Friday, November 29, 2019

Korean Pollution Essays - Air Pollution, Pollution, Pollutant

Korean Pollution Deadly particles are circulating within our air supply. They are ?the most life threatening for of air pollution.? These are tiny particles of soot and other matter released from diesel engines in lorries, buses, and coaches. They are believed to have played a role in the premature deaths of 8,000 people. Other pollutants known as GMM's are causing such damage. GMM's are genetically modified micro-organisms. These micro-organisms are released from factories and laboratories and go into the atmosphere, and water supplies. They are most life threatening to elderly, and already ill people. (McCarthy 1) Large clouds of these particles were originally believed to originate in Britain, but studies show now that they may also originate in continental Europe. These large clouds drift across the English Channel, and into the North Sea., thus contaminating the sea. Some of the main pollutants are as follows: Benzene, 1,2-butadiene, carbon monoxide, nitrogen dioxide, and sulfur dioxide. There have been different goals set to lower the amount of these pollutants, however some aren't expected to be decreased until 2008. In this time many lives may be lost prematurely. England, who is still believed to be the primary contributor of such toxins is planning to take action, but slowly, still maintaining that cleaning these pollutants is ?unachievable, even if every engine on British roads was turned off.? We believe that this is more harmful than Britain realizes, and more action must be taken. Such pollutants may kill animals, and lower the food supply, especially fish in the North Sea. More time and money must be dedicated to the immediate removal of such contaminants, and new emissions standards should be set. We would like the UN to set aside money, for the sole purpose of cleaning up the North Sea, and eliminating some of these GMM's and other such toxins. Such damage to the environment can be felt globally and is a huge issue. (McCarthy 1) Bibliography none

Monday, November 25, 2019

Isolation and Analysis of Essential Oils Using Gas Chromatography Essays

Isolation and Analysis of Essential Oils Using Gas Chromatography Essays Isolation and Analysis of Essential Oils Using Gas Chromatography Paper Isolation and Analysis of Essential Oils Using Gas Chromatography Paper Isolation and Analysis of Essential Oils using Gas Chromatography Lyndon Justin T. Guzman Institute of Chemistry, University of the Philippines, Diliman, Quezon City Date Performed: February 2; February 4, 2011 Date Submitted: February 18, 2011 Abstract The purpose of this experiment is to isolate the essential oil from eucalyptus leaves as a pure compound; moreover, the components of the essential oil, camphor and limonene, will be then separated using gas chromatography technique, identify the components by their retention times, and compute for the concentration and percentage content of each component by their peak areas and peak heights. The volatile oil from eucalyptus leaves was isolated with the use of steam distillation setup, then using a separatory funnel to pipette out the extract from the distillate. A gas chromatography, with nitrogen gas as the carrier gas and a flame ionization detector, was used to separate and characterize the components of the essential oil. The retention times, peak areas, and peak heights were obtained for qualitative and quantitative analysis. A percentage of 0. 05% and 2. 85% were obtained as the content of camphor and limonene in the extracted oil, respectively. It also goes to show that limonene has greater concentration than that of camphor in the essential oil extract. Indeed, steam distillation and gas chromatography techniques are essential methods for extracting essential oils and separating natural compounds from plants. I. Introduction Gas chromatography is used for separations of volatile or reasonably volatile organic liquids and solids. In this method of chromatography, the components are partitioned between a liquid coating on the column (the stationary phase) and an inert gas (the mobile phase). The stationary phase for gas chromatography is usually an organic polymer coated on the inside of a tube, such as long capillary, and the mobile phase is an inert gas, such as hydrogen, helium, or nitrogen. (Druelinger, 2000) Figure 1. Schematic diagram of a gas chromatographic system. cee. vt. edu/ewr/environmental/teach/smprimer/gc/gc. html A small volume (1-10 ? L) of a mixture of volatile substances (usually dissolved in a solvent) is injected by syringe onto a heated column through which an inert carrier gas is flowing. The heat applied, as well as the gas flow, helps the molecules from the sample travel through the column. Smaller, more volatile molecules generally emerge first from the opposite end of the column and are detected. The detector is connected to a recorder/data system, which shows a deflection when a sample passes the detector in proportion to the amount of sample detected. Compounds are eluted through an exit port either in an intact form or as combustion products, depending on the type of detector used. (Druelinger, 2000) The characteristic aromas of plants are due to the volatile oils, or also known as essential oils, which have been used since antiquity as a source of fragrances and flavorings. These oils occur in all living parts of the plant; they are often concentrated in twigs, leaves, flowers, and seeds. Essential oils are generally complex mixtures of hydrocarbons, alcohols, and carbonyl compounds mostly belonging to the broad group of plant products known as terpenes. (Dalrymple and Moore, 1976) One of the many types of samples easily characterized by the technique of gas chromatography is the essential oil. These essential oils are isolated from the plant tissue by steam distillation. Since organic compounds are generally miscible with one another, this phenomenon is usually observed only when one of the liquids is water with one or more immiscible organic liquids; in these cases, the distillation process is called steam distillation (Ault, 1983). The technique of steam distillation is based upon the principle that each component of immiscible liquid mixtures contributes to the total vapor pressure as if the other components were not there (Druelinger et. l. , 2000). As the temperature of such a mixture in an apparatus open to the atmosphere is raised, the vapor pressure of each substance increases until the total vapor pressure equals the pressure of the atmosphere. Since the total vapor pressure is the sum of the individual vapor pressures, the total vapor pressure must become equal to atmospheric pressure at a temperature below the boiling point of either pure substance (Ault, 1983). The mixture thus distills at a temperature below the boiling point of either pure component. This can be explained using a combination of Dalton’s and Raoult’s Law: Patm = XAPÂ °A + XBPÂ °B where Patm is the atmospheric pressure, XA and XB are the mole fractions of compounds A and B, and PÂ °A and PÂ °B are the vapor pressures of pure liquids A and B. Their individual contributions are dependent on their respective mole fractions, and both liquids contribute to the vapor pressure of the system (Institute of Chemistry, UPD, 2010). In this experiment, a major constituent of volatile oils from eucalyptus leaves will be isolated as a pure compound with high purity via steam distillation. These essential oils are camphor and limonene and by using the gas chromatography technique, the different components of the eucalyptus essential oil will be separated. This experiment also aims to manipulate the gas chromatography system and change conditions in order to effectively and efficiently separate the components, and therefore achieve a good resolution. The components will be identified by determination of their retention times relative to those of a homologous series of n-alkanes by co-injection with authentic (standard) samples. II. Methodology Extraction of Essential Oils by Steam Distillation A steam distillation setup was prepared as shown in Figure 2 below (Note 1). The sample (Note 2) was cut into small pieces and an amount enough to fill three-fourths of a 1-L round bottom flask was collected. 400-mL distilled water was weighed and added into the flask. The mixture was steam distilled rapidly until you have about 100 mL of the distillate. Figure 2. Steam distillation setup. pharmainfo. net/reviews/fractional-distillation-binary-solvent-mixture The distillate was placed in a separatory funnel and 2. 0 g NaCl was added. The funnel was left to stand until separation of layers occurred. All the extract was then pipetted out (Note 3). The mixture was dried by adding enough anhydrous sodium sulfate to the mixture until the sodium sulfate swirled freely. If the entire drying agent clumped, another spatula-full anhydrous sodium sulfate was added. The mixture was then swirled. The mixture was dry if there were no visible signs of water and the drying agent flowed freely in the container. The essential oil and aqueous distillate were stored in separate tightly-sealed, properly-labeled containers (vials) in the freezer for future use in the FT-IR analysis experiment or GC experiment or special project (Note 4). Gas Chromatographic Analysis of Essential Oils Solution Preparation 1. Reference Solution. Separate stock solutions of 500 ppm of camphor and limonene in acetone were prepared. 50-300 ppm working standard solutions were also prepared (50, 100, 150, 200, 250 ppm) (Note 5). 2. Essential Oil Extract. 0. 5 mL of the pure extract (from steam distillation) was measured and diluted with acetone in a 10-mL volumetric flask. Instrumentation Gas chromatography was performed using a Shimadzu GC-14B using Equity 1 (30 m x 0. 25 ? m ID, 0. 25 mm film thickness) capillary column with N2 as a carrier gas. The following were the operating conditions: N2 flow rate| 1. 0 mL/min| Column temperature| initial 50Â °C (at 4 mins)| Ramp| 20Â °C/min to 210Â °C| Injector temperature| 200Â °C| Detector temperature| 250Â °C| Before the start of the experiment, the GC must have warmed up. Refer to the GC condensed procedure. Gas Chromatographic Analysis 1. 0 ? L of the standard camphor solution was injected and its chromatogram was generated. The procedure was repeated using limonene standard solution. The recorded retention times and peak areas of these substances were noted. 1. 0 ? L of the test solution (essential oil extract) was injected. Using the retention times determined from the chromatogram with the standard solution, the components of the standard solution was located on the chromatogram obtained with the test solution (Note 6). After all solutions have been injected and data computer-processed, the GC was left to run at the highest column temperature used in the experiment with the N2 gas flowing at a slower rate than the experimental flow rate for 15-20 minutes. The injector temperature was set to room temperature and slowly lowered the column temperature down to room temperature with the N2 gas still flowing in the system. Once everything reached room temperature, the gas flow was left to stand for another 10-15 minutes, after which the GC can be turned off. Notes 1. Boiling chips were added to the steam generator and sample flasks. 2. Each group must use different plant samples. 3. There should be two layers after the addition of NaCl solution. One was mostly water. The other was mostly extracted oil. To find out which is which, a small amount of water was added to the flask, whichever layer dissolved the water drop was the aqueous layer. The layer of essential oil was then carefully pipetted out. . If you have to get more of the organic layer out of the water, you can perform a back-extraction (solvent extraction) experiment. 5. All standard and sample solutions were stored in a well-filled, airtight container, protected from light and a temperature not exceeding 25Â °C. 6. The assay was not valid unless the number of theoretical plates calculated for the peak due to limonene at 110Â °C was at leas t 30000; the resolution between the peaks corresponding to limonene and cineole was at least 1. 5. Waste Disposal All solid wastes were disposed in the trash can. Waste acetone was poured into properly labeled waste container exclusively for acetone. Do not pour waste acetone in the sink! III. Results and Discussion The extraction of the essential oils, camphor and limonene, from the eucalyptus leaves sample was carried out using the steam distillation technique. camphor Figure 3. Structural formulas for camphor and limonene. The boiling point of the oily, aqueous distillate will never exceed the boiling point of water. This is because both water and the oily component each contribute to the total vapor pressure as if the other component was not present. The mixture boils when the combined vapor pressures of water and oil equal the atmospheric pressure. The oil has a small, but significant vapor pressure at 100Â °C, so that the boiling point of the mixture will be just below the boiling point of water. (Druelinger, 2000) The mass of the eucalyptus leaves that were extracted was 112. 98 g. 100 mL of the distillate was produced from the steam distillation. Only a small amount of oil was extracted within the distillate by a separatory funnel. The components of the oil sample were then separated and characterized using the gas chromatography technique with a flame ionization detector. Nitrogen gas served as the carrier gas or the mobile phase that moved the sample throughout the column. The chromatograms, plots of detector response versus time, of the standards and the sample were taken. Retention times were noted for qualitative analysis. Peak areas and peak heights were also recorded for and quantitative analysis of the essential oils. Table 1. Retention times of camphor and limonene standard and sample solutions. Solution| Retention Time (min)| pure standard camphor| 9. 021| pure standard limonene| 7. 908| extracted camphor sample| 9. 347| extracted limonene sample| 7. 89| From the given data above for the retention time, the retention time of the camphor and limonene from the standard solutions, 9. 021 min and 7. 908 min, respectively, were close to the retention time of the camphor and limonene with that of the sample solution, 9. 347 min and 7. 889 min. It was deduced that the camphor and limonene from the sample solution were present compounds in the extrac ted oil from eucalyptus leaves. Below is a table shown for the resulted peak areas and peak heights from the chromatograms of camphor and limonene standard solutions. Table 2. Peak areas and peak heights of camphor and limonene standard solutions. Solution| Peak Area| Peak Height| pure standard camphor| 46848| 17109| 50 ppm| 4427| 1113| 150 ppm| 12904| 4627| 200 ppm| 20417| 6065| 250 ppm| 15683| 5282| pure standard limonene| 56156| 20681| 50 ppm| 4419| 1236| 150 ppm| 15058| 4946| 200 ppm| 20464| 6452| 250 ppm| 20875| 5913| Figure 4. Camphor standard solutions vs. Peak area. Figure 5. Camphor standard solutions vs. Peak height. Table 3. Determination of the concentration of camphor component in the sample. Camphor Sample| Value| Concentration (ppm)| Peak Area| 5820| 67. 8| Peak Height| 1544| 61. 57| From the plotted calibration curve on the peak height and peak area for the camphor component, a regression equation is formulated in each curve with linearities almost equal to 1. From the acquired data on peak area and peak height of the camphor sample, the concentration of the camphor is 67. 98 ppm when the peak area is 5820 and 61. 57 ppm when the peak heigh t is 1544. Figure 6. Limonene standard solutions vs. Peak area. Figure 7. Limonene standard solutions vs. Peak height. Table 4. Determination of the concentration of limonene component in the sample. Limonene Sample| Value| Concentration (ppm)| Peak Area| 306384| 2875. 39| Peak Height| 102881| 2943. 95| From the plotted calibration curve on the peak height and peak area for the limonene component, a regression equation is formulated in each curve with linearities also almost equal to 1. From the obtained data on peak and peak height of the limonene sample, the concentration of the limonene is 2875. 39 ppm when the peak area is 306384 and 2943. 95 ppm when the peak height is 102881. To determine the percentage content of the components of the essential oil, the area normalization method is applied. Determining the areas beneath all of the peaks of a chromatogram enables to assign percentages to each of the components of a sample. Table 5. Determination of the percentage content of camphor and limonene sample. Component| Area| Total Area| % Content| camphor| 5820| 10766407| 0. 05%| limonene| 306384| | 2. 85%| Using the formula for area normalization, the computed percentage contents for camphor and limonene are 0. 05% and 2. 85%, respectively. This suggests that there is a greater amount of limonene in the oil extracted from the eucalyptus leaves than that of camphor. The very low percentage implies that extracting and separating natural organic compounds from essential oils give you a very low yield that’s why you need to have huge amounts of starting material to extract from to get a relatively high percentage of its components. IV. Conclusion In this experiment, the essential oil from eucalyptus leaves was isolated as a pure compound by steam distillation. The components of the eucalyptus essential oil, camphor and limonene, were separated using the gas chromatography technique having a flame ionization detector. The components were also identified through determination of their retention times and were confirmed that camphor and limonene are present, having a retention time of 9. 347 and 7. 889, respectively. Calibration curves on peak areas and peak heights on camphor and limonene were formed. Concentrations of the components were calculated and gave 67. 98 ppm and 61. 57 ppm for camphor, and 2875. 39 ppm and 2943. 95 ppm for limonene. The percentage contents of the components were also determined. The essential oil extracted constituted 0. 5% camphor and 2. 85% limonene. Steam distillation is a useful method for isolating high-boiling liquids, such as oils, from other non-volatile organic compounds, such as waxes, complex fats, proteins, and sugars (Druelinger, 2000). Natural oils can be isolated readily by steam distillation. Individual compounds can be separated from the essential oil by gas chromatography wherein the components of a vaporized sample are separated as a consequence of bei ng partitioned between a mobile gaseous phase and a liquid stationary phase held in a column. Gas chromatography is the most widely used technique for qualitative and quantitative analysis for analysis times are short, very small amounts of sample are required and an ideal tool for the microscale and miniscale organic laboratories. If you want to obtain large percentage of compounds from the extracted essential oil, you need to have huge amounts of eucalyptus leaves and it will take you a long time to steam distill. The standards should be injected under the same set of conditions for if not, this will lead to erroneous comparisons of data. You can manipulate some parameters like type of column, carrier gas flow rate, injector temperature, and column temperature to compare some effects on the quantitative breakdown of the experiment. V. References Skoog, D. A. , West, D. M. , Holler, F. J. and S. R. Crouch. 2004. Fundamentals of Analytical Chemistry, 8th edition. Thomson Learning Asia, Singapore. Institiute of Chemistry. Intermediate Chemistry Laboratory II Manual. 2010. University of the Philippines, Diliman, Philippines. Druelinger, M. L. , B. A. Gaddis and A. M. Schoffstall. 2000. Microscale and Miniscale Organic Chemistry Laboratory Experiments. The McGraw-Hill Companies, Inc. , USA. Dalrymple, D. L. and J. A. Moore. 1976. Experimental Methods in Organic Chemistry, 2nd edition. W. B. Saunders Company, USA. Ault, A. 1983. Techniques and Experiments for Organic Chemistry, 4th edition. Allyn and Bacon, Inc. , USA. VI. Appendix Calculations Concentration of camphor component in the sample peak area = 5820 regression equation: y = 103. 48x – 1214. 9 5820 = 103. 48x – 1214. 9 x = 67. 98 ppm peak height = 1544 regression equation: y = 33. 317x – 507. 9 1544 = 33. 317x – 507. 29 x = 61. 57 ppm Concentration of limonene component in the sample peak area = 306384 regression equation: y = 106. 88x – 937. 57 306384 = 106. 88x – 937. 57 x = 2875. 39 ppm peak height = 102881 y = 35. 106x – 469. 43 102881 = 35. 106x – 469. 43 x = 2943. 95 ppm Percentage content of camphor sample %content = (area / total area) x 100 %co ntent = (5820/10766407) x 100 %content = 0. 05% Percentage content of limonene sample %content = (area / total area) x 100 %content = (306384/10766407) x 100 %content = 2. 85% Answers to Questions 1. The gas chromatography technique is used for separations of volatile or reasonably volatile organic liquids and solids. 2. Thermal conductivity detectors (TCD), flame ionization detectors (FID), and electron capture detectors (ECD) are commonly used type of detectors. The thermal conductivity detector, which was one of the earliest detectors for gas chromatography, senses a difference in thermal conductivity of gases eluting from a GC column. The thermal conductivities of helium and hydrogen are roughly 6 to 10 times greater than those of most organic compounds. Thus, even small amounts of organic species cause relatively large decreases in the thermal conductivity of the column effluent, which results in a marked rise in the temperature of the detector. (Skoog et. al. , 2004) Flame ionization detectors, the most widely used and applicable detector for GC, consist of a flame fueled by hydrogen gas. Functional groups, such as carbonyl, alcohol, halogen, and amine, yield fewer ions or none at all in a flame. The detector is insensitive towards non-combustible gases such as H2O, CO2, SO2, and NO2. These properties make the FID a most useful detector for the analysis of most organic samples, including those that are contaminated with water and the oxides of nitrogen and sulfur. (Skoog et. al. , 2004) The electron capture detector has become one of the most widely used detectors for environmental samples because this detector selectively responds to halogen-containing organic compounds, such as pesticides and polychlorinated biphenyls. (Skoog et. al. , 2004) 3. An elution with a single solvent or a solvent mixture of constant composition is isocratic. For samples with a broad boiling range, it is often desirable to employ temperature programming, whereby the column temperature is either increased continuously or in steps as the separation proceeds. 4. polydimethyl siloxane – general-purpose nonpolar phase, hydrocarbons, polynuclear aromatics, steroids, PCBs polyethylene glycol – free acids, alcohols, ethers, essential oils, glycols 5% phenyl-polydimethyl siloxane – fatty acid methyl esters, alkaloids, drugs, halogenated compounds 50% cyanopropyl-polydimethyl siloxane – polyunsaturated fatty acids, rosin acids, free acids, alcohols . Table 6. Internal Standard method for GC. % analyte| Peak height analyte| Peak height internal std| Peak height ratio (analyte/internal std)| 0. 05| 18. 8| 50. 0| 0. 38| 0. 10| 48. 1| 64. 1| 0. 75| 0. 15| 63. 4| 55. 1| 1. 15| 0. 20| 63. 2| 42. 7| 1. 48| 0. 25| 93. 6| 53. 8| 1. 74| unknown| 58. 9| 49. 4| 1. 19| Figure 8. Peak Height Ratio vs. Percent Analyte. regression equat ion: y = 6. 9x + 0. 065 slope = 6. 9 y-intercept = 0. 065 concentration of unknown: . 19 = 6. 9x + 0. 065 x = 0. 16304 standard deviation = 0. 007939 Chromatograms Figure 9. 50 ppm standard solution chromatogram. Figure 10. 150 ppm standard solution chromatogram. Figure 11. 200 ppm standard solution chromatogram. Figure 12. 250 ppm standard solution chromatogram. Figure 13. Pure standard camphor solution chromatogram. Figure 14. Pure standard limonene solution chromatogram. Figure 15. Essential oil extract chromatogram.

Friday, November 22, 2019

Movie Half Nelson Review Example | Topics and Well Written Essays - 500 words

Half Nelson - Movie Review Example All these make up the indifferent urban dramas. Dan and Drey are teacher and student with significant varying age differences but are faced with similar crisis. They are both looking for something to believe in and rely on. (Halliwell123) Dan does not only do drugs but is a successful history teacher at Brooklyn high school and finds time to coach girls basket ball team. He believes in the essence of history being the Hegelian dialects and this theory is seen to reflect in his own life. He is neither a good man with negative habits nor a bad man with positive habits. Rather he is both sides of himself at all times and this conflict is what is pulling him apart. (Halliwell128) Drey is also familiar with the world of drug abuse as her brother is in prison for related charges. With the realization that Dan is a user, both of them are alarmed with the possible negative or positive changes that they may not be capable to prevent or encourage. Frank is also a drug dealer and has ties with Drey's family. He seemed to be an intelligent and mediocre caring man.Drey knows that drugs are evil but does not view frank as a dangerous man (Halliwell130) Dan is a dedicated teacher, full of ideas and a skeptic, who devotes his life to improve others while destroying himself an

Wednesday, November 20, 2019

Autism Symptoms and Early Signs Essay Example | Topics and Well Written Essays - 1500 words

Autism Symptoms and Early Signs - Essay Example DSM-IV criteria describes the ASDs in children aged 3 years and older however, the emphasis is now given on characterizing the symptoms before three years as developmental abnormalities occur at a very young age and early intervention can also provide a good prognosis for ASD children. ASD leads to impairments in three functional spheres of influence: communication skills, both verbal and non-verbal, socialization and a deficiency of behavioral flexibility, making the child rely on routines. Autism is considered as the most prevalent among the severe developmental disorders. Classic autism was first described by Leo Lanner in 1943 and according to a 2007 report, it is estimated to occur in approximately 1 in 1000 individuals and ASD occurs in 1 in 150 individuals. Prevalence in Canada is estimated to be two per 1000 for autism and six per 1000 for the whole of the ASDs (Bryson et al 2004; Benson & Haith 2009). As mentioned earlier, the developmental abnormalities start manifesting at a very young age even before 3 years of age. Furthermore studies have provided evidence that early intervention can optimize the outcomes for the children affected with autism. Hence, early diagnosis by detecting the early signs and symptoms in the autistic children can aid early intervention and good prognosis. Before proceeding towards the symptoms and early signs of autism, it would be resourceful to overview the etiology of ASD. No singular cause can be pointed out however; the most common and popularly accepted cause is brain abnormalities and genetic etiology. Moreover, it should be made clear over here that autism is not a psychological disorder brought about by poor parenting or childhood years. One important etiological factor is the hereditary origin of autism. Cluster of unstable genes leading to brain abnormalities is also another explanation for the etiology of autism. Some other current theories which are under investigation include toxin ingestion during pregnancy an d environmental factors such as viruses (Evans & Daniels 2006). A male predomination is observed at a ratio of four to one. In monozygotic twins there is a high concordance rate around 90%. In children with pre-existing genetic disorders such as Fragile X syndrome, phenylketonuria, tuberous sclerosis, Angleman’s syndrome and Cornelia de Lange syndrome, autistic symptoms can be manifested (Benson & Haith 2009). The overview of ASD etiology exhibits genetic causes and hereditary co-relation as the main factors leading to the developmental abnormalities in the children. The core symptoms that manifest during the first two years of life represent the abnormalities in the social, communicative and cognitive developmental skills of the child. Any abnormality in the normal development of one functional domain also leads to negative outcome on the others as well. The social abnormalities of the autistic child exhibit themselves in categories of attachment, social imitation, joint att ention, orientation to social stimuli, face perception, emotion perception and expression and symbolic play. Children with autism exhibit disoriented relationships with their mothers. In autistic children the social behavior of looking at faces develops late at 12 months as compared to normal development at birth. Social behaviors such as following person’

Monday, November 18, 2019

The Ineffective Approach in Medicare Reimbursement Essay

The Ineffective Approach in Medicare Reimbursement - Essay Example On the other hand, the support on setting the Medicare reimbursement is that, there is no one general approach in which the most effective amount will be arrived at. In addition, the set guidelines and rules for Medicare reimbursement lack a proper structure making the approach more challenging to the practitioners. Nevertheless, the failure to involve the health practitioners, especially advanced nursing practitioners in management, effectively makes the approach ineffective. Therefore, their involvement is crucial to ensure an approach that suits the needs of all the stakeholders and making it responsive to the needs of both the patients and the healthcare providers. In addition, government intervention by creating proper legal guidelines is crucial to ensure that the approach meets the required needs. Keywords: reimbursement, Medicare, Medicaid The ineffective approach in Medicare Reimbursement Introduction Wong (1999) noted that, the Balanced Budget Act of 1997 provided the reimb ursement of APNs for the services they provided in any given setting at a fraction of the physicians fee. Nevertheless, a long process requiring meeting specific guidelines and documentation makes the process of reimbursing APNs hectic and confusing. In this case, the new era of providing medical care should be devoid of the factors that do not in any way help in simplifying the process of reimbursement. Background Reinhardt (2003) identifies the Medicare reimbursement system in the country as a large one and much more centralized than in other countries. Moreover, the inflexible nature of the system does not offer any assistance but only helps make the issue much more complex for advanced practice nurses in management. In this case, this makes the system fail to respond to the local markets conditions, patients’ requirements, and more significantly to nursing care providers’ needs and requirements. Moreover, the unresponsive nature of Medicare is made worse by the rul es and guidelines that groups of actors manipulate easily to meet their specific needs. Cohen and Spector (1996) noted that, the annual threat in a considerable cut in Medicare reimbursements often lead to speculation that hospitals will have a limit on the number of Medicare patients they admitted and treated. In effect, advanced nurses in charge of management faced a dilemma whether to admit these patients due to the cut in Medicare considering that the reimbursement formula to determine how much payment a hospital gets is determined by a particular number of cost-related factors and in particular the geographical location and inflationary rates. Position It is my position, as a nurse with advanced preparation in management, that the current Medicare reimbursement system is complex in its effort to offering quality care to the country’s population. In this case, the structure, rules, and guidelines on the reimbursement policy fails to capture the opinions of nursing practit ioners on how best to structure the reimbursement policy. On the other hand, the structure of obtaining the reimbursement amount in terms of cost-related measures such as geographical location and inflation makes the policy on reimbursement appear unfair to some states and nurses practitioners while others benefit. In fact, this makes the policy more complex and puts management at an awkward position in terms of implementation of their policies.

Saturday, November 16, 2019

Dementia Sufferer Mental

Dementia Sufferer Mental Introduction Dementia is a loss of mental function in two or more areas such as language, memory, visual and spatial abilities, or judgment severe enough to interfere with daily life3. Dementia is not a disease itself, sufferers show a broader set of symptoms that accompany certain diseases or physical conditions3. Well known diseases that cause dementia include Alzheimer’s disease, Creutzfeldt-Jakob disease and multi-infarct dementia3. Dementia is an acquired and progressive problem that affects cognitive functions, behavior, thinking processes and the ability to carry out normal activities. Vision is one of the most important primary senses, therefore serious or complete sight loss has a major impact on a individuals ability to communicate effectively and function independently. Individuals who suffer from both dementia and serious vision loss will inevitably be subject to profound emotional, practical, psychological and financial problems. These factors will also influence others around the sufferer and will extend to family and the greater society. As we get older both dementia and visual problems inevitably become much more prevalent. Current demographic trends show the increase of the number of very old in our population. Therefore it is inevitable that dementia and serious sight loss either alone or together, will have important consequences for all of us3. The vast majority of people are aware that dementia affects the memory. However it is the impact it has on the ability to carry out daily tasks and problems with behavior that cause particular problems, and in severe cases can lead to institutionalization. In the primary stages of dementia, the patient can be helped by friends and family through ‘reminders’. As progression occurs the individual will loose the skills needed for everyday tasks and may eventually fail to recognize family members, a condition known as prospagnosia. The result of such progression is that the individual becomes totally dependent on others. Dementia not only affects the lives of the individual, but also the family9. Dementia can present itself in varying forms. The most common form of dementia in the old is Alzheimers disease, affecting millions of people. It is a degenerative condition that attacks the brain. Progression is gradual and at a variable rate. Symptoms of Alzheimer’s disease are impaired memory, thinking and changes in behaviour. Dementia with Lewy bodies and dementias linked to Parkinsons disease are responsible for around 10-20% of all dementias. Dementia with Lewy bodies is of particular interest as individuals with this condition not only present confusion and varying cognition, but also present symptoms of visual hallucinations9. Another common conditions that causes dementia is multi-infarct dementia, also known as vascular dementia. It is the second most common form on dementia after alzheimers disease in the elderly. Multi infarct dementia is caused by multiple strokes in the brain. These series of strokes can affect some intellectual abilities, impair motor skills an d also cause individuals to experience visual hallucinations. Individuals with multi infarct dementia are prone to risk factors for stroke, such as high BP, heart disease and diabetes. Multi infarct dementia cannot be treated, once nerve cells die they cannot be replaced. X3 In most cases the symptoms of dementia and serious sight loss develop independently. However some conditions can cause both visual and cognitive impairments, for example Down syndrome, Multiple sclerosis and diabetes. Dementia is most prevalent in the elderly, as is sight loss. Therefore it is inevitable that a number of people will present dementia together with serious sight loss. There have been many studies into the prevalence of dementia in the UK. An estimate for the prevalence of dementia in people over 75 years of age is 15% of the population9. The Alzheimer’s society suggest that 775,200 people in the UK suffer from dementia (figures taken 2001). The Alzheimer’s society also calculates that the prevalence of dementia in the 65-75 years age group is 1 in 50, for 70-80 years 1 in 20 and for over 80 years of age 1 in 5. Estimates suggest that by 2010 approximately 840,000 people will become dementia sufferers in the UK. Estimates suggest that around 40% of dementia sufferers are in residential institutions. One study from 1996 showed that dementia sufferers are 30 times more likely to live in an institution than people without dementia. At 65 years of age men are 3 times more likely than women to live in an institution and at 86 men and women are equally likely to be institutionalized10 Visual impairments are not associated general diagnostic features of dementia. However recent research has shown the change in visual function and visual processing may be relevant. Alzheimer’s disease patients often present problems with visual acuity, contrast sensitivity, stereo-acuity and color vision. These problems are believed to be more true of cognitive dysfunction rather than any specific problems in the eye or optic nerve9. Early diagnosis is essential to both dementia and sight loss patients, as drug treatments are becoming more and more available. Therefore maximizing the treatment and care for the individual. On the other hand early diagnosis of visual conditions is also essential, so that progression is slowed and treatment is commenced, therefore further progression is prevented if plausible9. The Mini-Mental State examination MMSE, is the most commonly used cognitive test for the diagnosis of dementia. It involves the patient to undertake tests of memory and cognition. It takes the form of a series of questions/answers and uses written, verbal and visual material. Poor vision or blindness is the most common cause of poor performance on this test other than dementia itself9. Research, development and investment in the future will help to contribute to improved care for dementia and sight loss sufferers. A better understanding of the daily lives and experiences of these people will give us a greater insight into the problems faced and will help to improve the quality of care available9. Alzheimer’s disease The aim of this paper is to provide information about current knowledge on the topic on visual function dementia. With regards to Alzheimer’s disease there will be an inclination to several main foci of research, namely anatomical/structural changes, functional visual changes, cognitive brain changes and other changes such as the effects of diagnostic drugs on Alzheimer’s disease patients. Alzheimer’s disease is the most common cause of dementia amongst older adults. The Alzheimer’s research trust estimates that 700,000 individuals in the UK currently are afflicted. This number will inevitably increase exponentially in the near future with the trend of an increasingly aging UK population. Therefore it must be of the utmost of importance worldwide to have an understanding all behavioral, anatomical and physiological aspects of this disease. Alzheimer’s disease is a degenerative disease that attacks the brain, it begins gradually and progresses at a variable rate. Common signs are impaired thinking, memory and behavior. Health professionals and care givers agree that the memory deficit is usually the initial sign of the disease. However researchers have long known that Alzheimer’s disease is characterized by impairments of several additional domains, including visual function11. However these findings have not yet appeared in the diagnostic guides consulted by healthcare professionals, for example the most recent addition of the Diagnostic Statistical manual of mental disorders states that few sensory signs occur in early Alzheimer’s disease2. Therefore we still have a limited understanding of the true extent to which visual impairments affects Alzheimer’s disease. The current web site of the Alzheimer’s association1 and National Institute of Aging4 make no mention of the topic of sensory changes in Alzheimer’s disease. It has even been said that patients with Alzheimer’s disease report visual problems to their healthcare professionals less frequently than do healthy elderly individuals5. Nevertheless visual function is impaired in Alzheimer’s disease6. In terms of cognitive changes, the neuropathology of this disorder affects several other brain areas which are dedicated to processing low level visual functions as well as higher level visual cognition and attention11. These neuropathological cognitive changes are more dominant however in the visual variant of Alzheimer’s disease known as posterior cortical atrophy, however visual problems are also present in the more common Alzheimer’s disease. Alzheimer’s disease begins when there are deposits of abnormal proteins outside nerve cells located in the brain in the form of amyloid. These are known as diffuse plaques, and the amyloid also forms the central part of further structured plaques known as senile or neurotic plaques3. Buildup of anomalous filaments of protein inside nerve cells in the brain can also take place. This protein accumulates as masses of filaments known as neurofibril tangles. Atrophy of the affected areas of the brain can also occur as well as the enlargement of the ventricles3. There is also a loss of the neuro transmitter Serotonin, Acetylcholine, Norepinephrine and Somatostatin. Attempts have been made to try to slow the development of the disease by replacing the neurotransmitters with cholinesterase inhibitors, such as donepezil (Aricept), rivastigmine (excelon), galantamine (Reminyl) and memantine (Namenda)3. These drugs work by increasing the levels of transmitters between cells, which otherw ise become lacking in Alzheimer’s disease. The National Institute for Clinical Excellence NICE conducted a review of these drugs in March 2005 and concluded that none of these drugs provided sufficient enough advantages to the patient in order to justify their cost. They recommended against the use of such drugs in the Nhs, though the Department of Health later overturned this ruling. Visual Changes in Alzheimer’s Patients Loss of vision is a key healthcare dilemma amongst the elderly. By the age of 65 approximately one in three people have a vision reducing eye disease. Dementia, Alzheimer’s disease patients and elderly patients, consequently have many visual conditions in common. Alzheimer’s disease impairs visual; function early in the course of the disease and functional losses correlate with cognitive losses. There are several common visual functional deficits that are frequently identified in Alzheimer’s disease. There is evidence for deficits in Motion perception32,33 contrast sensitivity31 colour discrimination of blue short wavelength hues34 and performance on backward masking tests31 In Alzheimer’s disease the secondary point of damage is usually the visual association cortex and other higher cortical areas as well as the primary visual cortex 35,36. Some of the main changes that occur in the eye with aging inlclude7: The crystalline lens increases in thickness, therefore decreasing its transparency and elasticity; therefore there is a tendency for cataracts to appear. The conjunctiva can become thicker and wrinkled, therefore is subject to deposits such as pinguecela. The iris can atrophy, therefore pupils become constricted and their response to light becomes sluggish. The eyes ability to dark/light adapt is affected. Refractive index of the cornea decreases and it becomes less transparent. Arcus senilis can appear. The ocular globe and eyelids can shrink leading to conditions such as entropian, ectropian and trichiasis. Also while the lachrymal production is reduced the puncta lachrymalis can become stenosed and provide less drainage which gives rise to chronic watering of the eyes Anterior chamber usually becomes more shallow and the sclera more rigid, increasing the prospects of glaucoma. These changes summed together not only diminish the quality of vision, but many of them also make the examination of the eye much more complicated. In conjunction with the general visual symptoms of aging, Alzheimer’s patients can also experience visual disturbances caused by the brain rather than the visual system alone. This means that they can have problems and difficulties perceiving what they see rather than how clearly they see it3. Difficulties are usually experienced in the areas mentioned earlier, namely depth, motion, color, and contrast sensitivity. Visual hallucinations are also a common problem with linked to loss of vision in Alzheimer’s disease patients38. Another common disorder linked to patients with Alzheimer’s disease is a variant of motion blindness. The patient can appear to be confused and lost; the individual will see the world as a series of still frames8. Visual changes in Alzheimer’s disease may also be dependent upon which brain hemisphere is more severely damaged; this factor can often be overlooked. An individual with Alzheimer’s disease could have damage to a greater extent on their left brain hemisphere from plaques and tangles. This would therefore cause subsequent retinal changes in only the left hemi-retinas of each eye i.e. the right visual fields. The right eye visual field would be affected in the temporal side (right) and the left eye visual field would be affected nasally (right)51. When only half the retina is impacted, smaller regions of the optic nerve and nerve fiber layer show losses. The left eye with affected temporal retina would show optic nerve damage in differing regions of the nerve than the right eye with nasal retinal damage.51 Alzheimers patients commonly show selective degeneration of large ganglion cell axons located in the optic nerves. This suggests that there would be impairment of broadband channel visual function. Conversely studies have shown that broadband visual capabilities are not selectively impaired in Alzheimer’s disease. The magnocellular and parvocellular neurons are greatly affected in Alzheimer’s patients, this has been proved by studies of the dorsal Lateral geniculate nucleus(LGN)3. The geniculostirate projection system is split both functionally and anatomically into two sections. They include the parvocellular layers of the Lateral geniculate body and also incorporates the magnocellular layers. These systems are mainly divided in the primary visual cortex and go through further segregation in the visual association cortex. They conclude in the temporal and paritetal lobes3. The parvocellular layers contain smaller, centrally located receptive fields that account for high spatial frequencies (acuity), they also respond well to color. On the other hand these cells do not respond well rapid motion or high flicker rates. The magnocellular cells have larger receptive fields and respond superiorly to motion and flicker. They are however comparatively insensitive to color differences, the magnocellular neurons generally show poor spatial resolution, although the seem to respond better at low luminance contrasts. To summarize the parvocellular system is superior at detecting small, slow moving, colored targets placed in the centre of the visual field. Meanwhile the magnocellular system has the ability to process rapidly moving and optically degraded stimuli across larger areas of the visual field3. The parvocellular system projects ventrally to the inferior temporal areas, which are involved in visual research, pattern recognition and visual object memory. The magnocellular system projects dorsally to the posterior parietal and superior temporal areas. These are specialized for motion information processing. The cerebral cortical areas to which the parvocelluar system projects receives virtually no vestibular afferents. Alternatively the cerebral areas to which the magnocelullar system projects receives significant vestibular and other sensory inputs. These are believed to be involved in maintaining spatial orientation. Research shows shows that the magnocellular system is more involved in Alzheimer’s disease3. Oddly, many individuals experience difficulties at low spatial frequencies instead of high frequencies as in old age. This suggests that areas controlling the low spatial frequency processing in the primary visual cortex would be affected more than those for higher frequencies processing39 After neuropathilogical studies in 1997 by Hof et al were carried out on brains with visual impairments they concluded that cortical atrophy dominated on the posterior parietal cortex and occipital lobe40 Glaucoma is also a neurodegenerative disease that has similar effects on the visual system. Lower spatial frequencies in the contrast sensitivity, deficits in the blue short wavelength color range as well as reductions in motion perception are all linked to glaucomatous patients16. When patients diagnosed with Alzheimer’s disease also have glaucoma, the deterioration of vision related to glaucoma is much more rapid and progression is more aggressive than in people with glaucoma solely and not Alzheimer’s disease as well.19 Glaucoma is different from Alzheimer’s disease in that it affects the visual function at the early sites of neural activity, namely, the retinal ganglion cells. Glaucoma destroys the afferent axons at the nerve fiber layer in the retina. This loss of axons ultimately leads to added atrophy further up the visual pathway due to decreased neuronal input. Alternatively Alzheimer’s disease impacts the cells that are located terminally or intermediary in the visual pathway of the brain. The result is again reduced neuronal input due to loss of nerve fibre connections and atrophy along the visual pathway. When the two diseases exist in the same individual together it can be seen that there is likely to be a greater disruption to the visual system20, one key difference between the two diseases is that they affect the visual pathway at different points. Glaucoma is a degenerative disease starting at the beginning of the visual pathway, whereas Alzheimer’s disease is a deg enerative process starting relatively late in the visual pathway. When the two diseases coexist then the neuronal and functional losses of vision are cumulative. Optometric examination of dementia patients Dementia patients present special problems for optometrists. A standard eye test can be an audile to even the best of us. The patient is placed in an unfamiliar environment surrounded by unusual equipment, machinery and is subjected to probing questions about he medical history which will inevitably tax their already flawed memory. Dementia patients are most likely to be from the elderly. Therefore several difficulties are presented while conducting an ocular examination. The patient is required to maintain a position and has to maintain concentration throughout the testing procedures, which can be very difficult. Subjective examination requires responses from the patient, they are expected to remember and follow complex instructions given to them by the optometrist as well as make many precise discriminatory judgments in a short space of time. The multiple tasks required to be completed during the examination are often beyond dementia patients as they are limited by the disease. The refore it is common that patients with even a minor degree of dementia fail to provide valid answers, provide unpredictable responses to the subjective examination and retreat into an apathetic state3,9. During the visual examination of Alzheimer’s disease patients, several key visual problems can be detected. Moderate dementia patients will often experience problems such as topographic agnosia, alexia without agraphia, visual agnosia and prospagnosia3. Such patients often cannot describe individual components of photos and routinely fail to recognize family members. The degree to which such problems are experienced is consistent with the level of cytochrome oxidase deficits in the associated cortical area. In conjunction with these problems dementia patients often have problems with texture discrimination and blue violet discrimination3. During examination of the elderly dementia patients there are two contradictory requirements, firstly is ‘assurance’. The patient’s responses will be delayed and the patient may feel anxious in such an unfamiliar situation, therefore constant reassurance is required and they cannot be rushed. Alternatively time constraints are important, a dementia/elderly patient is likely to have a short attention span. Therefore the two factors above much be considered and balanced. The examination must be thorough yet carried out as quick as possible. Often when examining a dementia patient a family member of the carer must be present in order to aid the communication between optometrist and patient, for example difficulties are likely to occur when recording history and symptoms without a carer present. All factors need to be considered such as family history, medication, eye treatment and knowledge of any medical conditions and if so how long they have suffered from them. In terms of an external examination firstly, gross observations should be recorded for example does the patient have an abnormal head position or is there any lid tosis. Many external observations can also be detected with the aid of pupil reflexes. Upon carrying out the external examination the optometrist must be carful to explain exactly what each procedure will involve so as not to intimidate the patient. Internal examination Internal examination of an elderly patient often presents many problems. Older patients tend to have constricted pupils and often opacities in the media such as cataract. Patients with dementia also show poor fixation as well as lack of concentration. Pupil dilation is often used to aid external examination however many older patients can have a poor response to the insertion of mydriatic eye drops. There have been many studies into the affects of diagnostic mydriatic and miotic drugs. Many studies have shown excessive mydriatic pupil response to trompicamide (a pupil dilating drug) in patients with Alzheimer’s disease when compared to control individuals.))) on the other hand studies into the use of Miotic drops, particularly Pilocarpine have shown an increased response of pupil constriction in Alzheimer’s disease patients in comparison to normal control patients. These findings suggest a defect in pupillary innervation with Alzheimer’s disease individuals. Studies of post mortem individuals with exaggerated mydriatic pupil responses to Tropicamide found a definte disruption to the Edinger-Westphal nucleus. The Edinger-Westphal nucleus is one of the key structures of the brain involved in the autonomic nervous system, it mediates the sympathetic and para-sympathetic pupil responses. Research by Scinto et al found amyloid plaques and neurofibrillary tangles in all individuals tested with excessive mydriatic pupil responses. The conclusion was that the Edinger-Westphal nucleus is targeted early in the progression of Alzheimer’s disease. In terms of intraocular pressures use of the goldman an Perkins tonometers will be limited for the elderly dementia patients, due to health an safety reasons. Sudden movements whilst carrying out pressure tests on such equipment may be dangerous. Therefore this can be overcome to a degree by the use of handheld instruments such as the pulseair. However even with the pulseair problems can still be faces with uncooperative patients. Objective examination With uncooperative and awkward patients objective refraction through retinosopy may be difficult. Factors such as opacified media, miotic pupils, and poor fixation will influence the accuracy of the refraction. The recent introduction of hand held optometers has contributed to somewhat overcoming such problems. Instruments such as thee Nikon Retinomax are excellent for obtaining an objective refraction of the elderly patient with miotic pupils and cloudy media. When presenting the Snellen chart to a patient, the quality of their response will inevitably depend upon the degree of their dementia. Depending on which stage of dementia they are suffering from, responses could range from routine reading of the chart to no response at all. The later presents the optometrist with greater problems; however a visual acuity can still be measured via other techniques. Treatment of Alzheimer’s disease Alzheimer’s disease is often widespread and a prevalent problem, however it is often an untreated disorder. A reason for this impairment to be overlooked could be that visual function is typically only measured in terms of visual acuity in the majority of cases, which in Alzheimer’s patients is often normal. However, studies have shown that up to 60% of people with Alzheimer’s disease show deficits in on or multiple visual areas such as depth perception, motion perception, color discrimination or contrast sensitivity31, 32. Therefore detection and treatment of Alzheimer’s patients must include these other visual capacities and not only visual acuity tests. Deficits in depth perception have accurately been demonstrated in Alzheimer’s individuals33-37. Decline in this visual capacity is even seen at the early stages of Alzheimer’s disease, independently of the other visual capacities36. Impaired depth perception will inevitably cause problems in performing everyday tasks33,36 eg walking, cleaning and stair climbing. Motion perception is also a common deficit seen in Alzheimer’s disease41-45. Studies have shown that individuals with Alzheimer’s take significantly longer to identify stationary objects that can be identified by motion cues41,43. A study by Rizzo et al42 found that 33% of Alzheimer’s patients had car accidents when put through a set of driving scenarios in a virtual simulator, compared to 0 accidents with non demented age match participants. The decreased ability of Alzheimer’s patients to accurately process visual motion cues was a significant factor in avoiding accidents. Contrast sensitivity can be defined as the smallest difference in intensity that a person can resolve between an object and its immediate surround. Most elderly patients are impaired at high spatial frequencies. However Alzheimer’s sufferers are impaired at low spatial frequencies as well46,47,48,49-51. Problems with contrast sensitivity will have a subsequent impact on how a person with Alzheimer’s disease perceives their environment, and will adversely affect their ability to perform many everyday tasks such as dressing, washing and eating to name but a few. Contrast sensitivity problems cannot be cured or overcome by means such as optical correction through spectacles, medication or surgery. However individuals can be helped by environmental modifications. We will now go on to discuss a handful of simple environmental modifications that can be made for dementia patients in order to increase their quality of life. Firstly there are several key simple principles relating to colour and light that should always be considered when modifying a living area for a dementia individual. Color Light Use sharply contrasting color between back ground and foreground. Always have even distribution of light within a room. Use solid colors rather than stripes or multi color patterns. Good to have as much natural light as possible. Do not use ‘like’ colors next to each other Minimise glare Task lighting when applicable Place light behind reading or television chair to enhance vision. In the bedroom the main point of concern is not to bump into objects and not to fall out of bed. Caregivers can also find it problematic to get the patient into their bedroom at the end of the day. Enhancing the contrast of objects in the bedroom will help patients to recognize areas of their room and intern make care givers jobs much easier during care. In order to draw the patient into a room in a common technique many institutions or caregivers use is to paint the furthest most wall in the bedroom in a contrasting color to the rest of the room, for example in a light colored room (magnolia) it would be advantageous to paint the far wall in a dark contrasting color such as brown. This will provide a depth cue for the patient and will encourage them to enter the bedroom. Once in the room dementia patients can often have problems locating the bed. Again this problem can be aided by a simple modification of using a bed spread that is of high contrast when compared to the surrounding w alls and floor of the room. This simple modification will draw the patient towards the bed and help prevent them from tripping or stumbling over the bed. Other simple tips can be to modify appliances within the bedroom such as telephones, clocks and radios with different colored buttons to encourage independence. The bathroom is another frequently used area within the household and there are many simple modifications that can be made within this area to aid the user. Firstly placing a fixed bath mat of the same color as the floor is a simple useful modification. The matt with low contrast to the floor will decrease any depth perception problems and will aid the user when getting in and out of the bath tub. Also a fixed mat can be placed inside the bath tub, however in this case the matt should be of a contrasting color to the tub. The reasoning behind this is that the contrasting bath mat will provide a excellent depth cue for the user who would other wise would be unsure to about how deep the floor of the bath tub is. The bathroom can be a hazardous place for a dementia individual as there are many risks within this room especially the risk of hot water. Therefore an extremely important modification in the bathroom is to ensure all taps have different colored knobs on the hot and cold compon ents. The colored taps will provide a color cue and help the user to distinguish between the two. The kitchen can be a dangerous place, especially for the elderly and dementia su

Wednesday, November 13, 2019

how to do things right :: essays research papers

I plan to compare Lars Eighner’s essay â€Å"On Dumpster Diving† and Daniel Orozco’s short story â€Å"Orientation†. Eighners writes his essay after being homeless and experiencing poverty due to a loss job. He gives instructions on how to be an ingenious Dumpster scavenger, during the everyday life as a homeless person. On the other hand, Orozco writes a short story about going through a very detailed orientation on the first day at a new office setting job. Although both of the stories are completely different, one about a homeless man and his dog and his means of surviving , and the other describing a cooperate job, both works compare by: providing specific instruction on how to carry out their responsibilities proficiently, they are both the go-to people in the writing , and they both exhibit the same type of attitude toward work.   Ã‚  Ã‚  Ã‚  Ã‚  One way Eighner’s essay and Orozco’s short story compare is the use of precise instructions that pertain to successfully complete a specific task. Eighner gives great detail for the way one would scavenge through a Dumpster in a proficient manner. As one could imagine, there are obviously things that should not be used or eaten that could be found in a garbage can. He shows incredible knowledge about what types of food appear and what type of condition they are in, whose Dumpsters to ransack through, what is safe to eat and what type of things one could keep from scavenging during a regular day. He also displays knowledge on how to react when people are around and the type of behavior a homeless person should display in public. In comparison to Eighner, Orozco gives direct instructions to the implied reader as to what one should do during their days work within an â€Å"office environment†. He presents the information in such a meticulous way, he doesn’t leave one room to have any questions. Not only does he tell them what to do, he tells them how to manage their time wisely, and how to keep oneself out of trouble. He gives a considerable amount of information about the lives of those who work in the cubicles and who one should become comfortable with and who to stay away from. Seeing as though they are both giving instructions on how to skillfully complete a task, they are both seen as highly respected by others around them.   Ã‚  Ã‚  Ã‚  Ã‚  Another way the two works compare is they are both experts at what they are doing.

Monday, November 11, 2019

Clinical Trial and Nucleon Assignment Notes

Nucleon Assignment Notes Porter’s 5 Forces Industry Analysis †¢Competition: Intense †¢Buyer Power: Moderate to High oBig pharma companies likely have a lot of power, although as a small firm, your power increases once you clear phases of drug trials. †¢Supplier Power: Unsure, Moderate? oThe case makes it sound like there’s not many manufacturers out there for contracting purposes. Not sure what power suppliers of raw materials have. †¢Threat of Substitutes: Moderate to High oLots of firms racing to create the next blockbuster drug or treatment for big money illnesses.However, most drugs fail, so the likelihood of a substitute is probably only moderate. †¢Threat of New Entrants: Moderate oRelatively easy to start a new small drug research firm. Just need some smart scientists. Funding is currently difficult to come by, however. Nucleon †¢Competition: Moderate to Low oThe case mentioned they were in a pretty niche area of biotech. †¢Buye r Power: Moderate to High oBig pharma companies likely have a lot of power. But if Nucleon clears phase II their power increases substantially. †¢Supplier Power: Unsure, Moderate? The case makes it sound like there’s not many manufacturers out there for contracting purposes. Not sure what power suppliers of raw materials have. †¢Threat of Substitutes: Moderate to Low oI don’t think there’s much out there in the way of burn treatments (need to check on that). †¢Threat of New Entrants: Moderate to Low oThe drug research process is slow, so any new entrant in this specific area is going to be significantly behind with little to no way to catch up. Resource Based View VRIO Value:There’s definitely value in a successful drug for burn treatment; it also presents itself as a possible cure for other ailments as well (i. . kidney failure) Rarity:Not many alternatives for burn victim treatment (assumption based on the case’s voice); large mole cule research is still new and rare, tough to get into. Imitability: Not very imitable, especially if Nucleon can gain strong patent protection. Also, the slow development time means that even if another firm could mimic a similar drug, it would take time. Organization:Nucleon is currently not organized to begin trials and manufacturing of this drug. They also don’t have a significant amount of financial backing at this point.Transaction Based Economics Hold-ups †¢Contract manufacturer could hold up Nucleon for more money if drug passes phases and becomes more likely to be successful. †¢Contract manufacturer could increase manufacturing costs, slow production, or create problems in quality in order to hold up Nucleon. Options Going Forward Option 1: Build Pilot Plant Pros †¢Nucleon keeps tighter control of IP †¢Can retain ownership of product rights through phase I and II †¢More flexibility †¢Can begin to develop staff for in-house manufacturing, making scaling later easier Cons Expensive (likely need more financial backing/don’t have enough as is) †¢Risky oDrug could fail in clinical trials (which statistically is likely) oProcess uncertainty; bacterial vs. mammalian cells †¢Distracts Nucleon’s financial and human capital away from their core, the drug R&D Option 2: Contract Manufacturing Pros †¢No major upfront capital investment †¢Access to experienced manufacturing facilities and staff immediately †¢Retain ownership of product rights through phase I and II Cons †¢Still not cheap; doesn’t save Nucleon much money over Option 1 †¢Risk of IP issues Contract specifics are very difficult to hash out due to the nature of biotech †¢No faster than building their own plant due to slow process of negotiating, knowledge transfer, then scale-up Option 3: Licensing Pros †¢No capital investment †¢Little to no risk †¢Simple; allows Nucleon to focus on the R&D à ¢â‚¬ ¢Immediate cash flow †¢Keep rights for CRP-1 for other uses (other than for burn treatment) Cons †¢Much less share in the profits if drug is successful (mortgage the company’s success) †¢Would likely lower employee morale, which could in turn decrease likelihood of success of drug †¢Risk of IP issues Clinical Trial and Nucleon Assignment Notes Nucleon Assignment Notes Porter’s 5 Forces Industry Analysis †¢Competition: Intense †¢Buyer Power: Moderate to High oBig pharma companies likely have a lot of power, although as a small firm, your power increases once you clear phases of drug trials. †¢Supplier Power: Unsure, Moderate? oThe case makes it sound like there’s not many manufacturers out there for contracting purposes. Not sure what power suppliers of raw materials have. †¢Threat of Substitutes: Moderate to High oLots of firms racing to create the next blockbuster drug or treatment for big money illnesses.However, most drugs fail, so the likelihood of a substitute is probably only moderate. †¢Threat of New Entrants: Moderate oRelatively easy to start a new small drug research firm. Just need some smart scientists. Funding is currently difficult to come by, however. Nucleon †¢Competition: Moderate to Low oThe case mentioned they were in a pretty niche area of biotech. †¢Buye r Power: Moderate to High oBig pharma companies likely have a lot of power. But if Nucleon clears phase II their power increases substantially. †¢Supplier Power: Unsure, Moderate? The case makes it sound like there’s not many manufacturers out there for contracting purposes. Not sure what power suppliers of raw materials have. †¢Threat of Substitutes: Moderate to Low oI don’t think there’s much out there in the way of burn treatments (need to check on that). †¢Threat of New Entrants: Moderate to Low oThe drug research process is slow, so any new entrant in this specific area is going to be significantly behind with little to no way to catch up. Resource Based View VRIO Value:There’s definitely value in a successful drug for burn treatment; it also presents itself as a possible cure for other ailments as well (i. . kidney failure) Rarity:Not many alternatives for burn victim treatment (assumption based on the case’s voice); large mole cule research is still new and rare, tough to get into. Imitability: Not very imitable, especially if Nucleon can gain strong patent protection. Also, the slow development time means that even if another firm could mimic a similar drug, it would take time. Organization:Nucleon is currently not organized to begin trials and manufacturing of this drug. They also don’t have a significant amount of financial backing at this point.Transaction Based Economics Hold-ups †¢Contract manufacturer could hold up Nucleon for more money if drug passes phases and becomes more likely to be successful. †¢Contract manufacturer could increase manufacturing costs, slow production, or create problems in quality in order to hold up Nucleon. Options Going Forward Option 1: Build Pilot Plant Pros †¢Nucleon keeps tighter control of IP †¢Can retain ownership of product rights through phase I and II †¢More flexibility †¢Can begin to develop staff for in-house manufacturing, making scaling later easier Cons Expensive (likely need more financial backing/don’t have enough as is) †¢Risky oDrug could fail in clinical trials (which statistically is likely) oProcess uncertainty; bacterial vs. mammalian cells †¢Distracts Nucleon’s financial and human capital away from their core, the drug R&D Option 2: Contract Manufacturing Pros †¢No major upfront capital investment †¢Access to experienced manufacturing facilities and staff immediately †¢Retain ownership of product rights through phase I and II Cons †¢Still not cheap; doesn’t save Nucleon much money over Option 1 †¢Risk of IP issues Contract specifics are very difficult to hash out due to the nature of biotech †¢No faster than building their own plant due to slow process of negotiating, knowledge transfer, then scale-up Option 3: Licensing Pros †¢No capital investment †¢Little to no risk †¢Simple; allows Nucleon to focus on the R&D à ¢â‚¬ ¢Immediate cash flow †¢Keep rights for CRP-1 for other uses (other than for burn treatment) Cons †¢Much less share in the profits if drug is successful (mortgage the company’s success) †¢Would likely lower employee morale, which could in turn decrease likelihood of success of drug †¢Risk of IP issues

Saturday, November 9, 2019

Caribbean Studies Essay

â€Å"The history of the Caribbean is the history of exploitation of labour.† Discuss with reference to Encomienda, Slavery and Indentureship. According to the Oxford Dictionary, exploitation is defined as being the action or condition of treating someone or a group of people unfairly in order to benefit from their work, also, labour refers to work that is done using bodily strength and effort. In a historical sense, the Caribbean can be defined as being a group of countries sharing the same background of forced labour through the institutions of colonization, indentureship and slavery in some form or another (Robottom and Clayton, 2001). Understanding this, the historical Caribbean would be inclusive of the Bahamas and Guyana as well as some Central American countries. As it speaks to colonization, there were three main Old World colonizers that set out for land to conquer and riches to claim; Spaniards, the British, and the French, each of whom utilized systems of exploitation in order to obtain what they had sought from the so called â€Å"New World†, which were mainly new lands for the Feudal Lords or Kings and/or Queens of their respective mother countries. In contemporary Caribbean society, the population is one of the most demographically diverse regions in the world, this is a result of the heavy colonization of the region that was initiated by Christopher Columbus’ first voyage to the Caribbean in search of a shorter route to India, thus the reason for calling the region the West Indies, which resulted in more European colonists coming to the Caribbean in search of the riches and produce of the region. The exploitation of labour has long been the very backbone or foundation on which the diasporic and historical Caribbean has been formed through the Old  World colonists importing slaves and indentured labourers from various parts of the world like West Africa, India and China. Firstly speaking with reference to the Spaniard Encomienda system which started formally in 1503; the term â€Å"Encomienda† was coined from the Spanish verb encomendar, which means to entrust. This therefore means that both parties had entrusted their resources to each other, as the main objectives of the Encomienda system that was seemingly to be to the benefit of the indigenous people was to spread the doctrines of the Christian faith, provide adequate housing facilities and food provision for the native people of the colonized islands (Yeager, 843). In exchange for these amenities, the natives would have to work for the Spaniards as slaves. The Encomienda system was considered to be the most damaging institutions that the Spanish colonist implemented in the New World. The Encomienda system was also developed as a means of obtaining adequate and cheap labour. However it may be said that in being able to obtain this labour, the Spaniard Encomenderos were rewarded with land as well as the natives that accommodated that same land due to their endeavours on successful conquests. This was as early as 1499, and this took four years to become a formal rewarding system for the Spaniard Conquistadores. The Queen of Spain, Queen Isabella, did not support the notion of enslaving humans to do work. Knowing this, the Spaniard Encomenderos did not let Queen Isabella know that they were forcing others to labour on their plantations, so they sent her tributes from the indians such as goods and metals. However, the abolition of the encomienda system was becoming imminent as of 1510 when King Ferdinand and Queen Isabella had begun to regret allotting such power to Columbus, therefore they sent an agent to oversee the running of the system. Word had gotten to the King and Queen by means of this agent about the mistreatment of the natives of the region, thus leading to its abolition in 1542 and in effect its replacement by the crown governed Repartimiento system. This Encomienda system had impacted the Spanish speaking Caribbean countries  in both good and bad ways, whereas the demography of these islands are quite diverse due to the reception of the African slaves that mixed with the Amerindians, and later on the Spaniards that interbred with both African and Amerindian slaves which had slowly become deemed as the â€Å"Grey Area†; where whites and coloured people had copulated. Slavery had first begun in the British-colonized Caribbean during the period of the arrival of the first African that came to the Caribbean in 1517 by the Spaniards. This was in response to the decline of the tobacco industry in the Caribbean due to the the new focus on the crop in Virginia. Therefore, without a main crop that provided subsistence and export income, the British had turned to sugar cane, a plantation crop that required a stronger, more efficient work force that was overall more in numbers. The native Amerindians were dying out rapidly due to the unfamiliar notion of being overworked by their slave masters. They obtained their work force by means of stealing/tricking the African head tribesmen into trading his people for so called â€Å"riches†, which in fact were of no value to the Europeans, thus meaning that they robbed the tribesmen in what was seemingly a â€Å"fair trade†. These West-African slaves were brought to the Caribbean via ship across the Atlantic along a path known as the Middle Passage; a treacherous stretch of water where numerous West Africans lost their lives due to below standard living conditions, being killed by the Europeans and suicide by jumping overboard. Slavery’s impact on the Caribbean correlates with George Beckford’s analysis of the region as being a Plantation Society, a social system encompassing an entire lifestyle of the population inhabiting the region, inclusive of social, socio-economic and demographic factors. In the context of contemporary Caribbean society, as it relates to the Plantation System, social mobility in both contexts somewhat differ but yet share a common trait that coincides with the factor of the demography of the population. Social mobility is the ability of a person or a group of people to be able to advance within a social system of open stratification, meaning that it is a process by which one is able to advance in social class within their  population. In the era of slavery, the social system was one of closed stratification, therefore, a slave was not able to advance within the social strata or framework due to what Amartya Sen sees as an â€Å"unfreedom†; these unfreedoms are prejudices, inclusive of race and class, that cannot be changed and in effect, the slaves social standing could not either. However in the contemporary Caribbean society, a member of the society is able to move up in social class based on the wealth or property he acquires. Although this is dependent on the governmental framework, whether it be communist, in which case it would be closed stratification, or capitalist, social mobility is a key factor of the link between the era of slavery and the contemporary Caribbean, as it has evolved through the abolition of slavery in 1834 as well as the mixing of the demographic to create a third social strata apart from the black and whites, the mulattoes. The British and French slavery system has impacted the Caribbean society both in good and bad ways, as previously discussed, the evolution of social mobility may be deemed as good, while one of the shortcomings of the slavery system is that the slaves were being abused by their slave masters and were being treated as animals. This can be somewhat translated into contemporary Caribbean society as being a form of not only capital punishment in educational institutions, mostly primary, but also of abuse within the home. Although the numbers for these cases are not in the majority, the cases are still present in the Caribbean. The slavery system was abolished in 1834 finally fully abolished in 1838, by which time Indentureship had begun. Indentureship had begun from 1838 and was designed as a means of obtaining a work force to work on the plantations for low pay, especially since slavery was abolished. A strong and dependable workforce was in high demand at the point of it’s institution, as although some emancipated African slaves had stayed back, the number wasn’t enough to sustain the plantation. The first set of indentured labourers to have arrived to the Caribbean were the Chinese labourers. They had arrived in two main waves, where the first waves was intended to be the replacement work force to work on the sugar  cane plantations during the post Emancipation period. They mostly went to British Guiana, Trinidad and Cuba. The second wave, however, consisted of mostly relatives of the members of the first wave that went to British Guiana, Jamaica and Trinidad. The former slave owners had decided to use Chinese labourers due to them being â€Å"free civilized people†, thus that would set an example for the newly freed Africans in order to alleviate the chances of a rebellion against them. However, this venture was did not reap any substantial dividends as the mortality rate on the plantations were increasing as well as abandonment. The first wave of Chinese were not used to that level of physical labour and slowly died out, while the second wave of Chinese were free voluntary migrants that came due to the discontent of the labourers who had wanted to carry their families to the Caribbean with them. This therefore means that the most modern Caribbean Chinese are descendants of the second wave of Chinese immigrants. After the British had seen that the Chinese labourers were not as dependable and not as cheap, the sought a new workforce from India, so the British had sent agents to Calcutta to convince the Indians to come to the Caribbean and work on the sugar plantations. when the first Indian arrived in the Caribbean in 1838, they were forced to live under harsh conditions as the Europeans had the same mentality of slavery, so when the Indians tried to flee the plantation, they were chased, caught, brought back to the plantation and punished.By 1841, India had banned immigration to Guyana due to the news of the labourers being treated like slaves. However by 1845 the immigration of Indians would continue through Portugal, where the Portuguese workers who were coming to the Caribbean, knowing that they would be branded as slaves, had carried approximately 5000 Indians along with them. The Indentureship system had impacted the contemporary Caribbean lifestyle in the sense of the demographic factor, as well as business wise. Demographically speaking, both Indians and Chinese that came to the Caribbean have influenced the racial diversity of the region, where during the era of Indentureship, more Indians had gone to Guyana and Trinidad, in  contemporary Caribbean society, this same racial ratio is still present as approximately over 50% of Guyana’s population are of Indian descent. Along with the demographic factor comes cultural diversity, which encompasses a lifestyle unique to their homeland. In terms of style of business, this trait or practice was adopted from the Chinese indentured labourers who had left the plantation in order to establish shops and other income oriented businesses. In contemporary Caribbean society, Chinese citizens are usually thought to be in some sort of business management. The Caribbean does indeed have the history of the exploitation of labour as its own, and due to the Old World’s conquests of the New World’s land and riches, this provided a reason to find interest in the West Indies. The abundance of unclaimed land, availability of resources and an available workforce in the Amerindians was motivation enough to exploit not only the resources of the region, but also to exploit the labour of not only the Native people, but also the African slaves and East Indian indentured labourers. However, this history of exploitation is the very basis on which the contemporary Caribbean has been formed as with the slaves and indentured labourers that came, so did their cultures and practices. This therefore contributes to the diverse nature of the Caribbean society.

Wednesday, November 6, 2019

Behavior Goals for Individual Education Plans

Behavior Goals for Individual Education Plans Behavioral Goals may be placed in an IEP when it is accompanied by a Functional Behavioral Analysis (FBA) and Behavior Improvement Plan (BIP). An IEP that has behavioral goals should also have a behavioral section in the present levels, indicating that behavior is an educational need. If the behavior is one that could be handled by changing the environment or by establishing procedures, you need to attempt other interventions before you alter an IEP. With RTI (Response to Intervention) entering the area of behavior, your school may have a procedure for being sure that you attempt interventions before you add a behavioral goal to an IEP. Why Avoid Behavioral Goals? Behavioral goals will automatically withdraw a student from the progressive discipline plan in place in your school, as you have identified behavior as a part of the students disability.An IEP that has a BIP attached often labels a student when he or she is moved to another teacher, either to a new classroom or to a new schedule in middle school or high school.A BIP must be followed across all educational environments and can create new challenges not only to the teacher of record but also for specials, general education classroom teachers. It will not make you popular. It is best to attempt behavioral interventions such as learning contracts  before you move to a full FBA, BIP and behavioral goals.​ What Makes a Good Behavioral Goal? In order for a behavioral goal to legally be an appropriate part of an IEP, it should: Be stated in a positive manner. Describe the behavior you want to see, not the behavior you dont want. i.e.: Dont write: John wont hit or terrorize his classmates. Do Write: John will keep hands and feet to himself. Be measurable. Avoid subjective phrases like will be responsible, will make appropriate choices during lunch and recess, will act in a cooperative manner. (These last two were in my predecessors article on behavioral goals. PLEEZZ!) You should describe the topography of the behavior (what does it look like?) Examples: Tom will remain in his seat during instruction 80 percent of observed 5 minute intervals. or James will stand in line during class transitions with hands at his side, 6 out of 8 daily transitions. Should define the environments where the behavior is to be seen: In the classroom, Across all school environments, In specials, such as art and gym. A behavior goal should be easy for any teacher to understand and support, by knowing exactly what the behavior should look like as well as the behavior it replaces. Proviso We do not expect everyone to be quiet all the time. Many teachers who have a rule No talking in class usually do not enforce it. What they actually mean is No talking during instruction or directions. We are often not clear about when that is happening. Cueing systems, are invaluable to help students know when they can talk quietly and when they must remain in their seats and be silent. Examples of Common Behavior Challenges and Goals to Meet Them. Aggression: When John is angry he will throw a table, scream at the teacher, or hit other students. A Behavior Improvement Plan would include teaching John to identify when he needs to go to the cool down spot, self- calming strategies and social rewards for using his words when he is frustrated instead of expressing it physically. In his general education classroom, John will use a time out ticket to remove himself to the in class cool down spot, reducing aggression (throwing furniture, shouting profanities, hitting peers) to two episodes a week as recorded by his teacher in a frequency chart. Out of Seat Behavior: Shauna has difficulty spending much time in her seat. During instruction she will crawl around her classmates legs, get up and go to the classroom sink for a drink, she will rock her chair until she falls over, and she will throw her pencil or scissors so she needs to leave her seat. Her behavior is not a reflection only of her ADHD but also functions to get her the teacher and her peers attention. Her behavior plan will include social rewards such as being line leader for earning stars during instruction. The environment will be structured with visual cues which will make it clear when an instruction is happening, and breaks will be built into the schedule so Shauna can sit on the pilates ball or take a message to the office. During instruction, Shauna will remain in her seat for 80 percent of five minute intervals during 3 of 4 consecutive 90 minute data collection periods.

Monday, November 4, 2019

Criminology- TERM PAPER ASSIGNMENT Example | Topics and Well Written Essays - 1250 words

Criminology- ASSIGNMENT - Term Paper Example According to Clarke (1997, p 145), SCP is a crime prevention strategy in which opportunities for crime are reduced. Sacco and Kennedy (2008, p. 171) on the other hand state that SCP emphasizes the relationship between the criminal’s fear of being apprehended and the particular circumstances that surround the criminal activity This strategy targets highly specific forms of crime like domestic burglaries, burglaries at commercial places, carjacking in parking lots, kidnapping and even highly organized crimes. Measures applied in SCP involve the manipulation, management or designing the environment systematically and permanently (Clarke, 1997, p 148). Such measures make the crime seem harder to succeed, more risky and less rewarding according to Clarke (1997, p 148) and Sacco and Kennedy (2008, p. 337). They affect the target assessments carried out by potential offenders in regard to costs and benefits of committing the crime (Clarke, 1997, p 149). This makes potential offenders reconsider their plans because their ability to get away with and benefit from the crime has been challenged. Situational crime prevention also involves target hardening measures according to Clarke (1997, p 150). An example of environmental management and design that harden the target is proper surveillance in roadways and parking lots especially in new residential places. Such places are targeted more by burglars who park vehicles for transporting stolen goods in dark places near the targets. It also includes improving lighting and increasing security at most vulnerable times of the day in commercial places (Clarke, 1997, p168). Natural and techno-surveillance in potential target areas is boosted by having security personnel, and enhancing their work using closed-circuit television (CCTV) surveillance and burglary alarms according to Clarke (1997, p168). On their own, CCTVs may not lead to a reduction in crime

Saturday, November 2, 2019

Answer Critical Question about The Acute Effects of Humor and Exercise Essay

Answer Critical Question about The Acute Effects of Humor and Exercise on Mood and Anxiety - Essay Example Based on this information, the author is able to develop new variables which to study based on the hypothesis which has been developed form previous studies. The study design is a quasi-experimental design. This is because there are experiments which are being performed upon the participants but there is not control group, which is normally the case in true experimental design. The interventions are being applied to assess the outcome. The sampling design was non-randomised as the participants were selected with certain specifications which the researcher desired. The specifics of the participants imply that non-random approaches were utilised in the sampling of the participants. The number of participants which was utilised within the context of this research appears sufficient to achieve the desired purpose of the research. This is mainly because previous studies which had been carried out consisted of relatively smaller number of participants and still yielded reliable results. Ecological validity is the capability for a study to be able to approximate the real world requirements in terms of materials, methods and setting. The author sought to maximise ecological validity through not information the participants about their experiments to ensure that there is no bias as a result of perceptions and expectation The author ensured there is treatment fidelity through ensuring the comfort of the participants by adherence to the required regulation the quantity and exposure of the participants to the treatment has also been limited for the safety of the