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.