR
EXERCISE 1

WHO KILLED THE NEWSPAPER?

The most useful bit of the media is disappearing. A cause for concern, but not for panic.

"A GOOD newspaper, I suppose, is a nation talking to itself," mused Arthur Miller in 1961. A decade later, two
reporters from the Washington Post wrote a series of articles that brought down President Nixon and the status of
print journalism soared. At their best, newspapers hold governments and companies to account. They usually set
the news agenda for the rest of the media. But in the rich world newspapers are now an endangered species. The
business of selling words to readers and selling readers to advertisers, which has sustained their role in society, is
falling apart.

Of all the "old" media, newspapers have the most to lose from the internet. Circulation has been falling in
America, Western Europe, Latin America, Australia and New Zealand for decades (elsewhere, sales are rising).
But in the past few years the web has hastened the decline. In his book "The Vanishing Newspaper", Philip
Meyer calculates that the first quarter of 2043 will be the moment when newsprint dies in America as the last
exhausted reader tosses aside the last crumpled edition. That sort of extrapolation would have produced a
harrumph from a Beaverbrook or a Hearst, but even the most cynical news baron could not dismiss the way that
ever more young people are getting their news online. Britons aged between 15 and 24 say they spend almost
30% less time reading national newspapers once they start using the web.

Advertising is following readers out of the door. The rush is almost unseemly, largely because the internet is a
seductive medium that supposedly matches buyers with sellers and proves to advertisers that their money is well
spent. Classified ads, in particular, are quickly shifting online. Rupert Murdoch, the Beaverbrook of our age,
once described them as the industry's rivers of gold, but, as he said last year, "Sometimes rivers dry up." In
Switzerland and the Netherlands newspapers have lost half their classified advertising to the internet.

Newspapers have not yet started to shut down in large numbers, but it is only a matter of time. Over the next few
decades half the rich world's general papers may fold. Jobs are already disappearing. According to the
Newspaper Association of America, the number of people employed in the industry fell by 18% between 1990
and 2004. Tumbling shares of listed newspaper firms have prompted fury from investors. In 2005, a group of
shareholders in Knight Ridder, the owner of several big American dailies, got the firm to sell its papers and thus
end a 114-year history. This year Morgan Stanley, an investment bank, attacked the New York Times Company,
the most august journalistic institution of all, because its share price had fallen by nearly half in four years.

Having ignored reality for years, newspapers are at last doing something. In order to cut costs, they are already
spending less on journalism. Many are also trying to attract younger readers by shifting the mix of their stories
towards entertainment, lifestyle and subjects that may seem more relevant to people's daily lives than
international affairs and politics are. They are trying to create new businesses on and offline. And they are
investing in free daily papers, which do not use up any of their meagre editorial resources on uncovering
political corruption or corporate fraud. So far, this fit of activity looks unlikely to save many of them. Even if it
does, it bodes ill for the public role of the Fourth Estate.

In the future, as newspapers fade and change, will politicians therefore burgle their opponents' offices with
 STATE UNIVERSITY OF BOLIVAR
READING
GUARANDA – ECUADOR
impunity, and corporate villains whoop as they trample over their victims? Journalism schools and think-tanks,
especially in America, are worried about the effect of a crumbling Fourth Estate. Are today's news organisations
"up to the task of sustaining the informed citizenry on which democracy depends?" asked a recent report about
newspapers from the Carnegie Corporation of New York, a charitable research foundation.

Nobody should relish the demise of once-great titles. But the decline of newspapers will not be as harmful to
society as some fear. Democracy, remember, has already survived the huge television-led decline in circulation
since the 1950s. It has survived as readers have shunned papers and papers have shunned what was in stuffier
times thought of as serious news. And it will surely survive the decline to come.

That is partly because a few titles that invest in the kind of investigative stories which often benefit society the
most are in a good position to survive, as long as their owners do a competent job of adjusting to changing
circumstances. Publications like the New York Times and the Wall Street Journal should be able to put up the
price of their journalism to compensate for advertising revenues lost to the internet, especially as they cater to a
more global readership. As with many industries, it is those in the middle, neither highbrow, nor entertainingly
populist, that are likeliest to fall by the wayside.

The usefulness of the press goes much wider than investigating abuses or even spreading general news; it lies in
holding governments to account-trying them in the court of public opinion. The internet has expanded this court.
Anyone looking for information has never been better equipped. People no longer have to trust a handful of
national papers or, worse, their local city paper. News-aggregation sites such as Google News draw together
sources from around the world. The website of Britain's Guardian now has nearly half as many readers in
America as it does at home.

In addition, a new force of "citizen" journalists and bloggers is itching to hold politicians to account. The web
has opened the closed world of professional editors and reporters to anyone with a keyboard and an internet
connection. Several companies have been chastened by amateur postings of flames erupting from Dell's laptops
or of cable TV repairmen asleep on the sofa. Each blogger is capable of bias and slander, but, taken as a group,
bloggers offer the searcher after truth boundless material to chew over. Of course, the internet panders to closed
minds; but so has much of the press.

For hard-news reporting, as opposed to comment, the results of net journalism have admittedly been limited.
Most bloggers operate from their armchairs, not the frontline, and citizen journalists tend to stick to local
matters. But it is still the early days. New online models will spring up as papers retreat. One non-profit group,
New Assignment Net, plans to combine the work of amateurs and professionals to produce investigative stories
on the internet. Aptly, $l0,000 of cash for the project has come from Craig Newmark, of Craigslist, a group of
free classified advertisement websites that has probably done more than anything to destroy newspapers' income.

In the future, argues Carnegie, some high-quality journalism will also be backed by non-profit organisations.
Already, a few respected news organisations sustain themselves that way, including the Guardian , the Christian
Science Monitor and National Public Radio. An elite group of serious newspapers available everywhere online,
independent journalism backed by charities, thousands of fired-up bloggers and well informed citizen journalists:
there is every sign that Arthur Miller's national conversation will be louder than ever.
 STATE UNIVERSITY OF BOLIVAR
READING
GUARANDA – ECUADOR
SELECT THE CORRECT OPTION.

According to the text, a function of newspapers is ___________ to the public and private sectors.
a) ask for accounts
b) impose an agenda
c) sell new ideas
The decline in the number of newspaper readers
a) It happens now all over the world.
B) It started a few years ago.
b) It accelerated with the news online.
Those who advertised in newspapers are abandoning them, because they believe that advertising on the Internet
is more
a) cheap.
b) efficient.
c) simple.
As a result of the difficulties
a) Several famous newspapers have had to close.
b) the owners are selling their shares.
c) the number of employees is decreasing.
Many newspapers try to reverse their fall
a) with economic and editorial measures.
b) reinforcing its role of social criticism.
c) with more activism than planning.
According to the text, democracy
a) It depends on strong newspapers.
b) It requires informed citizens.
c) suffered with the rise of television.
Among the actions necessary for the survival of a newspaper is now
a) keep prices equal.
b) publish more general news.
c) know how to adapt to changes.
According to the text, one of the advantages of using the Internet for the public is that
a) Now it is easier to communicate with the government.
b) this has made governments become more responsible.
c) There are many more sources of information than before.
In the context of paragraph 10, the meaning closest to "is itching to" is
a) eager to start something
b) reluctant to do anything
c) undecided about something.
Make possible the participation of any person with Internet access in the journalistic work
a) caused a lot of resistance among professional journalists.
b) favored the publication of opinions rather than reports.
c) propitiated that what is published is less biased.
The author mentions some problems of online journalism to exemplify
a) the need to create new work models.
b) the limited space occupied by professional journalists.
c) the lack of funds to sustain new projects
At the end of the article, the author expresses himself in a _____________ tone about the future of journalism.
a) Dismayed
b) Negative
c) Positive
 STATE UNIVERSITY OF BOLIVAR
READING
GUARANDA – ECUADOR
EXERCISE 2

TEAM APPROACH WITH DIABETES PATIENTS

The team approach is optimal for working with patients with diabetes. Assessing the psychological and
physiological effects of stress, stress management, and biofeedback on blood glucose control are necessary. In
addition to a physician with special expertise in diabetes, the team consists of at least a certified biofeedback
practitioner, a certificate diabetes practitioner, a certified diabetes educator, and the patient. The team works
together in evaluating the effects of treatment on the physiological and psychological aspects of glycemic
control. Most biofeedback practitioners do not have expertise in diabetes education and management. However,
when they treat patients with diabetes, they need to know the basic physiology of diabetes and the fundamentals
of diabetes management.

The psychologist practitioner carries out an initial interview with the diabetic to determine stress -related
physical and emotional symptoms. One assesses the patient's perception of the effects of the stress on his or her
blood glucose and his or her perceived capabilities and management strategies. Psychological testing also may
be used to assess the person's level of depression, anxiety, anger, and current stress.

The practitioner also conducts a psychophysiological assessment. Practitioners differ on the specifics of this
assessment but often monitor multiple modalities. These often include muscle tension, skin conductance, and
blood flow in the hands (via skin temperature), heart rate, and breathing during the resisting baseline, and during
and after various standard office stressors. Our laboratory measures frontal electromyography (EMG), heart rate,
blood pressure, and finger temperature while patients sit quietly with their eyes closed. The practitioner provides
biofeedback, relaxation therapies, and stress management. Relaxation and biofeedback can help patients feel
more in control of their physiology, psychological state, and their illness. Furthermore, decreased plasma levels
of stress hormones and sympathetic activity mediate lowered arousal and diminished hyperglycemia.

The diabetes educator (and or physician) can interpret blood glucose values because he or she understands the
effects of hypoglycemic medications, diet, and exercise on blood glucose. This person also obtains information
about the person's diabetes care regime.

The diabetes educator studies:

History

1. Family history of diabetes

2. Other medical problems
3. Use of prescription and nonprescription medication

Medical Treatment Regimen for Diabetes, Knowledge, and Management

1. Diet: usual caloric intake, restrictions , time of meals , types and amounts of food eaten, meal-
planning skills, , compliance problems
2. Activity /exercise. Types.
Acute / Chronic Complications of Diabetes, Knowledge and Management
 STATE UNIVERSITY OF BOLIVAR
READING
GUARANDA – ECUADOR
1. Hypoglycemia: frequency of episodes , signs and symptoms , and usual causes

With this information, one identifies the patient's knowledge, current self, management, self - care deficits and
problems, and capabilities to make appropriate decisions and manage his or her disease. This information
provides the basis for instructing the patient about diabetes care and addressing problems with daily management
during later session

Starting at the time of diagnosis, patients with diabetes need to adjust their life-style and behavior significantly.
They must incorporate diabetes management behavior into their daily routine. Psychological adjustment to
IDDM and NIDDM often is problematic. Therefore, counseling and supportive psychotherapy can be useful
during the early weeks and months after diagnosis. However, beginning a biofeedback -assisted relaxation
program may not be appropriate. Adding the clinic appointment for biofeedback and home practice requirements
necessary to learn relaxation techniques might overload the resources of the patient. Furthermore, it would be
difficult to attribute improving in glycemic control to the biofeedback and relaxation because the patient is
starting multiple new behaviors concurrently.

Another reason for deferring biofeedback during the fist year after diagnosis is the so -called diabetic
"honeymoon period". This phenomenon is the partial or complete remission of the signs and symptoms of
diabetes soon after the onset of IDDM when the pancreas temporarily produces insulin. The blood glucose level
may stabilize at close to normal, and the need for exogenous insulin may decrease significantly or completely.
This period may last one, several, or, rarely, 12 months (Krall&Baser, 1989). One could mistakenly attribute a
decrease need for exogenous insulin to the biofeedback and stress management treatment instead of to temporary
pancreatic insulin production. When the honeymoon period ends and the patient's beta cells are not longer
capable of producing insulin, the patient could misattribute the renewed need for exogenous insulin as a total
failure of the self-regulation process.

Within a stepped -care model consider starting more conservative relaxation therapy or office-based biofeedback
-assisted relaxation sooner than 12 months after diagnosis for selected patients. For example, one could start with
audio cassette relaxation instructions and printed patient education about relaxation. The material should include
information to avoid misattributions about the honeymoon period.

Patients must at least partially accept the idea that stress can negatively impact on glycemic control. Increased
average blood glucose, a wider range of values, an increase in fasting blood glucose, and sometimes more
frequent hypoglycemia are common stress effects reported by patients. If a patient is unaware of or rejects the
correlation between stress and blood glucose, then perhaps stress is not affecting that person's blood glucose.
However, if he or she does not understand stress and is unaware of the potential or its effects, the person may
misunderstand its impact. In this case, educate the patients about stress and its relationship to blood glucose. This
can improve the chance for treatment to help normalize blood glucose levels.

The goals of biofeedback-assisted are to:

1) Increase the person's ability to perceive and effectively manage stress.

2) Decrease the neural and endocrine systems' effect son blood glucose and insulin.
 STATE UNIVERSITY OF BOLIVAR
READING
GUARANDA – ECUADOR
3) Reduce average blood glucose and increase the percentage of fasting blood glucose values at target range.

4) reduce dosage of hypoglycemic medication if blood glucose levels are well controlled at entry.

Relaxation therapies involve slow, diaphragmatic breathing, meditation, autogenic phrases, and/or progressive
muscle relaxation. One also may use "positive imagery" with other relaxation therapies. Measure the person's
blood glucose before and after at least the first relaxation session. In our program, most sessions include
instruction and practice of autogenic phrases. About one -fourth of the sessions include progressive relaxation.

There are no long term follow-up studies with diabetic population treated with biofeedback or relaxation.
However, we suggest periodic refresher sessions as is common practice when treating other chronic disorders.
The practitioner and the patient determine the timing of the follow-up office sessions. One periodically evaluates
control described earlier.

SELECT THE CORRECT OPTION.

Team members who participated in this study

a) They have been certified as experts in endocrinology.

b) They perform different functions according to their knowledge.
c) deepen the physiological foundations of diabetes.

One of the members of the group that makes the feedback to the patient

a) he must perceive the physiological effects that it produces and worsen the disease in the patient.
b) assesses the different emotional states of the patient before providing the appropriate medication.
c) It evaluates the patient's perception of the effects of stress on their illness.

Relaxation with feedback support

a) favors the reduction of plasma levels of stress hormones and glycemia.

b) always includes the detailed study of the same physiological modalities
c) it is carried out with the patient in a basal state during several intense sessions.

The diabetes educator

a) he must, within his functions and in the first place, educate the patient in all aspects of his illness and
daily management.
b) analyzes the disease in a global way in relation to the patient, inquires about his knowledge of the
disease and instructs him in its management.
c) You must receive a course that will instruct you about the disease before you can evaluate the problems
that the patient may present.

In paragraph 5 the author says that in some cases initiating an assisted relaxation program may not be
appropriate for the patient.

a) because the doctor would not know how to assign the value due to the different therapies that the patient
receives that would have saturated their ability to adapt.
 STATE UNIVERSITY OF BOLIVAR
READING
GUARANDA – ECUADOR
b) because this program would conflict with the supportive psychotherapy that is applied during the first
weeks or months after the diagnosis.
c) Due to the series of difficulties that arise, the patient must incorporate his understanding and
management of his diabetes into the daily routine.

The use of assisted relaxation during the first months after diagnosis

a) avoids partial or complete remission of the patient's symptoms during the period called "honeymoon".
b) interferes with the decrease in the need for exogenous insulin of the diabetic patient.
c) may mask the production of temporary pancreatic insulin from the "honeymoon" period.

The expression a stepped-care model means:

a) Start little by little with the therapeutic relaxation plan.

b) take more energetic measures to continue with the care model.
c) take the necessary steps so that the patient acquires the necessary information.

It is essential that the patient knows

a) the medical treatment that helps you normalize your glycemic values.
b) the relationship that exists between tense situations and glucose levels.
c) the impact of the increase in glucose in the body and the management of diabetes.

Part of relaxation goals

a) it is to reduce the effects of the endocrine and nervous systems on glucose and insulin.
b) it is to reduce the hypoglycemic medication of the patient according to controls established in advance.
c) Increase the patient's ability to try to reduce their fasting glucose measurement.

Relaxation therapy involves, among other things,

a) muscle relaxation and the use of videos with pleasant images.

b) the measurement of blood glucose before and after each session.
c) Diaphragmatic breathing and a series of self-conceived phrases.

Relaxation therapy

a) It has been studied in populations of chronic diabetics for a long time.

b) and their follow-up sessions are carried out by mutual agreement between the doctor and the patient.
c) for diabetics it is practiced for long periods since the disease is chronic.