Wednesday, October 30, 2019
Anti-globalization movement Case Study Example | Topics and Well Written Essays - 1250 words
Anti-globalization movement - Case Study Example The term globalisation has come become popular only since the 1980s and since then protest against globalisation started, the term anti-globalisation also became popular at almost the same time. The groups and individuals belonging to "anti-globalization movement" developed in the late twentieth century to resist the globalization of corporate economic activity and the free trade with developing nations that might result from such activity. For instance, these organisations are against the proliferation of multi-national corporations especially in the third world. Technological advances have made it easier and quicker to complete international transactions both trade of goods and financial flows. In other words globalisation refers to an extension beyond national borders of the same market forces that have operated for centuries at all levels of human economic activity-village markets, urban industries, or financial centers. There by turning the world into a global village. However, the opportunities provided by globalisation in real sense in not the same for all the countries and hence it has created an economic imbalance. This has resulted in the emergence of groups protesting against globalisation. ... rge corporations, as exercised in trade agreements and elsewhere, which they say undermines democracy, the environment, labor rights, national sovereignty, the third world, and other concerns (Wikipedia n. pag, 2007). There are several concerns that has been put forth by the anti-globalization movement. The people who oppose globalisation or the anti-globalisation movement argue that globalisation has been the main reason for enhancing poverty and claim that the creation of an unfettered international free market has benefited multinational corporations in the Western world at the expense of local enterprises, local cultures, and common people. Where as proponents of globalisation argue that it allows poor countries to develop economically and raise their standards of living. Hence resistance to globalization has been a result of people and governments trying to manage the flow of capital, labour, goods, and ideas that make up the current wave of globalization (Silicon Valley n.pag). Globalisation has been criticized on many fronts by politicians, members of conservative think tanks, mainstream economists, and other supporters of market-based economic integration. One of the major concern put forth by the anti-globalization movement, is that the major causes of poverty amongst developing and underdeveloped world. For instance, poor farmers in these countries face trade barriers. Besides it hs also been claimed by these groups that unemployment has also increased in third world countries. Another criticism against the movement is that, although it protests about things that are widely recognized as serious problems, such as human rights violations, genocide and global warming, these movements have never tired to solve these porbems. In many instances these
Sunday, October 27, 2019
Encephalitis Is An Infection Of The Brain Biology Essay
Encephalitis Is An Infection Of The Brain Biology Essay Encephalitis is an infection of the brain that cause of irritation and inflammation to the brain Medical Encylopedia, 2012. Primary encephalitis is happened when the infection of the brain or spinal cord. Secondary encephalitis is happened when the infection is started to spread to the whole body and to the brain (Nordqvist, 2009). Encephalitis is a swelling of the brain parenchyma (nervous tissue in brain) that responsible for function of electrochemical communication and the ability of body to send message to different parts (david) http://www.doereport.com/imagescooked/4049W.jpg Goodman (2003) argued that encephalitis is an acute inflammatory disease of the parenchyma of the brain. It is caused by direct viral invasion or hypersensitivity initiated by a virus. Encephalitis is characterized by inflammation primarily in the gray matter of the central nervous system (CNS). Neuronal death can result in edema. There can be damage to the vascular system and inflammation of the arachnoid and pia matter. 1.1.1 Encephalitis http://findlaw.doereport.com/imagescooked/4047W.jpg Debbie Bridges (2012) argue that encephalitis is a swelling of the brain tissue, it will become serious when it can cause change personality, debility and another symptoms with the different part of brain affected. It usually happened to children and elder with low immune system. It is very rare, in U.S, about one in 200,000 people in year. Nordqvist (2009) agreed that encephalitis is acute inflammation of the brain because immune system of the body is too low to attacks viral infection. Fever and headache usually the first symptoms and it become more dangerous like unconsciousness, confusion and coma. The patient will be faced a problem such as behaviour changes, loss of memory, language and speech problem (aphasia) and epilepsy. Arthropod à ¢Ã ¢Ã¢â¬Å¡Ã ¬ borne (mosquito à ¢Ã ¢Ã¢â¬Å¡Ã ¬ borne) viruses and herpes simplex (herpes simplex type 1) are the most common that causes encephalitis. Encephalitis is an acute febrile disease usually of viral origin and involves with nervous system (). 1.1.2 Viral Meningoencephalitis According to kumar 2004, viral encephalitis is infection of the brain at parenchymal almost constantly associated with meningoencephalitis (meningeal inflammation) and sometimes with encephalomyelitis (involves spinal cord). 1.2 Anatomy of brain http://healthy-lifestyle.most-effective-solution.com/wp-content/uploads/2010/09/human-anatomy-brain.jpg Figure Anatomy of the brain http://antranik.org/wp-content/uploads/2011/11/dura-mater-superior-sagittal-sinus-subdural-space-subarachnoid-space-falx-cerebri-periosteal-meningeal-arachnoid-villus.jpg Figure Layer of meninges The brain is protected by the scalp, the skull and the meninges, cerebrospinal fluid and blood-brain barrier. The structures of brain consists cerebellum, cerebrum, brainstem and pituitary gland. Layer of meninges include the dura mater (strongest layer), arachnoid mater) and pia mater (nearest to the brain). (Stephen n all 2010). Antranik (2011) states that meninges are surround the brain and protect the brain itself. The function meninges is cover and protect the blood vessel that supply at brain and contains cerebrospinal fluid (CSF) between the pia mater and arachnoid mater. Dura mater consists periosteal and meningeal at immediately deep to the poriosteum. Tortora (2009) notes that the function of the blood- brain barrier (BBB) is to protect the brain from harmful substances and pathogens by prevent it enter brain through blood. The function of CSF is protecting the brain and spinal cord from chemical and physical injury. The cerebrum is the largest part of the brain. Each area of cerebrum is the most important function for example controls movement and languages. The function of cerebellum is control coordination and movement. Function of brainstem is control involuntary functions such as blood pressure, temperature and breathing movement. The structure that controls of the endocrine gland is pituitary gland (Stephen 2010) 1.3 Type of Encephalitis Western equine encephalitis is arboviral infection that spread by mosquitoes which more occur in summer and most common in young children. St. Louis encephalitis is more usually at United States and affected older person. It is more seriously than younger person. West Nile fever is a form of encephalitis that caused by falvivirus, spread by mosquitoes with certain birds as an intermediate host. Encephalitis has spread from northeastern United States. Neuroborreliosis (lyme disease) is due by a spirochete, transmitted by tick bites in summer season. The part of the tick bite is red with a pale center and gradually increasing size. Herpes simplex encephalitis is arising from spread of herpes simplex virus type 1 from the trigeminal nerve ganglion. It is occurs occasionally and dangerous. This encephalitis can cause extensive necrosis and haemorrhage in the brain and usually involves the frontal and temporal lobes figures .. http://neuropathology-web.org/chapter5/images5/5-hsvl.jpg Figure heamorrhagic necrosis of the temporal and frontal lobe in adult Herpes Simplex Virus encephalitis. CHAPTER TWO LITERATURE REVIEW 2.1 Causes encephalitis Figure 2 a herpes simplex virus the most common cause encephalitis. Viral infection is the cause that affects the encephalitis. Encephalitis may be cause with different type of viruses. Herpes simplex virus is the main cause of severe cases in all ages including newborns. The person will get this virus from an infected person through breathing in respiratory droplets and skin contact. It can also through by insect bites like a mosquito and contaminated food or drink. Arbovirus encephalitis is a viral encephalitis that carried by insect (mosquito and ticks). It is rare condition where severe case more likely is happened to young children and elderly. Picture of Culex mosquito laying eggs Figure Culex mosquito laying eggs Picture of arbovirus transmission cycle It also may cause by a vaccine such as rubella, mumps and measles (Kathryn Sue 1994). Adenovirus, coxsackievirus. Eastern Equine Encephalitis Virus and Echovirus are also associated with encephalitis. A number of viruses for which there is now a vaccine may also cause encephalitis. These include meales, mumps, polio, rabies, rubella, varicella (chickenpox). Other causes of encephalitis may be occurring by an allergic reaction to vaccinations, autoimmune disease, bacteria (lyme disease and tuberculosis) and the effects of cancer. According to (Christian Nordiqst ) the causes of encephalitis can be category by two which are primary (infectious) encephalitis and secondary (post infectious) encephalitis. For primary encephalitis, there are three main categories of viruses which are common viruses (herpes simplex virus) , childhood viruses (measles ,mumps), and arboviruses. Secondary encephalitis can be caused by a complication of viral infection. 2.2 Incidence 2.2.1 Incidence Encephalitis in Malaysia In September 1998, an epidemic of severe fever encephalitis among pig farmers was first reported in the state of Perak Malaysia that was associated with high rate mortality. At first death were thought by Japanese encephalitis (JE) that is endemic in Malaysia and occur occasionally. However, characteristic of JE is different to these cases. A few cases patients were young children and most of the cases happened to men that have worked with pigs. Whereas, JE is mosquito borne that most common among young children and has no associated with particular occupation. JE was eliminated from possibility JE was the cause due to illness and deaths among infected pigs. By February 1999, similar disease were happened in pigs and humans in other area in Malaysia. 2.2.2 Incidence Encephalitis in Overseas Different viruses will occur in different locations. Many cases will tend to cluster in a certain season. According to Kathryn Sue (1994) the arthropod à ¢Ã ¢Ã¢â¬Å¡Ã ¬borne occurs in epidemics with different incidence like as geographic and seasonal incidence (table). Eastern equine encephalitis is the least common of encephalitis but is the most serious encephalitis. table Viral encephalitis Type Geographic incidence Seasonal incidence Arthropod- borne : Eastern equine encephalitis Eastern United States Autumn Western equine encephalitis Uniform distribution, throughout the United States Summer and early fall St. Louis encephalitis Widespread distribution , in the far west occur in rural area, elsewhere in urban areas Late summer Venezuelan equine encephalitis Sourthwestern united States Year round California virus encephalitis Midwestern states Early fall Herpes simplex encephalitis No particular geographic distribution No seasonal incidence Poliovirus poliomyelitis Sporadic distribution where nonimmunized persons cluster Summer and ealy fall Rabies Sporadic distribution throughout the United States Bites more common in the late spring and throughout the early fall DISEASE GEOGRAPHIC LOCATION VECTOR/ HOSTS Herpes encephalitis United states / the world Human to human contact West Nile encephalitis Africa, West Asia, Middle East, United States Mosquito / mostly birds Eastern equine encephalitis East Coast (from Massachussetts to Florida), Gulf Coast Mosquito / birds Western equine encephalitis Western United States and Canada Mosquito / birds Venezuelan equine encephalitis Western Hemisphere Mosquito / rodents La Crosse encephalitis United States (Midwestern Southeastern) Mosquito / chipmunks, squirrels St. Louis encephalitis Milwestern mid- Atlantic United States Mosquito/ birds Japanese encephalitis Temperate Asia, southern and southeastern Asia Mosquito/ birds and pigs Picture of worldwide distribution of major arboviral encephalitides Figure worldwide distribution and arbovirus transmission cycle. 2.3 Mortality/morbidity Encephalitis may be a mild infectious disease to a severe disorder that is life-threatening. The dramatic clinical manifestations of encephalitis are fever delirium or confusion progressing to unconsciousness, seizure activity cranial nerve palsies, paresis and paralysis, involuntary movement and abnormal reflexes. Signs of marked intracranial pressure may be present, 2.3.1 Mortality Charles Patrick 2012 argued that the certain of patients with encephalitis the death rate can be high. The death rates of St. Louis encephalitis can up to 30% of the cases. For Japanese encephalitis, the range death rate is from 0.3% to 60% of the people infected usually within the first week of illness and herpes encephalitis, 50%-755 of people die within 18 months. In contrast, it can increase survival up 90% when treatment by acyclovir (Zovirax). 2.3.2 Morbidity According to james nina 2004. Survival rates are due to the etiology of the disease. In some cases it can be fatal. In USA, according to Centers for Disease Controls and Prevention), encephalitis most occur in children, elderly people and individuals have weakened immune systems approximately in 0.5 in every 100,000 individuals. Besides that, in UK the National Health Service (NHS) places a figure at 1.5 cases per 100,000 people. ( Christian Nordqist 2009) 2.4 Signs and Symptoms 2.4.1 Symptoms of Encephalitis Before encephalitis begins, some patients will feel cold or stomach infection. For the case of encephalitis is not very severe, the symptoms may be similar with other disease such as fever (not very high), mild headache, low energy and poor appetite. For other symptom is confusion, drowsiness, light sensitivity, vomiting, irritability or poor temper control. (encephalitis , 2012) According to Christian norqist 2009, symptom for less common severe in encephalitis is the patients will experience stiff neck and back (occasionally). There also can be stiffness of the limbs, slow movement and clumsiness. The patient will also have cough and feels drowsy. For the more severe cases, the patients experience severe headaches, nausea, vomiting, confusion, memory loss, hearing problems, hallucination, seizures and possibly coma. The patient will be become aggressive for some cases. (christain norqist 2009). Symptoms of encephalitis in infants and newborns may be difficult to recognize. The parent or guardian should be alert of baby crying more than often (there will become worse when the baby is picked up and comforted). Besides that, the parent should be look out of vomiting, soft spot on the top of the head (frontal) may bulge out more. Other symptoms are includes body stiffness and poor feeding. (christain norqist 2009). For emergency symptoms in encephalitis is the patients will loss of consciousness, poor responsiveness, coma, muscle weakness, seizures, severe headache, and sudden change in mental functions which are amnesia, lack of mood, impaired of judgement inability to make decision and less interest in daily activities. (encephalitis 2012) 2.4.2 Signs of Encephalitis Signs of encephalitis may be show muscle weakness, speech problem, skin rash, mouth ulcers, mental confusion and neck stiffness. Other than that, signs of encephalitis are abnormal reflexes and increased intracranial pressure. Table Summary of symptoms Symptoms of encephalitis Less severe More severe In newborn and young infants Mild headache Fever Poor appetite Light sensitivity Vomiting Disorientation Stiff neck and back Severe headache Nausea Vomiting Confusion Memory loss Speech problem Hallucination Seizures coma body stiffness poor feeding Bulging soft spots on the top head table Summary signs of encephalitis Signs of encephalitis Muscle weakness Mouth ulcers Neck stiffness Skin rash Speech problem Abnormal reflexes Increased intracranial pressure Mental confusion 2.5 Pathophysiology The virus causes inflammation of brain tissue. The brain tissue swells (cerebral edema), which may destroy nerve cells, cause bleeding in the brain (intracerebral haemorrhage), and brain damage. When the virus spread by haematogenous (via bloodstream) like example rabies virus, it replicates outside the CNS and enter in the CNS. Since the virus through the blood- brain barrier t virus enter neural cells. These will result disruption of cell functioning, perivascular congestion, haemorrhage and a diffuse inflammatory response that disproportionately affects gray matters over white matter. Certain virus depend to neuron cell membrane preceptors that only found in specific parts of the brain like example Herpes Simplex Virus (HSV) more likely causes haemorrhage necrotic encephalitis with predilection for the limbic system, inferior and medial temporal lobes. (David) According to james nina 2004, individuals who obtain encephalitis more frequently develop permanent neurologic disabilities. This condition is more serious than meningitis. This is happened when the viral infection produce in cerebral edema with numerous hemorrhagic spots scattered throughout the cerebral hemispheres, brainstem and cerebellum. 2.6 Histopathology 2.6.1 Arthropod- Borne Viral Encephalitis CHAPTER THREE IMAGING MODALITIES 3.1 Computer Tomography (CT scan) Computer Tomography is the combination of computer technology and x-rays as a result two dimensional images of organ, bones and tissues. To detect sign of encephalitis or inflammation of the meninges, usually procedure with contrast is required. The contrast is injected into bloodstream to more differentiate tissues in the brain. (national institude of neurological disorder and stroke 2011) Mahesh (2011) states that in adult, encephalitis in CT scans visualize hypodensity in the temporal lobe either bilaterally or unilaterally. It also involves with or without frontal lobe. 3.2 Magnetic Resonance imaging (MRI) MRI is use strong magnet and computer- generates radio waves to produce more detail images of body structures which are tissues, bones, organs and nerves. MRI is better than CT scan which is give more clearly picture that can help to recognize brain and spinal cord inflammation. Infection, tumors, eye disease and blood vessel irregularities that can be stroke. The images that require more detail, a contrast may be injected. (national institude of neurological disorder and stroke 2011) 3.3 Electroencephalography (EEG) EEG is use by monitoring electrical activity in the brain through the skull to detect abnormal brain waves. The function of EEG is to help diagnose certain seizure disorder, specific viral infection, for example herpes virus and inflammation of the brain or spinal cord. (national institude of neurological disorder and stroke 2011) 3.4 Ultrasonography Mahesh (2011) states that the role of ultrasonography in detects herpes encephalitis are limited. This is because it limited to identify the periventicular destructive process in neonatal evaluation ultrasonogaphy. Ultrasound showing a good near field but less far field resolution (Cranial Ultrsonography in Neonates 2010) . According to (james nina , 2004) MRI is precious diagnosis because it can detect brain inflammation earlier than Computed tomography (CT), ultrasound, nuclear medicine studies, or EEG evaluation. Other anomalies such as a brain abscess or subdural emphysema or hematoma that mimics the clinical sign of viral encephalitis can be rule out by MR. 3.5 Nuclear Imaging CHAPTER FOUR IMAGES OF FEATURES OF PATHOLOGY 4.1 Computed Tomography (CT Scan) http://www.mypacs.net/repos/mpv3_repo/viz/full/0/38/120/39969726.jpghttp://www.mypacs.net/repos/mpv3_repo/viz/full/0/38/120/39969721.jpg Figure shows 30 years old men that have AIDS, presenting with left facial palsy. Figure (a) shows CT scan non contrast as a result a isodence lesion in the right basal ganglia, surrounded by hypodense edema and mass effect. Figure (b) shows CT with contrast that represent a ring- enchancing lesion in the right basal ganglia that surrounded by edema. ( Antonio, 2011) a b http://www.pediatriconcall.com/fordoctor/diseasesandcondition/pediatric_emergencies/IMAGE/v7c09a%5B1%5D.jpg Figure (a) show some hypodensity in the thalami and temporal lobes without contrast, indicative of bilateral cortical and subcortical edema. Figure (b) shows there is meningeal enhancement at the margins of abnormal parenchymas as well as mild central enhancement after IV contrast is injected. There is no evidence of herniation. a bImage of encephalitis Figure 4.1 (a) is a CT scan of a normal brain. Figure 4.1 (b) shows contrast materials have accumulate in infected areas and around the brain from encephalitis. (Paul 2011) 4.2 MRI Imaging http://upload.wikimedia.org/wikipedia/commons/thumb/d/d5/Hsv_encephalitis.jpg/230px-Hsv_encephalitis.jpg Figure 4.2 high signals in the temporal lobes including hippocampal formations and parahippogampal grae, insulae and right inferior gyrus by using coronal T2- weighted MR. http://images.radiopaedia.org/images/539441/ea09c9c0186c85af7c888a031e559c_gallery.jpg Figure shows that MRI demonstrates extensive oedema in the right temporal lobes with areas of intrinsic high T1 signal, in keeping with haemorrhage. Axial proton densityà ¢Ã ¢Ã¢â¬Å¡Ã ¬weighted image in a 62-year-o Figure shows 62 years old woman with confusion and herpes encephalitis with axial proton density- weight image. It demonstrates T2 hyperintensity involving the right temporal lobe. 4.3 Ultrosonography Full-size image (20 K) Figure demonstrate coronol ultrasound scan at the level of the frontal horns of the lateral ventricles. It performed with phased array transducer. It is shows mildly dilated frontal horns and bilateral grade 1 intraventricular hemorrhage (arrows). CHAPTER FIVE DISCUSSION 5.1 Difference Encephalitis and Meningitis Encephalitis is the dangerous than meningitis because the person that has encephalitis is more develop to permanent neurologic disabilities. According to james nina 2004, meningitis is an inflammation of the meningeal that covering the brain and spinal cord. Bacteria, viruses or other organisms that reach the meninges are the causes of meningitis. This can be happened in elsewhere in the body by blood or lymph as a result from trauma and penetrating wounds, or from adjacent structures that become infected. Most common that cause meningitis is bacterial infection. Kathryn sue 1994 states that meningitis is infection of meninges that causes by bacteria, viruses, fungi, parasites and other toxins. This infection can be classified to acute, subacute and chronic. The pathophysiology, treatment and clinical manifestation are different for each type of organism. Bacterial meningitis is a primary of an infection of the pia mater and arachnoid, the subarachnoid space, the ventricular system and the CFS (kathyn sue 1994). The types of bacteria that carry for acute bacterial meningitis are meningococci, streptococci, and pneumocci. Middle ear or frontal sinus is responsible that carried the bacteria to meninges. The most common meningitis in children is meningococcal, the most common meningitis in adult is pneumococcal and streptococcal meningitis is the most common in young children. CHAPTER SIX TREATMENT 6.1 Treatment The objective of treatment is to help the human body to fight the infection and relieve symptoms with give supportive care like example rest, nutrition, and fluids. Antibiotics will give to patients if the infection is caused by bacteria (certain bacteria) and antiviral medication (acyclovir and foscarnet) to treat herpes encephalitis or the severe viral infection. Anti seizure medication ( phenytoin) will be given to prevent seizures. (encephalitis 2012) Mayo 2011 states that treatment for mild cases include bed rest, drinking plenty of fluid and anti- inflammatory drugs such as acetaminophen to relieve fever and headache. For more severe cases of encephalitis can be category into three treatment which are Antiviral drugs, supportive care and follow up therapy. 6.1.1 Antiviral drugs Acylovir and Ganciclovir are antiviral drugs that common used to treat encephalitis but it is not responding for some viruses such as insect-borne viruses. This drug also can be very effective to treat herpes simplex virus. Nausea, vomiting, diarrhea, pain of muscle or joint and loss of appetite are the side effect for the antiviral drugs. Abnormalities in kidney or liver function are rare serious problem (Mayo 2011) 6.1.2 Supportive Care For severe encephalitis, additional supportive care also be needed in the hospital. This is including breathing assistance as monitor heart function and breathing, intravenous fluids is to ensure that appropriate levels of essential minerals and proper hydration. Anti- inflammatory also be given to help reduce pressure and swelling within the skull such as corticosteroids. Patient that have seizures or to prevent seizure, anticonvulsant medicine such as phenytoin is given (Mayo 2011). 6.1.3 Follow up therapy Follow up therapy is depending to the type or severity of complication. This therapy includes physical therapy which is to help improve flexibility, strength, motor coordination and balance. Occupational therapy is to use adaptive products that help with everyday activities and develop everyday skills. Patient that have speech problem, speech therapy can be help to relearn muscle control and coordination. Psychotherapy is learning how to be coping strategies and have new behavioural skills that can improve personality changes and mood disorder (Mayo 2011). 6.2 Diagnosis According to National Institute of Neurological disorders and stroke (2011), the doctor may diagnostic tests to confirm the presence of inflammation and infection by following a physical exam and medical history to looking activities of the past several days such as patient have bite by animal or insects or any contact with ill persons. The patients may perform a neurological examination, laboratory screening of blood, urine and body sections and analysis of the cerebrospinal fluid. A neurological examination is to assess nerve function, coordination and balance, mental status, changes in behaviour and function of motor and sensory. Usually, the doctor use small light, reflex hammer to test of strength and sensation or nervous system. Laboratory screening of blood, urine and body secretions is use to determine the presence of antibodies and foreign body that can detect and recognize brain and spinal cord inflammation and infection. Analysis of cerebrospinal fluid is the procedure that known as lumbar puncture. The procedure of lumbar puncture is special needle is inserted into the lower back and then a small of amount of cerebrospinal fluids is removed. CHAPTER SEVEN PROGNOSIS 7.1 Expectations Usually, outcome of encephalitis is depend on what infection involves, the severity of illness, how quickly time treatment is given. Patient with very mild encephalitis most of them can make a full recovery, although the process treatment may be slow. The patient can be recovering in 2-4 weeks for patient have experience only fever, body stiffness and headache. For the severe cases, the patient may be have problem with hearing, speech, blindness, behaviour changes, seizures, memory loss, muscle weakness, and cognitive disabilities. Long-term therapy, medication and supportive care may be required for these patients. (national institude of neurological disorder and stroke 2011) Goodman (2003) notes that patient who may have been ill at the onset , their rate recovery range from 10% to 50%. The patients have mumps meningoencephalitis and Venezuelan equine encephalitis have an excellent expectation. Other encephalitis that have moderate to good rate of survival are western equine, St. Louis and California encephalitis. Herpes simplex encephalitis has a moderately good outcome, 50% of person neurologic disorder and 20% mortality. With similar infections, young children more take longer recover than adults. In infants, permanent cerebral sequelae are occurred. 7.2 Prevention Christian Nordqist (2009) found that the effectives way to reduced risk to get encephalitis by keeping up to date with vaccines. Other than that, take measures to reduce the risk being bitten in area to have mosquito that carry virus encephalitis. For example, keep house mosquito free, wearing appropriate clothing, do not go mosquito infested area, using insect repellent, avoid go outside at specific time where there a lot of mosquito, for example at night and make sure there are no stagnant water in house. Beside that, encephalitis can be prevented by avoid sharing food, glasses or other object that have be exposed from infected person. Good personal hygiene also can reduce risk to get disease from infected person. Wash hand frequently with soap and rinse under running water ( National Institude of Neurologic Disorder and Stroke 2011). CHAPTER EIGHT CONCLUSION
Friday, October 25, 2019
Essays --
Biomedical engineering is a rapidly growing field of research that is making exciting discoveries and advancements in the field of medicine at an astounding pace. With such progress there are many ethical issues that arise concerning new innovative implants, medical devices, and diagnosis and therapeutic treatments in the field of biomedical engineering in order to improve an individualââ¬â¢s quality of life. Neuroethics in particular has become a big topic of debate as researchers gradually decode the complex organism called the human brain. The brain has long been an enigma, its intricate inner workings perplexing even the most scholarly of intellectuals for decades. Recent advancements in neuroimaging, brain implants, and scientistsââ¬â¢ increased knowledge of basic human psychology concerning the bases of individual behavior and personality have led to the fear that this new gained information has the potential to be misused by governments and other entities. Ethicist fear that the same devices meant to help patients suffering from devastating neural diseases could be manipulated to breach oneââ¬â¢s privacy. Devices and treatments used to cure or alleviate effects of neurodegenerative diseases such as Alzheimerââ¬â¢s and Parkinsonââ¬â¢s, or perhaps to help those who have mental illnesses or impairments could be used to decipher oneââ¬â¢s hidden thoughts, and even used as a way to discriminate against someone based on oneââ¬â¢s religious beliefs and values. The main areas of Neuroethics that have caused concern are brain implants and medical devices, neuroimaging, and brain machine interfacing. Implantable brain or neural devices are an exciting rapidly growing research area in class of biomedical devices. Brain implants usually function by interfering w... ... of the brain and the more complex interworkingââ¬â¢s of the human mind. As a result the field of Neuroscience is making strides in medicine and engineering at an astounding rate with no prospect of slowing down in the near future. With such great innovation in biomedical engineering concerning brain implants, neuroimaging, and brain machine interfacing meant to improve the quality of life of individuals. The potential misuse of this technology is of great concern. As engineers grow closer to producing brain scanners that can read someoneââ¬â¢s mind or neuroimaging machines that can be used to predict behavior and influence thoughts and emotions, Neuroethics must be a moral compass at the forefront of the field of biomedical engineering in area of neuroscience to ensure that ultimately the rights and privacy of the individuals the technology is meant to help are protected.
Thursday, October 24, 2019
Important Leaders in French and Indian War Essay
* George Washington ââ¬â led colonists during the war. He was a colonel. Made a name for him and the experience of this war helped in the American Revolution. Both civil and military because he led a group of Militia. * General Edward Braddock ââ¬â He led a group of two thousand men to capture Fort Duquesne. His group was ambushed and he died in the battle. * Earl of Loundoun ââ¬â He was appointed commander and chief in 1756 of the British forces and caused failures for the British. * William Pitt ââ¬â He took leadership of the British ministry in 1756. His aggressive new policies for the war were a major part in turning the favor of the war towards the British in the later half of the war. Important civilian leader. Known as the ââ¬Å"Great Commonerâ⬠. He drew much of his strength from the common people. * Captain Robin Rogers ââ¬â He led the Rangers (a group of New Hampshire men) and operated as spies and used guerrilla warfare against the French successfully through the war. * James Wolfe ââ¬â important general who led the British to an important victory at the Battle of Quebec. * Jeffry Amherst ââ¬â He is best known as one of the victors of the French and Indian War, when he conquered Louisbourg, Quebec City and Montreal. He was also the first British Governor General in the territories that became Canada. Many places and streets are named after him, in Canada and the United States. * James Abercrombie ââ¬â British General and commander and chief. He is most known for the terrible British defeats in the 1758 Battle of Carillon. * Edward Boscawen ââ¬â He was second in command for the siege of Louisburg and led a fleet and won in the Battle of Lagos. Important French military leaders and civilians/heroes * Louis-Joseph de Montcalm ââ¬â He took over as commander and chief of the French forces in North America. He was a great feared leader who died at the Battler of Quebec. * Francois-Marie de Lignery ââ¬â Colonial military leader in the French province of Canada. HE was active in the defense of New France in the French and Indian War. * Marquis de Vaudreuil ââ¬â In 1755, he became the governor of Canada, replacing the Marquis Duquesne. * Fort George/Fort Duquesne/Fort Pitt ââ¬â This centrally located fort in what is now Pittsburgh, PA changed hands many times during the war. It was the site of Englandââ¬â¢s first disastrous battle, in which Braddock lost his life. * Fort Necessity ââ¬â This hastily constructed fort in Great Meadows, PA was the site of George Washingtonââ¬â¢s first defeat in 1754. Later in American history, it oddly came to symbolize the rugged spirit of the colonials. * Fort William Henry ââ¬â Site of the most notorious massacre in colonial history, this fort located near the Hudson River fell to the French in 1757. * Louisbourg ââ¬â An important city on the east coast of Canada (in present-day Nova Scotia). It was a French stronghold of arms and supplies. * Ticonderoga ââ¬â A major French fort and city north of Albany. The British failed repeatedly to seize it; they finally succeeded in 1759.
Wednesday, October 23, 2019
Crisis Intervention Essay
PART 2: Application of Crisis Assessment & Intervention Skills 1. Tour 1st task of this qn is to comprehend the given case scenario below: Kelvin & Lemmy just celebrated their 10th weding anniversary. Lemmy was 39yrs old and expecting her 1st baby. She and her 41yrs old husband Kelvin were eagerly waiting the birth of their child. The child was also the 1st grandchild in the family on both sides At 17 weeks she went to her pediatrician for a scheduled check up. Subsequent to an examination and ultrasound examination, she learnt that the baby had died. She was thrown into a state of shock, simultaneously both angry and sad and cried uncontrollably. You were being called in to talk to Lemmy. 2. U r to use the 6-step crisis intervention model together with other aspects we have covered thus far. 3. The various steps must be clearly indicated in your ans 4. Pay close attention to demonstrating ur understanding of all the elements of the ci model including appropriate use of Triage Assessment System, Workerââ¬â¢s Continuum, Suicide Risk Assessment, The Crisis Trigger and the likely meaning that might be attached to the triggering event 5. When addressing step 4, 5 & 6 pls keep in mind the distinction between intervention in crisis state, as opposed to intervention when the client is stable and mobile(i. e. counseling). I will need to see that u hav a plan that focuses on immediate action aimed at restoring mobility & stability, not one which target long term decision making & personal change
Tuesday, October 22, 2019
How to Start Writing When You Dont Feel Like It
How to Start Writing When You Dont Feel Like It How to Start Writing When You Dont Feel Like It How to Start Writing When You Dont Feel Like It By Michael As a professional editor and copywriter, my biggest problem with clients is not that I get poorly written material from them. Oh no, not by a long shot. My biggest problem is I dont get anything from them at all. I dont mind the grammar or spelling or punctuation mistakes that my clients make. I just want them to write something. Theyre the experts on the subject, not me. My job is to edit and rewrite. But as long as their wisdom is bottled up in their heads, I cant do my job. If you care about something, you can probably talk about it, if you can talk at all. The strong silent types might need a little extra help. But the rest of us just need to prime the pump, to get the words flowing and the wisdom pouring. If your hours in the English classroom has left you with a chronic writers block (a problem which is almost epidemic), then learn to write differently. When writing is hard for you, how can you get started? Write about what you care about, and write to someone who cares. If you have to write about your business but cant get started, pretend your husband wants to know what you do for a living. Write an email or write a letter to him. If youre writing a paper for school, imagine that your teacher is really interested in reading every word you write. Too much to imagine? Pretend that youre writing an article for your favorite magazine. Or pretend youre writing to your grandmother or your best friend or your long-lost childhood friend. If you cant find someone who cares about what you have to say, imagine someone who does care. For example, I care. Dont you feel better already? If the thought of writing an email or letter still makes your words bottle up, make a phone call. Leave a long answering machine message for yourself, and then type up what you said. Call a friend and have them take notes while you talk. Anything to let the words loose. You may not be impressed with what comes out. But the sooner you get your wisdom out of your head and into your fingers or onto paper, the sooner you can make it better. No chance of improvement until you start. Want to improve your English in five minutes a day? Get a subscription and start receiving our writing tips and exercises daily! Keep learning! Browse the Writing Basics category, check our popular posts, or choose a related post below:100 Words for Facial Expressions"Confused With" and "Confused About""To Tide You Over"
Monday, October 21, 2019
Bi-Polar Article Review
Bi-Polar Article Review Free Online Research Papers The article that I choose was created by Himanshu P Upadhyaya and Mary C Fields and talked about bipolar disorder. I choose this article because I have a relative that suffered has suffered from bipolar disorder for many years. I really wanted to learn more about this disorder so if possible I can better assist my relative. I believe this disorder is something that is a lot more common than what people think and it really has the potential to disrupt your life unless you get a handle on it. The authors begin by giving a quick background of this disorder. They say that bipolar disorder is a mood of disorder in which feelings, thoughts, behaviors, and perceptions are altered in the contest of episodes of mania and depression. Bipolar disorder was previously known as mania disorder and was rarely thought to have occurred in youth. However with new research they say itââ¬â¢s now thought that 20% of cases start to occur in adolescence. The disorder is not distinguished differently in the diagnosis process whether it is a child or adult. The Diagnostic and Statistical Manual of Mental Disorders (DSM) uses universal symptoms to define the diagnostic criteria for mood episodes, including major depression and manic episodes. They say that type one bipolar disorder is defined as one true manic episode with or without psychotic features is the necessary and sufficient criterion. Type II bipolar disorder is diagnosed on the basis of at least one hypomania episode. Therefore, bi polar disorders are viewed as having a spectrum of symptoms that range from mild hypomania to the most extreme mania, which has the potential to including life threatening behaviors. The symptoms of this disease can include everything from an abnormal, often expansive and elevated mood lasting for at least 1 week, to a decreased need for sleep, racing thoughts or a sense that thoughts are out of control, rapid and often pressured speech, hyper sexuality, reckless behaviors and risk taking and more. In addition, increased risk taking has the potential to involve physical, emotional, or financial endangerment. Therefore the author says that a personââ¬â¢s financial accounts, or important relationships may be in such a disarray as to lead to adverse outcomes, including the loss if important family and friends, serious financial setbacks, job losses, legal problems, and the possibility of becoming homeless. Most patients with bipolar disorder present in early adulthood at the ages of 20-30 years old. The second most common age group is 15-19 years old. In distinction to Kraepelinââ¬â¢s report that 38% of his patients had an onset when they were younger than 20 years, the most recent estimates are that 20-30% of youths in whom a major depressive disorder previously diagnosed develop symptoms consistent with a manic state or at a later age. Therefore an adolescent or child who initially presents with depression may have a hidden bipolar disorder that becomes apparent later in life. During diagnosis itââ¬â¢s also important to examine the immediate family to the patient. Genetic and family factors have a profound influence on the appearance of bipolar disorder. Chang and colleagues in 2000 reported that children who have at least one biological parent with bipolar disorder have increased psychopathology. At this time, there is no lab study that can be used to simply diagnose this disorder. Therefore doctors must be extremely careful and must consider everything before making an evaluation. The need first step in evaluating a person for this disorder to make sure that no other medical condition, or medical prescription is causing the mood or thought disturbance. I personally have heard on several occasions where a patient was miss-diagnosed and was mistaken to have bipolar disorder when in fact it was another prescription that they were on, was the cause of the disturbance. The next step in potentially diagnosing someone with bipolar disorder is to perform a physical exam, and then gather information from family friends and perhaps other physicians to whom the patient has known. The disturbance may be caused by a physical health problem or by a mental health problem that was brought up upon by recent events in onesââ¬â¢ life. Other tests are also done to ensure proper diagnosis i s followed. Finally the authors say that numerous studies have been done to determine if, if any link between the disorder and cognitive neuro-developmental factors are also seen in the development of bipolar disorder. In recap, bipolar disorder can be a very life threatening disorder. Itââ¬â¢s also very hard at times to diagnose, and everything in the patientââ¬â¢s life must be considered before being diagnosed with bipolar disorder. Itââ¬â¢s a disease that has the potential to be very crippling on onesââ¬â¢ life as well as family. While I was looking for a more reactive approach to treating family with this disorder, it was very interesting to learn how they diagnose bipolar disease and what steps are involved in it. Research Papers on Bi-Polar Article ReviewThe Relationship Between Delinquency and Drug UseThree Concepts of PsychodynamicEffects of Television Violence on ChildrenIncorporating Risk and Uncertainty Factor in CapitalResearch Process Part OneWhere Wild and West MeetInfluences of Socio-Economic Status of Married MalesGenetic EngineeringThe Fifth HorsemanThe Effects of Illegal Immigration
Sunday, October 20, 2019
Wars in the Former Yugoslavia
Wars in the Former Yugoslavia In the early 1990s, the Balkan country of Yugoslavia fell apart in a series of wars which saw ethnic cleansing and genocide return to Europe. The driving force was not age-old ethnic tensions (as the Serb side liked to proclaim), but distinctly modern nationalism, fanned by the media and driven by politicians. As Yugoslavia collapsed, majority ethnicities pushed for independence. These nationalist governments ignored their minorities or actively persecuted them, forcing them out of jobs. As propaganda made these minorities paranoid, theyà armed themselves and smaller actions degenerated into a bloody set of wars. While the situation was rarely as clear as Serb versus Croat versus Muslim, many small civil wars erupted over decades of rivalry and those key patterns existed. Context: Yugoslavia and the Fall of Communism The Balkans had been the site of conflict between the Austrian and Ottoman Empires for centuries before both collapsed during World War I. The peace conference which redrew the maps of Europe created the Kingdom of the Serbs, Croats, and Slovenes out of territory in the area, pushing together groups of people who soon quarreled about how they wished to be governed. A strictly centralized state formed, but opposition continued, and in 1929 the king dismissed representative government- after the Croat leader was shot while at parliament- and began to rule as a monarchical dictator. The kingdom was renamed Yugoslavia, and the new government purposefully ignored the existing and traditional regions and peoples. In 1941, as World War II spread over the continent, Axis soldiers invaded. During the course of the war in Yugoslavia- which had turned from a war against the Nazis and their allies to a messy civil war complete with ethnic cleansing- communist partisans rose to prominence. When liberation was achieved it was the communists who took power under their leader, Josip Tito. The old kingdom was now replaced by a federation of supposedly six equal republics, which included Croatia, Serbia, and Bosnia, and two autonomous regions, including Kosovo. Tito kept this nation together partly by sheer force of will and a communist party which cut across ethnic boundaries, and, as the USSR broke with Yugoslavia, the latter took its own path. As Titoââ¬â¢s rule continued, ever more power filtered down, leaving just the Communist Party, the army, and Tito to hold it together. However, after Tito died, the different wishes of the six republics began to pull Yugoslavia apart, a situation exacerbated by the collapse of the USSR in the late 1980s, leaving just a Serb-dominated army. Without their old leader, and with the new possibilities of free elections and self-representation, Yugoslavia divided. The Rise of Serbian Nationalism Arguments began over centralism with a strong central government, versus federalism with the six republics having greater powers. Nationalism emerged, with people pushing for splitting Yugoslavia up or forcing it together under Serb domination. In 1986, the Serbian Academy of Sciences issued a Memorandum which became a focal point for Serb nationalism by reviving ideas of a Greater Serbia. The Memorandum claimed Tito, a Croat/Slovene, had deliberately tried to weaken Serb areas, which some people believed, as it explained why they were doing relatively poorly economically compared to the northern regions of Slovenia and Croatia. The Memorandum also claimed Kosovo had to remain Serbian, despite a 90 percent Albanian population, because of the importance to Serbia of a 14th century battle in that region. It was a conspiracy theory that twisted history, given weight by respected authors, and a Serb media which claimed Albanians were trying to rape and kill their way to genocide. They we renââ¬â¢t. Tensions between Albanians and local Serbs exploded and the region began to fragment. In 1987, Slobodan Milosevic was a low-key but powerful bureaucrat who, thanks to the major support of Ivan Stambolic (who had risen to be Serbiaââ¬â¢s Prime Minister) was able to leverage his position into an almost Stalin-like seizure of power in the Serb Communist Party by filling job after job with his own supporters. Until 1987 Milosevic was often portrayed as a dim-witted Stambolic lackey, but that year he was in the right place at the right time in Kosovo to make a televised speech in which he effectively seized control of the Serbian nationalism movement and then consolidated his part by seizing control of the Serbian communist party in a battle waged in the media. Having won and purged the party, Milosevic turned the Serb media into a propaganda machine which brainwashed many into paranoid nationalism. Milosevic than gained Serb ascendance over Kosovo, Montenegro, and Vojvodina, securing nationalist Serb power in four of the regionââ¬â¢s units; the Yugoslav government c ould not resist. Slovenia now feared a Greater Serbia and set themselves up as the opposition, so the Serb media turned its attack onto Slovenes. Milosevic then started a boycott of Slovenia. With one eye on Milosevicââ¬â¢s human rights abuses in Kosovo, the Slovenes began to believe the future was out of Yugoslavia and away from Milosevic. In 1990, with Communism collapsing in Russia and across Eastern Europe, the Yugoslavia Communist Congress fragmented along nationalist lines, with Croatia and Slovenia quitting and holding multi-party elections in response to Milosevic trying to use it to centralize Yugoslavââ¬â¢s remaining power in Serb hands. Milosevic was then elected President of Serbia, thanks in part to removing $1.8 billion from the federal bank to use as subsidies. Milosevic now appealed to all Serbs, whether they were in Serbia or not, supported by a new Serb constitution which claimed to represent Serbs in other Yugoslav nations. The Wars for Slovenia and Croatia With the collapse of the communist dictatorships in the late 1980s, the Slovenian and Croatian regions of Yugoslavia held free, multi-party elections. The victor in Croatia was the Croatian Democratic Union, a right-wing party. The fears of the Serb minority were fuelled by claims from within the remainder of Yugoslavia that the CDU planned a return to the anti-Serb hatred of World War II. As the CDU had taken power partly as a nationalistic response to Serbian propaganda and actions, they were easily cast as the Ustasha reborn, especially as they began to force Serbs out of jobs and positions of power. The Serb-dominated region of Knin- vital for the much needed Croatian tourism industry- then declared itself a sovereign nation, and a spiral of terrorism and violence began between Croatian Serbs and Croats. Just as the Croats were accused of being Ustaha, so the Serbs were accused of being Chetniks. Slovenia held a plebiscite for independence, which passed due to large fears over Serb domination and Milosevics actions in Kosovo, and both Slovenia and Croatia began arming local military and paramilitaries. Slovenia declared independence on June 25, 1991, and the JNA (Yugoslaviaââ¬â¢s Army, under Serbian control, but concerned whether their pay and benefits would survive the division into smaller states) was ordered in to hold Yugoslavia together. Sloveniaââ¬â¢s independence was aimed more at breaking from Milosevicââ¬â¢s Greater Serbia than from the Yugoslav ideal, but once the JNA went in, full independence was the only option. Slovenia had prepared for a short conflict, managing to keep some of their weapons when the JNA had disarmed Slovenia and Croatia,à and hoped that the JNA would soon get distracted by wars elsewhere. In the end, the JNA was defeated in 10 days, partly because there were few Serbs in the region for it to stay and fight to protect. When Croatia also declared independence on June 25, 1991, following a Serb seizure of Yugoslaviaââ¬â¢s presidency, clashes between Serbs and Croatians increased. Milosevic and the JNA used this as a reason to invade Croatia to try to protect the Serbs. This action was encouraged by the U.S. Secretary of State who told Milosevic that the U.S. would not recognize Slovenia and Croatia, giving the Serb leader the impression he had a free hand. A short war followed, where around a third of Croatia was occupied. The UN then acted, offering foreign troops to try and halt the warfare (in the form of UNPROFOR) and bring peace and demilitarization to the disputed areas. This was accepted by the Serbs because theyââ¬â¢d already conquered what they wanted and forced other ethnicities out, and they wanted to use the peace to focus on other areas. The international community recognized Croatian independence in 1992, but areas remained occupied by the Serbs and protected by the UN. Before these could be reclaimed, the conflict in Yugoslavia spread because both Serbia and Croatia wanted to break up Bosnia between them. In 1995 Croatiaââ¬â¢s government won back control of western Slavonia and central Croatia from the Serbs in Operation Storm, thanks in part to U.S. training and U.S. mercenaries; there was counter ethnic cleansing, and the Serb population fled. In 1996 pressure on Serbian president Slobodan Milosevic forced him to surrender eastern Slavonia and pull out his troops, and Croatia finally won back this region in 1998. UN Peacekeepers only left in 2002. The War for Bosnia After WWII, the Socialist Republic of Bosnia and Herzegovina became part of Yugoslavia, populated by a mixture of Serbs, Croats, and Muslims, the latter being recognized in 1971 as a class of ethnic identity. When a census was taken in the aftermath of the collapse of Communism, Muslims comprised 44 percent of the population, with 32 percent Serbs and fewer Croats. The free elections held then produced political parties with corresponding sizes, and a three-way coalition of nationalist parties. However, the Bosnian Serb party- pushed by Milosevic- agitated for more. In 1991 they declared the Serb Autonomous Regions and a national assembly for Bosnian Serbs only, with supplies coming from Serbia and the former Yugoslavian military. The Bosnian Croats responded by declaring their own power blocs. When Croatia was recognized by the international community as independent, Bosnia held its own referendum. Despite Bosnian-Serbian disruptions, a massive majority voted for independence, declared on March 3, 1992. This left a large Serb minority which, fuelled by Milosevicââ¬â¢s propaganda, felt threatened and ignored and wanted to join with Serbia. They had been armed by Milosevic, and would not go quietly. Initiatives by foreign diplomats to peacefully break Bosnia into three areas, defined by the ethnicity of the locals, failed as fighting broke out. War spread throughout Bosnia as Bosnian Serb paramilitaries attacked Muslim towns and executed people en masse to force the populations out, to try and create a united land filled with Serbs. The Bosnian Serbs were led by Radovan Karadzic, but criminals soon formed gangs and took their own bloody routes. The term ethnic cleansing was used to describe their actions. Those who werenââ¬â¢t killed or had not fled were put into detention camps and mistreated further. Shortly after, two-thirds of Bosnia came under the control of forces commanded from Serbia. After setbacks- an international arms embargo which favored the Serbs, a conflict with Croatia which saw them ethnically cleanse too (such as at Ahmici)- the Croats and Muslims agreedà to a federation. They fought the Serbs to a standstill and then took back theirà land. During this period, the U.N. refused to play any direct role despite evidence of genocide, preferring to provide humanitarian aid (which undoubtedly saved lives, but did not tackle the cause of the problem), a no-flyà zone, sponsoring safe areas, and promoting discussions such as the Vance-Owen Peace Plan. The latter has been much criticized as pro-Serbà but did involve them handing some conquered land back. It was scuppered by the international community. However, in 1995 NATO attacked Serbian forces after they ignored the U.N. This was thanks in no small part to one man, General Leighton W. Smith Jr., who was in charge in the area, although their effectiveness is debated. Peace talks- previously rejected by the Serbs but now accepted by a Milosevic who was turning against the Bosnian Serbs and their exposed weaknesses- produced the Dayton Agreement after the place of its negotiation in Ohio. This produced The Federation of Bosnia and Herzegovina between Croats and Muslims, with 51 percent of the land, and a Bosnian Serb republic with 49 percent of the land. A 60,000 man international peacekeeping force was sent in (IFOR). No one was happy: no Greater Serbia, no Greater Croatia, and a devastated Bosnia-Hercegovina moving towards partition, with huge areas politically dominated by Croatia and Serbia. There had been millions of refugees, perhaps half of the Bosnian population. In Bosnia, elections in 1996 elected another triple government. The War for Kosovo By the end of the 1980s, Kosovo was a supposedly autonomous area within Serbia, with a 90 percent Albanian population. Because of the regionââ¬â¢s religion and history- Kosovo was the location of a battle key in Serbian folklore and of some importance to Serbiaââ¬â¢s actual history- many nationalist Serbs began to demand, not just control of the region but a resettlement program to oust the Albanians permanently. Slobodan Milosevic canceled Kosovar autonomy in 1988ââ¬â1989, and Albanians retaliated with strikes and protests. A leadership emerged in the intellectual Democratic League of Kosovo, which aimed at pushing as far as they could towards independence without getting into a war with Serbia. A referendum called for independence, and newly autonomous structures were created within Kosovo itself. Given that Kosovo was poor and unarmed, this stance proved popular, and amazingly the region passed through the bitter Balkan wars of the early 1990s mostly unscathed. With ââ¬Ëpeaceââ¬â¢, Kosovo was ignored by the negotiators and found itself still in Serbia. For many, the way the region had been sidelined and lumped into Serbia by the West suggested that peaceful protest wasnââ¬â¢t enough. A militant arm, which had emerged in 1993 and produced the Kosovan Liberation Army (KLA), now grew stronger and was bankrolled by those Kosovars who worked abroad and could provide foreign capital. The KLA committed their first major actions in 1996, and a cycle of terrorism and counter-attack flared up between Kosovars and Serbs. As the situation worsened and Serbia refused diplomatic initiatives from the West, NATO decided it could intervene, especially after Serbs massacred 45 Albanian villagers in a highly publicized incident. A last-ditch attempt at finding peace diplomatically- which has also been accused of simply being a Western sideshow to establish clear good and bad sides- led the Kosovar contingent to accept terms but the Serbs to reject it, thus allowing the West to portray the Serbs as at fault. There thus began on March 24 a very new type of war, one which lasted until June 10 but which was conducted entirely from the NATO end by airpower. Eight hundred thousand people fled their homes, and NATO failed to work with the KLA to coordinate things on the ground. This air war progressed ineffectually for NATO until they finally accepted that they would need ground troops, and went about getting them ready- and until Russia agreed to force Serbia to concede. Quite which one of these was the most important is still up for debate. Serbia was to pull all its troops and police (who were largely Serb) out of Kosovo, and the KLA was to disarm. A force of peacekeepers dubbed KFOR would police the region, which was to have full autonomy inside Serbia. The Myths of Bosnia There is a myth, widely spread during the wars of the former Yugoslavia and still around now, that Bosnia was a modern creation with no history, and that fighting for it was wrong (in as much as the western and international powers did fight for it). Bosnia was a medieval kingdom under a monarchy founded in the 13th century. It survived until the Ottomans conquered it in the 15th century. Its boundaries remained among the most consistent of the Yugoslavian states as administrative regions of the Ottoman and Austro-Hungarian empires. Bosnia did have a history, but what it lacked was an ethnic or religious majority. Instead, it was a multi-cultural and relatively peaceful state. Bosnia was not torn apart by millennia-old religious or ethnic conflict, but by politics and modern tensions. Western bodies believed the myths (many spread by Serbia) and abandoned many in Bosnia to their fate. Western Lack of Intervention The wars in the former Yugoslavia could have proved even more embarrassing forà NATO, the UN, and the leading western nations like the U.K., U.S., and France, had the media chosen to report it as such. Atrocities were reported in 1992, but peacekeeping forces- which were undersupplied and given no powers- as well as a no-fly zone and an arms embargo which favored the Serbs, did little to stop the war or the genocide. In one dark incident, 7,000 males were killed in Srebrenica as UN Peacekeepers looked on unable to act. Western views on the wars were too often based on misreadings of ethnic tensions and Serbian propaganda. Conclusion The wars in the former Yugoslavia appear to be over for now. Nobody won, as the result was a redrawing of the ethnic map through fear and violence. All peoples- Croat, Muslim, Serb and others- saw centuries-old communities permanently erased through murder and the threat of murder, leading to states which were more ethnically homogenous but tainted by guilt. This may have pleased top players like Croat leader Tudjman, but it destroyed hundreds of thousands of lives. All 161 people charged by the International Criminal Tribunal for the Former Yugoslavia forà war crimesà have now been arrested.
Saturday, October 19, 2019
Healthcare Qui Tam Term Paper Example | Topics and Well Written Essays - 1000 words
Healthcare Qui Tam - Term Paper Example Healthcare Qui Tam In Virginia, many hospitals were billing for outpatient procedures with codes kept for physicianââ¬â¢s office visits rather than an outpatient procedure performed at the health center. Medicare pays a high rate for physicianââ¬â¢s office appointments to mirror the cost of their operating cost (Warren & Benson Group, 2009). Hospitals obtain a separate facilities fee to settle the overhead cost. Therefore, the correct repayment rates for hospital outpatient services are lesser. The hospitals agreed to a payment of $3 million. A Pennsylvania hospital settled on paying a $2.7 million defrayal due to its upcoding fraud. The center was submitting claims for a multifaceted form of pneumonia when the accurate diagnosis showed a simpler form, which is compensated at a lower rate. The hospital decided to pay $500,000 for other upcodings with counterfeit claims for septicemia (Warren & Benson Group, 2009). A Florida hospital decided to pay $2,531,000 for issuing false claims for laser procedures executed as part of post cataract elimination surgery by demonstrating that the procedures were executed after the 39-day post-operative phase. It is also issued claims for actions, which were either never upcoded or rendered. Finally, they issued claims for two management services and evaluations per patient visit. Finally, a Hawaii doctor agreed to recompense a $2.1 million settlement for issuing false claims to Medicaid. The doctor operated a pharmacy in his hospital. The doctor billed Medicaid for providing expensive drugs when the clinic issued cheaper generic substitutes (Warren & Benson Group, 2009). ... A Florida hospital decided to pay $2,531,000 for issuing false claims for laser procedures executed as part of post cataract elimination surgery by demonstrating that the procedures were executed after the 39-day post-operative phase. It is also issued claims for actions, which were either never upcoded or rendered. Finally, they issued claims for two management services and evaluations per patient visit. Finally, a Hawaii doctor agreed to recompense a $2.1 million settlement for issuing false claims to Medicaid. The doctor operated a pharmacy in his hospital. The doctor billed Medicaid for providing expensive drugs when the clinic issued cheaper generic substitutes (Warren & Benson Group, 2009). Question 3 The following procedure could be used to admit a patient to a hospital, which upholds the law about the required number of Medicare and Medicaid referrals. Permission letter always should be issued before the admission of the person in the hospital (McCarty, 2008). The patient sho uld be given Pre-requisite permission for a medical procedure and not for general consultations. The beneficiary will be urged to furnish a photocopy of a valid CGHS card, a request letter from CGHS, or a photocopy of the specialistââ¬â¢s professional advice. After that, then the patient will be offered an admission memo. In case of a therapeutic emergency, the hospital accepted under CGHS, shall not refuse or deny admission or demand early deposit from the concerned patient. Nevertheless, the hospital accepted under CGHS, shall offer credit facilities to the respective patient on issuing of a valid CGHS card (McCarty, 2008). Rooted in the virtues of the case study on an
Friday, October 18, 2019
Rational Improvement of Writing Skills Essay Example | Topics and Well Written Essays - 1000 words - 5
Rational Improvement of Writing Skills - Essay Example One of the weaknesses in my essays is lack of strong introductions and conclusions. Presently, this remains my goal that in future, I master the writing of good introductions and conclusions. In addition, I feel that my essays portrayed good organization, as shown in their structures. However, I feel I need further improvements to my sentence transitions between paragraphs. Redundancy is another aspect I should work on in my future essays. In two of my essays, I noted that I tend to repeat some ideas in an unacceptable manner. Finally, the objectivity aspect of the essays was well above average. In most of my essays, I focus on the topic I am supposed to address, without deviating to a different course, or beating around the bush. However, I feel I need to perfect on this aspect since it is core to the writing process. During this semester, we have widely discussed the issue of human rights in the world. This issue is real and is given great attention in most countries. Each one of us was asked to choose a topic associated with the human rights issue and write an essay addressing the solutions to the problems that arise from this issue, as well as the effects of the problems in society. Choosing a topic was not hard for me, so I quickly identified peace and racial conflicts as my topic. This essay was engaging as I was required to research on this issue in different countries in order to establish the presence of this issue in those countries, as well as the possible solutions to the problems the issue presents in those countries.
Economics for Business Essay Example | Topics and Well Written Essays - 1500 words
Economics for Business - Essay Example Since China was the biggest importer of the Australian rock lobsters, this industry would lose a significant amount of its revenues in the face of such a prohibition. The Australian Fishing Authorities had also requested the National Government to negotiate these trade restrictions with the Chinese Government. This would save their business from being affected (The Telegraph, 2010). 2. The Chinese economy was the largest buyer of the rock lobster exports of Australia. When the Chinese Government prohibited the Australian lobsters from being imported into the country in November 2010, this came as shocking news to the Australian fishing community. With the exclusion of its biggest export destination, the rock lobster industry in Australia was sure to suffer huge financial losses. The fishing communities in the Victorian province, Western and Southern Australia specialized in the trading of rock lobsters and were expected to be significantly affected as a result of the Chinese ban. The Australian fishing authorities feared that the countryââ¬â¢s fishing community would be compelled to sell their catch at very low prices in the market. This in turn would result in lower revenues for these indigenous people. Thus, Australiaââ¬â¢s fishing industry was set to be badly hit by Chinaââ¬â¢s import restrictions. ... This ban was expected to generate a host of impacts on the Australian economy, the Chinese markets as well as the international trading community. First of all, the Australian fishing communities were expected to be adversely affected by the Chinese prohibition. The fishing communities hailing from the Victorian province, the eastern and southern Australia specialize in the trading and exporting of rock lobsters. They would witness a sharp decline in the revenues earned from the lobster export. The price of lobsters in Australiaââ¬â¢s domestic market was expected to fall, as the demand for lobsters to be exported would reduce. This again would affect the profits of the Australian fishing communities, who would have to sell their lobster hauls at much lower prices to the local citizens. While China had implemented a ban on the import of the Australian rock lobsters, the nation continued to import lobsters from New Zealand and South Africa. If this resulted in a decline in the total quantity of lobsters imported in the Chinese economy, this would lead to a rise in lobster prices in the Chinese markets. However, if the country kept its import quantity the same as before by importing more lobsters from New Zealand and South Africa, then the internal lobster prices would not rise. Finally, there was an opportunity for New Zealand and South Africa to gain from the Chinese ban. Even after it had stopped importing Australian rock lobsters, China continued to import is seafood from New Zealand and South Africa. Both these countries could witness an increase in their lobster exports if China decided to import extra lobsters to replenish the missing imports from Australia. This would result in increased export revenues for both these nations (Herald Sun, 2010). The
Logistic management or supply chain management select one topic only Dissertation
Logistic management or supply chain management select one topic only - Dissertation Example Using case study research method, secondary data will be collected from different literature regarding the selected firms which include text books, journal and news articles. The next section on findings and discussion will analyse the two companies and how and what lean approaches are used to enhance operations in logistics. Finally, all the findings will be summarized and recommendations will be given on research and study. This study analyse the state of two logistic companies and their approach to the lean concept. It was found out that two companies have tried to initiate a number of lean methodsââ¬â¢ but still a lot remains to be done. There were significant losses that were covered by the company management in both cases, by effective implementation of lean logistics approach. INTRODUCTION Optimizing a business process is essential to the long term success of the business and its returns. However, this process is complex owing to the diversity of activities, departments, an d varied requirements of each business process, especially the process industries, (Taylor, 2003). This paper conducts a study on the logistics sector companies to analyse their current operations with a lean approach and subsequently suggest improvements to enhance their logistics operations. Research Aim: The purpose of this paper is to study the current state of affairs in the field of lean logistics concepts while giving a brief study upon the theory of constraints which is similar to lean concept of management. Analyse the implication of lean concepts of management on two logistics companies and how have they been able to implement and execute the methods and related technologies. Research objectives To cite the concept of lean theory and theory of constraints with relevant literature To critically review the theory and relate them to practice of the management To recommend for the solutions to enhance logistics operations The paper has been divided into different sections. Sec tion one will refer the relevant literature regarding Lean concepts of management and theory of constraints. Section two will discuss the methodology of research design and techniques used to such implications for the selected firms. Using case study research method, secondary data will be collected from different literature regarding the selected firms which include text books, journal and news articles. Section three would help to analyze the data of the selected firms. Finally, all the findings will be summarized and recommendations will be given on research and study. LITERATURE REVIEW TOC CONCEPT Theory of Constraints (TOC) and Lean concept have become popular in recent years. The objectives of these two are the same ââ¬â to provide process optimizations and performance improvements. TOC focuses the attention of the management to avoid and eliminate the few present constraints in the system. Lean approach assists managers to improve performances by eliminating all the waste activities. The TOC concepts have proved to be quite profitable by reducing inventories and lead times, and enhancing the operations within a value chain, (Eric, et.al, 1995). Giving a brief about TOC, the TOC views organizations as a source of resources which are actually interlinked with the various activities and processes. TOC further states a constraint as one that has the ability to limit the performance of the system. TOC is of the perspective that in
Thursday, October 17, 2019
The Concept of Healthy Lunch Provision Essay Example | Topics and Well Written Essays - 2750 words
The Concept of Healthy Lunch Provision - Essay Example Roundabout sixty-five years ago, a lunch program for the school children American federal was introduced to make them healthy. During the great depression of the 1930s, the concept of the school lunch program was introduced by the provision of a small number of funds through government on the ad hoc basis. But these funds were not enough for each student of every school, and poor students were in need of food due to the stark of world war two. In 1946, a political party Congress take an initial step to pass an Act ââ¬Å"as a measure of national securityâ⬠by naming it National School Act. It was a guaranteed law for the food provided to the millions of needy school children. The provision of school lunch program by the government of America not only benefited the children but also expanded the range of business communities of agriculture and cafeteria fields on the basis of the subsidized food program. In the start, the program was not as successful due to lack of proper manage ment, but in these days the lunch is totally free of cost for those children whose families have low incomes or belong to poor class (HINMAN). A British TV chef Jamie Oliver stated about the school lunch menus during ABC News interview that, ââ¬Å"Children are getting diabetes, heart disease, and all sorts of diseases that only used to show up in adults, because of the food they are eating. We can influence this in a massive way by improving at least one daily meal, school lunch.â⬠When there was no restriction of lunch commodities by the Government officials, then the school administrations did not care for calorie control strategies and the students were free to whatever they like.
International business Personal Statement Example | Topics and Well Written Essays - 250 words
International business - Personal Statement Example As an undergraduate student I have been able to get the most out of my academic experience through the boundless knowledge that has been offered to me by my professors, something that should be noted, is not available in the simple purchase of a textbook. The academic lessons offered to me have increased my understanding of the business world and molded my marketing perspectives to views that I consider unique and will play a big role in my career in the future. The next step in my path is the subject of International business, and I would like to continue my personal and academic growth with this respected base of education. I believe that I will be able to get the most out of my learning experiences if I am surrounded by not only what I see as familiar, but progressive surroundings as well. I have a great resolve to succeed in life, and I hold firm in my belief that this institution would be the best means of my doing that. I hope that you will humbly consider my application to continue with my education in your prestigious
Wednesday, October 16, 2019
The Concept of Healthy Lunch Provision Essay Example | Topics and Well Written Essays - 2750 words
The Concept of Healthy Lunch Provision - Essay Example Roundabout sixty-five years ago, a lunch program for the school children American federal was introduced to make them healthy. During the great depression of the 1930s, the concept of the school lunch program was introduced by the provision of a small number of funds through government on the ad hoc basis. But these funds were not enough for each student of every school, and poor students were in need of food due to the stark of world war two. In 1946, a political party Congress take an initial step to pass an Act ââ¬Å"as a measure of national securityâ⬠by naming it National School Act. It was a guaranteed law for the food provided to the millions of needy school children. The provision of school lunch program by the government of America not only benefited the children but also expanded the range of business communities of agriculture and cafeteria fields on the basis of the subsidized food program. In the start, the program was not as successful due to lack of proper manage ment, but in these days the lunch is totally free of cost for those children whose families have low incomes or belong to poor class (HINMAN). A British TV chef Jamie Oliver stated about the school lunch menus during ABC News interview that, ââ¬Å"Children are getting diabetes, heart disease, and all sorts of diseases that only used to show up in adults, because of the food they are eating. We can influence this in a massive way by improving at least one daily meal, school lunch.â⬠When there was no restriction of lunch commodities by the Government officials, then the school administrations did not care for calorie control strategies and the students were free to whatever they like.
Tuesday, October 15, 2019
Facing the Hard Facts of Life Essay Example | Topics and Well Written Essays - 1000 words
Facing the Hard Facts of Life - Essay Example Born in a well-to-do urban business class family, life had always been a cakewalk for me. A cakewalk, till the day the ââ¬Å"hard factsâ⬠of life were thrust on me! I remember having a carefree childhood, cushioned in the warm, caring love of my parents and elder sister. Being the younger child, and a chubby one with dimples to go with my naturally good looks, I was the apple of everyoneââ¬â¢s eye. Parents, grandparents, aunts, uncles, teachers, seniors, friends, and later girlfriends, everyone simply loved me. Life was just beautiful. In school, I was good in studies, sports and extra curricular activities. Dadââ¬â¢s business was thriving and we were used to the best in life. We lived in a palatial house, went to the best school in town, dined in fine restaurants on weekends with dadââ¬â¢s friends and had a chauffeur driven limousine to drop my sister and me to school every day. Once in a couple of years, we would have a foreign holiday. What more could one ask for in life? At least, that is what I thought when I entered my teens.
Monday, October 14, 2019
Effects of Computerized Cognitive Training
Effects of Computerized Cognitive Training CHAPTER FIVE: DISCUSSION This chapter will discussâ⬠¦ it will also discuss its public health significanceâ⬠¦ and also report strengths and limitations of the review. 5.1à Summary and discussion of the evidence: 5.1.1à To what extent was the intervention effective? The overall aim of this study was to investigate the effects of computerized cognitive training aimed at improving cognitive function in individuals at a high risk of developing dementia. The ten trials that have been included in this study are spread widely across different countries. They vary enormously even within each subdomain analysed in terms of sample size, intervention characteristics (overall length of duration, number of training sessions and their frequency) and outcome measures used. Participants were assessed on a number of cognitive outcome measures that were unrelated to the trained tasks, this was necessary to show that cognitive improvement was not task specific as suggested by previous studies (Ball et al. 2002). The results from these ten studies suggest that computerized cognitive training is a promising approach for improving cognitive performance in persons with mild cognitive impairment. Participants showed improvements over a wide variety of neurocognitive o utcome measures, such as memory, attention, executive function, working memory, visuospatial ability, general cognition and speed of processing. Among these cognitive domains the most consistent improvements across all studies were observed in visual and verbal memory, attention, and executive function. Improvements in cognitive outcome measures suggests that individuals with MCI, despite cognitive deficit retain significant amount of neuroplasticity (Rosen et al. 2011) which makes them responsive to cognitive training. These findings are consistent with previous studies that demonstrate positive effects of cognitive training on cognitive performance in individuals with MCI (Brum et al. 2009; Ball et al. 2002; Rapp et al. 2002). Previously it has been suggested that training gains are influenced by the frequency and duration of the intervention (Gates et al. 2011), however, findings show no difference in training effects among studies with longer duration of intervention and those with smaller duration (Rozzini et al. 2007). The inability to conduct a meta-analysis due to heterogeneity of diagnostic criteria, intervention characteristics and outcomes measured made it difficult to precisely identify which cognitive domains benefited the most from the training. It has been pointed out several times over the years that unless accompanied by behavioural, psychological or other changes, changes in cognition let alone are not sufficient to justify a cognitive intervention (Woods, 2006). Out of the ten studies included, five studies assessed behavioural, psychological and everyday functional symptoms apart from neurocognitive outcome measures (Gaitan et al. 2013; Gagnon and Belleville, 2012; Finn and McDonald, 2011; Rozzini et al. 2007; Galante et al. 2007). The findings revealed positive effect of the intervention on some aspects of subjective measures of memory. Depressive symptom scores decreased most consistently. This was followed by reduction in anxiety levels. However, no significant improvements were observed in self-reported activities of daily living or everyday functioning memory. This could be explained by the fact that as individuals were carefully screened out in order to meet criteria for MCI, the participants were not impaired in everyday functional abilities and hence, it was difficult to assess the effect of training in terms of transferability to real world outcomes. No changes in well-being were reported. This is in contrast to the findings by Belleville et al. (2006) which reported positive impact of computerized cognitive training on the participantââ¬â¢s feelings of well-being. This can perhaps be explained by the inclusion of pre-training sessions on stress, self-esteem and imagery that were part of the intervention in their study. Despite the importance of quality of life to patients and caregivers, none of the studies measured quality of life. According to Rozzini et al. (2007) although use of cholinesterase inhibitors has also been associated with reduced depressive symptoms, but computerized cognitive training supersedes pharmacological therapy as no negative or adverse effects of training have been found in participants, contrary to adverse effects and high dropout rates reported in drug tri als in MCI (Clare et al. 2003). 5.1.2à To what extent were the effects maintained after the intervention? Four studies included a follow up assessment ranging between 3 months to a period of 12 months (Gaitan et al. 2013; Herrera et al. 2012; Galante et al. 2007; Rozzini et al. 2007) and one study used a longitudinal design (Valdes et al. 2012) to ascertain if the training gains lasted longer, showed stability over time and hence, could possibly contribute to preventing future cognitive decline. General cognitive function remained stable up to 9 months post training (Galante et al. 2007); recognition, attention and recall improvements were maintained at 6 months (Herrera et al. 2012); executive function (Gaitan et al. 2013), episodic memory and abstract reasoning (Rozzini et al. 2007) showed improvement trends at 12 month follow up; and effects on speed of processing were maintained at 5 years after the end of the training programme (Valdes et al. 2012). Two studies showed reduction in behavioural disturbances such as depression and anxiety (Gaitan et al. 2013; Rozzini et al. 2007) at a 12 month follow up. Evidence suggests that computerized cognitive training is at least effective in slowing or delaying the progression of cognitive decline and onset of dementia. Moreover, it also suggests that if computerized cognitive training show cognitive gains, these improvements are likely to be preserved at follow up. In summary, computerized cognitive training justifies Swaabââ¬â¢s (1991) phrase ââ¬Å"use it or lose itâ⬠used to explain the relationship between declining neuronal activity and neurodegeneration. Overall, these results show findings similar to a recent meta-analysis by Li et al. (2011) that showed improved overall cognition, domain specific cognitive improvements and positive training effects on follow up in the intervention group after receiving traditional cognitive training. According to literature, computerized cognitive training has shown to be more effective than traditional cognitive training (Kueider et al. 2012), the results from this study suggest that structured computerized cognitive training produce significantly greater benefits in individuals with MCI as compared to those engaged in cognitively stimulating activities only. Evidence reveals that individuals with MCI that were randomized to intervention group showed larger cognitive gains as compared to active control groups. 5.2à Public health Significance: With the elderly population of the world increasing rapidly, the numbers of older adults suffering from dementia are bound to rise. With 1 in 3 people above 65 years developing dementia, the number of individuals with dementia are projected to be as high as 135.46 million in 2050 (Alzheimerââ¬â¢s Disease International, 2013). Dementia has several devastating consequences. The economic impact of dementia globally is quite alarming. This has diverted attention not only towards the treatment of dementia itself but also towards preventive therapies specifically aimed at individuals with MCI. In 2007, the average cost of care for a patient with Alzheimerââ¬â¢s disease in the United Kingdom was estimated to be around à £29,746 (Alzheimerââ¬â¢s Society, 2008). This makes the principles of disease prevention and health promotion particularly relevant to dementia (Geda, Negash and Petersen, 2011). The prevention of a disease involves the identification of groups that are at high ris k; MCI indeed, is a high risk state for dementia particularly of the Alzheimerââ¬â¢s type (Alzheimerââ¬â¢s Disease International, 2013). Individuals with MCI are identified as high risk groups as they are 3 to 5 times more at risk of developing dementia than those without MCI (Alzheimerââ¬â¢s Society, 2014). As findings from this study reveal that many of the cognitive domains retain effects from as low as 6 months up to 5 years post computerized cognitive training and demonstrate delay in the progression of cognitive impairment. This can have positive implications for public health. This is because according to the Alzheimerââ¬â¢s Society (2007) delaying the progression of cognitive decline and hence onset of dementia merely by 5 years would halve the number of deaths that are directly attributable to dementia. It would also reduce the huge economic costs associated with dementia care borne by the carers and the government. In addition, it would also cut down the costs borne by individuals or their carers as computerized approach itself is a cost effective approach as explained earlier. Growing evidence on the positive effects of computerized cognitive makes it a strong candidate to be on the priority agenda for policy making on tackling dementia in coming years. As demonstrated, much evidence in literature exists highlighting the positive impact of cognitive training on cognitive performance. NICE guidelines (2011) recommend the use of structured cognitively stimulating programmes for individuals with mild to moderate dementia irrespective of the drugs prescribed for the treatment of cognitive symptoms of dementia. Results from this study indicating the potential of computerized cognitive training and other relevant evidence in literature advocates that the use of computerised cognitive training for MCI patients can be included in the clinical practice guidelines. However, for that to be practically useful, there needs to be developed a structured computerised cognitive training service which can be commissioned when needed. Such service should identify in particul ar the software to be used, the duration and frequency of training sessions and sequencing of training sessions. Kueider et al. (2012) highlighted that older adults did not need to be tech savvy in order to complete and benefit from the intervention. Moreover, these findings could have positive implications as contrary to the old belief that older adults may not welcome the idea of using technology; research suggests that older adults in many cases are the fastest growing users of computer and internet technology (Wagner et al. 2010). Moreover, as mentioned earlier, computerized cognitive training offer flexible and personalized approach as the difficulty level can be adjusted according to the userââ¬â¢s performance, hence, keeping it engaging and enjoyable for users. 5.3à Strengths and limitations of the study: The review was undertaken after a thorough search of literature available around the research question. To the authorââ¬â¢s knowledge this is the only systematic review to-date that has been conducted on this topic and includes up to date evidence. Another strength of this study is the strict inclusion criteria in terms of study design. Only randomised controlled trials were included in the review. Although there were other relevant studies available having other study designs but according to the Cochrane review guidelines (Higgins and Green, 2011), the author decided to limit the final studies to randomised controlled trials. This helped to decrease bias and increase the methodological quality of the overall review. The author intended to synthesize the results from best available evidence. Although efforts were made to ensure a transparent and reproducible review, a number of caveats need to be mentioned that might have influenced the results. 5.3.1à Time frame: The time frame to conduct a systematic review was extremely limited keeping in view that there was only one researcher carrying out the entire procedure. Maximum time was spent searching through different electronic databases and other sources and reading the abstracts of different articles in an attempt to identify relevant studies. There may be a possibility of selection bias as the selection and screening of studies was done solely by one reviewer. However, in order to minimise such bias, the search and screening of articles was done twice. 5.3.2à Methodological limitations: Across the literature on computerised cognitive training common but notable methodological limitations emerge. One of the general limitations of this systematic review was small sample sizes used in majority of the studies. The small sample sizes led to reduced statistical power which may have obscured the detection of potential differences between the groups. Larger groups could have allowed detecting smaller gains in performance. A second limitation was that several studies lacked an adequate active or placebo control group. Failure to include a proper control group may not only have had an impact on the results but also made interpretation of results difficult as attribution of cognitive benefits could have originated from other sources besides computerized cognitive training. These issues impact on the main aim of the study which was assessing how computerized approaches compare with traditional approaches. Only two studies used an active control group indulged in activities similar to traditional cognitive training (Gaitan et al. 2012; Herrera et al. 2012) making it difficult to directly compare both the approaches. The review supports findings from previous studies (Sitzer et al. 2006) that intervention groups show larger effect sizes when compared to waitlist instead of active control conditions. Several studies reported inclusion of participants receiving pharmacological therapy (Cholinesterase Inhibito rs) raising the possibility that the cognitive gains were not because of the training solely but were a result of the synergistic effect between pharmacological therapy and training. An important limitation of this study was the scarce availability of data for individuals with mild cognitive impairment despite the relatively large time span covered. Furthermore, although most studies used the Petersenââ¬â¢s criteria to diagnose and assess individuals with MCI but modifications in the exact application of this definition existed e.g. the use of MMSE- scores one of the included studies used MMSE scores > 24 () while one study used MMSE scores of 23 (). Additionally the heterogeneity of the outcomes measured across studies made cross-comparison difficult but at the same time highlighted the need of developing robust research designs for cognitive training intervention studies. According to the inclusion criteria, only studies that were randomised controlled trials were to be included. This led to the exclusion of many quasi-experimental studies that were related to the research question and that could have contributed to the results (Talassi et al. 2007; Belleville et al. 2006; Cipriani et al. 2006; Tarraga et al. 2006; Schreiber et al. 1999). 5.3.3 Dual vs Single person data extraction: The Cochrane Collaboration (Higgins and Green, 2011) expects each study included in the review to be data extracted by at least two independent researchers who are blind to the study authors and institution from which the study has been published. This however, was not possible owing to the time limitations and practicality of an MSc degree and therefore, data extraction was carried out by a single reviewer. According to Edwards et al. (2002) study screening and data extraction by two or more researchers increases the reliability and accuracy of the systematic review. 5.3.4à Language limitation: The requirement of studies being published in English language led to the exclusion of two studies deemed relevant by their abstract as the body of text was published in German and Spanish (Ott-Chervet et al. 1998; Fernà ¡ndez-Calvo et al. 2011). Summary: This chapter discussed on the results that were generated in the previous chapter. Computerized cognitive training had positive impact on multiple aspects of cognition, including behavioural and psychological symptoms. The effects of training on multiple outcome measures were retained for as less as 6 months to 5 years after the end of the training programme. This showed that the effects of training were not only immediate but also halted cognitive decline. These findings were extremely important from the public health.
Sunday, October 13, 2019
Slavery During, In, and After the Civil War Essay -- Slavery Essays
Slavery During, In, and After the Civil War The Civil War was doubly tragic because it was completely unnecessary. Slavery had been ended in other nations with the stroke of a pen, and yet in the mighty United States the country was willing to go to war over the issue of whether slavery should remain. The southerners felt that it was their constitutional right to own slaves and did not see a time when they should be required to give up that right. However, upon the election of Lincoln as President, the southerners felt threatened, and felt their slave holding rights were being threatened, and in an effort to protect these rights they chose to secede from the union. Why would any one person want to own another human being with the same intestines, some of the same feelings yet a different color for their own good . This was quite crazy if you ask me , I feel that the southerners should have felt threatened and that if what they were doing were so right why feel so threatened about doing it.The northerners and Lincoln saw the importance of maintaining a united country, set out to bring back the seceded states. Thus the Civil War began. During the civil war many Americans were either killed or wounded, this number was only surpassed by World War II. While the civil war originally began as a quest to bring the southern states back to the union. However, the goal of the war did soon change to that of abolition. While the war may have seemed necessary to ...
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