Early Detection Of Perinatal Asphyxia Health And Social Care Essay

Meconium staining amnionic fluid ( MSAF ) is associated with tonss of inauspicious result and has long been considered to be a bad forecaster of foetal result. Meconium aspiration syndrome ( MAS ) is often associated with foetal hypoxia which promotes meconium discharge in amnionic fluid, panting and aspiration of MSAF, and besides alterations in the vascular muscular media of pneumonic arterias of the foetus. About 30 to 50 % of MAS required mechanical airing or uninterrupted positive air passage force per unit area ( CPAP ) .Aim: –This retrospective survey was undertaken to happen out immediate foetal result in meconium stained spirits in relation to perinatal asphyxia.MATERIAL AND METHOD: –It was a retrospective survey. We reviewed the medical records of all Neonates admitted to neonatal intensive attention unit ( NICU ) between 1st September 2011 to 31st July 2012 at NICU of Manipal Teaching Hospital, Nepal. Gestational age of babes & lt ; 37weeks are coded as prete rm, & gt ; 42weeks as station term and 37 to 42 hebdomads as term. Chi square trial and Binary logistic arrested development were used for the analysis. We calculated odds ratios ( OR ) and their 95 % assurance intervals ( 95 % CI ) . P-valueConsequence: –Out of 399 entire admittances in NICU, male ( 62.4 % ) showed preponderance as compared to female ( 37.6 % ) , among which 6.8 % were instances of MAS, doing female ( 10.7 % ) more prone compared to male ( 4.4 % ) while perinatal asphyxia came out to be 11.5 % , doing male ( 12 % ) more prone to female ( 10.7 % ) . Post term [ odds ratio=3.50 ( CI: 0.39, 31.42 ) ] and term [ odds ratio=2.58 ( CI: 1.16, 5.75 ) ] babes were holding more hazard of developing MAS compared to preterm ( P & lt ; 0.01 ) . Post term [ odds ratio=9.15 ( CI: 1.91, 43.75 ) ] and term [ odds ratio=2.67 ( CI: 1.41, 5.08 ) ] babes were holding more hazard of developing perinatal asphyxia compared to preterm ( P & lt ; 0.01 ) . MAS babe is holding 6.62 ( C I: 2.85, 15.38 ) times hazard of developing perinatal asphyxia ( p & lt ; 0.01 ) .Decision: –MAS is a perinatal job which requires a full co-operation and coordination of Obstetrician and Pediatrician if it is to be avoided. Prompt and efficient bringing room direction can minimise the sequeale of aspirated meconium and diminish the opportunity of perinatal asphyxia.KEYWORDS: –Meconium aspiration syndrome ( MAS ) , Perinatal asphyxia, NICU, PaediatricBackground: –In the early 2000, the prevalence of MAS ranged from 0.20 % to 0.54 % in the general population [ 2-4 ] and from 1.0 % to 6.8 % in babies born through MSAF [ 1, 2-4 ] . A reappraisal of 10 studies published from 1990 to 1998 showed a combined incidence of 13.1 % for MSAF, 0.52 % of MAS, 4.2 % of MAS among MSAF, and 49.7 % of MAS necessitating ventilatory support with a 4.6 % mortality rate [ 3 ] . However, big population-based surveies were scarce and suggested a lower incidence of MAS: the national US birth cohort survey conducted on the footing of singleton term non-Hispanic white unrecorded births ( 1995-2001 ) showed that the rate of MAS markedly increased with gestational age ( GA ) , that is, from 0.10 % at 37 hebdomads gestation ( WG ) to 0.22 and 0.31 % at 40 and 41 WG, severally [ 5 ] . The prevalence of MAS could be extrapolated to 0.18 % in this population of term babies. In Australia, the rate of MAS necessitating mechanical airing in flat III units ranged between 0.024 to 0.046 % at 36-40 WG and so increased to 0.080 % at 41 WG and 0.14 % at 42 WG [ 6 ] . In France, the prevalence of automatically ventilated MAS was estimated to 0.043 % by a retrospective national study among newborns born in 2000-2001 [ 7 ] . Meconium-stained amnionic fluid occurs in about 13 % of unrecorded births. Meconium aspiration syndrome ( MAS ) occurs in 5 to 10 % of babies born through meconium-stained amnionic fluid. When MAS occurs, there is an addition in neonatal mortality and morbidity. Great advancement has been made in the betterment of endurance of babies with MAS. Great advancement in direction has been made since first description of the pathophysiology and hapless result of babies with MAS in 1975. [ 8 ] These include improved intrapartum and post-delivery direction of MAS. Although there is a important lessening in the happening of MAS and associated mortality in developed states MAS remains a major job in developing states. Meconium, the faecal stuff that accumulates in the fetal colon throughout gestation, is a term derived from the Greek mekoni, intending poppy juice or opium. It is a unfertile, thick, black-green, odourless stuff foremost observed in the foetal bowel during the 3rd month of gestation. Meconium consequences from the accretion of dust, including desquamated cells from the bowel and tegument, GI mucin, lanugo hair, fatty stuff from the vernix caseosa, amnionic fluid and enteric secernments. The black-green colour consequences from bile pigments. [ 9, 10 ] Most babies have their first intestine motion after birth ( within the first 24 to 48 hour after birth ) . Occasionally a foetus can go through meconium in uteri. Aspiration of meconium and amnionic fluid can go on during any point of the labour and bringing. The foetus could draw out this mixture of fluids while they are still in the womb, coming through the birth canal, or when they take their first breathe after birth. This is refer red to as Meconium Aspiration Syndrome ( MAS ) . MAS is an of import cause of respiratory hurt in the term neonate, is a serious status with high morbidity and mortality. [ 11,12 ] The pathophysiology is complex and non good defined, including airway obstructor, pneumonic high blood pressure, epithelial hurt, surfactant inactivation, and redness. [ 11,13 ] Fetal asphyxia [ 14 ] and infection are suggested to be chief causative agents. [ 15,16 ] Meconium produces inflammatory responses in both carnal theoretical accounts and neonates with MAS. [ 17 ] After intratracheal instillment of meconium in animate beings, there is an intense pneumonic inflammatory reaction with inflow of polymorphonuclear leucocytes, monocytes/macrophages, and T cells within a few hours. The production of proinflammatory cytokines further propagates parenchymal lung cell hurt, [ 18,19 ] and apoptotic epithelial cells are present in meconium containing lungs. [ 20,21 ] MAS is a disease of the term and near-term baby that is associated with considerable respiratory morbidity. The disease is characterized by early oncoming of respiratory hurt in a meconium-stained baby, with hapless lung conformity and hypoxemia clinically and patchy opacification and hyperinflation radiographically. [ 22, 23 ] At least one tierce of babies with MAS require cannulation and mechanical airing, [ 24, 25 ] and newer neonatal therapies, such as high-frequency airing ( HFV ) , inhaled azotic oxide ( iNO ) , and surfactant disposal are frequently brought into drama. [ 26, 27 ] In the past few decennaries, there seems to hold been a decrease in the incidence of MAS in many centres, at least in the developed universe. [ 25, 28, 29 ] The evident decrease in the hazard of MAS has been attributed to better obstetric patterns, in peculiar, turning away of postmaturity and expeditious bringing where fetal hurt has been noted. [ 28 ]Aim:This retrospective survey was undertaken to happen out immediate foetal result in meconium stained spirits in relation to perinatal asphyxia.MATERIALS AND METHODS: –Study design and the participants:It was a infirmary based retrospective experimental survey conducted in the Department of Paediatrics, Manipal College of Medical Sciences ( MCOMS ) , Kathmandu University. Manipal learning infirmary ( MTH ) is a third attention infirmary in pokhara metropolis of Nepal and it is a good facilitated and equipped infirmary for patients with neonatal intensive attention unit ( NICU ) . It was chosen for the survey because Manipal lea rning infirmary is a third attention 825 bedded infirmary and it was expected that most of the patients will come to this infirmary from Western Nepal.DATA COLLECTION: –This survey was carried out from 1ST SEPTEMBER 2011to 31st JULY, 2012. The survey population included patients admitted in Pediatrics NICU from different parts of Pokhara, Nepal. After obtaining the permission from the caput of the section, information was collected from the medical record section of the patient from NICU. The variable collected were Age, sex, weight, manner of bringing and gestational age. Sum of 399 instances were included in the survey holding both meconium aspiration syndrome, perinatal asphyxia and other neonatal infections.INCLUSION CRITERIA:Gestational age of babes & lt ; 37weeks are coded as preterm, & gt ; 42weeks as station term and 37 to 42 hebdomads as term.SAMPLE SIZE CALCULATION: To be added subsequentlyResult Variables:To happen out immediate foetal result in meconium stained sp irits in relation to perinatal asphyxia.Explanatory Variables:Factors at single degree are gestational age and sex.ETHICAL COMMITTEE APPROVAL:Predating the survey, blessing for the survey was obtained from the institutional research ethical commission.DATA MANAGEMENT AND STATISTICAL ANALYSIS:Analysis was done utilizing descriptive statistics and proving of hypothesis. The information was analyzed utilizing Excel 2003, R 2.8.0, Statistical Package for the Social Sciences ( SPSS ) for Windows Version 16.0 ( SPSS Inc ; Chicago, IL, USA ) and the EPI Info 3.5.1 Windows Version. A p-value of & lt ; 0.05 ( two-tailed ) was used to set up statistical significance. [ 30, 31 ]Consequence: –Table 1: Cross tabular matter between Socio demographic factors and meconium aspiration syndrome: Variables MECONIUM ASPIRATION SYNDROME p-VALUE Yes NO Entire Sexual activity Male 11 ( 4.4 % ) 238 ( 95.6 % ) 249 0.016 Female 16 ( 10.7 % ) 134 ( 89.3 % ) 150 Gestational age 1 ( & lt ; 37 hebdomads ) 12 ( 4.5 % ) 252 ( 95.5 % ) 264 0.001 2 ( 37-42 hebdomads ) 14 ( 10.9 % ) 114 ( 89.1 % ) 128 3 ( & lt ; 42 hebdomads ) 1 ( 14.3 % ) 6 ( 85.7 % ) 7 Table 1depicts: female ( 10.7 % ) more prone compared to male ( 4.4 % ) . Post term [ odds ratio=3.50 ( CI: 0.39, 31.42 ) ] and term [ odds ratio=2.58 ( CI: 1.16, 5.75 ) ] babes were holding more hazard of developing MAS compared to preterm ( P & lt ; 0.01 ) . from the above statistics it ‘s really clear the female in our survey are doing an dominant portion as compared to do in meconium aspiration syndrome. Along with this, we can do out that station and term newborns are holding larger hazard of developing meconium aspiration syndrome. Table 2: shows relationship of perinatal asphyxia with Socio demographic factors and meconium aspiration syndrome: Variables PERINATAL ASPHYXIA p-VALUE Yes NO Sum Sexual activity Male 30 ( 12.0 % ) 219 ( 88.0 % ) 249 0.676 Female 16 ( 10.7 % ) 134 ( 89.3 % ) 150 Gestational age 1 ( & lt ; 37 hebdomads ) 20 ( 7.6 % ) 244 ( 92.4 % ) 264 0.001 2 ( 37-42 hebdomads ) 23 ( 18.0 % ) 105 ( 82.0 % ) 128 3 ( & gt ; 42 hebdomads ) 3 ( 42.9 % ) 4 ( 57.1 % ) 7 Meconium aspiration syndrome Yes 11 ( 40.7 % ) 16 ( 59.3 % ) 27 0.0001 NO 35 ( 9.4 % ) 337 ( 90.6 % ) 372 Table 2: shows Perinatal asphyxia came out to be 11.5 % , doing male ( 12 % ) more prone to female ( 10.7 % ) . Post term [ odds ratio=9.15 ( CI: 1.91, 43.75 ) ] and term [ odds ratio=2.67 ( CI: 1.41, 5.08 ) ] babes were holding more hazard of developing perinatal asphyxia compared to preterm ( P & lt ; 0.01 ) . MAS babe is holding 6.62 ( CI: 2.85, 15.38 ) times hazard of developing perinatal asphyxia ( p & lt ; 0.01 ) . From the tabular array we formulated that male are holding more hazard of developing perinatal asphyxia as compared to females.post term babes and term are holding greater hazard holding asphyxia. Therefore from the above consequence we can do out that there is strong relationship between MAS and perinatal asphyxia i.e, meconium aspiration newborns are prone for developing perinatal asphyxia.Discussion:The increased hazard for pneumonic morbidity and mortality among babies born through meconium stained amnionic fluid is good recognized. Though many studies have noted a clinical spectrum of pneumonic disfunction such as mild tachypnea and terrible pneumonic inadequacy, this survey confirms that meconium stained amnionic fluid is associated with an increased hazard for pneumonic disfunction. The hazard for pneumonic disease, nevertheless, is non manifested every bit in all babies with meconium staining. As it was shown by several old surveies, the greatest hazard for pneumonic disease occurred among babies with associated marks of possible intrapartum foetal via media. Despite airway direction following recommended guidelines, these babies continued to attest a high rate of pneu monic morbidity [ 32-35 ] . The recommendation by the American Academy of Pediatrics in 1983 did non propose that all babies born through thick meconium stained amnionic fluid needfully necessitate tracheal suction. The 2nd edition of these Guidelines noted the absence of extra surveies to back up or rebut the pattern of tracheal suction for meconium stained amnionic fluid and recommended that â€Å" in the presence of midst or particulate meconium, the voice box should be visualized, and if meconium is present, the clinician should cannulate the windpipe and use suction † . The most recent edition of the Guidelines published in 1992, is downwind dogmatic. It is recommended that down babies with meconium in the hypopharynx have tracheal suction. However, it is further noted that cord visual image and tracheal suction in the vigorous baby with thick meconium may non be necessary. None of the Guidelines have recommended tracheal suction of babies born through thin meconium stained amnionic fluid [ 32, 33 ] .MECONIUM ASPIRATION SYNDROME WITH GESTATIONAL AGE:The overall incidence of MAS and terrible MAS additions with GA as reported in recent population-based surveies [ 36, 37 ] . The overall rates of MAS in the USA [ 36 ] and Burgundy are similar: 1.0 versus 1.1 per 1000 unrecorded births ( aˆÂ ° ) at 37 hebdomads ; 1.1 versus 1.0aˆÂ ° at 38weeks ; 1.5 versus 1.1aˆÂ ° at 39weeks ; 2.2 versus 2.4aˆÂ ° at 40 hebdomads, and 3.1 versus 2.6aˆÂ ° at 41weeks. Furthermore the incidence of terrible MAS recorded in Australia [ 37 ] at 41weeks ( 0.80aˆÂ ° ) is close to the 0.67aˆÂ ° observed at 39-41weeks in our series. Some surveies suggested that bar of post term gestation prevents terrible MAS [ 38 ] .Our retrospective observational survey showed that station term [ odds ratio=3.50 ( CI: 0.39, 31.42 ) ] and term [ odds ratio=2.58 ( CI: 1.16, 5.75 ) ] babes were holding more hazard of developing MAS compared to preterm ( P & lt ; 0.01 ) .MECONIUM ASPIRATION S YNDROME WITH SEX:In our survey, male ( 62.4 % ) showed preponderance as compared to female ( 37.6 % ) , among which ( 6.8 % ) were instances of MAS, doing female ( 10.7 % ) more prone compared to male ( 4.4 % ) .PERINATAL ASPHYXIA WITH GESTATIONAL AGE:For more than two decennaries, post term gestation has been defined as a gestation that persists beyond 294 yearss or 42 hebdomads of gestation [ 39 ] . The most common ground to name it is inaccurate gestation dating. Last catamenial period with regular catamenial rhythm is the best physiological landmark to measure the gestational age in gestation. However, a few adult females are certain of their day of the months and frequently cause anxiousness when they come with postdates [ 40 ] . The cause of post-term gestation is unknown. A Post term gestations are associated with higher hazard of perinatal mortality and morbidity including meconium aspiration syndrome, A asphyxia neonatrum respiratory hurt syndrome, icterus neonatrum, sepsis neonatorum, oligohydramnios, macrosomia, foetal birth hurt, foetal hurt and increased rate of cesarean subdivision [ 41 ] . Our survey showed that station term [ odds ratio=9.15 ( CI: 1.91, 43.75 ) ] and term [ odds ratio=2.67 ( CI: 1.41, 5.08 ) ] babes were holding more hazard of developing perinatal asphyxia compared to preterm ( P & lt ; 0.01 ) .PERINATAL ASPHYXIA WITH SEX:In legion surveies, asphyxia was more prevailing in male than female [ 42, 43, 44 ] . In our survey, male preponderance is seen. Out of 399 instances perinatal asphyxia came out to be 11.5 % , doing male ( 12 % ) more prone to female ( 10.7 % ) .Decision:The present survey showed a good correlativity of prevalence of meconium aspiration syndrome and perinatal asphyxia both in term and post term babes doing perinatal asphyxia more common in meconium aspiration syndrome. There is demand of a big randomized controlled test to analyze the functions of intrapartum nasopharyngeal and immediate postpartum tracheal suctioning in newborns born through MSAF in developing state scene.Conflict OF INTERESTS:The writers do non hold any struggle of involvement originating from the survey.RecognitionsDr. K.S RAO, Professor and Head of Department, Pediatrics, Manipal College of Medical Sciences, Pokhara ( Nepal ) for allowing the writers to utilize the infirmary paperss during the survey.What this survey adds:By agencies of this survey we can turn out that perinatal asphyxia is more prevailing in meconium aspiration syndrome.

Improve Efficiency Essay

A very high percentage of the items selected (picked) in the distribution centers and re-stocked in the stores were in quantities of 1 case. This company’s roots were as a high volume, limited assortment retailer and distributor. Over time the business had shifted allowing the stores to reorder a higher mix of items at lower volumes. Given the companies market position as a low-price leader, this reduced profit margins. The two root causes of this shift were identified as: 1. Stock-keeping-unit (SKU) count growth outpacing sales growth, and 2. Allowing minimum order quantities from the stores to the distribution centers to drop to a quantity of one This white paper will study how this company quantified the impact of allowing its stores to order in one case quantity and then recalculated minimum order quantities for higher volume items. (For details of how SKUs were reduced see White Paper â€Å"SKU Reduction – Biggest SKLUsers†) A Supply Velocity Consultant led a team of employees through this 5 week project. The Supply Velocity consultant facilitated, but the employees did most of the analysis and therefore owned the improvements. nfo@supplyvelocity. com Copyright: Supply Velocity, Inc. 2 Project Outline ? Evaluated all SKUs and the case quantity they are most frequently ordered at, to establish baseline data for how stores are ordering ? Time studied retail store shelf restocking and distribution center order selection labor to determine the negative labor productivity impact of the current ordering policy o Graphed the results in a trend chart o Determined that the greatest labor productivity improvement happens when the order quantity increases from just 1 to 2 cases ? Recalculated minimum order quantity for all items using Multi-Variable Pareto analysis based on: o Item unit movement o Pack-out (number of units that fit on the shelf space allocated in stores) o Shelf life ? About 20% of all SKUs had a re-calculated minimum order quantity greater than 1 case o The most conservative methods were used to ensure this project didn’t just push inventory out to stores, resulting in shrink (throwing away items that go beyond their shelf-life limit or are damaged) ? Communicated all items on the minimum order quantity to all stores through a comprehensive communication plan o Communication plan included data to show stores how increasing minimum order quantity on select items would improve their labor productivity ? Created a control plan to ensure new items, SKU reduction and sales history will be used to update the minimum order quantity on a twice yearly basis info@supplyvelocity. com Copyright: Supply Velocity, Inc. 3 Time Study Analysis To quantify the problem, we time studied order selection in the distribution centers and shelf restocking in retail stores. We conducted a few snapshot analyses of different distribution centers to understand the current state of â€Å"order quantities†. The graph below shows that out of the approximately 2800 items, a majority are ordered in quantities of 1 case. The time study data also showed that the second case selected or stocked is essentially â€Å"free† and the same movement is used for two cases as for one case. At the outset of this project the team was worried that any increase in minimum order quantity would be viewed by store managers as an attempt to push inventory out from the distribution centers to the stores. This data showed that increasing minimum order quantity from one case to just two, gave us the greatest percentage of labor productivity improvement. However, we didn’t just want to increase all items to a 2 case minimum order quantity. Instead, a statistical tool, Multi-Variable Pareto was used to calculate the proper minimum order quantity based on a mix of inputs. nfo@supplyvelocity. com Copyright: Supply Velocity, Inc. 4 Distribution Center Order Selection Quantity (# of items picked per quantity) 57% of the items in distribution centers were selected at a 1 case quantity info@supplyvelocity. com Copyright: Supply Velocity, Inc. 5 â€Å"Time to Select per Case Quantity† in the Distribution Centers – Based on case count per selection When selecting 2 cas es of an item, the time per case drops by 45% from 1 case. info@supplyvelocity. com Copyright: Supply Velocity, Inc. 6 Time to Re-Stock SKUs on Shelves in Stores – Based on case count When restocking 2 cases of an item, the time per case drops by 61% from 1 case. This shows that the greatest productivity improvement occurs when going from 1 to 2 cases, which is easier to â€Å"sell† to the stores than making large increases in minimum order quantity. They can reduce labor by 37 seconds per case by ordering and stocking 2 cases of an item versus 1. info@supplyvelocity. com Copyright: Supply Velocity, Inc. 7 Multi Variable Pareto Analysis ? Recalculated minimum order quantity for all items using Multi-Variable Pareto analysis based on: o Item unit movement o Pack-out (number of units that fit on the shelf space allocated in stores) o Shelf life ? About 20% of all SKUs had a re-calculated minimum order quantity greater than 1 case o The most conservative methods were used to ensure this project didn’t just push inventory out to stores, resulting in shrink Multi-Variable Pareto is a method that uses more than one â€Å"measure† to sort SKUs from highest to lowest performing. Normal Pareto Analysis has been used to develop guidelines such as the 80/20 rule (20% of customers generate 80% of sales). When using multiple variables, there has to be a way to normalize the data so all variables are part of the analysis. We used three variables to determine the correct minimum order quantity for an item. ? Cases sold per week on average for each item ? The number of cases that fit in the given shelf space ? Product shelf-life Each of these variables are positively correlated to Minimum Order Quantity. ? The higher the cases sold equals higher Order Quantity ? The greater the shelf space (pack-out) equals higher Order Quantity ? The longer the item’s shelf-life equals higher Order Quantity The team of subject matter experts used retail experience to determine each of these factors and their impact on minimum order quantity. Results of this analysis are shown below. The calculation was very conservative, as the results have shown. Only 466 of 2800 items have a minimum order quantity greater than 1 case. This was largely driven by two factors. Item shelf-life limited our ability to make any shelf-life sensitive item greater than 1 case. Our calculation took this limiting factor into account, to ensure we weren’t causing shrink (throwing away items that go beyond their shelf-life limit or are damaged) at the stores. In addition, lower case movement drove many items to a 1 case minimum, even if they didn’t have shelf life limitations. The lower case movement is due to SKU proliferation and was addressed by the SKU Reduction (Biggest SKLUsers) project. info@supplyvelocity. com Copyright: Supply Velocity, Inc. 8 Results of Minimum Order Quantity Calculation info@supplyvelocity. om Copyright: Supply Velocity, Inc. 9 Communication & Control Plan ? Communicated with all retail stores about how the minimum order quantity analysis was conducted and the resulting new plan o Communication plan included data to show stores that increasing minimum order quantity on select items would improve their labor productivity ? Created a control plan so new items, SKU reduction and sales history will update the minimum order quantity on a twice yearly basis It was critical that this project was presented as a positive for our retail store-customers. We created a communication plan that showed two key aspects of this change: ? The conservative nature of the change o only 466 of 2800 items are receiving a minimum order quantity increase ? This change is good for the stores and will improve their labor productivity To ensure that this process endures and does not get reversed over time we included a control plan. This is shown in the graphic below. As Category Marketing Managers evaluate items, adding and reducing SKUs, changes will be reflected in new pack-out quantities. This quantity will get fed to Distribution Technology who will recalculate this items’ minimum order quantity using the same Multi-Variable Pareto calculation. A control group, made up of Merchandising, Distribution and Retail Directors will review the list, make changes in the ordering system and communicate changes to store customers. info@supplyvelocity. com Copyright: Supply Velocity, Inc. 10 Results By taking the higher sales volume SKUs and increasing the store minimum order quantity, we decreased the time per case to stock shelves in the stores and select items in the distribution centers. Using only the 1 to 2 case increase in minimum order quantity for the 466 SKUs reduced the labor time per case resulting in a labor savings of $1. 2 million. The expectation for this process is to slowly grow the number items with a minimum order quantity greater than 1 case beyond 20%. By rationalizing and reducing SKUs we should increase the shelf pack-out of remaining items, thereby increasing the minimum order quantity.

Barn Burning William Faulkner

Biography William Faulkner was born on September 25, 1897, in New Albany, Mississippi. During his adolescent years he was motivated to attend school and even skipped the second grade. Unfortunately, while becoming a young adult he grew less fond of his studies and dropped out of high school when he was fifteen. In 1918 he was rejected from the U. S Air Force since he did not meet weight and height requirements, he then returned home to Oxford, Mississippi. Faulkner attended University of Mississippi where he wrote the school newspapers and magazines.Due to his upbringing in the South which is duly noted in his literature works of art, Barn Burning would be considered his fictional representation of the merciless, money-making New South versus the land-owning, noble Old South. Barn Burning, part of a trilogy, also incorporates some aspects of his family life, for instance being brought in the times of the great depression. Barn Burning captures of the life of the south during this tim e period through his setting, characters, and symbols.In 1949, he won the Nobel Prize for literature which he used the income to establish a scholarship fund for black students. William Faulkner believed in integration of the South rather than segregation. William Faulkner â€Å"tells the story of his region and of his nation, to demonstrate the often tragic inextricability of past and present, to show the human capacity for baseness and for nobility, to search for truth and meaning in a world where values seem constantly to shift and to erode. † (Minter) Literary CritiqueIn the beginning, â€Å"Barn Burning† appears to be a story about a harsh father and his family, who seems to be caught up in his devilish ways. As you read further in to the story you find that the story is focused on the protagonist or son a poor sharecropper, Colonel Sartoris Snopes, who has to struggle with his father’s arsonist tendencies which are destroying his families’ reputatio n and life style, while coming to terms with his own ethics. However, don’t forget to notice the dialect in this story and Faulkner’s.Critic Hal Macdonald comments on dialect when Sarty Snopes says to himself, â€Å"He aims for me to lie [†¦ ] and I will have to do hit†(Faulkner 156) points out â€Å"Sarty's addition of an h before the pronoun â€Å"it,† although characteristic of some rural Southern dialects, nonetheless strikes the ear of a Southern reader† (Par. 1) In addition to the importance of dialect, we are missing out on a truly miserable pain in the context of the story seen through situations around a fire.Susan Yunis comments on the fact that Barn Burning focuses more on the tyranny of the father rather than the deplorable state his family is left in. An excerpt from the story shows this ongoing effect on his family: â€Å"The nights were still cool and they had a fire against it, of a rail lifted from a nearby fence and cut into lengths—a small fire, neat, niggard almost, a shrewd fire; such fires were his father's habit and custom always, even in freezing weather.Older, the boy might have remarked this and wondered why not a big one; why should not a man who had not only seen the waste and extravagance of war, but who had in his blood an inherent voracious prodigality with material not his own, have burned everything in sight?Then he might have gone a step farther and thought that that was the reason: that niggard blaze was the living fruit of nights passed during those four years in the woods hiding from all men, blue or gray, with his strings of horses (captured horses, he called them).And older still he might have divined the true reason: that the element of fire spoke to some deep mainspring of his father's being, as the element of steel or of powder spoke to other men, as the one weapon for the preservation of integrity, else breath were not worth the breathing, and hence to be regarded with r espect and used with discretion. †(Par. 2)One should see a boy whose family has been forced to leave their home, huddled by a small fire in the cool night, and who has huddled by such a small fire even on freezing nights to avoid the retaliation of angry landlords. I see discomfort, anger, even despair at the recurrence of this situation and at the powerlessness of the family to change it. Yet, this discomfort is never spoken by the narrator. Yunis states â€Å"that a narrator who focuses less on the child than on the motivation of his violent, even abusive parent seems incongruous† (Par. 3). Furthermore, the fire is one important symbol occurring in this story.Compared to Snopes fire he constructed for his family small and inadequate. His â€Å"barn-burning† flames had Confederate patrols after him many nights searching for the horse thief. Instead of becoming extremely satisfied by providing warmth and comfort for his family. Snopes would rather see a brief bla zing moment to preserve his integrity and feel powerful. In reality, he is powerless and poor with cruel intentions. In addition to the fire that says so much, the soiled rug portrays his resentment of individuals better off than him, taking it to a personal level.The luxurious rug symbolizes Snopes’ every relief, chance, and freedom he feels he has been unfairly denied, and in obliterating it, he gives up all regard for his life and family’s hope. Theme Level of Maturity in â€Å"Barn Burning† Being a parent is not easy. Parents must guide the children, should set good examples, and take care of them until the day that they can venture the world on their own. However, what if it’s the other way around? William Faulkner’s story titled â€Å"Barn Burning† shows a boy named Sartoris who matured at a very young age due to his family’s circumstances.He wished that things could be different for his family especially his father; the cold an d unyielding manipulator of the family. The innocence of a child is pure and beyond compare. They try things that is new to them or that intrigues them, and they usually role play or imitate what they see especially what the adults do. A child can be easily told to do this, do that, don’t say this, and don’t say that. Sartoris, on the other hand, doesn’t need to be told what to do nor what to say. He is a very intelligent and wise boy because he knows exactly what to do especially when he was being questioned by the authorities.He knows what will be the outcome if he tells the truth, so even if it is against his will, he lied to the authorities. Also, he felt that his father wanted him to lie â€Å"He aims for me to lie, he thought, again with that frantic grief and despair. And I will have to do hit† (Faulkner 156). This behavior shows how the father has planted the idea of how important family is for them to the point of being irrational. The critic Tho mas Bertonneau shares the same idea, â€Å"Abner's injunction to Sarty ‘to stick to your own blood’. Abner’s notion of ‘family’ only applies when it is convenient for him. Treating a child is very important as well.It molds and shapes them to be what they are in the future. It also shows what type of personality they will have like being bashful, lively, reserve, and sometimes aggressive. Child treatment is different and it depends on their gender. The example of this is if the child is a girl; she might be treated gently, but protective and tons of attention. On the other hand, if the child is a boy; he might be treated a little bit tougher, but somewhat lenient because boys sometimes do not need much attention than girls. Boys most of the time don’t cry that much or they don’t cry at all even though they are being scolded or sometimes being hit.They don’t show much of their emotions or thoughts because for them being a boy mea ns you need to be tough and not a cry baby. Also, be able to adjust their selves quickly to any situations, â€Å"If I had said they wanted only truth, justice, he would have hit me again† (Faulkner 158). Sartoris didn’t talk back nor cried even though he was hit by his father. He handled it very well because he knew if he talk back to his father; he will get hit and he will receive a lengthily sermon from his father. â€Å"The word ‘ferocious’ is related to the word ‘feral,’ or ‘wild’†(Bertonneau) Sartoris was treated very aggressively by his father.He wanted to tell the authorities the truth, but he couldn’t. As mentioned earlier, a child imitates what they see. If a parent is not careful with their actions or words a child might end up in the wrong direction. However, some children have a great distinction between right from wrong and what’s rude and what’s not. A child can also feel embarrassment if something has been done that they believe to be humiliating, â€Å" Watching him,†¦ his father held and saw the stiff foot come squarely down in a pile of fresh droppings†¦which his father could have avoided by a simple change of stride†(Faulkner 159).Sartoris felt so embarrassed because it’s a common sense that if there’s a pile of animal dropping on your way you should avoid it because if you don’t you will make such a mess and it will smell â€Å"Abner now barges into the de Spain house, tracking manure on the rug; he frightens Mrs. de Spain and humiliates the servant†(Bertonneau). This stubbornness of stepping on animal droppings shows Abner’s willful behavior of telling everyone that he was not their servant and he wanted his son to learn that. The developmental stage of a child is a step by step progression, but quick.On this case, Sartoris showed a great deal of maturity and thinking. He is more mature than his father. His judgment between right and wrong is impressive. He showed great thinking because he thinks it through before saying anything. He knew what’s going to happen if he tells the truth. Even if it’s against his will he remained silent because for him; his father is more important even though his father is trying to corrupt him. Sartoris have a bright future on his way because he has different outlook or view in the world; unlike his father.He is more of a man than his father because his respect to his self is great and the way that he thinks is mature rather than immature that you would expect from a child.? Works Cited Bertonneau, Thomas. â€Å"Barn Burning. â€Å"Short Stories for Students. Detroit: Gale, 2002. Literature Resource Center. Web. 11 Nov. 2012. Faulkner, William. â€Å"Barn Burning† Literature: An Introduction to Fiction, Poetry, Drama, and Writing. Ed. Kennedy, X. J. , and Dana Gioia. Boston: Pearson, 2013. 155-167. Print. McDonald, Hal. Faulkner's à ¢â‚¬ËœBarn Burning. ‘. † Explicator 61. 1 (Fall 2002): 46-48. Rpt. in Short Story Criticism. Ed. Jelena O. Krstovic. Vol. 92. Detroit: Gale, 2006. Literature Resource Center. Web. 11 Nov. 2012. Minter, David. â€Å"William Faulkner. † William Faulkner. Pearson Education, n. d. Web. 11 Nov. 2012. Yunis, Susan S. â€Å"The Narrator of Faulkner's ‘Barn Burning'. † The Faulkner Journal 6. 2 (Spring 1991): 23-31. Rpt. in Literature Resource Center. Detroit: Gale, 2012. Literature Resource Center. Web. 11 Nov. 2012.

Group Development and Motivation Essay Example | Topics and Well Written Essays - 2000 words

Group Development and Motivation - Essay Example The composition of the groups involves analyzing the characteristics of the persons to form a group and combine them effectively. This involves considering group roles, characteristics, and diversity (Lewis et al. 2007). The roles performed by a group can be task-oriented, relationship oriented and self oriented. The skills that are needed to accomplish the set goals and objectives and achieve success are task oriented behaviors. According to Bruce et al (2006, p. 136), includes; asking for information and giving the information to team members. Information acts as the basis of the group functioning. Without the relevant information required to perform the assigned tasks, the group cannot accomplish its objectives. One has to ask for information in order to understand what is required and those with information are willing to distribute to the rest of the members. The information is then summarized to come up with logical conclusions. Some members act as energizers to the group. They encourage others to perform their tasks however challenging they might be. Task behavior also involves clarification of information and putting personal feelings aside to accept consensus. Relationship behaviors are those that encourage positive relations between group members. This involves encouraging others to participate in group activities. When everyone participates, there is a feeling of cooperation and a good relationship between group members. Communication is important in ensuring effective teams as it enables decision making, resolving conflicts and setting of goals (Bruce et al. 2006, p. 137). Directing communication is thus one of the tasks involved in enhancing positive working relationships.... This paper stresses that giving the group clear expectations propels it to work towards achieving the set goals. To motivate the group, the management should set challenging goals for the group especially after accomplishment of a task to make them work harder. The goals should be communicated effectively to avoid confusion and continuous feedback given so that the group can know how it is progressing in accomplishing the challenging task. The management should also provide all the support needed to accomplish the task such as sufficient resources, tools, skills and training. The group will thus feel valued and purposeful hence motivated. This report makes a conclusion that effective teams are an asset to the organization as they ensure improved productivity and profitability and enable an organization to remain competitive. However, the management should make their expectations clear but setting realistic goals for the group. Ensuring the group has the right combination of skills and diversity ensures effectiveness. The group should also be of an appropriate size which is easy to coordinate and allows participation by all members and discourage free riding. The group develops through stages of formation, storming, norming, performing and transformation before it can be disbanded and a new one formed. At each stage, the leader has different tasks to perform to ensure success. After building the group, ensuring it remains motivated is essential for continuity and better performance. This can be done by ensuring clear goals, rewarding good performance, encouraging staff involvement, supporting the group and managing con flict effectively.

Islam Economic System Essay Example | Topics and Well Written Essays - 2250 words

Islam Economic System - Essay Example Islam is a significant, growing, and dynamic presence in the world. (Microsoft Encarta 2007) "Though 'Capitalistic' in nature, the Islamic economic system is not, however, based on the European or American capitalist economic principles, which in no way heed moral or ethical conceptions. The Islamic system obeys fully and unconditionally the dictates of moral and ethical doctrines. The difference between the Islamic and the capitalist economic systems is thus a cardinal and fundamental one. "The Islamic economic system also laid down the principle of the equality of value between labor and capital, by recognizing that labor should be accorded equal consideration with capital--in fact that it can itself be regarded as form of 'capital'. (https://www.vedamsbooks.com/no34563.htm - 3k ) Islam's economic system is not merely a matter of broad appeal to voluntary charity; rather, it gives a more comprehensive approach or view of economic life, which in turn is based on the basic teaching in the tenets of Islam. Despite the universality of the Islamic laws, the economic systems could vary since there are communist, socialist, capitalist, and Islamic economic systems. Each is based on goals, principals, or philosophies which are quite unique to that particular ideology. Islam recognized that humans will unde... om the buying of food, taking ownership of property, selling goods, investment, agriculture, taking loans, exchanging currency, taking up employment and giving work, setting up a company, importing and exporting abroad, disposing of assets etc. In this regard, Islam made a distinction between the economic system and economic science i.e. it views them as two separate issues. This is because there is a fundamental difference between the method of production of goods and services (economic science) from the manner of their distribution (economic system). The production of goods and services follow no particular viewpoint in life. A conveyor belt is neither Capitalist, Islamic nor is Communist .It is universal. Questions as to how processes can be made more technological, how mechanisms and robots can improve productivity and how inventions can improve the process of manufacturing do not follow any specific viewpoint in life. This means basic facts on productivity, marketing and manufacturing (economic science) remain the same irrespective of belief or location. This is similar to scientific facts. These are the same whether in China or the US because they are not influenced by any belief. They are questions based upon the reality i.e. understanding the reality at hand leads one to a conclusion. So the fact Inflation occurs when there is too much money chasing too few goods does not change if one is a Christian or if an atheist becomes Muslim or if one moves form China to the US. This is no different to the fact that wood burns whatever your religion or weather you're in the UK or the North Pole. The distribution of resources, how goods and services should be given to the public, whether they should go to the rich or the orphans, aristocracy or the landlords is not a

The Cyclermate Project -Referral Essay Example | Topics and Well Written Essays - 2000 words

The Cyclermate Project -Referral - Essay Example In human relation planning, few changes are recommended in hr structure of the company. Short term marketing planning has also been made. Last requirement of investigation will be stated followed by recommendation for the overall growth of the company. Finally, a brief conclusion of this report will be provided. PEST Analysis PEST analysis has been done to assess the impact of environmental factors on the company’s business operations. Political factor has a substantial impact on labor law, income tax, trade barriers etc. Current number of worker is less than the output of the company. So, they recruit very less people and the workers have to work overtime for achieving company’s production target. But, the workers are not getting paid at normal wage rate for overtime work. This situation results frequent strike by them which affect the flow of productivity. Continuous overtime work is also the reason for lower productivity rate of individual workers. Economical factor has a major impact on financial health of a company. Though there is not any substantial impact of external environmental factors on the business but few internal issues are there which affect the economical stability of the company. Major issues is company’s purchase of bigger assets like it has purchased a huge warehouse which actually not needed according the demand and production capacity of the company. if they would have bought a smaller warehouse based their production capacity and inventories capacity then they would have invest the rest amount for new product development which would have more essential for the company’s product portfolio. This badly affected company’s economical stability. Social factor has strong impact on organizational culture and human factor of the company. Organizational work culture is of lower standard than what it should be as the workers have to overtime work each h and every day and also they do not get leaves by their won de mand. This is because the company has lesser number of employees than its production target. Technological factor has major impact on production division of a firm. Cyclermate has been using manual methods for production of cy-cycles. They do not adopt technology advancement for production process like use of hi-tech machines for faster production. Using technology would enhance its productivity and the worker also would not have do overtime work. A single employee is responsible whole administrative work without help of any technology. SWOT Analysis SWOT analysis has been developed to assess internal and external factors like strength, weakness, opportunity and threat of the company. Strengths Employees of Cyclermate are the main strengths of the business as they are expert of making good designed and quality cycles. The company has huge warehouse for higher level production and stock management. The company was one of the leading bicycle companies in the market. Owner of the compa ny has a potential investor to raise fund for the company’s new project. Weakness Cyclermate do not provide initial training to the new workers and thus it has maximum number of untrained workers which is a major weakness of the company with respect to productivity of the company. Employees do not have any specific job roles. They do not display the variety of products in the company showroom in Wales. The company has done ineffective investment by purchasing a huge warehouse

The Way we really are Essay Example | Topics and Well Written Essays - 750 words

The Way we really are - Essay Example the publication of her previous book coinciding with the 1992 United States presidential election campaign that publicised debates about traditional American family values and the alleged decline of those values with associated declines in public and private behavior standards. Coontz was concerned that the conservatives within the Republican Party were making untrue claims that the decline of traditional family values was detrimental to American society and has harmful social, economic, and political consequences.1 Stephanie Coontz seemed to echo the opinions of many that believed the myth of traditional American family values underpinning traditional nuclear families was generally an unfounded fiction. The primary theme of ‘The Way We Never were: American families and the Nostalgia Trap’ was the argument that the idea that the traditional nuclear family was the main form of social unit that was not as prevalent as some argued. The conservative politicians and fundament alist religious groups spread such myths, as they would like the American public to believe. The Way We Never Were was very successful in making that point as well as being another example of Coontz’s ability to examine and evaluate American social history besides making valid arguments about contemporary American society. This book brought Coontz critical acclaim as well as increased book sales.2 The Way we Really are is a book that Stephanie Coontz intended to use to describe and examine the reality of family life in contemporary American society rather than describing American social history as her previous books had done so well. The Way we Really are was a change of approach and perspective that had commenced with The Way We Never Were.3 Coontz’s changes in approach and perspective were mainly in response to intensified public and political debates concerning changes to family lives in American society in the past, the present, and indeed in the future.4 To classify it in

Oral Colonization of Mutans Streptococci in Young Children Research Paper

Oral Colonization of Mutans Streptococci in Young Children - Research Paper Example The bacterial properties (virulence factors) of these organisms favorable for colonization Can acquiring MS at early age influence incidences of dental caries in later years MS transmission routes. Whether nonmutans in oral flora affect colonization and or action of Mutans. Research question: what are the host and microbe factors influencing oral colonization by MS in young children. Materials and Methods: In the course of research paper preparation the microbiological as well as molecular biological approaches taken by the researchers would be presented. These are used to differentiate between mutans and nonmutans from oral cavity, production of mutacin and glucan, identification of different MS genotypes etc. The methods of longitudinal surveys used in various studies are also part of the intended research. Results and discussion: The results obtained in the chosen host and bacterial factors responsible for MS colonization would be presented. For the convenience of explanation of results the results and discussion are combined in this paper. The manuscript would contain at least a total of 7-8 tables and figures. These are integrated in the text and attached as per the instructions. The title page with author's (of this paper) name and affiliation, abstract, acknowledgement and a bibliography of all sources of literature also to be included in the paper. FULL PAPER Author (s): Affiliation(s): Oral colonization of mutans streptococci (MS) in young children ABSTRACT The aim of this study was to evaluate influence of host and bacterial factors on oral colonization by MS in young children. It was observed during the course of investigation that children acquired MS by horizontal as well as vertical transmission. More... As the report stresses  various surveys, in many countries, have indicated presence of a type of dental caries, early childhood caries. These decays of primary teeth lead to dental abscesses and toothache which often requires anesthesia for treatment. Colonization by mutans streptococci (MS), particularly S. mutans and S. sobrinus, is the major cause of ECC in young children. There are disputes regarding time of entry of oral MS in young children and whether these are part of normal oral microflora or not. Since colonization by MS could be targeted to relieve young children from experiences of ECC, the paper would critically discuss host and microbial factors important for transmission and colonization of these bacteria.  From this paper it is clear that  mutans was also detected in predentate children, despite a low caries rate. Together, these reports suggest that children may be colonized by S. mutans before the "window of infectivity" opens. A predentate infant is not likel y to have MS in salivary flow since swallowing occurs fast while bacterial divisions are only 2-4 times. MS could instead persist by forming adherent colonies on mucosal surfaces.   Tanner and coworkers have demonstrated that the fur ­rows of the tongue appear to be an important ecological niche for oral MS.   It is contrary to the prior observations that MS colonization occurs only at the time of primary teeth eruption.   

Overpopulation on Earth Essay Example | Topics and Well Written Essays - 500 words

Overpopulation on Earth - Essay Example He leaves a conclusion using this argument: "a planet with relatively few people, each of whom can live with dignity and a high quality of life, is far superior to a world where too many people, awash in pollution, stretch resources to the breaking point, and where billions struggle to survive at mere subsistence levels". Benjamin Zuckerman creates a topic that is really interesting and timely. His purpose of delivering his theme and thesis make the readers understand very well the situation as well as the main idea of the essay. But unfortunately, Benjamin Zuckerman fails to write his essay in a rhetorical manner. Although he uses some of the metaphorical questions and symbolism as he mentioned angels and pin which represent people and the Earth, still, the theme will be loved only by the topic-lover audience, it will not pass to the standard of good writers and keen readers. The style of the essay reflects the writer being a proletarian even though his viewpoint has a great sense. The topic is effective but he placed it inappropriately.

Phenomenology and building Essay Example | Topics and Well Written Essays - 1750 words

Phenomenology and building - Essay Example Thesis Statement: The purpose of this paper is to write a phenomenological account of Le Corbusier’s Chapelle Notre-Dame du-Haut at Ronchamp. This account emphasizing the qualities of one’s personal experience of the feelings, images and emotions evoked by the building will be related to its material, form and spaces. Le Corbusier states that â€Å"the purpose of architecture is to move us. Architectural emotion exists when the work rings within us in tune with a universe whose laws we obey, recognize and respect† (Fortkamp 39). Similarly, according to Heidegger’s (1962) theory underscoring the phenomenology of built spaces, â€Å"there is no being apart from a world, rather there is first and only a Being in the world† (Seamon 248). Norberg-Schulz (1971), Relph (1976) and other theorists have identified modes of spatial experience as evident in a loose, continuous occurrence ranging from the abstract, measured geometric space to the concretely experienced space of daily living referred to as lived space. Unlike Plato and Euclid’s conceptualization of geometry as the science of space, the phenomenological perspective considers geometric space as having â€Å"a powerful predictive capacity rather than any superior claims to truth† (Seamon 248), while perspectives and impressions of the lived space of the life world form the actual reality. The history of the site as well as that of the earlier predecessor buildings catalysed the creative imagination of Le Corbusier into developing the building as it now exists (Figure 1). The Chapelle Notre-Dame du-Haut at Ronchamp is a chapel of pilgrimmage located at an ancient pilgimmage site, standing on a hill above the village of Ronchamp on the southern edge of the Vosges mountains in France. The present building is used for religious purposes by the clergy. Le Corbusier’s mind took inspiration from an ancient era of human antiquity to create the

Feasibility I Assignment Example | Topics and Well Written Essays - 1250 words

Feasibility I - Assignment Example Venture concept refers to a start-up entity built with the intention of benefiting financially. A business endeavor may also be deemed a small business. Numerous ventures will be advanced by one or more groups or individuals with the anticipation of the business raising a financial benefit for all sponsors. Most business ideas are generated on an insufficient supply in the market or the market demand. If the new venture is accepted by entrepreneurs or investors the growth of the new proposal will start and all supporting players will help expand and market the new venture to gain financially. The Food retail industry, for instance, particularly bake products has continued to develop into consumer demand. Rolls, fresh bread, cakes, and pastries are products customers seek on a daily basis. The new venture notion of Innovative bakery services and goods consumer is what Sweet Berry Company seeks about to establish. Introducing New Business Proposal –Sweet Berry Company The company makes customized pastries. What this means is that the clients log onto our website choose the product, for example, a cake then choose the ingredients that they want to be used to make a cake. The advantages of this are numerous as we can specify needs such as health or medical concerns for the clients. For example, clients who are lactose intolerant can place an order where the cake is made without the use of dairy products. This is where a business owner takes into consideration factors such as labor, location, suppliers, transportation amongst other factors (EPA, 2008). Investors are usually able to gauge a good business plan from the information contained in the technical feasibility. It is used to asses costs, long-term planning and troubleshooting. For our particular model of business, we have no competitors for this particular brand locally. The model that we have taken is from companies such as Indulge bakery in Colorado and sweet themes

Socio-Economic Consequences of Ecotourism Essay Example for Free

Socio-Economic Consequences of Ecotourism Essay Discuss the environmental and socio-economic consequences of ecotourism. What additional factors need to be considered in establishing ecotourism projects? Ecotourism aims to protect landscapes and wildlife, promoting also financial benefits to the local communities. According to Chaynee (2010), in Malaysia, ecotourism is the second largest source of Gross Domestic Product. It provides job opportunities and stimulates voyagers to show respect for the conservation of the environment. There are numerous positive and negative effects of ecotourism, and as a result, there is the need to apply additional actions to minimize the unbalanced outcomes. This essay will discuss the environmental consequences of ecotourism, such as, the conservation and deterioration of the surrounding areas. Secondly, it will analyse the socio-economic effects; finally the essay will suggest some factors for future ecotourism projects. The implementation of ecotourism has positive environmental consequences. Firstly, ecotourism allows the discovery of new places and the improvement on territory conservation. In her case study, Nikitina (2007) shows that in Russia, ecotourism has been showing off the natural areas, which during the Soviet Period were strictly protected. She also points out that the populations have more appreciation of the nature. What this means is that ecotourism may be seen as an environmental education program. Ecotourists are interested to respect rules and acquire knowledge about nature; consequentially, local communities may look at tourists as a correct model to imitate (Chaynee 2010; Waylen et al. 2009). Furthermore, according to Chaynee (2010), there is a positive impact on the attitude of local people towards conservation of their own culture. Being ecotourists interested to learn, local communities are incited to protect the cultural property value such as rituals, ceremonies, arts and crafts. However, besides protecting natural sites, ecotourism may also be the indirect reason of negative environmental consequences. This view is commonly shared; as Hueter in Jaffe (2009: 1) states, â€Å"There comes a time when you have so much interference through ecotourism that you affect the thing you’re trying to protect†. The reason for this could be that as ecotourism is becoming a phenomenon widely promoted, the large number of ecotourists attracted, may cause a higher rate of pollution and an increased deterioration of the environment. The island of Damas shows how over-crowing of tourists influences the natural behaviour of wildlife; penguins in contact with people may abandon their own natural habitats (Ellenberg in Jeff 2009). In addition, in Tortoguero, the significant amount of rubbish left by tourist harms the habitat of the animals (Meletis in Jeff 2009). Furthermore, according to York (2005), the establishment of tourist accommodations and the need of firewood have caused water contamination and deforestation. In conclusion, environment and wildlife are often victims of the ecotourism activities. Furthermore, ecotourism produces consequences in the socio-economic status of the local community, as the creation of new businesses increases job opportunities and improves the economy. For example, it involves host communities in the tourist industry, such as restaurants, accommodation, and local tours. In addition, in Zapovednik, a natural area in Russia, extra financial helps often occur by visitors for supporting the population (Nikitina 2007). On the other hand, it needs to be underlined that socio-economic consequences can also be negatives. A study to find out the effects of ecotourism on the Masai population claims that â€Å"The Masai have faced eviction from tribal lands, economic dislocation, assaults on traditional values, and environmental degradation† (York 2005: 2). For the local community, forests were the main source of income, allowing them to practice farming and other activities. However, since wildwood has become protected for the landscape conservation or destroyed for lodge constructions, the Masai are unable to use the natural resources for practicing their own businesses. In addition, in these places, industries duplicate traditional homemade products and sell these at a cheaper price; as a result the local economy is compromised (York 2005). Secondly, he believes that the prices of products and services have increased as an economic result of the turnout of a wide number of tourists. Indeed, in the Philippines, many people migrate due to the higher cost of living. Furthermore, a lack of water emerges due to the growing demand, both from the tourist facilities and local families (ibid). In conclusion, the drawbacks for the local people are various. Almost all of the above outcomes, both environmental and socio-economic, may be improved by applying corrective actions when considering future projects. Firstly, according to Libosada (2009) ecotourism should be managed like as a business and seen as a networked industry: tourist agents should work on tour promotions, the host communities provide accommodation, and the government should fix rules within the ecotourism business. In fact, a successful model for the development of ecotourism requires the participation of all of the subjects involved. In addition, by developing an accurate framework become possible resolving the conflict of interest between them, planning the use of resources and also auditing the results during the implementation of the project. Furthermore, in order to avoid some negative effects of mass tourism, Libosada (2009) suggests to identify the physical limits of the local area, in relation to carrying capacity of tourists, and use these limitations to plan future strategies; this is known as the LAC concept. Another example of how minimize the environmental deteriorations is the creation of buffer zones close to the core-protected areas. In these are promoted all the tourist activities in order to attract people and leave the protected sites intact (Nikitina 2007). Finally, in order to prevent the migration of local people, Jaffe (2009) points out that an agreement should ensure that they are employed in the village activities, so that money remains in the economy of the local area. This essay has discussed the wide impact of ecotourism on the environment, and how it may affects the socio-economic status of the communities. The several drawbacks may be minimized with the adoption of an accurate framework as guideline, the creation of buffer zones and the identification of physical limits of the ecotourism hosting areas. These actions may be fundamentals for the establishment of future ecotourism projects. Therefore, co-operation between government, local people and tourist industry is the key tool. If all the potential beneficiaries of the projects work together for the same targets, ecotourism will be more profitable and successful. List of References Chaynee, W. (2010). Benefits of Ecotourism for Local Communities. Available at: http://www.mier.org. [Accessed 22/05/10]. Jaffe, E. (2009). Science News.  © 2009 Science Service, Inc. 170(14). Libosada Jr. C.M. (2009). Ocean Coastal Management, 52, 390–394. Available at: http://www.elsevier.com/locate/ocecoaman. [Accessed 15 Nov 2012]. Nikitina, E (2007) Ecotourism: an Opportunity for Sustainable Development Available at http://www.russianconservation.org [Accessed 19/05/09]. Waylen, K.A., McGowan,P.J.K., Pawi Study Group and Milner-Gulland, E.J. (2009). Ecotourism positively affects awareness and attitudes but not conservation behaviours: a case study at Grande Riviere, Trinidad. Fauna Flora International Oryx. 43(3), 343–351 Available at: http://journals.cambridge.org [Accessed 28/05/10]. York, S. (2005) Eco-Tourism Can Be Both a Boon and a Curse for Indigenous Peoples. Available at: http://commongroundmag.com. [Accessed 16/05/06].

Pathophysiology of Systemic Lupus Erythematosus

Pathophysiology of Systemic Lupus Erythematosus Introduction This essay will explore the pathophysiology relating to a call I attended while on practice placement as a student technician. The initial call details were that it was a 45 year old female in pain. On our arrival the patient was sat in a chair and was breathing rapidly and had a very flushed face. After introducing ourselves and gaining the patients consent we then proceeded to take her basic observations and take her history. Most of her observations were within acceptable limits however her blood pressure was slightly high, she had a raised pulse at 120 beats per minute and slightly high temperature at 38 degrees Celsius. On questioning the patient had a localised pain score of 8/10 in her back and a pains in her joints and muscles with a pain score of 4/10. When questioned about her medical history, she stated she had a condition called systemic lupus erythematosus. This is not a condition I had heard of before I, therefore, questioned her more about it. Differential Diagnosis A 20 year-old women patient presented with fatigue, heart palpitations and anxiety. Reviewing the patient’s history revealed that she started experiencing anxiety, fatigue and heart palpitations approximately two years ago when she was still pregnant and she arranged to visit her own doctor. At that time her doctor stated that this was was due to stress. However, her symptoms became worse after she had another child. She stated that before going into labour she experienced premature contractions, headaches, increased fatigue, and swelling of her legs. Her doctor advised her to stay off work and have some bed rest. Shortly after giving birth to her third child, the patient began experiencing several new symptoms. Her knees and ankles started swelling, she also developed sever pain in her knees, wrists, elbows, and fingers. During the winter the patient started feeling painful and her peripheral joints became discolored whenever exposed to cold. She had recently been admitted to hospital in order for tests to be carried out and although she was still waiting for a definative outcome, a rhueamatology consultant she was under stated he was fairly certain that she had stemic lupus erythematosus. Epidemiology According to Somers et al (2007) approximately five people in every ten thousand suffer from systemic lupus erythematosus. Ninety percent of patients who are diagnosed with systemic lupus erythematosus are female (GinzlerTayar 2012; Blank et al 2009). It most commonly develops in women aged between 20 and 40 although anyone of any gender and age can develop it at any time. With regards to ethnic origin systemic lupus erythematosus is more prevalent in those with Afro-caribean, Asian or Chinese ancestry. Although there is a possibility of having a genetic pre-disposition to the disease only 3 of 100 children of those diagnosed with systemic lupus erythematosus will go on to develop it. According to National Health and Nutrition Examination Survey (2004) a survey in which it was observed that 100% of patients with System lupus erythematosus were receiving treatment. Aetiology Although there is no definate cause of systemic lupus erythematosus (Giannouli 2006), there is thought to be several factors increasing the likelihood of developing systemic lupus erythematous they include Genetics {where members of the family have lupus this condition will often increase the childs chances of developing it} (Hemminki 2009). It is also thought it can also be triggered by environmental factors such as trauma, ultraviolet rays and also emotional stress. Gender and hormones is thought to be the biggest factor affecting the chances of developing systemic lupus erythematous as it is proven that it mostly affects women than men especially when they are in menstrual periods or in their pregnancy, it is said to occur nine times more to women in comparison to men (GinzlerTayar 2012). Pathophysiology System lupus erythematosus is an autoimmune disease. The autoimmune system is responsible for fighting foreign and often harmful bacteria in the human system. However with systemic lupus erythematosus the immune system will attack itself, the pathology of this disease is similar to that of rheumatoid arthritis and can affect any part of the body (GinzlerTayar 2012). Systemic lupus erythematosus may also occur in the form of periarticular inflammation that affects the tendon sheaths, the illness causes the patient to experience coexisting fibromyalgia that results to poor sleep, chronic disease, inactivity ,mood problems and depression (Knott 2012). Patients who suffer from this condition have abnormalities when it comes to their immune system, this includes the B cell function, apoptosis and also the T cell function. Systemic lupus erythematous mostly attacks the blood vessels, the skin, the heart, nervous system, liver, lungs and the kidneys (Knott 2012). Unfortunately when System lupus erythematous persists without effective treatment it may result in serious complications such as stroke, heart inflammation, lung damage, blood clots and if the patient is female it may result in miscarriage or pregnancy complications. Research shows that the exact cause of immune deregulation is not yet clear but it may be as a result of interference of endogenous metabolism that affects the function of antigens in the human system (GinzlerTayar 2012). The abnormalities caused by System lupus erythematosus may vary from one ethnic group to another for instance East Asians who have this problem they have extra cytotoxic T lymphocyte antigen-4 while the white populations abnormalities is observed through having more Fc-Y receptors (Hemminki 2009) . For effective diagnosis of System lupus erythematosus it is of essence to deal with specific autoantibodies in order to treat the root cause of the disease (GinzlerTayar 2012). The symptoms of systemic lupus erythematosus will vary from patient to patient as the signs and symptoms displayed will depend on the body part or system that is being affected by the systemic lupus erythematosus (Arthritis Research UK 2014). However there are some generalised symptoms and these are about to be discussed. Dermatological symptoms caused by systemic lupus erythematosus could include rashes and in some cases a specific rash to the cheeks known as a â€Å"butterfly rash† can be identified (Knott 2012). Another common issue for the majority of people with systemic lupus erythematosus find that they become much more sensitive to sunlight. It is also common for the blood vessels under the skin in the joints to become inflamed and this can lead to poor circulation to these areas (this is called Raynauds phenomenon)(GinzlerTayar 2012). Oral ulceration can sometimes occur for this very reason. Blood disorders have been known to develop especially in children, the most common being anaemia. Having anaemia would obviously cause lethargy and low mood (Giannouli 2006). Patients with systemic lupus erythematosus are much more at risk of developing cardiac issues than the general public as the disease often causes inflammation of the blood vessels within the heart, thus increasing the risk of developing atherosclerosis which in turn could lead to a myocardial infarction if one of the blood vessels was to become blocked(Blank et al 2009). If the kidneys were to become inflamed due to the systemic lupus erythematosus, this could cause symptoms including haematuria (blood in the urine). Also, if the kidneys become inflamed this could lead to the patient developing a kidney infection which will result in the patient having moderate to severe back pain (GinzlerTayar 2012). The most common issue for patients suffering from systemic lupus erythematosus is to do with their joints (Somers et al 2007). Most people suffering from systemic lupus erythematosus will develop pain in their muscles, joints and peripheral joints such as joints in their hands and knees can often become inflamed. This can be due to a condition known as Osteonecrosis developing due to the systemic lupus erythematosus (Giannouli 2006). Osteonecrosis is a condition that develops when there is a reduced blood supply to the bones. Osteonecrosis will affect the bones ability to replace old bone with new bone and if an injury is sustained it may never be able to heal properly (Knott 2012). Most patients find that it is worse when they wake up in the morning and as this is a chronic condition, it can often feel better in periods of remission and more painful during a relapse period (GinzlerTayar 2012). Diagnosis The process involves the blood tests including antibody tests, urinalysis and a chest X-ray which is mostly overseen by Rheumatology Consultants whose area of specialisation is autoimmune diseases and also soft tissue treatment. Musculoskeletal symptoms are analysed when trying to diagnose System lupus erythematous and it can be manifested as arthritis or arthralgia in which the patient expresses it as stiffness and pain, when it occurs in System lupus erythematous it can be in the form of migratory or transient pain and it is difficult to be diagnosed since it may be present when the patient makes the appointment with a doctor only to be resolved in the process of evaluation(Ginzler Tayar 2012 and Knott 2012). Systemic lupus erythematosus caused fewer erosions or fixed deformities unlike rheumatoid arthritis which is much more degernerative to the joints (GinzlerTayar 2012). There is also the possibility of around 4% of the patients will suffer from myositis ( which is the inflamat ion of the muscle tissue) and this can be examined by taking a biopsy of muscle tissue (Giannouli 2006). Pharmacology and associated treatment: Unfortunately there is no cure for Systemic lupus erythematosus and the treatment plan is based on symptom relief as opposed to direct treatment of the disease(GinzlerTayar 2012, Blank et al 2007, Knott 2012). Treatment of Systemic lupus erythematosus is very specific to the individual patient and it always depends in manifestation of the symptoms, the disease severity and most importantly the specific organ affected(Giannouli 2006). In order to devise the most appropriate treatment plan the rheumatology consultant will perform a number of diagnostic tests and depending on what the results are will influence the treatment plan (Giannouli 2006). Patients suffering from systemic lupus erythematosus will often need to take a group of medications called non-steroidal anti inflammatory drugs (Knott 2012). This group of medications work by reducing the inflammation in the affected joints and hopefully reducing the amount of pain the patient is in. Some common non-steroidal anti inflammatory drugs are ibuprofen, aspirin and diclofenac sodium (these are all available without a prescription from a pharmacy), the rheumatology consultant may recommend Naproxen or pirixicam in certain circumstances (BNF 2014). With non-steroidal anti inflammatory drugs there is a risk that they may cause damage to the lining of the stomach and could even cause ulceration in the stomach when taken over long periods of time in high doses(Knott 2012). If the patient is taking frequent non-steroidal anti inflammatory drugs they may be prescribed a proton pump inhibitor medication in order to protect the stomach. These medications work by reducing the amount of acid the stomach produced and thus protecting the lining of the stomach (Knott 2012). Common proton pump inhibitor medications include; omperazole, lansoprazole, pantoprazole and esomeprazole (BNF 2014). A further treratment that a rheumatology consultant may consider is the use of a medication called hydroxychloroquine (Giannouli 2006). Hydroxychloroquine was originally an anti-malarial drug however it has recently started being used to treat the symptoms of systemic lupus erythematosus and is a disease modifying anti-rheumatic drug (also known as DMARD)(Knott 2012). Hydroxychloroquine works by reducing the response from the immune system which is causing the symptoms (this is probably the closest treatment to treating the cause as opposed to just the symptoms). It is used as a long term treatment to try and prevent relapses or flare ups of the disease (GinzlerTayar 2012). Corticosteroids may be used in severe systemic lupus erythematosus (GinzlerTayar 2012). They may be prescribed during relapses of the disease. Corticosteroids work by blocking the normal function of the white blood cells and reducing the inflammation response(Knott 2012). However the negative aspect of this is that it leaves patients very vulnerable to infections(GinzlerTayar 2012). Other side effect could include the patients bones becoming more fragile, the skin becoming thinner, hypertension and also weight gain. For this reason corticosteroids will only be used to treat flare ups at the minimum effective dose and then reduce the dose slowly as the symptoms ease. Corticosteroids used in the treatment of this disease are hydrocortisone and predniselone(BNF 2014). Often used in conjunction with corticosteroids during a relapse are a group of medications called immunosuppressants . These medications will work by reducing the action of the immune system and will be used when the immune system is attacking a healthy part of the patients body(Knott 2012). Again these medications will reduce the pateints ability to fight harmful infections and can cause many side effects. Immunosuppresent medications used include: azathioprine, mycophenolate mofetil and cyclophosphamide (BNF 2014). The final medication to be discussed is called Rituximab. Rituximab was originally created to treat blood cancer however an â€Å"off-label† use for this medication is to treat autoimmune diseases. The way Rituximab works is by destroying the B-Cells(The B-Cells which cause the release of antibodies resulting in the symptoms). As with all the other medications there could be side effects the most common being dizziness and vomiting. Rituximab can only be administered intravenoulsy so will normally require hospital admission for the patient to receive it . (Knott 2012) Other interventions include an advice session from the doctor regarding the patients lifestyle and diet may be of vital importance this may help the patient and minimise lifestyle related stress (GinzlerTayar 2012) . The patient may be suggested to work with a support group or even receive counselling as the condition can cause severe and life limiting symptoms while in relapse. Most patients with systemic lupus erythematosus are also advised to avoid the sun as it can aggravate and skin symptoms(Knott 2012). Conclusion Systemic Lupus Erythematosus is a very complex disease and can present itself in many different ways depending on the patient and the part of the body affected. In the pre-hospital environment it is very important to get a detailed history in order to identify whether they have been diagnosed with this disease. Clinicians must remember systemic lupus ertythematosus can limit a patients quality off life while they are having a relapse so it is important to assess each patients individual symptoms and if necessary administer pain relief and position them so they are comfortable. It is also important for ambulance clinicians to be mindful of the patients joints when using moving and handling techniques as this could obviously cause the patient discomfort or even pain due to the condition. References: Arthritus Research UK. (2014). Systemic Lupus Erythematosus. Available: http://www.arthritisresearchuk.org/arthritis-information/drugs/hydroxychloroquine/what-it-is.aspx. Last accessed 20/03/2014. Blank M, Shoenfeld Y, Perl A. 2009. Cross-talk of the environment with the host genome and the immune system through endogenous retroviruses in systemic lupus erythematosus. Lupus. Nov;18 (13):1136-43 Giannouli, S (2006) Annals of rheumatic disease, Anaemia in systemic lupus erythematosus from pathophysiology to clinical diagnosis. 65(2) p144-148 Ginzler E, Tayar J. 2012. Systemic lupus erythematosus (lupus). Updated: January 2012. Available at http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/lupus.pdf#search=sle. [Accessed on February 21, 2014 at 21:30] Hemminki K, Li X, Sundquist J, Sundquist K (February 2009). Familial associations of rheumatoid arthritis with autoimmune diseases and related conditions. Arthritis Rheumatology. 60 (3): 661–8 Knott, L. (2012). Systemic Lupus Erythematosus. Available: http://www.patient.co.uk/health/systemic-lupus-erythematosus. Last accessed 20/03/2014. Somers E, Thomas L, Smeeth L .2007. Incidence of systemic lupus erythematosus in the United Kingdom, Arthritus Rheum 15;57(4) p612 – p618.

Case Report of Secondary Narcolepsy

Case Report of Secondary Narcolepsy Title of the article: â€Å" Case Report of Secondary Narcolepsy presenting as self-inflicted genital injury † Abstract: Primary Narcolepsy is a sleep disorder with classical presentation showing tetrad of excessive daytime sleepiness, cataplexy, sleep paralysis, and Hypnogogic hallucinations. Some conditions that result in secondary narcolepsy include traumatic brain injury, tumors, and stroke. [1] A rare case of secondary narcolepsy was seen in a patient with self-inflicted genital injury. A 30 year old male was referred to Psychiatry from Surgery for a self-inflicted incised wound on hydrocoele. Since last 1 year, he had multiple episodes of 1. Sudden falls while working 2. Sleep during daytime often at unusual places 3. Periods of unresponsiveness during which he was aware but unable to move. During hospital stay, daytime somnolence, sleep paralysis and cataplexy were noted several times, but hallucinations were not consistently reported. Based on DSM-IV-TR Narcolepsy was diagnosed. Possible reasons for genital injury were 1. To remove fluid from swelling 2. Under sleep paralysis 3. Under Hypnogogic hallucinations. Patients EEG was normal. MRI brain showed Gliosis at cervico-medullary junction.MRI spine was advised to examine the cervico-vertebral junction but patient was lost to follow-up. But from history and investigations, it was concluded that he had secondary narcolep sy due to traumatic brain injury. Narcolepsy typically begins in the 2nd and 3rd decades of life and negatively impacts the quality of life of affected patients. Diagnosis relies on patient history and objective data gathered from polysomnography and multiple sleep latency testing. Treatment focuses on symptom relief through medication, education, and behavioural modification. Key-words: Cataplexy; Narcolepsy; Polysomnography; Self inflicted injury, Key Messages [D1]:Secondary narcolepsy is rare and sometimes can be missed to diagnose. Such rare presentation of secondary narcolepsy helps in diagnosing other cases of self-inflicting injuries. Introduction:[D2] Narcolepsy is neither a type of epilepsy nor a psychogenic disturbance. It is an abnormality of the sleep mechanisms specifically, REM-inhibiting mechanisms and it has been studied in dogs, sheep, and humans. Narcolepsy can occur at any age, but it most frequently begins in adolescence or young adulthood, generally before the age of 30. The disorder either progresses slowly or reaches a plateau that is maintained throughout life.[2]. The prevalence of narcolepsy varies across countries and with different ethnic groups, and so the exact prevalence is not known. Prevalence estimates have been reported to be between 168 and 799 per 100,000 in most studies, although Japanese studies have indicated a higher prevalence of 1600 per 100,000.[2,3]. There are no genetic tests current ly available for clinical use to make a positive diagnosis of narcolepsy. Genetic testing may correlate best to narcolepsy when there is already clear cataplexy.[4]. Supporting the evidence for an environmental influence is the fact that the disease is not apparent at birth, but instead commonly has its onset during the second decade of life. Additionally, there are apparent precipitating factors such as head trauma, infection, and changes in sleep-waking habits that have been identified in some cases.[6] Chronic, daytime sleepiness is a major, disabling symptom for many patients with traumatic brain injury (TBI), but thus far, its aetiology is not well understood. Extensive loss of the hypothalamic neurons that produce the wake-promoting neuropeptide hypocretin (orexin) causes the severe sleepiness of narcolepsy, and partial loss of these cells may contribute to the sleepiness of Parkinson disease and other disorders. One study has found that the number of hypocretin neurons is significantly reduced in patients with severe TBI. This observation highlights the often overlooked hypothalamic injury in TBI and provides new insights into the causes o f chronic sleepiness in patients with TBI.[7] Amphetamine usage has been associated with addiction, psychosis and self-injurious behaviour. There are reports on two patients who severely and repeatedly mutilated their own genitalia while intoxicated on amphetamines and consider possible diagnostic aetiologies.[8] Genital mutilation is common in males compared to females.[9] But narcolepsy presenting as self inflicted genital injury has not been reported so far. That is why this is a rare case. Case History[D3]: A case of secondary narcolepsy was seen in a patient presenting as self-inflicted genital injury. A 30 year old Hindi speaking illiterate male was referred to Psychiatry from Surgery for a self-inflicted incised wound on hydrocele. After primary wound closure at surgical side, patient was taken transfer to Psychiatry for detailed assessment. When detailed history was obtained from patients elder brother and father, it was found that since last 1 year, he had multiple episodes of sudden falls while working at kitchen as he was a cook. He used to sleep during daytime often at unusual places like in the courtyard, once over the road and sometimes in bathroom. Patient also had periods of unresponsiveness during which he was aware but unable to move himself even on painful stimulation. During hospital stay, daytime somnolence, sleep paralysis and cataplexy were noted several times, but hallucinations were not consistently reported. Based on DSM-IV-TR Narcolepsy was diagn osed. Possible reasons for genital injury were 1. To remove fluid from swelling 2. Under sleep paralysis 3. Under Hypnogogic hallucinations. Patients EEG was normal. MRI brain showed Gliosis at cervico-medullary junction.MRI spine advised to examine the cervico-vertebral junction but patient was lost to follow-up. But from history and investigations, it was concluded that he had secondary narcolepsy due to traumatic brain injury Discussion: Narcolepsy is a condition characterized by excessive sleepiness, as well as auxiliary symptoms that represent the intrusion of aspects of REM sleep into the wakingstate. The sleep attacks of narcolepsy represent episodes of irresistible sleepiness, leading to perhaps 10 to 20 minutes of sleep, after which the patient feels refreshed, at least briefly. They can occur at inappropriate times (e.g., while eating, talking, or driving and during sex). The REM sleep includes Hypnogogic and Hypnopompic hallucinations, cataplexy, and sleep paralysis. The appearance of REM sleep within 10 minutes of sleep onset (sleep-onset REM periods) is also considered evidence of narcolepsy. The disorder can be dangerous because it can lead to automobile and industrial accidents. Other symptoms include Hypnogogic or Hypnopompic hallucinations, which are vivid perceptual experiences, either auditory or visual, occurring at sleep onset or on awakening. Patients are often momentarily frightened, but within a minute or two they return to an entirely normal frame of mind and are aware that nothing was actually there. Here patient had symptoms of narcolepsy after head injury and patient himself injured his scrotum with sharp blade for which he had no clear memory and there was no history suggestive of epilepsy so diagnosis of secondary narcolepsy presenting as self-inflicted genital injury was considered.In this case, patient showed clinical features of narcolepsy as diagnosed by DSM- IV which was secondary type as there was history of multiple falls and MRI brain showed gliosis. But in this case, unusual presentation was genital self-inflicted injury. Possible reasons for genital injury are: Automatic behavior. Acting on Hypnogogic/Hypnopompic hallucinations. Due to impaired cognitive function/ judgment due to long-standing Narcolepsy. No cure exists for narcolepsy, but symptom management is possible. A regimen of forced naps at a regular time of day occasionally helps patients with narcolepsy and, in some cases, the regimen alone, without medication, can almost cure the condition. When medication is required, stimulants are most commonly used.[10] Although drug therapy is the treatment of choice, the overall therapeutic approach should include scheduled naps, lifestyle adjustment, psychological counselling, drug holidays to reduce tolerance, and careful monitoring of drug refills, general health, and cardiac status. References[D4]: 1. Narcolepsy: Clinical features, co-morbidities treatment Jeremy Peacock Ruth M. Benca Indian J Med Res 131, pp 338-349: 2010 2. Longstreth WT, Jr., Koepsell TD, Ton TG, Hendrickson AF, van Belle G. The epidemiology of narcolepsy. Sleep 2007; 30 : 13-26. 3.Tashiro T, Kanbayashi T, Iijima S, Hishakawa Y. An epidemiological study on prevalence of narcolepsy in Japanese. J Sleep Res 1992; (Suppl 1) : 228. 4. Bourgin P, Zeitzer JM, Mignot E. CSF hypocretin-1 assessment in sleep and neurological disorders. Lancet Neurol 2008; 7 : 649-62 5. Krahn LE, Pankratz VS, Oliver L, Boeve BF et al, Narcoleptic and schizophrenic hallucinations. Implications for differential diagnosis and pathophysiology. Eur J Health Econ. 2002; 3 (Suppl 2) : S94-8. 6. Bourgin P, Zeitzer JM, Mignot E. CSF hypocretin-1 assessment in sleep and neurological disorders. Lancet Neurol 2008; 7 :649-62. 7. Christian R. Baumann MD, Claudio L. Bassetti MD, Philipp O. Valko MD, Johannes Haybaeck MD,et al Loss of hypocretin (orexin) neurons with traumatic brain injury. 8. Joshua A. Israel and Kewchang, Lee Article first published online: Amphetamine usage and genital self-mutilation. 2002 DOI:10.1046/j.1360-0443.2002.00230.x 9. MartinT. ·GattazW.F, Psychiatric Aspects of Male Genital Self-Mutilation.Psychopathology; 24:170–178,1991. 10. synopsis of psychiatry 10th edition Case series of genital mutilation :The Journal of Urology150(4):1143-1146] 1993. [D1]1 Provide appropriate messages of about 35-50 words to be printed in centre box [D2]1 Please include why this case is unique. If it is rare, how rare, how many cases have been reported. [D3]1 Include the tables/charts at appropriate places in the text it self. Do not include images in the text. Mark the point of insertion of images (e.g. Figure 1) along with the legends. Send the images separately as jpeg files (not larger than 100 kb each) [D4]1 Follow the punctuation marks carefully. Do not include unnecessary bibliographic elements such as issue number, month of publication, etc. Include names of six authors followed by et al if there are more than six authors.

Sartres Philosophy Essays -- Philosophy Sartre Essays Papers

Sartre's Philosophy Sartre believed that one day man happened, or occurred, and after this anomalous event man’s life took meaning. With this theory, Sartre articulated the premise that â€Å"existence precedes essence†. Through this assumption, Sartre evolves further ideas in which a human can gain a greater understanding of human nature and responsibility.   Ã‚  Ã‚  Ã‚  Ã‚  In his theory stating that â€Å"existence precedes essence†, Sartre takes the belief that life has a meaning that far transcends our short and insignificant lives. He believed that life has no meaning unless we gave it meaning. In the search for life, we become anguished by the affairs of life. Sartre believed that when this occurred, we pursue a fundamental project in an attempt to flee this anguish. Sartre said that in this, we try to make ourselves Gods in hopes that others will see us as divine, and hold us in high or higher regard. To pursue a fundamental project according to Sartre is to act in bad faith. Consequently, to act in bad faith, according to Sartre is to manifest our freedom inauthenticaly.   Ã‚  Ã‚  Ã‚  Ã‚  Sartre assessed how when man acknowledges and accepts that he is a living being with a biological and social past. He can transcend beyond that to nothingness, the realm of the etre pour soi (the â€Å"being-for-itself†). At this point he is, according to Sartre, clearheaded and in good faith. Because he is acting in good faith, he is not pursuing a fundamental project in an attempt to ci...

Installing an Intake :: essays research papers

Installing an aftermarket intake is easier then you think with these easy to follow instructions. All that is needed are a few basic tools: a regular screw driver (flat head) and a ratchet with a 3/8† bit and an adjustable wrench. There is no need to jack the car up for installing this part; all that is needed is to pop the hood.   Ã‚  Ã‚  Ã‚  Ã‚  After you have gathered all of your tools, pop the hood and get familiar with what you we will be replacing. The intake is the big black plastic box found at the lower left hand corner of the engine and the pipe that runs up to the intake manifold that is at the top of the engine. What the short ram intake does is create a more direct path to the intake manifold; it also increases the amount of air taken in with the bigger filter. Before doing anything to the car, it is always a good idea to take the negative terminal off the battery just so there is no power in the wires in case something slips. Use your adjustable wrench and loosen the negative terminal on the battery. Now just pull the wire off and let it rest somewhere on the battery making sure it is not touching the positive terminal or the negative terminal.   Ã‚  Ã‚  Ã‚  Ã‚  Now that the battery is disconnected, let’s start by loosening the clamp at the intake manifold and the intake pipe. Use the screw driver and loosen the clamp until you can get your small finger underneath the clamp. There should be two bots holding down the intake box. Use the ratchet with your 3/8† bit and use the bolts right out and place them somewhere safe in case you ever decide to put the old intake back on. Now that the bolts are out, carefully pull up on the air box and remove it from the connecting pipes under it. The air box should just come up so just wiggle it a bit if it appears to be stuck. Now pull the intake pipe off the intake manifold but watch for the clamp you will need this for the next step. Once again if it appears to be stuck just, give it a little wiggle. Now pull the entire piece out of the engine and you will notice a lot of free space. You are now ready to put in the AEM short ram intake. Installing an Intake :: essays research papers Installing an aftermarket intake is easier then you think with these easy to follow instructions. All that is needed are a few basic tools: a regular screw driver (flat head) and a ratchet with a 3/8† bit and an adjustable wrench. There is no need to jack the car up for installing this part; all that is needed is to pop the hood.   Ã‚  Ã‚  Ã‚  Ã‚  After you have gathered all of your tools, pop the hood and get familiar with what you we will be replacing. The intake is the big black plastic box found at the lower left hand corner of the engine and the pipe that runs up to the intake manifold that is at the top of the engine. What the short ram intake does is create a more direct path to the intake manifold; it also increases the amount of air taken in with the bigger filter. Before doing anything to the car, it is always a good idea to take the negative terminal off the battery just so there is no power in the wires in case something slips. Use your adjustable wrench and loosen the negative terminal on the battery. Now just pull the wire off and let it rest somewhere on the battery making sure it is not touching the positive terminal or the negative terminal.   Ã‚  Ã‚  Ã‚  Ã‚  Now that the battery is disconnected, let’s start by loosening the clamp at the intake manifold and the intake pipe. Use the screw driver and loosen the clamp until you can get your small finger underneath the clamp. There should be two bots holding down the intake box. Use the ratchet with your 3/8† bit and use the bolts right out and place them somewhere safe in case you ever decide to put the old intake back on. Now that the bolts are out, carefully pull up on the air box and remove it from the connecting pipes under it. The air box should just come up so just wiggle it a bit if it appears to be stuck. Now pull the intake pipe off the intake manifold but watch for the clamp you will need this for the next step. Once again if it appears to be stuck just, give it a little wiggle. Now pull the entire piece out of the engine and you will notice a lot of free space. You are now ready to put in the AEM short ram intake.