Interventions for Sexual Issues and Dysfunctions Essay

Interventions for Sexual Issues and Dysfunctions LaShawnda Ogle Walden University The Wilson’s are currently experiencing some sexual dysfunctions, a condition that can cause a lot of distress during intercourse (Hecker & Wetchler, 2010). In the case study Mrs. Wilson has been diagnosed with having Vaginismus. Vaginismus is known for causing some severe pain and as a result causes the female to avoid sexual activity (p. 377). It’s formally defined as the involuntary spastic contraction of the outer one-third of the vagina. There can be treatment techniques. The two sexual therapy interventions I would suggest for the Wilson’s are Cognitive Behavioral Therapy (CBT) and a medically treated approach using a vaginal dilator. The one intervention method suggested for Mrs. Wilson would be that of Cognitive Behavioral Therapy. According to Hecker & Wetchler, (2010), women with vaginismus can show fear and have some anxiety with the thought of penetration. In order to help decrease those fears and anxieties CBT may help Mrs. Wilson’s sexual satisfaction increase as well as her over all well-being: addressing not only the physical pain or discomfort of sex but also the psychological aspects. For example: there are cognitive strategies such as: sexual exercises and relaxation techniques that can be applied with CBT in order to help relieve the pain associated with vaginismus (Hecker & Wetchler, 2010). CBT can also offer some coping skills along with restructuring a person’s way of thinking. Another intervention treatment method for sexual disorders such as that of Mrs. Wilson is more of a medically treated approach. Hecker & Wetchler, (2010) suggest a vaginal dilator as being a useful technique for modifying a conditioned response. Vaginal dilators are used to teach control of circumvaginal muscles (p. 377). In order to use these dilators they are generally supplied to people from a doctor’s office with or without the presence of the person’s partner. The private space offers the opportunity to help decrease the fear and anxiety with sex so that penetration can occur. The similarities of both CBT therapy and the medically treated approach using a vaginal dilator are that they both focus on calming the painful symptoms associated with sexual discourse in females. Another similarity with the two interventions is that they both offer suggestions in how to cope and deal with the shame and/or guilt associated with sexual dysfunctions. The only differences are the methods used to intervene. CBT focuses more on the cognition of dealing with negative thoughts that often occur with sexual disorders. The vaginal dilators focus on ways to relieve the stress without the conditioned fear response (p. 377). A challenge with using CBT therapy and vaginal dilators is that it encourages having both partners actively involved (Hecker & Wetchler, 2010). Sexual intercourse and dysfunctions can be a touchy subject that does not resolve itself without partner interaction, so getting both partners together could be somewhat of a challenge. In order to know whether or not a treatment intervention is working, both Mr. and Mrs. Wilson need to report the improvements in the symptoms of Mrs. Wilson. I would also like to know from both partners if increased enjoyment has occurred after treatment, in order to know whether or not my treatment interventions were working. Nonetheless, getting both partners together to discuss a sexual dysfunction is something I see as a challenge. References Hecker, L. , L. , & Wetchler, J. L. , eds. (2003). An Introduction to Marriage and Family Therapy (1st ed. ). Binghamton, NY: The Haworth Clinical Practice Press.

Is the belief in God rational? Essay

â€Å"The fool hath said in his heart, There is no God† (Psalm 14:1, KJV ) â€Å" He that believeth on me, as the scripture hath said, out of his belly shall flow rivers of living water† (John 7:38, KJV) As per Holy Bible, in the beginning, when there was no form, God had worked for six days in creating heaven and earth, â€Å"God saw every thing that he had made, and behold, it was very good† (Genesis 1:31 KJV). On seventh day, God ended his work and took rest. The very existence of earth, sun, moon, sky and stars are the resemblances of God’s work which are working without the intervention of human science which produces a fact there is a supernatural strength of spirit beyond the recognition of human knowledge and understanding. Accepting the fact that who believe in God is a theist and a non-believer is an atheist, each must have own justification of epistemic beliefs or non-beliefs on God with supportive arguments, irrespective of religion whether it is Buddhism, Hinduism, Islam or Christianity. Theists are fundamental believers on God and atheists draw scientific conclusions and explanations that God is unnecessary. Buddhism and Hinduism have a unique identity in explaining about atheism and also about the rationality about belief in God and so also the religion of Islam. Christianity as a religion, propagates Jesus Christ as God with a strong evidence of empty tomb and also taking the evidence of miracles performed and teachings quoted in four gospels of New Testament. According to Apostle Paul Jesus was â€Å" declared the son of God with power by the resurrection from the dead†. (Romans 1:4). The above concludes an opinion that God is a supreme being who is omnipotent and omnipresent, creator and ruler of the whole universe for Christianity scriptures are the proof of God. Belief or non-belief on God is based on a personal life experiences and the interaction with inner soul and God. A view at Old Testament of Holy Bible reveals some of the facts that God did communicate with Adam, Eve, Abraham, Isaac and Jacob. Moses was commanded by God to divide the red sea and to lead the Israel out of bondage from Pharaoh. The rationality behind the above, produces a strong evidence that the presence of God always surrounds the earth and this supernatural force controls the entire universe. This is a fact for those who believe and who listen to the voice of God. According to the Holy Bible, the seed of disbelief on the existence of God is none other than evil force which transforms the human minds who get carried away into material facts of the world and become the cause of self-fall. Conclusion Belief on God is good and is rational, as it is stated in Psalms â€Å"The fear of the Lord is the beginning of wisdom†. Human knowledge, development and wisdom are the gifts of God who is an embodiment of kindness, mercy and wisdom. If King Solomon asked for wisdom to lead kingdom, Moses asked for accuracy in speech to communicate with people, each according to the wants and desires, were offered gifts by God. This was made possible only by God and for believers the history of past glories of God is the holy grail to carry and move on. Reference Gregory Kouki (2001), It is rational to believe in God? Accessed on 21 February, 2007

Nursing curricullum Essay Example | Topics and Well Written Essays - 1000 words - 1

Nursing curricullum - Essay Example the clinical setting entails role modelling, influencing others, improving care and considering situational leadership particularly when in communication with different parties in all situations1. Practice based learning, on the other hand, helps in providing experience and serves a pivotal role in development of skills among students in interacting with their families and patients2. The students assist in interpersonal, technical, psychomotor and communication skills. Practice based learning gives students an opportunity to link practice and theory while promoting professional identity development. By ensuring that specific standards are dully met alongside the assessment in practice, practice based learning, effectively ensures students are well informed for practice before registration. Because of the vocation nature of the nurses’ jobs, practice based learning serves a crucial role in the professionalism of nursing and it helps in safeguarding the public, as well as in ass essment of the clinical competency of the nurses. This study analyses the factors that impact on how students integrate into the practice setting, as well as the assessment and accountability processes in the learning practice. There are five factors that impact on how students integrate into the practice settings. These are orienting the learner to the practice setting, encouraging the patient acceptance of the learner and the role of the practice as a teaching facility, adapting the patient schedule while working with the learner, keeping the flow going, and finding some time to teach the students3. The efficient and effective orientation includes the establishment of a system that can orient learners to help assure the teacher that he or she will be able to cover all the relevant points with each learner. Some preceptors tend to use checklist in reminding the learners of the topics that are to be covered while clarifying his or her expectation4. If learners are made to be available

Sex Insomnia Research Paper Example | Topics and Well Written Essays - 1250 words

Sex Insomnia - Research Paper Example Sexsomnia is a NREM (non- rapid eye movement) disorder caused by confusional arousal results to sexual activities. In simple terms, sleep sex occurs when the mind is inactive, but the body is active. Most case studies reveal that sleep sex takes place during the first five stages of sleep known as deep sleep. Just like children experience nightmares triggered off by scary movies, an arousing dream or a slight touch from a partner in bed can trigger off sleep sex in an individual. The amygdale in the brainstem is the organ responsible for sexual drive. At this stage, the cortex is part of the brain responsible for thinking, planning and awareness (Michael, 2011). Sexsomaniacs especially women tend to masturbate and moan loudly while asleep while men engage in sex with their female partners. In extreme situations, victims can become aggressive and out of control resulting in sexual assault cases. In addition, sleep sex occurs mostly in individuals who have bed partners. Therefore, ther e is no need to walk and look for a partner. Individuals that suffer from sleep sex often have a history of other parasomnia disorders like sleep talking, sleep walking and teeth grinding. Recurrence of sexsomnia is unpredictable. Individuals who exhibit this disorder are partly conscious when it occurs. This is because part of the brain responsible for decision-making is at rest while the brain stem responsible for sexual desire remains active. ... Later she started having sex with strangers she met on the streets while sleepwalking. Other triggers of sleep sex include; lack of enough sleep, excessive consumption of alcohol and other narcotic drugs, stress, poor sleeping habits and tiredness (Michael, 2011). People who have epilepsy may experience seizures that trigger off sexual arousal. These seizures come inform of abdominal thrusts, eventually engaging in sexual acts. However, epileptic sufferers’ remember their sexual acts the next day. Genes and gender are also factors that contribute to sleep sex. Studies indicate that, sexsomnia affect more men than women. Over two thirds of reported sleep sex cases are men. Many people who suffer from sleep sex exhibit feelings of shame, denial and confusion Often victims of sexsomnia shy away from treatment and medical intervention. They do not realize the adverse psychological effects it can have on them (Joris, 2008). The earlier they seek for medical help the better. Victims lack self-esteem and are always under stress. Sleep sex exert in relationship lots of pressure and tension resulting to breakups. Individuals whose partner’s exhibit sleep sex tendencies often fail to understand the behavior. Those who suffer from the condition cannot open up and talk about it. Victims that fail to open up for fear of judgment and ridicule from people do not comprehend what they were undergoing. In worst case scenario, they end up convicted for rape (Joris, 2008). Some suffer from serious injuries around their genitalia due to rough sex and heavy groping while asleep. Cases of sexsomnia have been on the rise since the nineties. An excellent example could be of woman in her mid twenties, who in deep sleep, tore her clothes and masturbated

Personality assesment Essay Example | Topics and Well Written Essays - 500 words

Personality assesment - Essay Example (Funder 1991, Tellegen 1991) personality psychologists predominantly make use of the ‘Five Factor Model’ for the assessment of an individual’s personality. (Digman 1990, Goldberg 1993a) This model reflects an individual’s psychological, social and cultural components that contribute towards his personality. It also reveals if an individual has had a troubled history or comes from a very poor socio- economic background. Research has given us an invaluable theory of personality which could be used for assessing the different personality variables. Personality assessment helps us to get a better idea of an individual and also helps us understand the individual’s behavioral pattern in a better light, thereby avoiding many conflicting issues. The 8th edition of Robert Feldman’s (2006) book on Understanding Psychology, stimulates the understanding and capabilities of students through his broad vision and insightful thinking. He strongly felt that if students understood psychology then they would learn it well. The principles and concepts contained in his book cover the areas of five important perspectives – Cognitive, behavioral, neuro-scientific, psychodynamic and humanistic. 1. Validity – Validity is considered to be the subjective judgment which could be based on either experience or other empirical indicators. Validity is also considered to be the maximum extent to which a test measures what’s needed to be measured. For a test to be considered valid it has to be first of all reliable; but reliability of the test does not guarantee its validity. The different types of validity include – 1) Face validity, 2) Construct validity, 3) Criterion validity, 4)Convergent validity and 5) Discriminant validity. 2. Reliability – Reliability is nothing but consistency. Reliability is considered to be the extent to which any test provides consistent scores. Measuring procedures do

Social movement Essay Example | Topics and Well Written Essays - 750 words - 2

Social movement - Essay Example The homogeneity of the Abolitionist Movement was however soon to be fragmented with the increasing participation of African-Americans in this movement for their emancipation. The involvement of Blacks in the movement made it move beyond its erstwhile minimalist agenda of slave emancipation. The movement gradually began to press for political and social equality in all domains for Black Americans. This perhaps somewhat predictably caused a rift between the White abolitionists and their Black counterparts. The abolitionists adopted a number of measures to have their demands heard. They sent innumerable petitions to the American Congress, wrote pamphlets and treatises giving moral, religious and social arguments against slavery and held conferences and speeches to mobilize mass support for their cause. One of the very first White abolitionist was Benjamin Lay pointed to the moral and religious underpinnings of slavery and termed it a â€Å"notorious sin†. Anthony Benezet, yet another early abolitionist combined a didactic critique of slavery with its economic implications. He argued that if owners of slaves would stop their demand for slaves, the heinous practice of the Atlantic slave trade would inevitably come to an end (Abolition, Anti-Slavery Movements, and the Rise of the Sectional Controversy). Perhaps the first outspoken Black abolitionist figures were Frederick Douglass and Sojourner Truth. Truth spent a considerable part of her life as a slave before gaining independence through the New York Gradual Abolition Act of 1827. She advocated not merely race equality but was also extremely ahead of her times in advocating gender equality. Douglass on the other hand was an extremely impressive orator who worked in collaboration with leading abolitionist leader William Lloyd Garrison to speak widely and powerfully for the cause of slave emancipation. Douglass’ numerous writings and speeches went a long way in

Chinese Culture Research Paper Example | Topics and Well Written Essays - 4500 words

Chinese Culture - Research Paper Example If in case any individual in a group is having opinion mismatch with that of the group, then the individual is expected to suppress the thoughts without disturbing the group's activities. (Pratt, D. D.1991) Such a practice could also be viewed as forcing a common thought upon everybody. But this is their culture and they have been practicing it for quite long years. We have to say that they got used to it. Now, in the recent past a TV show called "Super girls" has been commenced and succeeded as well. It is a talent reality show which brings out the talents of an individual to the sight of everybody by giving them a suitable platform. Another interesting fact about this show is that, it is the public who judge the show. They vote for their favorite star of the show and thus the winner is selected. But it is been condemned by the commentators that the Super girls show is kindling the individualistic feeling amidst the collectivism practitioners. Many have started protesting against the show fearing that the show may disturb the Chinese culture. But on the other hand the public started enjoying the entertainment. They are glad to vote for their stars. (Ding, Y. 2008) China is a country which always value team success. Simply speaking, they follow collectivism. They give much importance to group thoughts than the individual opinion. This practice is strictly followed by them in the name of culture. Chinese people have not practiced direct election. But recently the situation has changed because of the Super Girl show in China. It is condemned by the analysts that this show has initiated amidst people individualism. Let us discuss whether the show is really spreading individualism among the Chinese youths. The Chinese culture -A History Change - has been the most prominent factor characterizing the world of today. Every second of our life is changed as discoveries and inventions galore the place we live on. This kind of transformation is not new to the least. It has been a constant factor; right from man finding fire to the scientific revolution, travelling from bullock-carts to modern cars, from eating anything to standardizing the meal we take, the world has almost seen everything. Each change in turn was diversified among several groups of people based on their idealistic values, the ethical principles they followed and their welfare corresponding to their geographical region. These diversified changes slowly developed as cultural behavior of that particular group. Then there came a point where all the diversifications attained saturation. In the end, instead of these changes governing the cultural behavior, it turned out the direct opposite way where cultural behavior dominates the changes. (Songhua, F, n. d) For now, the cycle has turned again. It's almost a revolutionizing act if a person does the direct opposite of what their culture intends them to do. Chinese culture gives the Chinese people their basic identity. They have certain core values which are exclusive and consistent, and these are fashioned by a tradition of four thousand years of history and maintained by the same language as well. Considered to be one of the oldest cultures, the Chinese culture has a vast and traditional history. Several groups of p

Talent Management at Google Company Assignment Example | Topics and Well Written Essays - 1500 words

Talent Management at Google Company - Assignment Example The objective of the paper is to evaluate the implementation of diversity and equality, adherence to employment law and recruitment and selection processes of Google Inc. Talent management is the systematic approach which involves attraction, identification, deployment and retention of individuals or a group of people who are of a high value to the organization to help the enterprise meet its short and long run achievements. There are two approaches to talent management: the inclusive and the exclusive approach (Tucker, Kao and Verma, 2005). The inclusive approach includes the skill and knowledge development of all the employees in the enterprise. The exclusive approach is the process of development of a particular group of individuals considered as high potentials in the company (Buttiens and Hondeghem, 2012). Inclusive approach focuses on the talent development of all the employees of the organization, while, exclusive approach emphasizes on the development of a selected group of high potentials (Accenture, 2009). Inclusive approach does not add any value to the organization (Lockwood, N.R., 2006). In the inclusive approach, the difference between the less talented and the high performers is small while in the exclusive approach it is very high. The psychological contract is the unwritten expectations between the employee and the employer. According to psychological contract, the employee believes that the employer is compelled to behave in a certain manner and the enterprise also has some obligations toward the employee (Accenture, 2009). The psychological contract involves the employee and employer compulsions and the physiological contract evaluation. Under the exclusive approach, talented employees experience less violation of psychological contract and non-talented employees face more violation of the contract in their employment relations. The exclusive approach has high positive results for the high performers, but it adversely effects the employment

MSU Grade Module on Mobile using Android OS Essay Example for Free

MSU Grade Module on Mobile using Android OS Essay The proposed system entitled MSU Grade Module on Mobile using Android OS is a mobile version of the current Grade Module of Mindanao State University. This system enables the instructor to input grades and update INC grades at any location and at any time. Obtaining the Grade Module password is also done using mobile connection. Reasons: * With the convenience of an Android-powered mobile phone, the instructor does not need to physically go to the clerk to request for Grade Module password. * The Grade Module password is sent through email which is more secure than printed Grade Module stub. * The instructor does not need to be in their respective department or in the university to input and/or update grades. * The scarcity of available computers in the university is no longer a concern. * If the instructor is away for seminars, vacations, and other reasons, the instructor no longer needs to request favour from other instructors to input and/or update grades for them, thus the accountability of the grade resides only to the instructor in-charge and lessen bothering other instructors. * With this kind of application, an instructor can become invisible from students who keep following him/her because of various reasons. Possible Problem: * Not all instructors have an Android-powered mobile phone. * Not all instructors maintain an email address, especially those who are not technology-savvy. * Internet connection is not stable for instructors who want to input and/or update grades within the university. * The availability of online modules of the university is not stable.

Developing Anti-Mycobacterial Therapeutics

Developing Anti-Mycobacterial Therapeutics Using a specific example discuss a possible target for the development of anti-mycobacterial therapeutics. Introduction It is estimated 1.8 billion people worldwide are infected by tuberculosis (TB)- an infectious disease caused by the etiologic agent Mycobacterium tuberculosis (Mtb) (Fullam et al., 2012). This bacterium is responsible for 2 million deaths each year and remains a continuing threat (Ouellet, Johnston and Montellano, 2011). 70-90% of individuals infected carry latent TB and never develop the disease, on the other hand, 10-30% of individuals infected can develop active TB. Over the years, the threat of TB has increased alarmingly due to the rise of multi-drug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB). The rise of MDR-TB and XDR-TB threatens to overwhelm all currently available drugs (Yam et al., 2009). Hence, the need to develop new anti-mycobacterial therapeutics. Currently, there have been numerous potential targets identified for the development of novel inhibitors. This review focuses on Mtb DNA gyrase as one such possible target (Mdluli and Spigelman, 2006). Structure and Function of DNA Gyrase DNA gyrase is an essential tetrameric enzyme involved in DNA synthesis and is understood to be the only type II topoisomerase present in Mtb. The structure of DNA gyrase consists of two subunits called GyrA and GyrB which initially form homodimers, called A2 and B2, and then form a larger heterodimer, called A2B2. The two subunits carry out different functions with the GyrA subunit carrying out cleavage of positive supercoiled DNA, while the GyrB subunit promotes ATP hydrolysis. The GyrA and GyrB subunits are products of the gyrA gene and gyrB gene. The gyrB gene is 34 base-pairs upstream to the gyrA gene and both genes are located close to the origin of replication (Unniraman, Chatterji and Nagaraja, 2002). Mtb reproduce by binary fission. During DNA replication, DNA helicase binds to the DNA double helix and begins to unwind the parental strands by utilising ATP to break the hydrogen bonds between the base-pairs. Single-stranded binding proteins help to stabilise the unwound DNA strands and prevent them from re-pairing. The point at which the two strands of DNA separate are known as replication fork. DNA polymerase then moves along each strand of DNA behind each replication fork synthesising new DNA nucleotides. As the replication fork expands, positive supercoils begin to accumulate ahead of the replication fork. For DNA replication to continue, the positive supercoils need to be removed. Supercoiling causes the DNA to form a more compact structure. DNA gyrase inserts negative supercoils to Mtb DNA. DNA gyrase binds to a circular, supercoiled DNA molecule and this alleviates one positive supercoils. Gyrase first introduces a double-stranded break in the DNA, then a segment of DNA pass es through the break to the opposite side of the gyrase protein. This movement of the DNA requires ATP hydrolysis by gyrase, and introduces a negative supercoil into the DNA molecule. Subsequently, the break in the strands is repaired and gyrase is released from the DNA. Thus, a DNA molecule with one positive supercoil now has one negative supercoil. The GyrA subunit consists of two domains called the GyrA N-terminal domain (GyrA-NTD) and GyrA C-terminal domain (GyrA-CTD). The GyrA-NTD whereas, the GyrA-CTD stabilises the binding of DNA gyrase to DNA. The residue Tyr-122 of GyrA is the site of covalent attachment to DNA. Similarly, the GyrB subunit consists of two domains called the GyrB N-terminal domain (GyrB-NTD) and GyrB C-terminal domain (GyrB-CTD). The GyrB-NTD contains the ATP binding sites. DNA gyrase is absent in eukaryotic organisms even though a less homologous enzyme does exist. Fluoroquinolones Fluoroquinolones (FQs) bind to the enzyme-DNA complex. By targeting GyrA, the duration of treatment can be shortened making it a validated target. C-terminal Domain of GyrA  Ã‚   The ability of Mtb DNA gyrase to bind and insert negative supercoils into DNA is mediated by the C-terminal domain of the GyrA subunit (GyrA-CTD). Several highly-conserved residues in GyrA-CTD were selected as potentially participating in DNA binding and bending. The use of site-directed mutagenesis resulted in the identification of four key residues which were R691A, Y577A, R745A and D669A. Substitution of these four residues resulted in a total loss of DNA binding activity by GyrA. This in turn caused a loss in supercoiling activity and relaxation. The ability of Mtb DNA gyrase to carry out its function only occurs when the GyrA subunit is combined with the GyrB subunit. Mutagenesis of R691A, Y577A, R745A and D669A not only results in loss of DNA binding activity of GyrA in the absence of GyrB, but also results in a loss of DNA binding activity in the presence of GyrB. This again led to a loss in loss in supercoiling activity and relaxation. The findings of GyrA-CTD to be essential for Mtb survival strongly promotes the idea of a new potential drug target. GyrB Subunit of Mtb DNA Gyrase The emergence of fluoroquinolone-resistant tuberculosis has meant there is a need to develop new classes of drugs targeting Mtb DNA gyrase. A lot of emphasis is often focused on targeting the GyrA subunit and this had led to research in developing novel inhibitors targeting the GyrB subunit (Medapi et al., 2015). The GyrB subunit is an attractive target for the development of anti-mycobacterial therapeutics for several reasons. Firstly, the GyrB subunit is present in a single copy. Secondly, it is an essential gene for the survival of Mtb. Thirdly, there are no alternatives to GyrB present in Mtb which could carry out the same function if it is inhibited because it contains the ATP binding pocket. Fourthly, the various strains of Mtb have a 99.9% homology for GyrB. Fifthly, GyrB exerts the same phenotypic effects on Mtb viability as FQs. Finally, the development of inhibitors targeting GyrB can be effective in shortening the duration of TB treatment and delaying the emergence of drug resistance (Chopra et al., 2012). The residues involved in ATP binding are found in the GyrB-NTD and are between residues 1-220. Moreover, two further residues, Gln335 and Lys337, found in the GyrB-CTD are also involved in ATP binding. To the date, there are hundreds of potential novel inhibitors which have been identified to inhibit the activity of GyrB. Inhibitors could be design to target the ATP-binding site or the non-ATP-binding site, however, little is known about structure of the non-ATP binding site. Novobiocin is the only approved antibiotic which has shown to inhibit the activity of GyrB. However, novobiocin has been withdrawn from the market because it is extremely toxic and has low permeability. Another drug class of drugs, aminobenzimidazole, are another strong candidate for inhibiting GyrB due to their excellent efficacy against MDR-TB strains (Chaudhari et al., 2016).

Porters Five Forces Analysed The External Environment Industry Marketing Essay

Porters Five Forces Analysed The External Environment Industry Marketing Essay Among the different choices, Apple has chosen the differentiation focus strategy in the broad industry. The invention and development of products by Apple are its highly unique attributes, with devices such as the iPhone, iPod and iPad where the use touch screen and other interfaces to operate the products. Apple spends billions of dollars every year on RD (Research and Development) to develop and promote its products in order to achieve superior quality over competitors products. Apple slogan is Think Different, which drives them to innovate and provide high quality regarding their products. Apples markets are global, but they are focusing on active markets such as America, the EU and some Asian countries. However, Apple focuses on a market segment where customers clearly feel that Apple provides value for its customers. In addition, Apple had a positive growth rate during the economic crisis of 2007-2009 (Business week, 2010). Apples premium price strategy and its success have beco me a significant barrier to competitors such as Nokia, Motorola, HTC and the E-book by Sony. Porters Five Forces Analysis Porters Five Forces analysed the external environment of the industry in order to give a better understanding of the strengths and weaknesses within the organisation. These analyses give the company the ability to identify the opportunities and threats from external factors (Harrison, 2003). These forces include: Threat of new entrants For each of its product lines, Apple, like any other company, faces rigorous competition. This high-tech industry requires continual research and development (RD). This sector is difficult for new companies to enter because new entrants must spend a large amount of capital on RD and on the advertising and promotion of their brand. There are some dominant producers in this sector such as Apple, Microsoft, Dell and Sony, who share the majority of the market. Apple should be aware of new entrants because they may come up with surprisingly better technology or a better product. However, these new entrants are less of a threat because it is difficult to enter and penetrate the market in a limited time (Harrison, 2003). Power of the supplier Porters second force states that the bargaining power of suppliers imposes a threat to any company. It also includes, the availability of substitute suppliers which is an important factor in determining the power of the supplier. Suppliers are known as third parties in this industry, and they are classified in two groups. The first group makes the major parts for the products. This group is not strong because of the availability and easy of replacing the items they make, such as batteries, wire connections, screens and other internal components. In contrast, the second group provides accurate parts and important programmes such as flash-memory and DRAM. This group is strong because of their specialized and advanced products, as well as the lack of alternative products (Nistor, 2010). There are some suppliers who dominate the market; for example, Intel, Microsoft and Sony. So, it is important for Apple to have a good relationship with its suppliers. Power of the buyer The buyers bargaining power is very high in the industry because competitors offer a wide range of similar products with competitive prices. The Apple Corporation faces a moderate threat from buyers because they have a lot of products that consumers can choose from. In addition, the threat of buyers comes from their demand for new features in Apple products. However, there are a large number of companies that offer similar products and there is quite a big differentiation in price and performance. Therefore, loyalty is often shown towards a specific brand because there are not many differences in the quality and price between brands (Nistor, 2010). Buyers are often more sensitive to brand rather than price. Apples customers are individuals, education departments, enterprises, governments and creative customers. So, the variety of consumers and their needs has a direct impact on Apples future strategies. Threat of substitutes The technological environment is changing fast every day. There are not many substitutes in this industry because of the high-tech features. However, alternatives are always available from competitors. If some other company such as BlackBerry, Google, Samsung or Microsoft come up with new technology or the same kind of phone at a lower price or with more features at the same price, then this is a problem for Apple (O Grady, 2009). Customers usually tend to look to the latest technology instead of traditional methods. Apple has the ability and efficiently to design and develop its own hardware and application software to become unique and distinct from its competitors. Competitive rivalry The competition in this industry is very high, almost in all areas of business, because of the continuing requirement to provide new products all the time. Competitive prices, new products, design innovations and technology are the main factors that Apple has to compete with other international companies on, such as IBM, HP, Acer and Dell. The consumers choices also differ; some prefer to save some cash rather purchase high performance specification technology and some prefer the newest technology. So, the result is that companies implement different strategies; for example, low-cost and best-cost strategies. Some manufacturers offer products at the lowest price in an attempt to cut their costs by ignoring everything except some basic features. Some other companies in the middle price range, such as Dell and HP, focus on attracting customers by offering varying prices. And the top of the range companies, like Apple, gain customers through their high quality products, features and inn ovative design, which makes their products popular all over the world (O Grady, 2009). APPENDICES: Porters Generic Strategy model: Porters Five Forces model:

Charles Yale Harrison’s Generals Die in Bed vs Colin McDougall’s Execut

Charles Yale Harrison’s Generals Die in Bed vs Colin McDougall’s Execution As with any genre, all novels termed ‘war stories’ share certain elements in common. The place and time settings of the novels, obviously, take in at least some aspect of at least one war or conflict. The characters tend to either be soldiers or are at least immediately affected by the military. An ever present sense of doom with punctuated moments of peace is almost a standard of the war novel. Beyond the basic similarities, however, each of these battle books stands apart as an individual. Charles Yale Harrison’s World War I novel, Generals Die in Bed is, in essence, quite different than Colin McDougall’s Execution. Coming years earlier, Generals can almost be seen to hold the wisdom one would expect see in an older sibling, while Execution suffers the growing pains that the younger child inevitably feels. Most war novels center on themes of valor and heroism. Some concentrate on the opposites of these virtues in an attempt to display raw realism. Harrison, right from the beginning of his novel, shows us both. The narrator of this first-person narrative paints a picture of a totally un-heroic bunch of soldiers preparing for debarkation. The drinking and debauchery are followed the next morning by a parade that the suffering soldiers must march through, while the people watch their ‘heroes’ leaving to bravely fight the good fight. While this clearly demarcates the innocent civilians from the savvy soldiers, it also shows the reader that the narrator is going to try to tell the real story. Execution starts with what is seemingly a journal entry, implying that it will be a first person narrative much the same as Ge... ... enough contrasts between them that allow them to stand out as completely individual from one another. Each of these novels, then, is able to both expand upon the other, while being free in its own expression at the same time. Works Cited Harrison, Charles Yale. Generals Die in Bed. Waterdown: Potlatch Publications, 1999. Lenoski, Daniel S. â€Å"Morning Glory: Execution and Romance.† American Review of Canadian Studies. Volume 23 (1993): 387 – 406. Mason, Michael A. â€Å"Execution: Heroism in a Modern War-Novel.† English Studies in Canada. Volume 5 (1979): 94 - 104. McDougall, Colin. Execution. Toronto: Macmillan, 1958. Thompson, Eric. â€Å"Canadian Fiction of the Great War.† Canadian Literature. Volume 91 (1981): 81 – 96. Vance, Jonathan. Death So Noble: Memory, Meaning, and the First World War. Vancouver: UBC Press, 1997.

The Price System :: essays research papers

The Price System   Ã‚  Ã‚  Ã‚  Ã‚  The price system is a means of organizing economic activity. It does this by coordinating the decisions of consumers, producers, and owners of productive resources. Millions of economic agents who have no direct communication with each other are led by the price system to supply each other's wants. Every economic system has three functions. In a decentralized usually private enterprise economic system, the price mechanism is the instrument by which these functions are performed.   Ã‚  Ã‚  Ã‚  Ã‚  Prices are an expression of the consensus on the values of different things, and every society that permits exchanges among consumers has prices. Because prices are expressed in terms of a widely acceptable commodity, they permit a comparison of the comparative values of various commodities--if shoes are $15 per pair and bread 30 cents per loaf, a pair of shoes is worth 50 loaves of bread. The price of anything is its value in exchange for a commodity of wide acceptability, money.   Ã‚  Ã‚  Ã‚  Ã‚  A system of prices exists because individual prices are related to each other. If, for example, metal rods cost 40 cents a pound and the process of drawing a rod into wire costs 25 cents a pound, then, if the price of wire exceeds 65 cents, it will be profitable to produce wire; and if the price of wire falls below 65 cents, it will be ruinous to produce wire. Competition, therefore, will hold the price of wire about 25 cents per pound above that of rods. A variety of such economic forces ties the entire structure of prices together.   Ã‚  Ã‚  Ã‚  Ã‚  One function of the price system is to determine what is to be produced and in what quantity. Even an ancient economy must choose between food and shelter, weapons and tools, priests and hunters. In a modern economy the potential variety of goods and services that may be produced is immense. Consider simply the 10,000 new book titles that are published each year or the hundreds of colors of paint or the thousands o f styles of clothing that are produced--each of these actual collections being much smaller than modern technology permits.   Ã‚  Ã‚  Ã‚  Ã‚  The second function of the price system an economy must perform is to decide how the desired goods are to be produced. There is more than one way not only to skin a cow but also to grow wheat, train lawyers, refine petroleum, and transport baggage. The efficient production of goods requires that certain obvious rules be followed: no resource should be used in producing one thing when it could be producing something more valuable elsewhere; and each product should be made with the smallest possible amount of resources.

Behind the Sun

Behind the Sun (Abril Despedacado) was a thought-provoking and captivating work of art by Walter Salles, Sergio Machado and Karim Ainouz; who collaboratively derived the story from an Albanian book (Broken April by Ismail Kadare). Behind the Sun was set in 1910 in the Northeast region of Brazil. The movie unfolds with this line, â€Å"This is the story of me, my brother, and a shirt in the wind†¦ † The line was narrated by a charming young boy, Pacu (com/english-4-b-calpac/">Ravi Ramos Lacerda). He comes from a family of peasants, who grows sugarcane for a living.Pacu's oldest brother had just been murdered at the beginning of the movie. The setting was miserable, to say the least. The opening of the movie only matched this misery in the setting by showing a gory sight of a blood-stained shirt. The shirt belonged to Pacu's oldest brother, who was then the latest victim in their family's feud with the Ferreiras family. The two families had been warring over land and territ orial issues. Tradition dictates that the Breves family should avenge the death of their family member, but not long before the stain has turned from red to yellow.â€Å"When the blood on the shirt turns yellow, someone will die,† Pacu narrated further. The surviving eldest son of the Breves family, Tonio (Rodrigo Santaro), did what he had to do, according to their tradition — he killed the eldest son of the Ferreiras family. Tonio felt that the vicious cycle of killing and revenge, disguising as a noble tradition, had to end; but he felt powerless to end it, so he allowed it to continue by killing the eldest son in the other family. As a result, he was next in line to be killed.But the charming and much too adorable boy, Pacu, had a way of keeping Tonio alive. Pacu died for Tonio. He knew at a tender age that sacrifice, an act of love, was the key to end the vicious cycle that their family was caught in. In relation to Brazilian notions of ethnicity, the deep set often mysterious-looking eyes of the Breves brothers were captivating. Ironically, the softness of their looks couldn't match with the ferocious tradition they keep. The film is a story about a strong family bond, so strong in fact, that one had to be prepared to die in revenge of the other.Moreover, one was willing to die to let the other live and move on. The photography and sequence of shots in the movie are absolute astounding and even poetic in nature. It seemed that every beat of its music matched with every frame in the screen with grace and much respect to art. Their clothing was not far from imaginable, the family bonding was very plausible, considering how tight family bonding was (still is) in Brazil. If it were a movie set in this time and age, it wouldn’t have been plausible, with all the killings.But it was in 1910, when a lot of things, like respect for life, have yet to be discovered. Certainly, the work of art from the sounds to the overall direction and cinematog raphy helped in establishing the depth and heaviness of the movie. Truth be told, Hollywood cannot create movie that is as profound as this without resorting to much gimmickry. What Behind the Sun producers did that Hollywood won’t dare to try is to simply tell a tragic story in the most poetic way possible. It was a wonderful movie, overall. It was heavy in the mind, and it certainly will not be easy to forget.

Fi516 Advanced Finance

Study Guide for Final Exam 1. (TCO B) Which of the following statements concerning the MM extension with growth is NOT CORRECT? (a) The tax shields should be discounted at the unlevered cost of equity. (b) The value of a growing tax shield is greater than the value of a constant tax shield. (c) For a given D/S, the levered cost of equity is greater than the levered cost of equity under MM's original (with tax) assumptions. (d) For a given D/S, the WACC is greater than the WACC under MM's original (with tax) assumptions. e) The total value of the firm is independent of the amount of debt it uses. (Points: 20) 2. (TCO D) Which of the following statements is most CORRECT? (a) In a private placement, securities are sold to private (individual) investors rather than to institutions. (b) Private placements occur most frequently with stocks, but bonds can also be sold in a private placement. (c) Private placements are convenient for issuers, but the convenience is offset by higher flotation costs. (d) The SEC requires that all private placements be handled by a registered investment banker. e) Private placements can generally bring in funds faster than is the case with public offerings. (Points: 20) 3. (TCO E) Dakota Trucking Company (DTC) is evaluating a potential lease for a truck with a 4-year life that costs $40,000 and falls into the MACRS 3-year class. If the firm borrows and buys the truck, the loan rate would be 10%, and the loan would be amortized over the truck's 4-year life. The loan payments would be made at the end of each year. The truck will be used for 4 years, at the end of which time it will be sold at an estimated residual value of $10,000. If DTC buys the truck, its after tax cash flows would be the following: (Year 1) – 6,339; (Year 2) -4,764; (Year 3)-9,943; (Year 4) -5,640; all occurring at the end of respective years. The lease terms, call for a $10,000 lease payment (4 payments total) at the beginning of each year. DTC's tax rate is 40%. Should the firm lease or buy? (a) $849 (b) $896 (c) $945 (d) $997 (e) $1,047 (Points: 20) 4. (TCO I) Suppose 90-day investments in Britain have a 6% annualized return and a 1. 5% quarterly (90-day) return. In the U. S. 90-day investments of similar risk have a 4% annualized return and a 1% quarterly (90-day) return. In the 90-day forward market, 1 British pound equals $1. 65. If interest rate parity holds, what is the spot exchange rate? (a) 1 pound = $1. 8000 (b) 1 pound = $1. 6582 (c) 1 pound = $1. 0000 (d) 1 pound = $0. 8500 (e) 1 pound = $0. 6031 (Points: 20) 1. (TCO C) D. Paul Inc. forecasts a capital budget of $725,000. The CFO wants to maintain a target capital struc ture of 45% debt and 55% equity, and it also wants to pay dividends of $500,000. If the company follows the residual dividend policy, how much income must it earn, and what will its dividend payout ratio be? Net Income Payout (a) $898,750 55. 63% (b) $943,688 58. 41% (c) $990,872 61. 43% (d) $1,040,415 64. 40% (e) $1,092,436 67. 62% (Points: 20) 2. (TCO F) Warren Corporation's stock sells for $42 per share. The company wants to sell some 20-year, annual interest, $1,000 par value bonds. Each bond would have 75 warrants attached to it, each exercisable into one share of stock at an exercise price of $47. The firm's straight bonds yield 10%. Each warrant is expected to have a market value of $2. 00 given that the stock sells for $42. What coupon interest rate must the company set on the bonds in order to sell the bonds-with-warrants at par? (a) 7. 83% (b) 8. 24% (c) 8. 65% (d) 9. 08% (e) 9. 54% (Points: 20) 3. (TCO B) Which of the following statements is CORRECT, holding other things constant? (a) Firms whose assets are relatively liquid tend to have relatively low bankruptcy costs, hence they tend to use relatively little debt. b) An increase in the personal tax rate is likely to increase the debt ratio of the average corporation. (c) If changes in the bankruptcy code make bankruptcy less costly to corporations, then this would likely reduce the debt ratio of the average corporation. (d) An increase in the company's degree of operating leverage is likely to encourage a company to use more debt in its capital structure. (e) An increase in the corporate tax rate is likely to encourage a company to use more debt in its capital structure. (Points: 20) 4. TCO G) Chapter 7 of the Bankruptcy Act is designed to do which of the following? (a) Protect shareholders against creditors. (b) Establish the rules of reorganization for firms with projected cash flows that eventually will be sufficient to meet debt payments. (c) Ensure that the firm is viable after emerging from bankruptcy. (d) Allow the firm to negotiate with each creditor individually. (e) Provide safeguards against the withdrawal of assets by the owners of the bankrupt firm and allow insolvent debtors to discharge all of their obligations and to start over unhampered by a burden of prior debt. . (TCO I) Suppose one British pound can purchase 1. 82 U. S. dollars today in the foreign exchange market, and currency forecasters predict that the U. S. dollar will depreciate by 12. 0% against the pound over the next 30 days. How many dollars will a pound buy in 30 days? (a) 1. 12 (b) 1. 63 (c) 1. 82 (d) 2. 04 (e) 3. 64 (Points: 20) 2. (TCO H) Which of the following statements about valuing a firm using the APV approach is most CORRECT? (a) The value of operations is calculated by discounting the horizon value, the tax shields, and the free cash flows at the cost of equity. b) The value of equity is calculated by discounting the horizon value, the tax shields, and the free cash flows at the cost of equity. (c) The value of operations is calculated by discounting the horizon value, the tax shields, and the free cash flows before the horizon date at the unlevered cost of equity. (d) The value of equity is calculated by discounting the horizon value and the free cash flows at the cost of equity. (e) The APV approach stands for the accounting pre-valuation approach. (Points: 20) 3. (TCO A) Which of the following statements is CORRECT? a) Put options give investors the right to buy a stock at a certain strike price before a specified date. (b) Call options give investors the right to sell a stock at a certain strike price before a specified date. (c) Options typically sell for less than their exercise value. (d) LEAPS are very short-term options that were created relatively recently and now trade in the market. (e) An option holder is not entitled to receive dividends unless he or she exercises their option before the stock goes ex dividend. (Points: 20) 4. (TCO F) A swap is a method used to reduce financial risk. Which of the following statements about swaps, if any, is NOT CORRECT? (a) A swap involves the exchange of cash payment obligations. (b) The earliest swaps were currency swaps, in which companies traded debt denominated in different currencies, say dollars and pounds. (c) Swaps are very often arranged by a financial intermediary, who may or may not take the position of one of the counterparties. (d) A problem with swaps is that no standardized contracts exist, which has prevented the development of a secondary market. (e) A company can swap fixed interest payments for floating interest payments. (Points: 20)

Ford Motor Company: Organizational Agility Essay

Ford Motor Company has recently experienced a problem with regard to a fraudulent e-mail which notifies consumers that the company has chosen them as the winner of a Ford Edge Jeep and that they can claim their prize after they have deposited a certain amount in a bank account. The company immediately issued a statement within a few days saying that the notifications are not from the company and that the e-mails are scams designed to acquire personal information from unwary individuals, especially from the consumers of Ford Motors. Moreover, the company released a public statement claiming that the company is not in any way connected with the e-mails circulating over the internet inasmuch as the company has not granted either authority or permission to use the name of the company, its trademark and its intellectual properties in order to engage in such a scam. The company noted that the e-mails may be a form of â€Å"phishing† activity, and advised the consumers to simply delete the message and avoid replying. In terms of demonstrating environmental responsiveness, the Ford Motor Company has formulated a way in order to reduce greenhouse gases used in painting vehicles by as much as 15 percent. The new paint technology is not only â€Å"environmentally sound† but also efficient in terms of cost such that painted automobiles are more durable and look more beautiful than before. The technology used is a combination of â€Å"advanced chemical formulation of high-solids† with a â€Å"three-wet application process† which uses paint shop that is more earth-friendly as compared to traditional vehicle paints. Apart from the reduction in CO2 emissions from the painting of vehicles, the new paint technology also boasts the benefit of a decrease in VOCs or volatile organic compounds by as much as 10 percent. The company states that it can save money in the production of the vehicles and lessen the completion of painting an automobile by a fifth of the total time previously estimated. More importantly, there is also a great reduction in the amount of conventional paint used in the painting process. Even if the Ford Motor Company has already used the new painting technology, the company is still gathering data for wider application. The monitoring of the automobiles over the next year will give the company more data which will enable them to gather â€Å"long-term rollout plans† for the pioneering paint technology that they have developed. In fact, the company has already won international acclaim in France for the new paint technology. The concepts of Total Quality Management apply to the Ford Motor Company in terms of how it handles the current environmental requirements in the industry. Instead of abandoning or taking a step back from the automobile industry, the company opted to stay ahead of the rest by developing tools which will meet the environmental demands of the time. The ability to manage the company efficiently and effectively in such a pressing circumstance is equally significant to the ability to enact the company visions and progress on them through time. The company acts by not resorting to isolated departments in handling the issue at hand. Rather, the company makes the full use of its structured departments in order to arrive at a better approach in providing the suitable method to address the environmental issues typically attributed to automobile companies. That is, Ford Motor Company’s efforts to develop the new paint technology incorporated the input coming from the production department to the conception department. Post-production departments also share a role in assessing the actual impacts of the new paint technology which allows for the acquisition and accumulation of new data which can be used as basis for great improvements in the future.

The Return: Nightfall Chapter 20

â€Å"Ohhhh.† Bonnie melted back into the bucket seat. â€Å"It was like†¦kapow! Zap! Zowie! Like†¦fireworks.† â€Å"You're smirking.† â€Å"I am not smirking,† Bonnie said with dignity. â€Å"I am smiling in fond remembrance. Besides – â€Å" â€Å"Besides, if you hadn't Called him, we'd still be stuck in that horror of a room. Thank you, Bonnie. You saved us.† Abruptly Meredith was at her most serious and sincere. â€Å"I guess Elena was maybe right when she said he didn't hate all humans,† Bonnie said slowly. â€Å"But, you know, I just realized. I couldn't see his aura at all. All I could see was black: smooth hard black, like a shell around him.† â€Å"Maybe that's how he protects himself. He makes a shell so no one can see inside.† â€Å"Maybe,† Bonnie said, but there was worried note in her voice. â€Å"And what about that message from Elena?† â€Å"It says that Tami Bryce is definitely acting strangely and that she and Matt are going out to check out the Old Wood.† â€Å"Maybe that's who they're going to meet – Damon, I mean. At 4:44, like he said. Too bad we can't call her.† â€Å"I know,† Meredith said grimly. Everyone in Fell's Church knew that there was no reception in the Old Wood or the cemetery area. â€Å"But go ahead and try anyway.† Bonnie did, and as usual got a no-service message. She shook her head. â€Å"No good. They must already be in the woods.† â€Å"Well, what she wants is for us to go ahead and get a look at Isobel Saitou – you know, because she's Jim Bryce's girlfriend.† Meredith made a turn. â€Å"That reminds me, Bonnie: did you get a look atCaroline's aura? Do you think she has one of those things – inside her?† â€Å"I guess so. I saw her aura, and yuck, I never want to see it again. She used to be a kind of deep bronzy-green, but now she's muddy brown with black lightning zigzagging all through. I don't know if that means one of those things was inside her, but she sure didn't mind cuddling up to them!† Bonnie shuddered. â€Å"Okay,† Meredith said soothingly. â€Å"I know what I would say if I had to make a guess – and if you're going to be sick, I'll stop.† Bonnie gulped. â€Å"I'm all right. But we're seriously going to Isobel Saitou's house?† â€Å"We're very seriously going there. As a matter of fact, we're almost there. Let's just brush our hair, take a few deep breaths, and get it over with. How well do you know her?† â€Å"Well, she's smart. We didn't have any classes together. But we both got out of athletics at the same time – she had a jumpy heart or something, and I used to get that terrible asthma†¦.† â€Å"From any exertion except dancing, which you could keep up all night,† Meredith said dryly. â€Å"I don't know her very well at all. What's she like?† â€Å"Well, nice. Looks a bit like you, except Asian. Shorter than you – Elena's height, but skinnier. Sort of pretty. A little shy – the quiet type, you know. Sort of hard to get to know. And†¦nice.† â€Å"Shy and quiet and nice sounds good to me.† â€Å"Me, too,† Bonnie said, pressing her sweaty hands together between her knees. What sounded even better, she thought, was for Isobel to be not at home. However, there were several cars parked in front of the Saitou house. Bonnie and Meredith knocked on the door hesitantly, mindful of what had happened the last time they had done this. It was Jim Bryce who answered, a tall, lanky boy who hadn't filled out yet and stooped a bit. What Bonnie found amazing was the change in his face as he recognized Meredith. When he'd answered he'd looked awful; his face white under a medium tan, his body somehow crumpled. When he saw Meredith, some of the color came to his cheeks and he seemed to†¦well, to smooth out like a piece of paper. He stood taller. Meredith didn't say a word. She just stepped forward and put her arms around him. He clutched at her as if he was afraid she'd run away, and buried his face in her dark hair. â€Å"Meredith.† â€Å"Just breathe, Jim. Breathe.† â€Å"You don't know what it's been like. My parents left because my great-grandpa's really sick – I think he's dying. And then Tami – Tami – â€Å" â€Å"Tell me slowly. And keep breathing.† â€Å"She threw knives, Meredith. Butcher knives. She got me in the leg here.† Jim plucked at his jeans to show a small slit of a hole in the fabric over the lower part of one thigh. â€Å"Have you had a tetanus shot recently?† Meredith was at her most efficient. â€Å"No, but it's not really a big cut. It's a puncture wound, mainly.† â€Å"Those are exactly the kind that are most dangerous. You need to call Dr. Alpert right away.† Old Dr. Alpert was an institution in Fell's Church: a doctor who even made house calls, in a country where carrying around a little black bag and stethoscope was pretty much unheard-of behavior. â€Å"Ican't . I can't leave†¦.† Jim jerked his head backward toward the interior of the house as if he couldn't bring himself to say a name. Bonnie tugged at Meredith's sleeve. â€Å"I have a very bad feeling about this,† she hissed. Meredith turned back to Jim. â€Å"You mean Isobel? Where areher parents?† â€Å"Isa-chan, I mean Isobel, I just call her Isa-chan, you know†¦Ã¢â‚¬  â€Å"It's all right,† said Meredith. â€Å"Just say what comes naturally. Go on.† â€Å"Well, Isa-chan only has her grandma, and Grandma Saitou doesn't even come downstairs much. I made her lunch a while ago and she thought I was – Isobel's father. She gets†¦confused.† Meredith glanced at Bonnie, and said, â€Å"And Isobel? Is she confused, too?† Jim shut his eyes, looking utterly miserable. â€Å"I wish you'd go in and, well, just talk to her.† Bonnie's bad feeling was only getting worse. She really couldn't stand another scare like the one at Caroline's house – and she certainly didn't have the strength to Call again, even if Damon weren't in a hurry to get somewhere. But Meredith knew all this, and Meredith was giving her the sort of look that couldn't be denied. It also promised that Meredith would protect Bonnie, no matter what. â€Å"Is she hurting anybody? Isobel?† Bonnie heard herself ask as they crossed through the kitchen and toward a bedroom at the end of the hallway. She could hardly hear Jim's whispered, â€Å"Yeah.† And then, as Bonnie groaned internally, he added, â€Å"Herself.† Isobel's room was just what you'd expect from a quiet and studious girl. At least one side was. The other side looked as if a tidal wave had picked everything up and thrown it down again randomly. Isobel was sitting in the middle of this mess like a spider on a web. But that wasn't what made Bonnie's gut churn. It was what Isobel was doing. She had laid out beside her what looked a lot like Mrs. Flowers' kit for cleaning out wounds, but she wasn't healing anything. She was piercing herself. She had already done her lip, her nose, one eyebrow, and her ears, many times. Blood was dripping from all these places, dripping and falling onto the unmade sheets of her bed. Bonnie saw all that as Isobel looked up at them with a frown, except that the frown was only half there. On the pierced side, the eyebrow didn't move at all. Her aura was shattered orange with black lashings through it. Bonnie knew, all at once, that she was going to be sick. She knew it with the deep knowledge that overcame all embarrassment and which sent her flying to a wastebasket she didn't even remember seeing. Thank God, it had a white plastic bag lining it, she thought, and then she was completely occupied for a few minutes. Her ears recorded a voice, even as she was thinking she was glad she hadn't had lunch. â€Å"My God,are you crazy ? Isobel, what have you done to yourself? Don't you know the kind of infections you can get†¦the veins you can hit†¦the muscles you can paralyze†¦? I think you've already pierced the muscle in your eyebrow – and you shouldn't still be bleeding unless you've hit veins or arteries.† Bonnie retched dryly into the wastebasket, and spat. And just then she heard a meaty thud. She looked up, half knowing what she would see. But it still was a shock. Meredith was doubled over from what must have been a punch in the stomach. The next thing Bonnie knew, she was beside Meredith. â€Å"Oh, my God, did shestab you?† A stab wound†¦deep enough into the abdomen†¦ Meredith clearly couldn't get her breath. From somewhere a bit of advice from her sister Mary, the nurse, floated into Bonnie's mind. Bonnie pounded with both fists on Meredith's back, and suddenly Meredith took a huge gulp of air. â€Å"Thanks,† she was saying weakly, but Bonnie was already dragging her away, away from the laughing Isobel and a collection of the world's longest nails and the rubbing alcohol and other things that she had on a breakfast tray beside her. Bonnie got to the door and almost collided with Jim, who had a wet washcloth in his hand. For her, she supposed. Or maybe for Isobel. All Bonnie was interested in was making Meredith pull up her top to make absolutely, positively sure that there were no holes in her. â€Å"I got it – out of her hand – before she punched me,† Meredith said, still breathing painfully as Bonnie anxiously scanned the area above her low-rise jeans. â€Å"I'll have a bruise, that's all.† â€Å"She hit you, too?† Jim said in dismay. Except that he didn't say it. He whispered it. You poor guy, Bonnie thought, finally satisfied that Meredith wasn't perforated. What with Caroline and your sister Tami and your girlfriend, you don't have the first idea of what's going on. How could you? And if we told you, you'd just think we were two more crazy girls. â€Å"Jimmy, youhave to call Dr. Alpert right away, and then I think they're going to have to go to the hospital in Ridgemont. Isobel's already done permanent damage to herself – God knows how much.All those piercings are almost certainly going to be infected. When did she start this?† â€Å"Um, well†¦she first started acting weird after Caroline came to see her.† â€Å"Caroline!† Bonnie blurted, confused. â€Å"Was she crawling?† Jim gave her a look. â€Å"Huh?† â€Å"Never mind Bonnie; she was joking,† Meredith said easily. â€Å"Jimmy, you don't have to tell us about Caroline if you don't want to. We – well, we know she was over at your house.† â€Å"Doeseverybody know?† Jim asked miserably. â€Å"No. Just Matt, and he only told us so that somebody could go check on your little sister.† Jim looked guilty and stricken at once. The words poured out of him as if they'd been bottled up and now the cork was out of the bottle. â€Å"I don't know what's going on anymore. All I can tell you is what happened. It was a couple days ago – late evening,† Jim said. â€Å"Caroline came over, and – I mean, I never even had a crush on her. It's like, sure, she's good-looking, and my parents were away and all, but I never thought I was the kind of guy†¦Ã¢â‚¬  â€Å"Never mind that now. Just tell us about Caroline and Isobel.† â€Å"Well, Caroline came over wearing this outfit that was – well, the top was practically transparent. And she just – she said, did I want to dance and it was, like, slow dancing and she – she, like,seduced me. That's the truth. And the next morning she left – just about the time Matt came. That was the day before yesterday. And then I noticed Tami acting – crazy. Nothing I could do would stop her. And then I got a phone call from Isa-chan and – I've never heard her so hysterical. Caroline must have gone straight from my house to her house. Isa-chan said she was going to kill herself. And so I ran over here. I had to get away from Tami anyway because me being there at home just seemed to make it worse.† Bonnie looked at Meredith and knew that they were both thinking the same thing:and somewhere in there, both Caroline and Tami propositioned Matt, too. â€Å"Caroline must have told her everything.† Jim gulped. â€Å"Isa-chan and I haven't – we were waiting, you know? But all Isa-chan would say to me was that I was going to be sorry. ;;You'll be sorry; just wait and see,' over and over and over. And, God, Iam sorry.† â€Å"Well, now you can stop being sorry and start calling the doctor. Rightnow , Jimmy.† Meredith gave him a swat on the behind. â€Å"And then you need to call your parents. Don't give me those big brown puppy-dog eyes. You're over eighteen; I don't know what they can do to you for leaving Tami alone all this time.† â€Å"But – â€Å" â€Å"But me no buts. Imean it, Jimmy.† Then she did what Bonnie knew she would, but was dreading. She approached Isobel again. Isobel's head was down; she was pinching her navel with one hand. In the other, she held a long, shining nail. Before Meredith could even speak, Isobel said, â€Å"So you're in on it, too. I heard the way you called him  ¡Ã‚ ®Jimmy.' You're all trying to take him away from me. All you bitches are trying to hurt me.Yurusenai! Zettai yurusenai! â€Å" â€Å"Isobel! Don't! Can't you see that you're hurtingyourself ?† â€Å"I'm only hurting myself to take away the pain. You're the one who's really doing it, you know. You're pricking me with needles inside.† Bonnie jumped inside her own skin, but not just because Isobel suddenly gave a vicious thrust of the nail. She felt heat sweep up into her cheeks. Her heart began to pound even faster than it was already going. Trying to keep one eye on Meredith, she pulled her mobile phone out of her back pocket where she'd stashed it after the visit to Caroline's house. Still with half her attention on Meredith, she went on the Internet and rapidly entered just two search words. Then, as she made a couple of selections from her hits, she realized that she could never absorb all the information in a week, much less a few minutes. But at least she had a start. Just now, Meredith was backing away from Isobel. She put her mouth close to Bonnie's ear and whispered, â€Å"I think we're just antagonizing her. Did you get a good look at her aura?† Bonnie nodded. â€Å"Then we probably should leave the room, at least.† Bonnie nodded again. â€Å"Were you trying to call Matt and Elena?† Meredith was eyeing the mobile phone. Bonnie shook her head and turned the phone so Meredith could see her two search words. Meredith stared, then lifted dark eyes to Bonnie's in a kind of horrified recognition. Salem witches.

AFFORDABLE HEALTH CARE Essay Example | Topics and Well Written Essays - 500 words

AFFORDABLE HEALTH CARE - Essay Example Thinking of the possible strategies and reforms to mitigate the problem, I came up with the accurate suggestions and critical thoughts on Medicare, which I would share within the following reflection. As it has been mentioned in the case, the Rosalyns preexisting condition of ulcer restrained her from receiving due to the few compounding circumstances: first, she was divorced, second, her annual salary at the gift-wrapping company of $19,000 was insufficient to cover medical care and the employee did not provided any sort of medical coverage for her, the last, but not the least, a â€Å"relatively innocent† disorder, an ulcer, made so far expensive medical insurance to cost like a sort of luxury. Obviously, if Rosalyn was not rejected at first, her cancer would not metastasized into womans hips and she would not break her fragile hip bone. The woman died a decade after her surgeries. In the aftermath of Rosalyns case, it may seem that costly medical advantages seem to be a kind of unattainable service even for those, who are, like, Rosalyn, in desperate need for emergent medical assistance. It is impossibly cruel to make someone suffer, witness how their health state progressively deteriorate. What make things feel even worse, is that getting sick for average middle-aged employed American citizen is a sort of fatal disaster. Rosalyns case seems to be outrageous, if observed through the lens of distributive justice theory. That concept is related to the fair distribution of existent resources amidst diverse members of the society. That justice is grounded on the total amount of goods to be allocated, the procedure and distributive pattern. In the health care settings, like in any other field, distributive justice is expected to work for the good of patients. Allocation of medical services, thereof, should be based on the criteria of need, equity and equality. Currently, the United States of America maintains a patchwork system of five

Offsite manufacturing in the construction industry Essay

Offsite manufacturing in the construction industry - Essay Example Introduction and Context Too often construction projects conducted on site have exhibited inefficient project processes, low integration among team members, poor productivity levels, and poor performance in safety and health. In comparison the manufacturing sector does not normally experience these repercussions which has led some innovative mind in the industry to consider a better way. This turned out to be off site building, which has been noted to have many advantages over traditional construction (Ogden, 2007). In the light of the need for Zenith PM to develop a new strategy to improve its revenues and retain its skilled personnel, the company has identified off-site construction as its most viable option. Current thinking on offsite manufacturing New developments The off-site construction trend grew significantly in 2006 in various countries worldwide, partly because clients and contracts have come to realise its benefits in terms of lower cost, better quality, predictability o f outcome, sustainability, and better compliance with health and safety standards. The off-site industry is still in its infancy despite the rise in the demand for its products; at this point, the industry is still a diverse and fragmented group of technologies and off-site producers. There is certainly room for further development which, as the sector matures, will enhance standardisation and regulation so that clients and contractors could benefit from more reliable products and also more options per product. There are currently four off-site construction techniques where the manufacturing or fabrication is performed away from the project site and before the installation. Na and Bausman (2008) identified these as: (1) Offsite preassembly, referring to the process wherein different building materials, equipment, and prefabricated components are assembled at a remote location for later installation. It is focused on a system instead of a product. One example is roof trusses, or prea ssembled vessels complete with installations, platforms piping and ladders. (2) Hybrid systems are prefabricated building facilities, i.e. they are building units that are fully factory finished, complete with internal furnishes and building services. An example is a factory finished bathroom with interior finishing, plumbing, electrical service, and factory completed office rooms. (3) Panelized Building Systems are comprised of the structural frame, or building envelop, employing factory manufactured building panels. These consist more of factory-built components rather than completed modules – usually including the factory based fabrication like finished wall panels with cladding insulation, internal finishes, doors and windows. They are brought to the site and are there assembled and permanently secured (4) Modular buildings are popularly known as the factory-built homes of one or more units completely assembled or fabricated in a manufacturing plant far from the jobsite. They consist typically of multi-rooms with three-dimensional units, that are constructed and pre-assembled and already include installed trim work, electrical, mechanical, and plumbing. After fabrication, they are transported and assembled on site. Benefits and core challenges There are a host of benefits brought about by off-site construction that have been long-recognized by the HSE and other monitoring agencies. These include ‘predictability, quality assurance, faster construction times, less waste,

Case Study Analysis Example | Topics and Well Written Essays - 1250 words

Analysis - Case Study Example This clearly means than Janisha seriously need help and must be counseled. In fact, even her parents need some advices because their ignorance of family duties is what makes Janisha change her behaviors to incorporate bad and unresponsive behaviors. Therefore, the ultimate aim of this context is to provide proper psychoanalytical counseling for Janisha using knowledge comprehended from chapter five of the book, Counseling Children by Paul Dubois Henderson and Thompson. According to chapter five of the book Counseling Children, psychoanalysis, as a form of therapy, is centered on the comprehension that people are massively unaware of the mental procedures that settle on their feelings, thoughts, and behavior, and that psychological suffering can be eased by making those procedures open to the individual (Thompson & Henderson, 2010). The best example of such people is Janisha who does things absent-mindedly in the sense that through her bad behaviors, she was able to implicit the same to other teens particularly to her friends and her brother Marcus. She influenced her friends to sneak out of school without permission. According to the book Counseling Children, Henderson and Thompson clearly stated that Stigmunt Freud was the initial person to establish the theory and method of psychoanalysis in the mid 1890s. This theory and method of psychoanalysis integrates new insights about human development and behavior centered on psychoanalytic study and re cognitions from associated fields. Therefore, through understanding this theory by Freud, it is possible to solve Janisha’s situation because she seriously need behavioral change and seriousness in studies in order to perform well (Novie, 2007). According to Thompson and Henderson, the main goals of psychoanalysis as highlighted in chapter five of their book encompass increased self-awareness, relief, and more

Travel industry in Europe Essay Example | Topics and Well Written Essays - 2750 words

Travel industry in Europe - Essay Example This essay tells that the popularity of British Airways was since the year 1974 after the combination of British overseas airways corporation and the British European Airways Corporation. Since its formation it has been one of the primary airlines in UK and Europe. Since its inception it has been the largest airline based on the fleet size and in respect of the number of passengers in UK as well. It serves a massive number of 150 destinations. The organization has been able to perform consistently over the years and has been one of the major profit making organizations in the airline industry. The operational excellence of the British airways can be linked to the fact that it has successfully implemented the 24 hour IT system. Besides this it has gained significant achievement within its community, market place and workplace. Other than being the largest airline in Britain it has contributed significantly in donations and has devised proper training strategies for noise reductions in the flights. British airways have also developed a lot with respect to the infrastructure. The new terminal 5 has been delivering fantastic service for the airlines and has benefitted the passengers as well. The overall organizational efficiency gained by the organization can be contributed to variety of factors. The general study in management reflects that there are various factors which lead to the operational efficiency of an organization.... Besides this it has gained significant achievement within its community, market place and workplace. Other than being the largest airline in Britain it has contributed significantly in donations and has devised proper training strategies for noise reductions in the flights. British airways have also developed a lot with respect to the infrastructure. The new terminal 5 has been delivering fantastic service for the airlines and has benefitted the passengers as well. (Overview – achievements, n. d) The overall organizational efficiency gained by the organization can be contributed to variety of factors. The general study in management reflects that there are various factors which lead to the operational efficiency of an organization. Research studies reflect that the prime factors leading to operational effectiveness are organization culture, organization operation, and organizational leadership. The paper analyzes each of the above mentioned factors with respect to the British airways. Leadership: The theory of leadership deals with managing a team of people for attaining a common set of goals. In British airways the organization opts for various leadership development programs. The leadership development program focuses on various issues like leaders will skill and commitment. The leaders will helps to identify the willingness of the leader to deliver according to reach the business benefits. The skill assessment measures the current level of skill the leader’s posses and the styles adopted by them to make it an effective learning process. Management ways of the organization emphasizes upon the manager’s response to obeying of

Impact of the Globalization Process in Different Fields Essay

Impact of the Globalization Process in Different Fields - Essay Example This essay outlines the significance of globalization process, that favorably resulted in the rapidity of change, together with different priorities of nations and people. Globalization has boomed in the aftermath of the oil crisis in the 1970s and it changed the relative costs of production inputs and products, gave new impetus to technological innovations, fuelled international financial transactions, as OPEC countries invested their surging revenues in the USA, changed the structure of trade. As economic force, globalization process makes multinational companies (MNCs) the principle vehicle of imperialism’s drive to re-divide the world according to economic power. Economic crisis that is considered to be the greatest since the times of the Great Depression can have negatively impact on the business environment. This is particularly true in countries in transition; moreover, foreign investments can make economics more uneven, with disastrous consequences for both the developing and developed countries. This polarization must be recognized by international business structures and governments through poverty alleviation programmes and strategies designed to reposition marginalized economies to make them possible to participate in current developments. The problem is that even small American enterprises to have an impact on the global market are to think, produce and sell globally. The so-called ‘global firm’ have to link all the small enterprises into global webs of production, distribution and services. The process is rather long-term and complicated one, because the new business model has possess strategic flexibility, competition with co-operation, horizontal, decentralized work structures, and constant communication in real time. [Held D., McGrew A., Goldblatt D. and Perraton J., 1999] The re-organizational process has already begun, that's in why it has got an unstoppable power: it exists at all levels, including economics, politics, social and labor spheres. As economic force, globalization process makes multinational companies (MNCs) the principle vehicle of imperialism's drive to re-divide the world according to economic power. [Douglas I., and Tervio M., 2000] The process of integration of global financial markets has increased capital mobility and global production and distribution structures, but has also weakened the bargaining power of trade unions everywhere - the most key decisions are made by private business that deepened the increase of privatization; such policies have a potential negative impact on jobs and incomes everywhere. [Thomas T., 2000] Through the process of restructuring jobs in some sectors and places have been lost, but the relocation from developed to developing countries has influenced capital mobility and the locational choices of firms, which favors social stability, local infrastructure development, and market proximity. But from the social point of view, the existence of firms with a global reach and profile calls for new business ethics, and over-emphasises on efficiency and technology, that has affected the human element, causing depersonalization and spreading apathy. [Thomas T., 2000] In general, the global economy is to reform the labour market, and its outcomes are directly connected with the way these markets function, with the unionized and non-unionized sectors. There is a close

Edit1 Essay Example | Topics and Well Written Essays - 250 words

Edit1 - Essay Example Furthermore, the reports and their analysis thereof have not only illuminated the very deficiency of my daily caloric consumption, but have informed the modification of my food diet towards more healthy foods such as fruits, vegetables and whole grains, as already alluded to above. Noteworthy, proper management of the daily calorie intake goes a long way in preventing not just obesity already, but numerous chronic diseases such as diabetes and heart diseases. The change in my food diet to include those foods rich in fiber will tremendously help in regaining the very crucial minerals and vitamins that are somehow in short supply for proper functioning of my body systems. To be specific, the graphic on â€Å"My Plate† was but informational with regards to contents of a balance diet; fruits, vegetables, grains, protein and a variety of dietary products are all recommended. Additionally, the questions of this assignment were indeed helpful, for they introduce me to the exact amounts of protein, carbohydrates and fats that I need to consume to live a healthy

Strategic Management Analysis Assignment Example | Topics and Well Written Essays - 4250 words

Strategic Management Analysis - Assignment Example The task of tour operators is to manage proper blend of aircraft, hotel, and tourism spots to make the holiday experience of customers easy, reasonable and expedient. They provide customers a variety of choices for spending on the holidays. In the year 1950, UK had first experienced inexpensive holiday package and since then this industry has become quite vast in the international market. Many big tour operator companies compete with each other for providing inexpensive holiday packages for family customer segment. In the study, the company which has been considered is easyJet. easyJet Holidays encompasses together the easyJet, an UK-based airline company and one of the foremost planners of accommodation in the UK lowcostbeds.com. The prime aim of easyJet Holidays is to provide immense ‘value for money’ beach holidays and city breaks to each destination’s of easyJet. easyJet Holidays offers a collection of around 100 destinations to select from and also provides a ir travels from around 13 airports of the UK with supreme choice, value as well as flexibility. easyJet Holidays also provides custom-made holiday tours along with availability of more than 10,000 hotels of quality in travel destinations arraying from 2 stars to 5 stars for its customers (easyJet Holidays, 2011). The package holiday is enormously popular for British tour creators. The package holiday industry provides people ranges of customised holiday packages to choose from (TUI UK Retail Limited, n.d.). 2.0 Task A 2.1 PESTEL Analysis PESTEL analysis helps to determine the external macro–environmental factors that can impact on the package holiday industry as a whole. 2.1.1 Political Aspects The political condition of any country can influence the laws of business. The political factors include the rules and laws of government and legal problems for operating a business. The political condition in the UK is relatively stable. Factors which can manipulate the package holida y industry are essentially the war and taxes on aviation among others. The UK government is currently trying to impose extra duty on aviation which can impact on the package holiday industry. easyJet, which is one of the biggest airline companies of the UK, had concluded that the hike of taxes on aviation can affect millions of customers and thus it can affect the profit of easyJet. The easyJet had already faced enormous tax increase for family trip i.e. tax had increased by 33%. It can affect the package holiday industry and the employment factor in the UK (Pierre, 2011). 2.1.2 Economical Aspects The economic factors can determine the purchasing power of people which affect the airline and package holiday companies’ offers. The economic condition includes the GDP growth rate, the

Rise of Civilization in Mesoamerica and Andean South America Essay

Rise of Civilization in Mesoamerica and Andean South America - Essay Example Monuments with hieroglyphic texts were constructed and ceremonial centers had outstanding artistic developments. The Post Classic period extended from A.D. 950 to 1521, local governments were divided into branches for different purposes and directed towards commercial activities. Great houses with many and large rooms were constructed serving purposes of royal ceremonies and host to long distance alliances, each of these buildings had a sophisticated level of art and craft impressions. Traders and craftsmen were involved in the competition for entry into exclusive exchange networks that they sought the rarest and most exotic materials for their gifts. Smelting of gold, silver and copper was introduced in Central and South America. As pointed out by Gonzales, Merchants and Artisans only made up a small percentage of the Mesoamerican population but had a great impact that led to an extensive trading network (17). The Andean region of South America is also significant in the rise of ear ly intricate societies. The Andean people had their own distinct cultures different from other people in the world. Before invasion of Peru by Spain in 1532, western South America was inhabited by different High Mountain and desert coastal societies. These people had unique artistic and technological achievements which is the reason behind the name Andean Civilization by modern observers. South American territories were controlled by the Inca and were spread over Ecuador, Chile, Peru, Bolivia and Argentina; they were all part of a state called Tawantinsuyu which means the ‘Realm of the Four Parts’. The Inca began as a tribe in 1200 B.C., after defeating neighboring Andean tribes founded the Inca Empire. It was the most powerful civilization in South America. An existing... The Andean region of South America is also significant in the rise of early intricate societies. The Andean people had their own distinct cultures different from other people in the world. Before the invasion of Peru by Spain in 1532, western South America was inhabited by different High Mountain and desert coastal societies. These people had unique artistic and technological achievements which are the reason behind the name Andean Civilization by modern observers. South American territories were controlled by the Inca and were spread over Ecuador, Chile, Peru, Bolivia and Argentina; they were all part of a state called Tawantinsuyu which means the ‘Realm of the Four Parts’. The Inca began as a tribe in 1200 B.C., after defeating neighboring Andean tribes founded the Inca Empire. It was the most powerful civilization in South America. An existing indication of the social unity of the Andean people is the Quechua language which is still used by millions of people from North Ecuador and North Argentina. The Incas were great warriors and shrewd rulers. They exchanged gifts with neighboring tribes, intermarried and formed political alliances. Their populations were large in numbers and their administrative and economic systems were established in all their regions. Inca civilization had reached great feats in architecture; they constructed buildings with fine cut stones eliminating the need for mortar. They melted gold and silver and were in fact very famous for their gold.

The power of music Essay Example for Free

The power of music Essay Did you know that music have some special power that help our mankind too? Most people love to listen to music because music give us feel comfortable. That is why people are create several types of music such as hip-hop, rock, pop-rock, pop, metal, classic and jazz. Music had been with human for such a long time, but most of us didn’t know that music had the effects that affect our life too. Music has three main power that affects people such as physical, mental, the healing power and improvement brain function. The first one that music affects people is physical and mental effect. There are the research show about listening different types of music can affect people in physical and mental. According to â€Å"The power of music†, â€Å"Classical music, certain types of jazz or our favorite ballad singer can physically relax our bodies and distract our minds from the cares of the day†. Rhythm of music can affect our mind too. The power of music found that listening loud or fast music that has a powerful rhythm can cheer us up or make us feel uncomfortable. In short, listening different types of music or different rhythm will affects people in physical and mental. The second effect is music has a healing power to help patient. This effect called music therapy. Music therapy is a therapy that uses music to help the patient by making patient listening to music. According to The Healing Power of Music, â€Å"Music used therapeutically creates an environment where the patient can be nurtured and cared for in a way that is safe, gentle and appropriate. Accordingly, the therapist said that listen to music can help the patient who has a problem with memory such as Alzheimer’s get better. The Healing Power of Music found that music has the capability to organize the brain of people with Alzheimer’s disease. In brief, music has a healing power to help patient such as Alzheimer’s disease get better. The last effect of music is listening to music will improve brain function. There are the research that confirm that listening to music or playing an instrument can make you learn better. How Music Affects Us and Promotes Health said that music has an ability to help brain function which improve your reading and literacy skills, spatial-temporal reasoning, mathematic skill and emotional intelligence. Music also makes your brain memorize better. A study by How Music Affects Us and Promotes Health, â€Å" There is clear evidence, that children who take music lessons develop a better memory compared with children who have no musical training†. Furthermore, listening to music when you excercising can boost your cognative levels and verbal fluency skills. In summary, music can improve brain function such as mathematic skill, emotional intelligence, reading skill and makes your brain memorize better. In conclusion, these are the three main benefits of music that help people improve their mind, physical, mental and brain function. Nowadays, we have mobile phone, mp3 or mp4 that has function to listen to music. So, we can listen to music everytime that we want. Now that you know about these then, you should listening music that you love everyday.

Quality Life For Older People: Dementia

Quality Life For Older People: Dementia There is no mental disorder that is inevitable in old age. Older people describe their overall well-being as good. Hence there is such a thing as normal ageing in terms of mental (as well as physical) health. Nevertheless, as in all age groups, mental disorder is not uncommon in older people and there are some disorders that become more prevalent as age increases. Mental disorder in old age can be divided into two broad categories: à ¢Ã¢â€š ¬Ã‚ ¢ Organic disorders These are characterized by confusion, which may be acute (i.e. delirium) or chronic (i.e. dementia); à ¢Ã¢â€š ¬Ã‚ ¢ Functional disorders Such as depression, anxiety and panic; but also psychotic disorders, such as late-onset schizophrenia (formerly known as late paraphrenia) In addition, drug and alcohol misuse and dependence can (like many disorders) continue into old age, or emerge for the first time when the person is older. Similarly, it should not be forgotten that personality difficulties do not necessarily disappear with ageing. (Wolstenholme et al, 2002) Epidemiology The prevalence of mental disorder in elderly people depends on exactly which age group is examined and where they are living. In community surveys of all people aged over 65 years, approximately 5% are found to have severe organic brain disorders (mainly dementia) and a further 5% to have mild symptoms of forgetfulness. 2.5-5% will have depression severe enough to warrant treatment with a further 10% complaining of minor depressive/anxiety symptoms. Late onset schizophrenic illnesses are much less common, perhaps 0.5-1.0%. (Landau et al, 2008) If one looks at the very elderly (greater than 80 years) the rates of organic disorders, mainly dementia, are much increased, (e.g. 20%) whereas other diagnoses may occur less frequently in other words organic disorder is (as one might expect) a disorder associated with increasing age. In residents in local authority homes, hospitals or other institutional care, the rates for both organic and functional disorder (particularly depression) are much increased about 30% for each type. It is probable that mental disorder will have contributed to the person entering the institution, e.g. dementia making them unable to survive safely in their own home but the combination of losing ones home and familiar surroundings can also aggravate existing confusion and/or depression. (Landau et al, 2008) Ethics and Law The main ethical concern in older people relates to the issue of capacity. In some jurisdictions (e.g. Scotland) there are now laws around incapacity. Capacity legislation will appear shortly in England and Wales. Irrespective of the legislation, however, the need to maintain the older persons ability to make autonomous decisions is clearly of ethical importance. Autonomy can be undermined by both professionals and families for both benign and malignant reasons (Colin, 2008). The presumption should always be that the person has the capacity to make a particular decision. Judgements about capacity should always be made with respect to a specific ability: a person may not be able to drive, but may still be able to run his or her own finances. Having a particular capacity (or competence) means that the person can recall and understand the relevant information and that the person shows evidence of weighing up the information as he or she makes a decision (which need not be the decision t hat the person assessing capacity would have reached). (Colin, 2008) If the person lacks capacity, those involved must act in the persons best interests. These have to be understood broadly. The criteria for assessing a persons best interests should include: taking account of what the person has said or stipulated (e.g. on an advance directive or living will) in the past; taking account of what the person now says when enabled to participate in the decision; taking account of the views of all those other people involved in the persons welfare, insofar as this is practicable, especially as regards what they think the persons wishes would have been under the present circumstances if the person had been able to express his or her wishes; making sure that the least restrictive course of action is taken. There are particular procedures to be followed if the person lacks certain capacities. For instance, there is a variety of steps to be taken (involving the Court of Protection) when the person cannot manage his or her finances; and if the person lacks the capacity to drive, the requirements of confidentiality may be put aside in the interests of public safety. Having said this, however, the doctors duty is to be on the side of the patient and it is an affront to the persons standing as an autonomous individual if his or her abilities are undermined without due cause. The General Medical Council offers advice on such issues. (Van, 1996) The Aging Population The table (based on 1991 projections) shows the age structure of the UK population for the years 2001 to 2041. The increase in the proportion of elderly people is in the 75-84 year group (+39%) and more particularly in those 85+ years (+55%). Meanwhile, the numbers of younger people changing little. The vast majority of these older people live at the present time in their own homes, only 6% being in institutional care (residential homes or hospital). The over-85 group are predominantly women, the majority widowed and living alone. The very elderly group have high consultation rates with general practitioners, with many more home visits and occupy up to 50% of all NHS beds (medical, surgical and psychiatric). They are more likely to have complex combinations of physical, psychological and social difficulties, which require multidisciplinary assessment and treatment. (Birk and Harvey, 2006) Dementia About 5% of the general population over 65 years suffer from severe cognitive impairment with further 5% showing mild changes, which may progress with time. Dementia refers to a global impairment of mental function which follows a chronic and progressive course. The symptoms and signs have usually been present for at least 6 months (Birk and Harvey, 2006). The impairment of mental function is commonly associated with deterioration in emotional control, social behaviour, motivation and the ability to perform activities of daily living (ADLs). These non-cognitive features of dementia, which are often the most upsetting aspects for family carers and friends, tend now to be referred to as Behavioural and Psychological Symptoms in Dementia (BPSD). Dementia is related to progressive cerebral degeneration, which may be caused by a variety of pathological processes, such as Alzheimers disease, vascular dementia and dementia with Lewy bodies. Post mortem changes found in the brains of people with dementia suggest the following diagnoses (approximate figures): Alzheimers disease 50% Vascular dementia 15% Dementia with Lewy bodies 15% Mixed vascular/Alzheimers disease 15% Other causes 5% Alzheimers disease Alzheimers disease is characterised by a gradual insidious onset and progressive course, often beginning with memory failure before other cognitive functions (e.g. language, praxis) become affected. Non-cognitive features (depression, psychosis, wandering, aggression, incontinence) are common. Physical examination is often normal, as are routine blood investigations. (Farrer, 2001) Computerized tomography (CT) scans may be normal or show generalised atrophy and dilatation of ventricles. CT scans also play a role in excluding other possible causes of confusion (e.g. space-occupying lesions, haemorrhages). Angled CT scans afford better views of the medial temporal lobes, which can show marked atrophy. However, this is not specific for Alzheimers disease. Hippo-campal atrophy is also seen with magnetic resonance imaging (MRI) scanning. Single photon emission computerized tomography (SPECT) provides information on how the brain is functioning, usually by tracing blood flow using radio-labelled technetium. In Alzheimers disease SPECT scanning can show a generalized decrease in blood flow, or biparietal and bitemporal hypo-perfusion. However, the diagnosis must always be made on the basis of the overall clinical presentation rather than solely on the appearance of scans. (Farrer, 2001) Dementia with Lewy bodies Dementia with Lewy bodies is characterised by the triad of fluctuating cognitive impairment, recurrent visual hallucinations and spontaneous Parkinsonism, though not all occur in every patient. As with Alzheimers disease, onset is insidious and may begin with cognitive problems, Parkinsonism, or both. Cognitive impairment initially affects attentional and visuo-spatial function, with memory initially relatively spared. As with Alzheimers disease, non-cognitive features are common. Parkinsonism consists mainly of bradykinesia rather than tremor and, once again, routine blood investigations are normal. CT scan may be normal or show generalised atrophy and dilatation of ventricles, with less temporal lobe atrophy than in AD. Blood flow SPECT can show similar changes to those seen in Alzheimers disease, though DLB is more likely to be associated with occipital hypoperfusion than Alzheimers disease, a finding which may relate to the hallucinations and visuospatial disturbance. Parkinsonis m in DLB is associated with nigrostriatal degeneration, similar to that seen in Parkinsons disease. It is possible to image nigrostriatal degeneration using SPECT scanning with a ligand for the dopamine transporter (FP-CIT or DaTSCAN imaging) which can be helpful in assisting with the diagnosis of Parkinsons disease. In the future it is hoped such imaging methods may be helpful in diagnosing DLB as well. (Mo Ray, 2009) Vascular dementia In contrast, vascular dementia usually has an abrupt onset, often in association with a recognised stroke, and is associated with a fluctuating course, a stepwise decline and often reasonable insight at least in the early stages of illness. An exception to this course is subcortical vascular dementia, which may cause some 20% of all vascular dementia, when sudden onset and a stepwise course may not be seen. Patients will often have risk factors for vascular disease, for example high or low blood pressure, ischaemic heart disease or peripheral vascular disease, but also diabetes mellitus and hypercholesterolaemia. Physical examination is likely to reveal focal neurology and a CT scan would be expected to show evidence of cerebrovascular disease. (Mo Ray, 2009) Other dementias Other causes include rarer degenerative processes, e.g. Fronto-temporal dementia, Huntingtons disease, in addition to alcoholic dementia, tumours, haematoma, etc. In some cases no discernible pathology is found. (Mo Ray, 2009) Clinical assessment and management By careful history taking (usually from patient and informant) and examination of both physical (particularly neurological) and mental state, it is possible to predict the likely underlying pathology in most patients with dementia. No specific diagnostic tests are yet available, but clinical diagnosis may be usefully supported by structural brain imaging methods such as CT or MRI scanning and functional imaging techniques such as SPECT (Single Photon Emission Computer Tomography) scanning. It is important to develop methods of establishing the aetiology of dementia during lifetime (Eastwood and Reisberh, 1996): à ¢Ã¢â€š ¬Ã‚ ¢ To assist in predicting course of illness and determining prognosis. à ¢Ã¢â€š ¬Ã‚ ¢ To inform management decisions; for example specific treatments are becoming available for Alzheimers disease (cholinesterase inhibitors) and vascular dementia and it is necessary to know which patients should receive which treatment. Patients with dementia usually present either because of failure to cope or with disturbed behaviour occasionally with both. They often lack insight into their illness or, in the early stages, deny it. People with dementia require: à ¢Ã¢â€š ¬Ã‚ ¢ An assessment of the cause and severity of the dementia (cognitive impairment and behavioural abnormalities); à ¢Ã¢â€š ¬Ã‚ ¢ An assessment of deficits in function and the need for care (dependency); à ¢Ã¢â€š ¬Ã‚ ¢ An assessment of the persons social situation; à ¢Ã¢â€š ¬Ã‚ ¢ Provision of treatment and care appropriate to the identified needs; à ¢Ã¢â€š ¬Ã‚ ¢ Support for carers both practical and emotional; à ¢Ã¢â€š ¬Ã‚ ¢ Review of the above points is the treatment and care appropriate and beneficial? About 50% of cases of dementia have concurrent physical health problems. The burden of care produced by a physically sick patient with dementia is greater than that of a fit one; therefore, diseases should be sought and treated where appropriate. Dementia may also be complicated by: à ¢Ã¢â€š ¬Ã‚ ¢ Emotional liability à ¢Ã¢â€š ¬Ã‚ ¢ Depression à ¢Ã¢â€š ¬Ã‚ ¢ Psychotic features (i.e. delusions and hallucinations) à ¢Ã¢â€š ¬Ã‚ ¢ Behavioural disturbances (i.e., wandering, aggression, incontinence) These may be helped by pharmacotherapy, counselling and explanation and support to relatives. Such patients may respond either to antidepressants for liability and depression, or antipsychotic agents for psychotic features and some behavioural disturbances. Patients with dementia are often sensitive to side effects of psychotropic drugs and so it is important to begin therapy with very low doses of medication and monitor carefully for side-effects, particularly extra-pyramidal problems. In 2004, the two drugs Risperidone and Olanzapine were recommended not to be used for the control of agitation and disturbed behaviour in dementia because of the risk of stroke. The use of antipsychotic medication to control agitation and other difficult behaviours in moderate to severe dementia remains common but controversial. (Birk and Grimley, 2005) Memory Clinics The assessment of forgetfulness is often undertaken by memory clinics. These exist in a variety of forms (some being very clinically focused and others having a research basis). The aim is to provide thorough assessment (clinical history, with mental state, neuropsychological and physical examinations and appropriate investigations e.g. blood tests and neuro-imaging) in order to arrive at an accurate diagnosis. Some clinics then initiate and monitor the use of medication (e.g. the cholinesterase inhibitors for Alzheimers disease). Increasingly, memory clinics are seeing people with milder symptoms, many of whom will be anxious about the possibility of dementia. Some such patients will have other conditions, such as depression (i.e. pseudo-dementia) or other physical illnesses. (Seltzer et al, 2004) The diagnosis of mild cognitive impairment (MCI) is now sometimes made in people who present with forgetfulness but who do not satisfy the criteria for even a mild dementia (because, for instance, their everyday activities are not impaired). A proportion of people given the diagnosis of MCI will progress to develop dementia on followed-up. Identifying MCI may, therefore, open up the possibility of early treatment. But MCI is not uncontroversial, because some people given this label will show no such progression of symptoms and might be more properly regarded as normal. (Seltzer et al, 2004) Acute Confusion (Delirium) Elderly people seem particularly likely to develop confusion in response to a wide range of stimuli either physical insults or sudden social change. This presumably reflects the reduced ability of the aged brain to cope with such events, particularly if it is additionally damaged by a dementing process. An acute confusional episode may sometimes be the first evidence of an underlying dementia. Elderly patients with acute confusion are seen throughout medical practice, e.g. 20% of all acute medical ward admissions are found to be acutely confused. In elderly people apathy, under-activity and clouding of consciousness are more common presentations of delirium than the florid, overactive restless, hallucinating states usually described in relation to younger patients. Causes include (Birk et al, 2006): à ¢Ã¢â€š ¬Ã‚ ¢ Intercurrent physical ill-health à ¢Ã¢â€š ¬Ã‚ ¢Adverse reaction to a prescribed drug or drugs à ¢Ã¢â€š ¬Ã‚ ¢Catastrophic social situations, e.g. a move into residential care Acute confusion should be regarded as indicative of underlying disease and investigated medically. Untreated it has a 40% mortality rate. The clinical approach is to complete a full physical examination looking for evidence of infection, stoke, MI or other illness. A review of medication should focus on drugs started or stopped recently. Until the underlying cause is determined and treated, a small dose of an antipsychotic agent may reduce the severity of delirious episodes. (Birk et al, 2006) Functional Disorders Depression This is the most common psychiatric disorder found in old people (if milder cases are counted) and the second commonest single underlying cause for all GP consultations for people over 70. The majority of depressive syndromes are of mild to moderate severity. About one fifth of cases are severe and carry the risk of suicide especially in men, in those which fail to remit within 6 months of onset and in those who feel physically ill (hypochondriacal) especially if they have the delusional belief that they suffer from cancer. Depression in old age may be precipitated by adverse life circumstances: bereavement; loss of health; threat of bereavement or loss of health in a key figure. As with younger patients, those who suffer from depression may have vulnerable personalities (i.e. they may be anxious and obsessional by nature) or they may have no close confidantes (i.e. they may be socially isolated). More recently evidence has emerged suggesting that depression occurring for the first time in later life may be associated with subtle brain abnormalities, such as an increase in white matter lesions (detected on neuroimaging), which may reflect hidden or undetected cerebrovascular disease. (Rands et al, 2006) Depressive illness in old people shows a wide range of clinical presentations. The typical picture of low mood, anhedonia and vegetative disturbance of sleep and appetite seen in younger people may predominate. Some patients become apathetic, withdrawn and appear to lose their cognitive abilities (this is called depressive pseudo-dementia as cognitive impairment may be so marked as to mimic organic dementia). Others may present with a picture of severe agitation and restlessness, accompanied by delusions of ill health or poverty, e.g. that they are dying of a brain tumour, that their bowels have stopped working and are rotting inside them, or that they are unable to pay for their hospital treatments. The clinical approach with mild cases of depression is unlikely to involve the Old Age Psychiatry Service, since they will be treated by the Primary Health Care Team. Support and counselling may be supplemented by the use of antidepressants. More severe or persistent cases are likely to be referred for specialist assessment and treatment. The majority of cases respond as well to treatment as younger patients perhaps even better! Poor outcome is often the consequence of inadequate treatment. The older tricyclic antidepressants are often not well tolerated, postural hypotension, urinary and gastrointestinal side effects being prominent. (Rands et al, 2006) Dosage should be titrated to the maximum tolerated, starting doses generally being 1/3 1/2 of those for younger patients. Newer antidepressants such as SSRIs have a particular place in the treatment of the elderly. Delusional depressions require the addition of neuroleptics for unresponsive or severe depressions ECT is a safe and effective treatment. Lithium carbonate has a valuable place in prophylaxis of recurrent episodes and is also effective in potentiating or augmenting the antidepressant actions of tricyclics. Many elderly depressed patients have previous or current physical illness. Not only must this be taken into account during treatment (e.g. tricyclic antidepressants are usually avoided in a patient with ischaemic heart disease and, in patients with a high risk of bleeding, SSRIs should be used with caution), but also physical illness must be treated in its own right to maximise the patients chances of recovering from the depression. (Rands et al, 2006) Anxiety Disorders Anxiety disorders do occur in old people, about half of it persisting from early life and half coming on for the first time in response to the stresses of ageing. A common precipitant stress is that of failing physical health, e.g. developing an acute phobic state after a fall from a bus, leading to a fracture and a period of reduced mobility. Behavioural methods of treatment may be effective. Diffuse anxiety and loss of confidence, even if precipitated by an adverse event, may indicate an atypical form of depression. Such patients respond better to antidepressant, rather than anxiolytic, drugs. (Rands et al, 2006) Paranoid States It appears to be a normal feature of ageing that individuals become rather more inflexible in their attitudes and fearful of adverse influence by the outside world. Elderly people are often not only physically and financially disadvantaged, but they enjoy relatively low social status and are often the victims of attack or deception. It is, therefore, perhaps not surprising that persecutory ideas (which we tend to lump together as paranoid symptoms) often emerge. The main conditions in which paranoid persecutory symptoms occur are as follows (Corey-Bloom, 2000): Late onset schizophrenia/delusional disorder This was formerly known as paraphrenia. The typical subject is an elderly spinster, with sensory impairments (deafness or visual impairment), living alone and isolated. Her self-care skills are good and she is apparently normal apart from the possession of a complex delusional system in which she believes she is the victim of a conspiracy (usually to defraud her). She hears third person auditory hallucinations, may smell odours, which she interprets as poison gas pumped into her room and misinterprets chance occurrences as having special significance. This psychotic illness, similar to schizophrenia in younger life, responds to antipsychotic drugs if the patient can be persuaded to take them. The delusions, however, seldom completely disappear but instead become encapsulated: the patient is no longer bothered by them although he or she never gains full insight into their delusional nature. A depot injection given by a Community Psychiatric Nurse is often a useful vehicle which improv es compliance with medication and provides regular contact with the patient. (Corey-Bloom, 2000) Acute confusional state/delirium Paranoid symptoms are common during delirium, the patient misinterpreting events because of his/her altered level of consciousness. The management of these symptoms has already been described neuroleptic medication may help to reduce agitation and behavioural disturbances. Paranoid Reactions to Forgetfulness These usually occur in independent old people who explain their experience of forgetting where things have been placed by accusing others of stealing them. Objects stolen are usually everyday ones, e.g. cups, teapots, pension book, money or glasses. Stolen objects often are returned or reappear in the usual place. The most likely cause of forgetfulness and paranoid misinterpretation is, of course, a dementing process. Neuroleptic medication is seldom of benefit in these circumstances. (Corey-Bloom, 2000) Assessment Procedures Clinical diagnosis of dementia includes identifying the cause of the cognitive impairment, which may be a treatable non-dementing process, delirium, or depression (Rockwood et al., 2007). When an illness that is associated with dementia is identified, the severity and character of cognitive impairment is commonly assessed in conjunction with the degree of illness and the potential for other psychiatric disorders such as depression (APA, 2000). Diagnostic assessments include a review of the patients medical history, a physical exam, and evaluation of depression, delirium, and cognitive status (Beck, Cody, Souder, Zhang, Small, 2000). Physical assessment results may identify treatable physiological imbalances that affect cognition (Freter, Bergman, Gold, Chertkow, Clarfield, 1998). Referral to neurology, neuropsychiatry, or a geriatric specialist in dementia has been stated as an important element in diagnostic assessment (Beck et al., 2000). Other elements in the assessment process commonly include neuro-imaging that can support the findings of assessments, and over time, the progression of the disease (Van Der Flier et al., 2005). Studies have also indicated that research using electroencephalography (EEG) might be an inexpensive tool that could contribute to the differentiation of dementias. Another important set of tools for assessment of cognitive deficits is neuropsychological testing (Sano, 2007). Neuropsychological assessments include testing for deficits in cognitive abilities such as current intellectual functioning, orientation, attention, verbal and non-verbal memory, verbal fluency, naming of items, and executive functioning (Petersen Lantz, 2002). Neuropsychological testing has been suggested as providing a contribution to clinical data in diagnostic assessment for dementia, differentiating between different types of dementias, early detection of cognitive loss, and identifying potential interventions (Sano, 2007; Savla Palmer, 2005). The diagnosis of dementia, even with the use of diagnostic tools, remains primarily based on observational data and judgment of the combined clinical data. The process involved in dementia assessment and diagnosis can be overwhelming and has been reported as one reason for delaying diagnosis (Sternberg, Wolfson, Baumgarten, 2000). There is also evidence that suggests that differentiating between MCI that can precede AD, and memory loss that does not have emerging pathology, poses difficulty and hesitation in requests for formal assessment (Shah, Tangalos, Petersen, 2000). The literature also suggests that there is a strong need for individuals and families to bring their concerns forward to a physician for assessment as often the first indication that an older adult is experiencing cognitive problems occurs during a crisis situation (Boise, Neal, Kaye, 2004; Borson, Scanlan, Watanabe, Tu, Lessig, 2006). In AD, memory loss has been described as insidious and can include a period of concealment preceding diagnostic investigation related to a need to preserve feelings of self-worth, identity and control (Keady Gilliard, 1997, p. 245). A diagnosis of dementia coinciding with a health crisis (e.g., stroke leading to vascular dementia) or with a progressive neurological disease (e.g., Parkinsons disease) are reported more frequently because of a higher associated incidence and known relationship with these disorders (Lindsay, Hebert, Rockwood, 1997; Wientraub, Moberg, Duda, Katz, Stern, 2004). The most common impetus for diagnostic evaluation is a realization of memory problems by the individual, or their family and social contacts, or associated with upsetting behaviour in social situations. Thomas and OBrien (2002) described behavioural changes that have been reported in dementia categorized as psychotic symptoms or possible alterations in mood or motivation. Psychotic symptoms include delusional ideas and beliefs (e.g., believing that misplaced articles have been stolen), hallucinations (e.g., seeing and speaking to people who are not physically present in a room), and misidentification of individuals (e.g., mistaking a son for a husband). Subtle changes in mood or motivation that may initially go unaddressed but increase in level of concern include apathy (e.g., lethargy), agitation (e.g., wandering, repeated dressing and undressing), aggression (e.g., verbal and/or physical, or increasing frustration with common tasks), sleep disturbances (e.g., up during the night related to distortions in sleep cycles), changes in eating habits (e.g., progressing to dependency for awareness of meal times) and personality changes (e.g., depression or unsubstantiated suspiciousness of motives of family members). Dementia and depression have been reported as the two most common medical problems in older adults (Leplaire Buntinx, 1999). However, the ass ociation between depression and dementia severity has not been confirmed, and in some instances depression has been misdiagnosed as signalling cognitive impairment (Maynard, 2003). Diagnostic Procedures These are of primary importance and include both psychiatric and medical history-taking together with physical examination and mental state assessment (including cognitive examination). Investigative procedures, e.g. EEG, blood tests, CT, MRI or SPECT scans are used as necessary. There are now operational criteria or consensus statements for the diagnosis of the main types of dementia (e.g. Alzheimers, Lewy body, vascular and fronto-temporal dementias), as well as for functional disorders. Many of the investigative procedures used in old age psychiatry are aimed at excluding other conditions in order to satisfy accepted international diagnostic criteria (e.g. the International Classification of Diseases, Tenth Edition, and ICD-10). Thus, the diagnosis of Alzheimers disease requires that other systemic or brain disease[s] should be absent. This suggests the importance of blood tests (e.g. to exclude amongst other things vitamin B12 or folate deficiency) and brain scans (e.g. to rule out the possibility of tumours or haematomas). On the other hand, some diagnoses can be clinched by a particular finding on investigation (e.g. the finding on CT of multiple cerebral infarcts in a person whose history is in keeping with a diagnosis of vascular dementia). A functional scan, e.g. SPECT, might be a useful means to confirm a diagnosis of fronto-temporal dementia in someone where the anatomical scan (e.g. CT) only shows very mild frontal lobe atrophy. Such a scan might then be used to explain this bewildering and distressing condition to the family. Illnesses in old age are commonly multiple, so that patients often suffer from several disorders simultaneously. Investigations become important, therefore, in functional illnesses too, not only because certain conditions need to be excluded (e.g. hypothyroidism in depression), but also because other physical conditions might make some psychiatric symptoms worse, or might preclude the use of certain medications. For example, chronic obstructive pulmonary disease, if not optimally treated, might exacerbate anxiety and panic; or a bleeding disorder or ulcer might limit the use of SSRIs. Disorder of Function Diagnosis alone does not tell you how severely disabled someone is. Two people with the same condition may behave very differently, e.g. dementia due to Alzheimers disease may render one person unsafe for independent living, but simply slow the other one down in the time taken to complete the daily crossword. It is important therefore to assess the functional disability that an old person suffers from and decide whether it can be relieved. Occupational Therapists and Physiotherapists play an important part here, but the doctor needs to be aware of this aspect of illness when he/she is taking a history. No