George Walker Bush Leadership Style Essay

Barbara and George H. W. Shrub are the guardians of the 43rd leader of the United Sates, George W. Shrubbery. The two were hitched on January sixth, 1945 and it was said that they encountered all consuming, instant adoration when meeting. George Bush Sr. was 17 when hitched, and Barbara was 16. The two have lived in 29 homes situated in 17 urban communities, and is the main presidential couple to arrive at 60 years of marriage. Barbara’s foundation incorporates working a mid year work arranging stray pieces during World War II just as working at the Yale Coup while her significant other was going to the school, and until her first kid was conceived. She is the second lady in history to have both a child and spouse fill in as leader of the United States. George H. W. Bramble filled in as the 41st president, just as various different situations inside our administration. A portion of these incorporate VP to Ronald Reagan, executive of the CIA, congressman, minister to the United Nations, and director of the Republican National Committee. Other than these administrative positions he was a pilot in the naval force just as an oil representative in Texas. George Walker Bush was conceived on July 6, 1946 in New Haven, Connecticut. He was the most established of his five different kin: Pauline (Robin), John Ellis (Jeb), Neil, Marvin, and Dorothy (Doro). George’s sister Robin kicked the bucket at three years old from leukemia when George was just seven years of age. His sibling Jeb would likewise proceed to turn into the 43rd legislative leader of Florida. In 1948, George Sr. furthermore, Barbara moved the family to Midland, Texas, where H. W. would make his fortune in the oil business. George went to tuition based school in Massachusetts where he was an extraordinary competitor in baseball, football, and b-ball. He was acceptable in school, but on the other hand was known for being somewhat of a troublemaker. He proceeded to be acknowledged to Yale University where he was the leader of the Delta Kappa Epsilon clique, played rugby, and was an individual from the cryptic Skull and Bones society. Fourteen days before graduation George enrolled in the Texas National Guard. In spite of the fact that there is a ton of hypothesis concerning whether he totally satisfied his obligation, he was respectably released in 1974. In 1977, Bush met Laura Welch and wedded her after just three months. The couple has two youngsters together, twins Jenna and Barbara. Family is enormous to George, and he characteristics Laura for settling his life and helping him to surrender liquor in 1986. With respect to George W. Bush’s administration style, numerous things through his life have influenced how he decides to lead. In 1978 he lost in a political decision for a House of Representatives seat in Texas, which helped him to lower himself and understand that things would not be given to him as a result of his dad. He assisted with his father’s presidential crusade in the year 1988, and this helped him to become familiar with the intricate details of battles just as accomplishing the grimy work expected of such a position. After this, George purchased a portion of the Texas Rangers baseball crew and filled in as overseeing general accomplice for a long time, where he figured out how a business functions and runs. He became legislative head of Texas in 1995 and served until 2000, when he won the presidential political race on the republican ticket. He served two terms as president, and managed catastrophes, for example, Hurricane Katrina and September eleventh. George has been cited talking about Katrina saying, â€Å"Throughout the zone hit by the tropical storm, we will take the necessary steps, we will remain as long as it takes, go assist residents with modifying their networks and their lives†. George W. Bush’s initiative style can be portrayed as issue solver, delegator, unequivocal, visionary, and created. He was an issue solver since he accepted that getting issues understood right when they should have been was critical, and didn't push them off until the following individual came around to fix it. Concerning delegator, Bush was acceptable at knowing when it was his place to complete something, or when he should let another person assume control over the activity for him. George was an unequivocal pioneer in that he settled on extreme choices all through his administration, however consistently did what he accepted was best for our nation. Visionary is one approach to portray his initiative style seeing as he had a get vision set out toward the start of his administration for how he needed our nation to run, and this is something that he is known very well for. Finally, during Bush’s administration he needed to lead our nation through two horrible occurrences. Through the entirety of this, he had the option to keep up his poise and stay a powerful pioneer through intense occasions, which shows his self-restraint as a pioneer. Something that George W. Hedge is most notable for would be his discourse that he gave at seeing ground zero a couple of days after 9/11. I can hear you; the remainder of the world hears you. Furthermore, the individuals who thumped down these structures will hear we all soon. † I accept that this statement from him assists with demonstrating the entirety of the distinctive authority styles that he displayed all through his spell as legislative leader of Texas just as leader of the United States. These days, you can discover George investing energy with his significant other Barbara on his farm in Texas. He as of late composed his book, â€Å"Decision Points† and had a library set up in his name on the Southern Methodist University in the incredible province of Texas.

Suicide of Vietnam Veterans Essay Example For Students

Self destruction of Vietnam Veterans Essay The passings that were knowledgeable about Vietnam because of Agent Orange and other wilderness sicknesses have gotten notable by the overall population. Nonetheless, it is self destruction that has brought about the passings of more than 150,000 Vietnam fighters during and after the war. A colossal measure of suicides came about because of what a great many people call ensuring our nation. The Vietnam War brought more than fifty-8,000 passings and is to somebody of the darkest fights in United States history. If not executed during the war, many accept any Vietnam veteran would get back incredible and glad. In any case, this isn't the situation. Numerous Vietnam veterans have ended it all previously, during, and after the war. Not just have these men and lady took a chance with their lives for our nation, yet now, return various individuals and can not grasp whether to proceed with their lives. Numerous individuals accept we win wars, when in reality, nobody does, particularly the individuals who serve in the military (Suicide Wall, 11-10-2000). The Vietnam and different wars have intellectually and once in a while genuinely eviscerated numerous veterans. Another factor that assumes a job in a war-related self destruction is the expansion of numerous on location maladies, for example, defoliants, Agent Orange specifically. We will compose a custom exposition on Suicide of Vietnam Veterans explicitly for you for just $16.38 $13.9/page Request now Comprised of a balance of N-Butyl Ester 2,4,- D and N-Butyl Ester 2,4,5,- T, Agent Orange made numerous Vietnam warriors go crazy (Vietnam Veterans, 11-10-2000). This appalling substance lead and still today prompts demise, distortion, and diabetes. Dr. Joel E. Michalek, who manages measurements for the aviation based armed forces, was the first to see a connection between Agent Orange and diabetes. Be that as it may, the central government was not willing . ..to burn through a huge number of dollars on such examinations. Dr. Michael Gough, a resigned scholar was cited as saying the end Ive come to is that there is no proof at all to help any association between low-level dioxin introduction and any human ailment. Some state they won't do explore on the grounds that it is something else . ..that will be connected to the wellbeing grumblings of Vietnam veterans (Kolata, A16). There is trust still. In 1996, Clinton requested inability benefits for Vietnam veterans experiencing prostate malignancy and nerve illness related with Agent Orange. In the long run, the legislature will subsidize an ever increasing number of maladies for the individuals who served in the war and were presented to the substances. Nobody truly knows without a doubt what it does, however numerous maladies have been related with the fatal defoliant, Agent Orange (Purdum, A17). There have been such a significant number of suicides submitted by Vietnam veterans; it is currently on the most effective instrument of the twenty-first century. Destinations have sprung up everywhere throughout the Internet managing the people who served in the Vietnam War. One site, clearly just regarding this matter, recounts distinctive data on those ending it all the most, Vietnam Vets. The site, Suicide Wall, .. .is an endeavor to decide what number of Vietnam veterans have really ended their own lives (Suicide Wall, 11-10-2000). An on going investigation on why and how these suicides happen is proceeding with ordinary. A major discussion is entirely numerous individuals took their lives because of the war. The United States have their measurements, however Australia went inside and out to see a genuine sum. The U.S. guarantees around 58,000 suicides have occurred because of the war. This check is about 20% of all passings in the Vietnam War, which would be put in the class of self destruction. However, Australia accepts through the equivalent and different insights that around 150,000 individuals ended it all. That would carry the United States rate to roughly half of a self destruction rate. Nobody could very know what number of passed on because of post-emotional pressure and various defoliants from the Vietnam War, yet a progressing battle to comprehend the disasters of this war appears will be proceeding in the years to come. Numerous veterans served in Vietnam somewhere in the range of 1969 and 1973. Numerous insights on self destruction appropriate showcase the realities of the Vietnam War. The . .ub81dfbd39e09e41d94eda4f18edb0d21 , .ub81dfbd39e09e41d94eda4f18edb0d21 .postImageUrl , .ub81dfbd39e09e41d94eda4f18edb0d21 .focused content region { min-stature: 80px; position: relative; } .ub81dfbd39e09e41d94eda4f18edb0d21 , .ub81dfbd39e09e41d94eda4f18edb0d21:hover , .ub81dfbd39e09e41d94eda4f18edb0d21:visited , .ub81dfbd39e09e41d94eda4f18edb0d21:active { border:0!important; } .ub81dfbd39e09e41d94eda4f18edb0d21 .clearfix:after { content: ; show: table; clear: both; } .ub81dfbd39e09e41d94eda4f18edb0d21 { show: square; progress: foundation shading 250ms; webkit-change: foundation shading 250ms; width: 100%; obscurity: 1; change: darkness 250ms; webkit-change: mistiness 250ms; foundation shading: #95A5A6; } .ub81dfbd39e09e41d94eda4f18edb0d21:active , .ub81dfbd39e09e41d94eda4f18edb0d21:hover { murkiness: 1; change: haziness 250ms; webkit-change: obscurity 250ms; foundation shading: #2C3E50; } .ub81dfbd39e09e41d94eda4f18edb0d21 .focused content region { width: 100%; position: relative; } .ub81dfbd39e09e41d94eda4f18edb0d21 .ctaText { outskirt base: 0 strong #fff; shading: #2980B9; text dimension: 16px; textual style weight: intense; edge: 0; cushioning: 0; text-improvement: underline; } .ub81dfbd39e09e41d94eda4f18edb0d21 .postTitle { shading: #FFFFFF; text dimension: 16px; text style weight: 600; edge: 0; cushioning: 0; width: 100%; } .ub81dfbd39e09e41d94eda4f18edb0d21 .ctaButton { foundation shading: #7F8C8D!important; shading: #2980B9; fringe: none; fringe range: 3px; box-shadow: none; text dimension: 14px; text style weight: striking; line-tallness: 26px; moz-outskirt span: 3px; text-adjust: focus; text-embellishment: none; text-shadow: none; width: 80px; min-tallness: 80px; foundation: url(https://artscolumbia.org/wp-content/modules/intelly-related-posts/resources/pictures/basic arrow.png)no-rehash; position: outright; right: 0; top: 0; } .ub81dfbd39e09e41d94eda4f18edb0d21:hover .ctaButton { foundation shading: #34495E!important; } .ub81dfbd39e09e41d94eda4f18edb 0d21 .focused content { show: table; tallness: 80px; cushioning left: 18px; top: 0; } .ub81dfbd39e09e41d94eda4f18edb0d21-content { show: table-cell; edge: 0; cushioning: 0; cushioning right: 108px; position: relative; vertical-adjust: center; width: 100%; } .ub81dfbd39e09e41d94eda4f18edb0d21:after { content: ; show: square; clear: both; } READ: Media Violence Essay..mortality rate in Vietnam Veterans was 17% higher than for Vietnam-time veterans during the initial five years following release (Kelley, 1997). Michael Dean served in Vietnam for just two years and about never took an interest in battle. In 1986, he slaughtered his .

Multi-Cultural Law Enforcement Definition Essay Example | Topics and Well Written Essays - 500 words

Multi-Cultural Law Enforcement Definition - Essay Example For example, an African man who moves to live in Europe begins to gain the attributes of Europeans. Predisposition alludes to ‘unfair’ judgment. A one-sided individual acts for one side. It is along these lines a propensity of an individual to portray tendency, for the most part towards the sudden side. For example an European manager gives an occupation to a kindred European to the detriment of individuals from different nationalities, not by merit however source. Culture alludes to the measures related with a given society, and which has unmistakable traits which can help in extraordinarily recognizing the individuals from the general public. For example the African culture, which distinguishes individuals of African inception. The prevailing society alludes to the way of life that has most noteworthy number of individuals, when contrasted with the other culture. Along these lines, a prevailing society is the one that shapes the most elevated populace rate. For example the prevailing society in America is that of the whites. Ethnocentrism alludes to the conviction that, one’s ethnic gathering is superior to the others. Thus, the individual appointed authorities the other ethnic gatherings on premise of his own ethnic gathering. For instance, an American appointed authorities African culture dependent on the principles of his ethnic gathering. It alludes to a biased supposition by an individual who doesn’t base on any thinking. The individual has a negative vibe against the other. For example a negative remark from an instructor to an African understudy, whereby the teacher has a recognition that Africans can have nothing advantageous. It is a conduct, through which a gathering or an individual is singled out from a gathering for ridiculous negative treatment (Stafford, 1977). For instance, a dark individual is disengaged from whites and whipped for no reasons. Zagefka, H., Gonzã ¡lez, R., and Brown, R. (2011). How minority individuals impression of greater part members cultural assimilation inclinations shape minority individuals own cultural assimilation preferences: Evidence from Chile. British Journal Of Social Psychology,â 50(2), 216-233. doi:10.1348/014466610x512211 There exist

Venn Diagram Free Essays

Visual device to assist understudies with sorting out complex data in a visual manner. The Venn chart originates from a part of arithmetic called a set hypothesis. John Venn created them in 1891 to show the connection between sets. We will compose a custom paper test on Venn Diagram or on the other hand any comparable theme just for you Request Now The data is typically introduced in straight content and understudies make the outline to sort out the data. It makes it simpler when there is a great deal of data, in light of the fact that with direct content it isn't as simple to see the relationship. The Venn graph is a significant device for marks since it is another route for them to issue comprehend throughout everyday life. On the off chance that you are given a great deal of data that is befuddling you can utilize the Venn chart to sort out the data and once you have the data it is simple for you to see everything spread out before you. This chart is something that likewise helps understudies who are to a greater extent a visual student. On the off chance that you can put the entirety of the data out in an outline and afterward you can not just observe the entirety of the data, you can have everything sorted out in a chart and right here for you to see. This strategy is useful for all understudies, even the individuals who are not visual students. With the Venn graph you are additionally ready to perceive how the data identifies with one another, just as where the data doesn't relate. Have consistently discovered the Venn outline a simple strategy for learning for bunches of data. A model would be on the off chance that you had a rundown of understudies who were acceptable in math, a rundown of understudies who are acceptable in English and afterward a gathering of understudies who are acceptable in science and alongside that rundown you have a sit of understudies who are acceptable in every one of the three subjects. Step by step instructions to refer to Venn Diagram, Papers

Grounded Theory

Definition Grounded hypothesis is a subjective way to deal with examine that envelops the utilization diverse iterative procedures to do methodical examination of social wonders. The grounded hypothesis approach is expressly applied in the age and additionally improvement of new speculations concerning intuitive social inquiries.Advertising We will compose a custom basic composing test on Grounded Theory explicitly for you for just $16.05 $11/page Learn More Creswell (2012) uncovers that the grounded hypothesis is appropriate for looking for cutting edge information about a particular social marvel. The grounded hypothesis approach utilizes abductive instead of inductive or deductive thinking. In any case, abductive thinking is a trade off of both inductive and deductive perspectives. Inductive and deductive ways of thinking look for the best clarification about the subject of study. This trademark makes grounded hypothesis inquire about suitable for investigating mind boggling socia l events in the general public. Not at all like numerous other hypothetical ideas, grounded hypothesis examine utilizes information to create speculations. For this situation, information is broke down with a perspective on building a hypothesis. The analyst isn't relied upon to move toward sensational information with a hypothesis (Lawrence Tar, 2013). Sorts of Grounded Theory Research Designs There are three kinds of grounded hypothesis plans that incorporate efficient, developing, and constructivist grounded hypothesis inquire about structures. The efficient grounded hypothesis configuration centers around the use of open, hub, and particular coding strategies during the time spent information examination (Creswell, 2012). These orderly stages empower the analyst to build up a pertinent paradigm of the normal hypothesis. Then again, the rising plan stresses permits the hypothesis to create from the acquired information. This sort of grounded hypothesis investigate doesn't utilize foreordained stages as in the precise grounded hypothesis plan. Finally, the constructivist configuration involves the examination of respondents’ perspectives, values, desires, convictions, and ways of thinking. It tries to analyze singular encounters. Procedure of approaching this Research Creswell (2012) clarifies the different particular stages that are associated with the way toward approaching the grounded hypothesis investigate. The grounded hypothesis technique begins with information assortment. Individual interviews, direct perceptions, and diary data establish the various procedures that specialists use to gather grounded information. The strategy that is utilized to gather information relies upon its capacity to give adaptable data since grounded look into is a powerful procedure. The subsequent advance involves note taking. The astuteness of the specialist is significant to acquire pertinent data. The affectability of the data that is gathered during the time sp ent grounded hypothesis explore decides the pertinence of the created concepts.Advertising Looking for basic composition on reasoning? How about we check whether we can support you! Get your first paper with 15% OFF Learn More In the third step, the scientist is relied upon to look for endorsement and consent to get to data from significant sources. Fourthly, the grounded hypothesis examine includes purposeful conduction of hypothetical testing. Next, the gathered information is coded to give a structure to building up the foreseen hypothesis. The 6th step involves approval of the created hypothesis. At last, the specialist needs to compose a grounded hypothesis look into report to help the created hypothesis. Challenges Grounded hypothesis look into includes troublesome procedures, for example, assortment and investigation of recurrent information. Without a doubt, the assortment of recurrent information, investigation, and assurance of ends is tedious. This test altogether influen ces the capacity of the specialist to keep up unending correlation of grounded information (Lawrence Tar, 2013). Besides, grounded speculations are inferential as opposed to distinct. This nature of research entangles the comprehension of unique data. This circumstance influences adaptability and capacity to maintain unwavering quality all through the whole procedure of research. Points of interest and Disadvantages of the Grounded Theory Research Creswell (2012) sets that each subjective way to deal with look into has its own favorable circumstances and detriments that decide its reasonableness for examination. Perhaps the best bit of leeway of the grounded hypothesis approach is its deliberately and thoroughly confined examination methodology. The efficient course of action of the theory’s stages facilitates the assortments, investigation, and age useful answers for social issues. Also, the grounded hypothesis look into furnishes the scientist with rich information that is picked up from the encounters of others. The hypothesis gets information from encounters relating to various social marvels. This preferred position empowers the scientist to go through old data to accompany elective answers for complex issues. In any case, the grounded hypothesis look into has different weaknesses. To begin with, since the hypothesis is a trade off among inductive and deductive thinking, the inclination of the data meddles with the reliability and validation of the whole procedure of information examination. Also, the subjective idea of the outcomes that are acquired for the grounded look into process is on occasion vague for practitioners.Advertising We will compose a custom basic composing test on Grounded Theory explicitly for you for just $16.05 $11/page Learn More Field in which the Grounded Theory Research is for the most part broadly utilized The grounded hypothesis investigate is utilized in numerous fields to look for practicable answers for social marvel. Lawrence and Tar (2013) uncover that the grounded hypothesis inquire about has gotten progressively mainstream in leading clinical investigations. Its subjective viewpoints make it suitable for planning, justification, and age of spearheading discoveries that upgrade the treatment of patients and organization of treatment. Besides, the grounded hypothesis approach is valuable in bookkeeping. Bookkeepers require abductive thinking to accumulate and examine coded information. It empowers them to create relevant hypotheses through the control of bookkeeping information. Bookkeeping rehearses request continuous appraisal of complex data from business reports. The examination of such data requires the use of subjective strategies, for example, the grounded hypothesis look into. Reference List Creswell, J. (2012). Subjective Inquiry and Research Design: Choosing Among Five Approaches. New York, NY: Sage Publications. Lawrence, J., Tar, U. (2013). The utilization of Grounded Theory Techni que as a Practical Tool for Qualitative Data Collection and Analysis. Electronic Journal of Business Research Methods, 11(1), 29-40. This basic composition on Grounded Theory was composed and put together by client Karlee O. to help you with your own investigations. You are allowed to utilize it for research and reference purposes so as to compose your own paper; in any case, you should refer to it in like manner. You can give your paper here.

The Academic Mindset Part 3 The Art of Showing Up

The Academic Mindset Part 3 â€" The Art of Showing Up Were continuing into the third part of my five-part series about developing an academic mindset to get you through your four years of college, regardless of your major. So far, weve discussed the importance of trying in whatever you do, and weve also talked about the importance of making your work pretty, essentially, giving your all in whatever youre setting your mind to. Now, were going to talk about one of the most important skills Ive learned in undergrad: The art of showing up. Just show up. Show up to anything and everything, from school stuff to club stuff. Ive found that showing up puts you ahead of almost everyone in college, because no one realizes how much power is found in showing up. When you get to college, youll find out that no one really requires you to do anything. You dont have to go to any club meetings, you dont have to go to office hours, you dont have to go to sporting events, or class, or help sessions, or study groups. The only thing you really have to show up to are exams. Thats basically it. What Im telling you is to show up to everything that I just mentioned you dont have to show up to. Show up to help sessions, office hours, and every class. Even if you spend the whole class looking at ESPN, the discipline of showing up keeps your head in the fight. It gets you in a frame of thinking that allows you to accomplish huge goals by completing smaller, simpler tasks. Whenever you show up, you are essentially disciplining yourself. You need to be relentless if you want to do anything of worth in college. Understanding complex biological mechanisms will not magically come to you one evening. The first paper you write will be unbelievably bad. What were trying to get started with this academic mindset is a way of approaching work that can translate to skills you can use effectively when you enter the workforce. Showing up, day after day, week after week, month after month, is the way you build skills that make you effective. Simply by waking up in the morning and making it to the 8 a.m. lecture where attendance isnt mandatory, you are teaching yourself to show up. Showing up gives you a huge advantage in developing yourself socially and mentally, as well. This really cant be overstated. Showing up gives you a psychological edge, and it gives you solid evidence you can point to and tell yourself Im working toward something.Showing up is the secret power in college. When you think about it, it sort of makes sense: youre constantly looking for new experiences that you can learn from. Show up to club meetings. Want to know the secret to being an effective leader in an organization? Consistent attendance. You prove yourself to be a dependable member of the organizaation, aand someone whom leadership can trust with incrementally larger responsibilities. Showing up is hard. Its not glamorous at all. If anything, its costly, and its painful. When I was taking organic chemistry, office hours were pretty brutal. I was constantly confronted with my lack of understanding of the material, while everyone else who attenteded seemed to have everything under control. There were countless times where I aggressively did not want to ever return to office hours and have the professor look at me like the fraud I was. Nevertheless, I kept going. I even played pump-up songs before heading into the office just to keep myself from leaving! Did all of that pay off? You bet it did. Show up. Show up. Show up. All you have to do. Just show up. Mark Class of 2020 I was born and raised in Naperville, Illinois. I’m a pre-dental student studying Integrative Biology, and I’m trying to pursue minors in Chemistry and English. My posts are for students who want to know what college is actually like and how to survive once you get here.

Maltreatment and diabetes - Free Essay Example

Study Rationale The primary goal of this study is to conduct an empirical investigation of the association between an early life stressor such as childhood maltreatment and subsequent diagnosis of Type II diabetes in adulthood. This study will specifically explore if a relationship exists between the type and severity of childhood maltreatment encountered and participants diabetes-related quality of life. To provide a context for the current study, background literature focusing on two dimensions that have received considerable attention in the psychological literature is first thoroughly reviewed: definition and effects of childhood maltreatment and the biopsychosocial aspect of Type II diabetes. The current studys purpose, hypotheses, method, and data analytic strategy will then be proposed. Background Information Childhood Maltreatment Childhood maltreatment refers to, any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child (Centers for Disease Control [CDC], n.d., para. 1). In their report, Child Maltreatment Surveillance, Leeb, Paulozzo, Melanson, Simon, Arias (2007) defined acts of commission as deliberate and intentional use of words or actions that cause harm, potential harm, or threat of harm to a child. Examples of acts of commission include physical, sexual, and/or psychological abuse. Acts of omission, on the other hand, are the failure to provide for a childs basic physical, emotional, or educational needs or to protect a child from harm (Leeb et al., 2007). Thus, acts of omission include physical, emotional, medical, or educational neglect, the failure to supervise or insufficient supervision, and/or exposure to a violent environment. According to the most recent publication by the U.S. Department of H ealth and Human Services (USDHHS) on childhood maltreatment, an estimated 905,000 children were determined to be victims of abuse or neglect (USDHHS, 2006). Specifically, 64.2 percent of child victims experienced neglect, 16.0 percent were physically abused, 8.8 percent were sexually abused, and 6.6 percent were emotionally or psychologically maltreated. The report suggests that rates of victimization by maltreatment type have fluctuated only slightly during the past several years. The long-term consequences of child maltreatment are significant and include the risk of alterations of brain structure and function, sexual risk taking behaviors, eating disorders, suicidal intent and behavior, lower self-esteem, adjustment problems, internalizing problems (i.e. anxiety and depressive disorders), externalizing problems (i.e. personality disorders and substance abuse), adult trauma, continuation of intergenerational violence and/or neglect, and developmental and cognitive disabilities (Anda, Felitti, Bremner, Walker, Whitfield, Perry, Dube, Giles, 2006; Arata, Langhinrichsen-Rohling, Bowers, OFarrill-Swails, 2005; Bardone-Cone, Maldonado, Crosby, Mitchell, Wonderlich, Joiner, Crow, Peterson, Klein, Grange, 2008; Johnson, Sheahan, Chard, 2003; Kaplow Widom, 2007; Kaslow, Okun, Young, Wyckoff, Thompson, Price, Bender, Twomey, Golding, Parker, 2002; Lewis, Jospitre, Griffing, Chu, Sage, Madry, Primm, 2006; Medrano, Hatch, Zule, Desmond, 2002; Smith, 1996; Sobsey, 2002; Taft, Marshall, Schumm, Panuzio, Holtzworth-Munroe, 2008). A consistent relationship between abuse history and poorer overall health has also been demonstrated in a stratified, epidemiological sample of both men and women within the United States (Cromer and Sachs-Ericsson, 2006). Childhood Maltreatment and Physical Health Problems A consistent dose-relationship between abuse history, poorer overall health, and sustained losses in health-related quality of life has been well established (Cromer Sachs-Ericsson, 2006; Golding, 1994; Corso, Edwards, Fange, Mercy, 2008). Childhood sexual abuse has been associated with physical complaints such as migraine, irritable bowel syndrome, fibromyalgia, and chronic pain (Goldberg, Pachas, Keith, 1999; Goodwin, Hoven, Murison, Hotopf, 2003; Ross, 2005; Walker, Keegan, Gardner, Sullivan, Bernstein, Katon, 1997). Furthermore, using data from the National Corbidity Study, a nationally representative general population study, Arnow (2004) found that abused children were likely to have pelvic and musculoskeletal pain as adults, and utilize health care services at a greater proportion in adulthood. However, a major limitation of these studies is exclusion of emotional and/or psychological abuse experienced in childhood. Additionally, results regarding the incidence of types of childhood maltreatment and diabetes have been mixed. Diabetes Diabetes is a chronic disease characterized by the deficiency or resistance to insulin, a hormone needed to convert sugar, starches and other food into energy needed for daily living. As such, insulin deficiency compromises the body tissues access to essential nutrients for fuel or storage. According to the American Diabetes Association (ADA), there are 23.6 million children and adults in the United States, or 7.8% of the population, who have diabetes, many of which unaware that they have the disease (ADA, n.d., para. 2). Diabetes occurs in two primary forms. Type I diabetes is characterized by absolute deficiency and typically occurs before the age of 30. Type II diabetes, however, is typified by insulin resistance with varying degrees of deficiencies in the bodys ability to secrete insulin. Sedentary lifestyle and diet have been linked to the development of Type II diabetes. Other risk factors for this type of diabetes include obesity, pregnancy, metabolic syndrome, and variou s medications. Physiologic and emotional stress has also been thought to play a key role in the development of Type II diabetes specifically. Prolonged elevation of stress hormones, namely cortisol, glucagon, epinephrine, and growth hormone, increases blood glucose levels, which in turn places increased demands on the pancreas. Such stress ultimately leads to the inability of the pancreas to keep up with the bodys need for insulin and high levels of glucose and insulin circulate in the bloodstream, setting the stage for Type II diabetes (Diseases, 2006). Role of Stress in the Onset of Diabetes Animal Studies Researchers have found that both a history and presence of existing stressors play a significant role in the onset and course of diabetes. Through the use of animal studies, researchers have been able to prospectively test the influence of stress on both types of diabetes. For example, Lehman, Rodin, McEwen, and Brinton (1991) investigated whether an environmental challenge promoted the expression of diabetes in bio-breeding rats. Researchers introduced a triad of stressors to the animals over a 14-week period, including rotation of the cage, vibration, and restraint in individual containers. They found that the administration of these stressors repeatedly increased the likelihood of the rats developing Type I diabetes as indicated by elevated blood sugar levels (Lehman et al., 1991). One of the first observations that stress could contribute to the expression of Type II diabetes was made during metabolic studies of the native North African sand rat (psammonys obesus). Once fed with laboratory chow and allowed to become obese, the North African sand rat will eventually develop Type II diabetes in response to an environmental stressor (Surwit, Schenider, Feinglos, 1992). Notably, Mikat, Hackel, Cruz, and Lebowitz (1972) administered an esophageal intubation of saline in an effort to control the dietary intake of the sand rat. This tube feeding resulted in an alteration of glucose tolerance and precipitated the onset of Type II diabetes in these rats. Similar research was done on the genetically obese (ob/ob) mouse, which is used as a prototype of Type II diabetes in humans because of its pattern of obesity, hyperinsulinemia, hyperglycemia, insulin resistance, and glucose intolerance (Surwit, Feinglos, Livingston, Kuhn, McCubbin, 1984). To study the effects of environmental stress and sympathetic nervous system arousal on plasma glucose in ob/ob mice, Surwit et al. (1984) designed two experimental conditions. In the first condition, 15 ob/ob mice were shak en in their cage at a rate of 200 strokes per minute for five minutes. In the second condition, 16 ob/ob mice were injected with epinephrine bitartrate, a chemical whose effects mimic those of the stress response. Plasma glucose levels in mice from both conditions were found to be significantly elevated. The researchers concluded that environmental stress was partially responsible for the expression of the diabetic phenotype in this animal model of diabetes. Role of Stress in the Onset of Diabetes Human Studies Data gathered on the impact of life events on Types I diabetes in a human sample has yielded inconsistent results. An early study by Grant, Kyle, Teichman, and Mendels (1974) examined the relationship between the occurrence of life events and the course of illness in a group of 37 diabetic patients. Using Holmes and Rahes Schedule of Recent Events (SRE), a scale in which 43 significant recent life events are assigned a numeric value of life change units as a measurement of life stress, Grant et al. (1974) found that of the 26 participants who had a positive correlation between undesirable life events and illness, 24 had a positive correlation between undesirable events scores and diabetic condition. This data suggests that negative events were primarily responsible between life events and changes in diabetic condition since the inclusion of neutral and positive events did not increase the magnitude of the correlations. Despite the significant results, this study had a number of lim itations, including the utilization of a small sample size, difficulty in establishing reliable criteria for assessing subtle changes in the diabetic condition, lack of sufficient time to elapse between assessments for significant life changes to occur, and the lack of delineation of the types of diabetes studied (i.e. Type I vs. II). However, in a more recent meta-analysis, Cosgrove (2004) found no evidence to support the hypothesis that life events cause or precipitate Type I diabetes. Using an electronic and manual literature search of appropriate key words (namely, diabetes and depression, diabetes and depressive, diabetes and life events, diabetes and stress) in the literature up to July 2003, Cosgrove (2004) aimed to establish whether there might be a link between depression, stress, or life events and the onset of Type I diabetes. A total of nine papers were found from the electronic and manual search. It was concluded that when the number and severity of life events was c ompared to controls in all nine reviewed studies, no differences were detected in the diabetics (Cosgrove, 2004). Though data from small, older studies and large, randomized studies showed that early losses in childhood increase the risk of developing Type I diabetes, no evidence was found to support the hypothesis that life events cause or precipitate this diagnosis. Meta-analyses with more recent studies have not been found studying the relationships between stressful life events in both types of diabetes. As such, it is unknown whether links have since been found by other researchers. More consistent evidence was found supporting the notion that stressful circumstances precipitate Type II diabetes. In their study of environmental stress on Type II diabetics, McCleskey, Lewis, and Woodruff (1978) measured glucagon and glucose levels on 25 patients who were undergoing elective surgery, a physical stressor. Ten samples were obtained during pre-operative, intra-operative, and post -operative periods for each patient. It was found that throughout the sampling period, diabetic patients had two times the amount of glucagon (a hormone produced by the pancreas that stimulates the increase of blood sugar levels) in their body compared to their non-diabetic counterparts (McCleskey, Lewis, Woodruff, 1978). This effect was also found in Pima Indians, who have an approximately 60% chance of eventually developing Type II diabetes, compared with 5% of the Caucasian population (Surwit, Schenider, Feinglos, 1992). The effects of a simple arithmetic task on blood glucose levels were studied in both Caucasian and Pima Indian samples. Surwit, McCubbin, Feinglos, Esposito-Del Puente, and Lillioja (1990) found that blood glucose was consistently higher during and following the stressful task in ten of 13 Pima Indians, concluding that altered glycemic responsivity to behavioral stressors anticipates the development of Type II diabetes in individuals who are genetically pred isposed to the disease (Surwit et al., 1990). Results from The Hoorn Study further illustrated the effects of stress on Type II diabetes. Mooy, De Vries, Grootenhuis, Boutner, and Heine (2000) analyzed data from a large population-based survey of 2,262 adults in the Netherlands upon which the researchers were able to explore whether chronic stress is positively associated with the prevalence of Type II diabetes. Analysis of data confirmed their hypothesis; a high number of rather common major life events that are correlated with chronic psychological stress, such as death of a spouse or relocation of residence, were indeed found to correspond to a significantly higher percentage of undetected diabetes (Mooy et al., 2000). Because the study was conducted in the Netherlands on a Caucasian, middle-aged population, it is uncertain whether these findings are generalizable to other demographics in different geographic regions. Childhood Maltreatment and Diabetes Thus far, with the exception of one study, the research discussed has demonstrated a positive correlation between a variety of recent or current environmental stressors, such as anesthesia, surgery, cognitive tasks, death of a loved one, and other significant losses, and the onset of Type I and/or II diabetes in animals and human beings. However, the literature is somewhat limited as to the relationship between a past environmental stressor, namely childhood maltreatment, and Type II diabetes in adulthood. Numerous researchers examined the prevalence of medical problems in abused populations and have reported that diabetes is one of the most common health conditions among those who have experienced maltreatment. For example, using data drawn from the National Comorbidity Study conducted in the early 1990s, Sachs-Ericsson, Blazer, Plant, and Arnow (2005) examined the independent effects of childhood sexual and physical abuse on adult health status in a large community sample of 5 ,877 men and women. Sachs-Ericsson et al. (2005) found that childhood sexual and physical abuse was associated with the one-year prevalence of serious health problems for both men and women. Specifically, participants who experienced any form of childhood abuse were more likely to report having a medical condition, including AIDS, arthritis, asthma, bronchitis, cancer, diabetes, high blood pressure, kidney or liver disease, neurological problems, stroke, gastrointestinal disorders, or any other serious health problem (Sachs-Ericsson et al., 2005). Though data from this epidemiological study likely represents the U.S. demographics, a number of limitations exist. Specifically, the researchers did not report the prevalence of each disorder endorsed and thus, the actual incidence of diabetes in the population sample is unknown. Furthermore, Sachs-Ericsson et. al (2005) did not look at additional forms of maltreatment, such as verbal abuse, emotional abuse, and neglect. Similarly, Wal ker, Gelfand, Katon, Koss, Von Korff, Bernstein, and Russo (1999) found a significant association between childhood maltreatment and adverse adult health outcomes. In particular, the researchers administered a survey to 1,225 women randomly selected from the membership of a large HMO in Washington State. Results indicated that women with childhood maltreatment histories were more likely to have an increased number of physician-coded ICD-9 diagnoses, grouped together as high blood pressure, diabetes, dermatitis, asthma, allergy, acne, and abnormal menstrual bleeding. Though the group of women in this study who reported threshold levels of sexual maltreatment had the poorest health outcomes, a major limitation of this study is the uncertainty as to whether additional forms of maltreatment were concomitantly experienced. Specifically, the authors do not establish whether sexual abuse solely was the cause of poorer health or is largely due to multiple forms of maltreatment in girls who were not properly protected in their early families. Moreover, Walker et al. (1999) do not differentiate between types of diabetes. Gender differences have been established in the association between physical abuse in childhood and overall health problems in adulthood. Analysis of data from 16,000 individuals interviewed in the National Violence Against Women Survey found that female abuse victims were at greater risk for health problems than their male counterparts (Thompson, Kingree, Desai, 2004). Furthermore, women with maltreatment history tend to have more distressing physical experiences, have an increased number of physician-coded diagnoses, and were more likely to engage in multiple health risk behaviors, including obesity a significant risk factor associated with Type II diabetes (Trickett, Putnam, Noll, 2005; Walker, Gelgand, Katon, Koss, Von Korff, Bernstein, Russo, 1999). Moreover, sexual assault history throughout ones lifespan was also associated with chronic di sease (i.e. diabetes, arthritis, and physical disability) in a sample of women from Los Angeles (Golding, 1994). Conversely, in their sample of 680 primary care patients, Norman, Means-Christensen, Craske, Sherbourne, Roy-Byrne, and Stein (2006) found that the experience of trauma significantly increased the odds of arthritis and diabetes for men, while trauma was associated with increased odds for digestive disorders and cancer in women. Although the data suggests that childhood maltreatment is related to adverse health outcomes in adulthood, they do not address as to why associations differed by gender. Analyzing data from the Midlife Development in the United States Survey (MIDUS), Goodwin and Weisberg (2002) sought to determine the association between childhood emotional and physical abuse and the odds of self-reported diabetes among adults in the general population. Their results revealed that self-reported diabetes occurred in 4.8% of its representative sample of 3,032 adul ts aged 25-74 years. Childhood abuse was associated with significantly increased odds of self-reported diabetes, which persisted after adjusting for differences in socio-demographic characteristics and mental health status (Goodwin Weisberg, 2002). Moreover, individuals who specifically reported maternal emotional abuse and maternal physical abuse had significantly higher rates of diabetes (Goodwin Weisberg, 2002). Furthermore, data gathered from a sample of 130 patients (65 abused, 65 non-abused controls) drawn from an adult primary-care practice in a small, affluent, predominantly Caucasian community in northern New England revealed that patients with a history of victimization were more likely to report diabetes or endorse symptoms of this illness than non-abused participants (Kendall-Tackett Marshall, 1999). Specifically, four patients in the abused group reported diabetes, with none in the control group. Interestingly, those patients in the abused group did not have a sig nificantly higher family history of diabetes than those in the non-abused group and a higher percentage of patients in the abused group reported having three of more symptoms than did those in the control group. Kendall-Tackett and Marshall (1999) assert that although only four people identified themselves as having diabetes, this number should be interpreted in the broader context of incidence of diabetes in the general population. Nonetheless, this finding could have been due to chance and many of the symptoms endorsed could have been related to other diseases (Kendall-Tackett Marshall, 1999). Additional limitations include the failure to differentiate between the types of abuse endured and the use of a non-empirically validated measure to gather data. Furthermore, the researchers did not specify which type of diabetes the participants were diagnosed with and did not indicate the severity of the disease. Data from the Adverse Childhood Experiences Study (ACE), however, found a lternative results. Researchers Felliti, Anda, Nordenberg, Williamson, Spitz, Edwards, Koss, and Marks (1998) mailed questionnaires about adverse childhood experiences to 9,508 adults who had completed a standardized medical evaluation at a large HMO in California. It was found that abuse and other types of household dysfunction were significantly related to the number of disease conditions, with the exception of diabetes. Specifically, when those who had experienced multiple forms of childhood maltreatment were compared to those with no experiences, the odds-ratio for the presence of diabetes was a non-significant 1.6 (Felliti et al., 1998). The researchers believe that their estimates of the long-term relationship between adverse childhood experiences and adult health are conservative. Specifically, it is likely that, consistent with well-documented longitudinal follow-up studies, that reports of childhood abuse were underestimated due to the premature mortality in persons with mu ltiple adverse childhood exposures (Felliti et al., 1998). Similarly, in a sample of 1,359 community-dwelling men and women aged 50 years or older, Stein and Barrett-Connor (2000) found no relationship between sexual assault history in participants lifetime and reported rates of diabetes. Rather, a history of sexual assault was associated with an increased risk of arthritis and breast cancer in women and thyroid disease in men (Stein Barrett-Connor, 2000). In this study, the researchers posit that the possibility of response bias is a major limitation. Namely, Stein and Barrett-Connor (2000) consider the likelihood that previously assaulted respondents have a greater tendency to visit doctors, leading to the increased opportunities for health conditions to be detected. Additional limitations include the lack of consideration for other types of abuse encountered in childhood. The Link between Childhood Maltreatment and Diabetes The above findings provide support for the hypothesis that childhood maltreatment may be associated with increased likelihood of the diagnosis of a medical condition, with the inclusion of diabetes in some studies. An essential question posed by this observation is by what mechanisms are adverse childhood experiences linked to health risk behaviors and adult diseases? A number of researchers have found that psychological stress, in particular, has been associated with the onset of Type II diabetes. This impact of stress on the etiology and course of Type II diabetes can be considered via the metabolic pathways by means of obesity and/or activation of the hypothalamic-pituitary-adrenal (HPA) axis, the gene-environment interaction, and the correlation of coping with diabetes and stressors. The stress response is a physiological coping response that involves the HPA axis, the sympathetic nervous system, the neurotransmitter system, and then immune system. There is growing evidence that victims of various forms of abuse and stressors often experience biological changes, particularly in the neuroendocrine system implicated in the stress response, as well as the brain (Glaser, 2000; Goenjian, Pynoos, Steinberg, Endres, Abraham, Geffner, Fairbanks, 2003; King, Mandansky, King, Fletcher, Brewer, 2001; McEwen, 2000). The HPA axis is the primary mechanism studied in the literature on the neurobiology of stress and is estimated through the non-invasive measurement of cortisol in saliva samples. During psychological stress, cortisol is elevated beyond normal levels in response to adrenocorticotropic hormone from the pituitary, mobilizing energy stores, and facilitating behavioral responses to threat (Diseases, 2006). In the presence of prolonged stress, especially in which the individual has difficulty coping, this physiological response may occur to an atypical extent and prove harmful. Dienstbier (1989) asserts that prolonged and/or extreme stress can create a vic ious cycle of pathology, as individuals with a history of abuse may become even more vulnerable in the face of new victimization because they become threat-sensitized, resulting in either an over- or under-reaction of the HPA system to new stressors. As Vaillancourt, Duku, Decatanzaro, Macmillan, Muir, and Schmidt (2008) cite, this process is best illustrated by Cicchetti and Rogoschs (2001) study of maltreated children attending a summer day camp. These authors found that in comparison to non-abused children, children who had been both sexually and physically abused, in addition to emotionally maltreated or neglected, exhibited higher morning cortisol levels, whereas a subgroup of children who had only been physically abused exhibited lower levels. Recent evidence suggests that increased cortisol concentrations may contribute to the prevalence of metabolic syndromes, such as Type II diabetes. For example, in their assessment of 190 Type II diabetic patients who volunteered from a population study of 12,430 in suburban Germany, Oltmanns, Dodt, Schultes, Raspe, Schweiger, Born, Fehm, and Peters (2006), sought to assess the relationship between diabetes-associated metabolic disturbances and cortisol concentrations in patients with Type II diabetes. The target population comprised of men and women born between 1939 and 1958 who completed a postal questionnaire about their health status. Results demonstrated that in patients with Type II diabetes, those with the highest cortisol profiles had higher glucose levels and blood pressures (Oltmanns et al., 2006). Their findings suggest that HPA axis activity may play a role in the development of Type II diabetes-associated metabolic disturbances. Cartmell (2006) proposes a model by which this may occur. Namely, high levels of cortisol decreases metabolism of glucose and increase mobilization and metabolism of fats. This decreased metabolism of glucose contributes to increased blood glucose levels. Furthermore, increa sed blood fat levels contribute to insulin resistance. This increase level of blood glucose and fats are characteristic symptoms of diabetes (Cartmell, 2006). Researchers Chiodini, Adda, Scillitani, Colleti, Morelli, Di Lembo, Epaminonda, Masserini, Beck-Peccoz, Orsi, Ambrosi, and Arosio (2007) extended the literature by studying HPA axis secretion of cortisol and chronic diabetic complications. An evaluation was conducted on HPA activity in a sample of 117 Type II diabetic patients with and without chronic complications and in a sample of 53 non-diabetic patients at a hospital in Italy. Chiodini et al. (2007) found that in diabetic subjects without chronic complications, HPA axis activity was comparable with that of non-diabetic patients, whereas in diabetic subjects with chronic complications, cortisol level was increased in respect to both diabetic subjects and control subjects. Though the design of their study did not look for a cause-effect relationship, Chiodini et al. (200 7) purport that higher levels of cortisol, either due to a constitutive HPA axis activation or secondary to a chronic stress condition, may predispose an individual to the development of chronic diabetic complications. Type II diabetes is now a well-recognized syndrome characteristic of hyperglycemia, insulin resistance, obesity, dyslipidemia, and hypertension (Sridhar Madhu, 2001). One theory that purports the biological plausibility of a stress-diabetes association has been formulated by Swiss researcher, Dr. Per BjÃÆ'Â ¶rntorp. BjÃÆ'Â ¶rntorp (1997) postulated that stress could be responsible for sympathetic nervous system activation, hormone abnormalities, and obesity. This theory states that perceived psychological stress with a defeatist or helplessness reaction leads to an activation of the HPA axis. This in turn results in endocrine abnormalities, including increased cortisol and decreased sex steroid levels that disrupt the actions of insulin. In addition, this horm onal imbalance causes visceral adiposity, which plays an important role in diabetes and cardiovascular disease by contributing to the development of insulin resistance (Cartmell, 2006). Researchers of The Hoorn Study described above tested BjÃÆ'Â ¶rntorps theory and found only partial support (Mooy et al., 2000). Specifically, the accumulation of visceral fat did not seem to be the major mediating factor between stress and diabetes and fasting insulin concentration, which is an approximation of insulin resistance, was not higher in the individuals in their sample who had experienced more stressful events. Study Significance The significance of this study is its potential to provide medical practitioners with information regarding the impact of past psychosocial factors, such as childhood maltreatment, on the current physical health of Type II diabetics. Diabetes and its complications affect a significant portion of the United States population and has become the fifth leading cause of death in the country (Florida Department of Health, 2008). As researchers continue to look for the cause(s) of diabetes and methods to treat, prevent, or cure the disorder, it is vital that practitioners take a holistic and comprehensive approach to assessing the diabetics life. As long as abuse and other potentially damaging experiences in childhood contribute to the development of risk factors, then these childhood exposures should be recognized as the basic causes of morbidity and mortality in adult life (Felliti et al., 1998). Major limitations of past literature include lack of specificity of type of diabetes, famil y history, and self-reported diabetes without data on physiological measures. In addition to replication, future studies should include detailed studies on diabetes-type, a ruling-out of serious medical conditions that could potentially act as confounds, and identify maltreatment subtypes experienced. This study aims to uncover a relationship between childhood maltreatment and adult physical health, namely with Type II diabetes, so as to assist with screening and intervention. If doctors caring for adults who suffer from a medical condition associated with diabetes are unaware of this relationship, they will neither obtain early maltreatment history nor make appropriate patient referrals leading to higher health care utilization and poorer outcomes (Arnow, 2004; Springer, Sheridan, Kuo, Carnes, 2003). Research Questions and Hypotheses This study aims to answer the following questions: Is a history of childhood maltreatment associated with diabetes-related quality of life? If so, is a decrease in diabetes-related quality of life associated with an increase in the types of childhood maltreatment experienced? It is hypothesized that the more types of abuse endured during childhood (i.e. physical, emotional, and/or sexual, neglect, and/or the witnessing of family violence), the more chronic and severe an individuals diabetes will be and the greater impact of their illness on their reported quality of life. Method Participants Data will be collected from individuals with Type II diabetes, recruited from psychiatric practices located in Plant City and Tampa, Florida. Participants will be recruited from these sites due to likelihood that patients receiving psychiatric care have a history of childhood maltreatment. Participants will be included in the study if they are aged 40 and older, as non-insulin dependent diabetes appears after this age. Participants will be excluded from the study if they have additional existing physical conditions which may negatively impact their quality of life, as discussed in the Measures section. A projected sample size of 100 total participants has been chosen, using a sample size calculation provided by a statistics consultant. Procedure Details regarding the study will be posted in the form of a flyer (Appendix D) in the waiting rooms of the psychiatric practices. Patients interested in participating in the study will inform the front office staff, who will provide the prospective participant with a packet including informed consent and all measures. Specifically, the informed consent will include the purpose of the research, the procedures to be followed, risks and discomforts as well as potential benefits associated with participation, and alternative procedures or treatments, if any, to the study procedures or treatments. Once potential participants have read the consent document, have their questions are answered, and agree to participate in the research, the informed consent document will be signed, dated, and stored in a secure location. Participants will then be asked to fill out the questionnaires either in the waiting room or in a more private location of the office as they wait for their appointment. Once completed, participants will place the questionnaires in an attached blank envelope and placed in a collection box. A notation will be made in their chart signifying that they have completed the study so as to avoid duplicates. Potential subjects will also be given a copy of the informed consent document so they can carefully review the document and discuss the research with the significant others and/or physician and develop questions to ask at their next psychiatric appointment and subsequent meeting with the researcher. Measures Once informed consent has been obtained, each participant from either group is to complete a demographics questionnaire, as well as two measures that explore maltreatment in childhood and diabetes quality of life. These measures are to be self-administered and anonymous. The demographics questionnaire (Appendix A) will inquire about participants age, height, and weight. This information will be used to obtain a measure of their body mass index (BMI). The BMI provides a standardized measure, and thus, reliable indicator of body fatness for most people and is used to screen for weight categories, such as obese, that may lead to health problems (CDC, n.d., para. 2). Since obesity is known to be a significant predictor leading to poorer quality of life (Sundaram, Kavookjian, Patrick, Miller, Madhavan, and Scott, 2007), it is important for the purposes of this study to exlude those participants who fall into this weight categories so as to avoid confounding variables. The demographic s questionnaire will also include exclusionary criteria consisting of a variety of chronic physical conditions. In their research on comorbidity of chronic diseases, Rijken, van Kerhof, Dekker, and Schellevis (2005) note that the presence of multiple comorbid conditions complicates the question how a specific disease is related to quality of life and other outcome variables. It has been found that arthritis, osteoarthritis, cardiovascular diseases, chest pain, stroke, respiratory diseases, and cancer significantly reduces the quality of life in patients with Type II diabetes (Bowker, Pohar, Johnson, 2006; Maddigan, Feeny, Johnson, 2005; Miksch, Hermann, Rolz, Joos, Szecsenyi, Ose, Rosemann, 2009; Rijken et al., 2005; Stone, Khunti, Squire, Paul, 2008; de Visser, Bilo, Groenier, de Visser, Meyboom-de Jong, 2002). Therefore it is vital for patients with these comorbid conditions to be excluded from the present study so as to accurately ascertain the impact of childhood maltreatme nt on their diabetes-related quality of life. Maltreatment status is to be measured using the Childhood Trauma Questionnaire (CTQ; Bernstein et al, 2003; Scher et al., 2001). The CTQ is a self-report instrument that consists of five subscales assessing emotional, physical, and sexual abuse, as well as emotional and physical neglect. Rather than duration and intensity of traumatic experiences, the extent of the maltreatment is measured using a score that is calculated for each subscale and reflects the total number of items endorses. Each subscale score is categorized into four groups: none or minimal, low to moderate, moderate to severe, and severe to extreme (Bernstein and Fink, 1998). The CTQ has been well validated in both clinical and non-clinical populations. Furthermore, it has excellent reliability (.70-.93) for all subscales, with the lowest reliability for physical neglect and the highest for sexual abuse (Bernstein and Fink, 1998; Paivio and Cramer, 2004). The Diabet es-39 questionnaire (D-39; Appendix C; Boyer Earp, 1997) specifically asks patients to indicate the impact of items on their quality of life and elicits responses that reflect the individual burden of diabetes and its impact on the overall life of the patient. The instrument consists of 39 items and covers five dimensions of the patients lives: energy and mobility (15 items), diabetes control (12 items), anxiety and worry (4 items), social burden (5 items), and sexual functioning (3 items). Reliability of the D-39 instrument as measured by Cronbachs coefficient alpha ranged from 0.82 to 0.93. In a review of health outcome measures for diabetes, Garratt, Schmidt, and Fitzpatrick (2002) note that this instrument has good evidence for reliability, and internal and external construct validity. Proposed Data Analytic Strategy To measure the degree of relationship between childhood maltreatment and diabetes-related quality of life, two continuous variables, the Pearsons product moment correlation coefficient r will be calculated. The coefficient of determination, or r2, will also be calculated so as to ascertain how much of the variability (if any) in diabetes-related quality of life is explained by the variability in childhood maltreatment. 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