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’

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.

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

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.

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

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.

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.