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

The Island Move Analysis

The Island Move Analysis In the beginning of the film Lincoln 6 Echo is very inquisitive, reminding me much of a child whos favorite question is why. He wants to know why he has to wear white, why he has to package vitamins, why survivors are being found, why people are drawn at random to go to the island, why he cant eat certain things and the list goes on and on. He has a friend who can do these things, that he visits by faking a shortage in his identity bracelet, unknown to him, this man is an actual human, while Lincoln 6 Echo and his friends are clones of extremely wealthy individuals who pay many millions of dollars to have themselves duplicated should they ever need an organ, skin, or want a surrogate to carry their child. Lincoln, goes exploring one day and realized that there is no island, those who supposedly win the lottery are killed shortly after giving birth, or having organs removed. Jordan 2 Delta, had won the lottery the evening before, and he goes and convinces her to run with him. They esc ape the under ground bunker and realize there is an entire world on the outside with people. They find out that they are clones, created with the sole purpose of keeping their human counterparts alive for many years longer then a natural life. They go in search of their counterparts to show them that they are too living, feeling, thinking individuals and not kept in a vegetative state, as they were lead to believe. Jordans counterpart had been in a car accident so they went in search of Lincolns counterpart an extremely wealthy man named Tom Lincoln, who resided in Los Angeles. They are being hunted by the institution to be brought back before the general population learns the truth of how human they are and what the institution actually does. They eventually find Tom Lincoln and tell him the story; he agrees to take them to the news station to tell their story. Jordan realizes that the original Tom is lying, because his eyes get the same look as Lincolns. Lincoln convinces her to s tay behind, so she doesnt get captured when he double-crosses them. Tom does in fact call the institution because he is not ready to die, and Lincoln is his insurance policy. Lincoln pretends to be the original Tom and the real Tom gets shot, with the mercenary thinking he is the clone. The institute offers Tom a replacement insurance policy. Jordan is captured the next day while Lincoln is going to the institute under the disguise of Tom; his goal is to save all of the other clones. During this time the institute realized that there was a defect in the clones from the echo generation on, giving them the human curiosity personality characteristic, to get rid of this problem they decide to do damage control and kill all of the clones. Jordan and Lincoln intervene and ultimately stop the institution from killing everyone. They save their friends, and the institution is destroyed and prevented from causing any further destruction. I love how this plays in with organ donation and harvesting organs from cadavers as we learned about in class, I think it is such and interesting solution that I hope our society never turns to. The public was lead to believe that the clones were kept in a vegetative state, not feeling, or thinking, or having emotions, which allowed them to be more at ease with the concept. I cant say if I had the money and I was promised that my clone would always be vegetative, that I would say no to that. I can see why it was such a popular concept from the public, I do think that if the public had known about the clones living and breathing, and feeling and being human in everyway except having a natural birth and a childhood, that some would still pay for this privilege. Many people are so scared of death that it doesnt matter how they survive, it just matters that they do. I loved that an underlying theme of the movie was not to trust anyone; humans are manipulative, and only care about their b est interests. This really hit true to me, that we lose so much of our innocents, and our trust as we age because we become so self serving, you could see that happen with Lincoln as he and Jordan spent more time in the human world. He was so trusting and willing to do anything for any one, yet he sacrificed his original counterparts life to save his own. I dont think it is a bad thing, but I think that in the beginning of the movie, it is not something he would have done. When he said, Im not ready to die either, I think it had come full circle that he was starting to become more human, and more self-serving. I think this also played very well into the end of life stages, really focusing on how far would you go to prevent your own death? My main issues with the concept of cloning for organ use are all ethical, is it ethical to clone? What will cloning lead to? What is okay to clone? Not ok? Animals? Adults? Children? Why would people need or want to clone for use other than to use organs and or other body parts? My next issue is the issue of creating life to suit and ulterior need. To me this is using life as a means to achieve a goal, and life should not be a tool to help succeed in other areas, a life should be enough to just be lived and enjoyed. My last concern is that after the clone in the movie has served its purpose, whether it be give birth or donate a kidney the clone is killed, and I cannot grasp making killing the clone ok. Cloning, the act of creating something in the exact form that already exists; to me this alone is unethical there is no need or reason in my mind why society needs to do this. I see no good or benefit for society that can come from cloning, I think it creates unnecessary temptations to do just what was done in the movie, by allowing the wealthy to clone themselves to serve a purpose. If we make cloning a common practice I see no reason why this will not become a reality, and that to me is frightening. The clones in the movie thought, felt, loved, and had all human emotions and to imagine being a clone and knowing you were created to eventually die, so someone else could live makes me ill. I would not choose to prolong someone elses life at the expense of my own unless I truly loved this person. I imagine a clone would feel the same way since they have human emotions. In this situation I think the golden rule applies, do unto others as you would want done to you. My next issue is creating life to serve an ulterior purpose. This reminds me of the book My Sisters Keeper, by Jodi Pullcott. Where the youngest daughter was conceived to ultimately save the elder daughters life. Not only does this make the produced person feel like a means to the end, but also it creates an issue of individual rights. Does the Produced person have the right to refuse to help save the life of the person needing saved? Do they have the right to put their health above the other person? I think that they should. Whether or not you were born out of the desire to create a life to love that person, or created out of the desire to save someone else, that the person who is ultimately being used should given the right to the most important issue in donation, free will in the form of informed consent. If we are going to create people to serve a purpose of saving other lives what is to stop society from breeding slaves? No there isnt the same promise that the organs will be as good of a match, but it would be a lot cheaper. My last issue is that the clones were killed after surgeries they could have easily lived through. I can maybe, in so stretch make it okay, if the clones were only being used to donate organs that they could survive with out, and if they were being compensated for them. Or if they were being treated as real surrogates, but killing them after routine operations amazed me. It seemed almost too cruel to do that just to protect the rest of the clone population from learning the truth. The killing seemed senseless and completely unnecessary. All in all I thought this was an amazing movie and I really enjoyed watching it. It was not something I would have picked to watch on my own but I am very glad that I did.

Economic Conditions of the Australian Economy :: essays research papers

Economic Conditions of the Australian Economy Over the past five years the Australian economy has gone through many changes experiencing both the peaks and troughs associated with business cycle. Five years ago, in the middle of 1997 Australia’s economic growth had begun to upturn after a period of recession during the ’96 year. This was unmistakably shown through the composite indicators of retail trade, dwelling investment and Australian share market valuations, all concurring with one another and demonstrating the effects of an upturn in economic growth. This economic growth continued to increase through ‘98 and ‘99, partly being attributed to the weakening Australian dollar that allowed for the opening up and increasing market shares held by Australian exports on world markets. This was the case, as the reduction in the Australian dollar’s value, triggered decreases in the prices of our exports for foreign buyers, thereby increasing demand for our products and increasing the amount of money and investments coming into Australia. This therefore resulting in the aforementioned increases economic growth when combined with the high levels of employment and consumer confidence. This economic growth didn’t however continue for long, with the economy peaking just before the start of the year 2000 followed by a sharp downturn that resulted in a temporary recession occurring around the middle of the year. This erratic behavior, most pronounced in retail trade, can be explained by the effects of both the millennium bug and the introduction of a general consumption tax in the form of the GST. The millennium bug caused much panic and with it bought panic spending especially in the IT sector thereby over inflating an already close to booming economy and after the non-event that the millennium (or Y2K) bug caused spending slumped and then further slumped due to the holding back of consumer spending on big ticket items such as cars and houses until the introduction of the GST. In spite of the aforementioned pre GST economic slump, in the second half of 2000, with the implementation of the GST and the advent of the Olympics, the economy quickly boomed again before experiencing another sharp downturn followed by an equally sharp upturn. The initial upturn was due to increased post GST spending followed by huge foreign cash injections into the Australian economy as a result of the Sydney Olympic Games. The Olympics spending however was only temporary and consequently caused a post Olympics downturn, which was quickly countered by the introduction of the first homeowners grant.

Christ of the Holy Bible and Dionysus of Euripides Essay -- Comparison

Christ of the Holy Bible and Dionysus of Euripides    Christ resembles Dionysus in many ways. Is it possible that Christ is simply an extension of the Dionysian myth? Though the concepts of wine and faith unite the two, the idea of revenge compared to self-sacrifice separates the two deities. Dionysus fits the Greek understanding of vengeful and selfish God that bear more anthropomorphic traits than Godly traits. Christ, however, transcends human desires for revenge and acts in self-sacrifice. This is the key separation between them. The similarity between the two Gods is striking. Dionysus is associated with wine and revelry. Christ forever associated himself with wine and celebration through the act of Communion and the Wedding at Cana. Contrary to many popular beliefs, Christ is a celebratory God. The Bible lists many occasions where God accepted the gift of his followers' song and dance. 2 Samuel 6:14, "David, wearing a linen ephod, danced before the Lord with all his might." Dionysus also encourages festivities. "I came to this city of Greeks when I had set ...

Unit 19 P3

P3 – Plan marketing for a micro start-up business that is relevant to customer needs a) Marketing definition and opportunity At East Side we understand that we cannot sell to the whole market, but by knowing the size and trends in the market we will be able to assess future opportunities and predict future sales patterns. The people who will buy from us include middle class – professional people, these individuals can be either high earners or those on a budget. b) Proposed target marketing segments Age 20-45 years SexMale/Female OccupationProfessional people/middle class Income? 18,000 and above ) Demand for product The reasons for demand of our products include: The area is just developing due to the construction of the London Luton Airport. It will benefit from the boost in tourist – those self-catering tourist who will require our services and due to our strategic location consumers must shop as there are no other routes to and from the Airport. d) Competitio n There are many rivals offering similar products and services, in an effort to attract customers and be different our consumers will be able to shop in spacious air conditioned comfort. * Leaflets will also be place in the weekly newspaper. Flyers will also be distributed and interested parties can make an order through the contact details on the flyer. * Our sales team covers every village and town. * We are open 24/7 and do home deliveries to our customers * Loyalty cards which offer benefits to loyal customers Also a unique feature of East side is the meat department which is the walk-in refrigerated cooler. It is an experience like no other. Customers can stroll through isles of the largest selections of bulk meats, fresh cut meats and provisions; a customer can always be assured to find their favourite cuts.A customer can select a bulk item and have it custom cut by our experienced butcher at no additional charge. e) How success will be measured To ensure that our marketing ef forts were successful, East Side will check performance in: * Stock turnover – this will enable us to identify which items or services are slow to sell and which are very popular and to review the product mix effectively. * Customer satisfaction – if customers are happy this in turn will generate more sales, we will review all complaints and comments and their views on our prices and other improvements they may want us to make. Sales levels – a monthly analysis will help our business to identify patterns in sales and show when we need to take action to boost sales. * The amount of new customers who visit the business f) Other external influences Government regulations All VAT (Value Added Tax) will be paid over to the Government. This can create cash flow problem for the business, because all VAT is payable on all sales, including credit sales, which means that the business has to pay over VAT before the money is actually collected from the customer.If the busin ess fails to pay the VAT, then eventually the Government will send authorities to insist on payments or face legal actions. Ethical Issues Expiry Dates: All expired products will be removed from the shelves and will be disposed of according to local and international guidelines. Expired goods on the shelves can ruin the reputation of the business and drive away customers. It can also be dangerous to our health. Trends * People eating healthier will affect what you stock. There has been an increase in more healthful products being marketed by the major food companies than ever before. Pricing will be stable and somewhat boring compared to prior year price swings. * Private label will continue to gain market share compared to branded products. P4 – Plan a costed promotional activity for a micro start-up business that is appropriate for customer groups a) Coordinating with the rest of the marketing mix Promotion is a very important part of the marketing mix. In an effort to incl ude the other aspects of the marketing mix to reach our target customers we will do research to identify which products target customers need and will buy.Offering these will increase sales and profits. Offering products no one wants or which have expensive or unnecessary features will do the opposite. We have to decide on a price, this is the amount of money customers must exchange for the product or service. Price is a key element of the marketing mix as it generates income for the organization. All other elements of the mix incur costs. Therefore, the pricing decision is critical to the success of the organization. Finally, we have to decide where and how the products and services should be placed. b) Image to be developedThe image our promotional plan will reflect is that we are an environmentally friendly business providing for but not limited to the needs of middle class people. c) Costs and schedule for the campaign A chap an effective way our business will get noticed is by advertising on our business vehicle. We are a small business therefore we will have to spend the available money wisely. We will also advertise through the local newspaper and the internet, this will be very beneficial as both methods are relatively inexpensive newspapers provide timely information and the internet can be directly involved with promotional activities.Schedule for the campaign: The purpose of the promotional campaign is to make the public aware of the launch of our new business. This campaign will start on Monday 16th April and run for two weeks ending on the 30th April 2012. d) Types of promotional materials Not all promotional materials will attract the same customer group, this is why East Side will use different promotional methods to attract more customer groups. After studying the buying habits of our target customers and where they look for information.It was observed that a poster attracts the attention of the travelling public, leaflets are preferred when pr omoting a local service and a large amount of people will look for information online. e) Nature of the promotional materials The aim of our promotional materials is to attract attention and interest. Effective colour and wording helps to reflect the image of the business, this is why we will hire professional graphic designers to help us devise a style for our business stationery and marketing materials. This will ensure they are easily recognizable and reflect the right image. ) Name of the business The names of the business will be East Side this is because no one else has this name. The name is appropriate as it is not offensive in any way and does not already exist as a recognized brand. It will also be easy for our customers to remember. g) Ideas for branding At East Side we would like to develop a brand, this would be a major asset for us because it will help people to remember our business and if we provide a good service, it wll associate specific qualities such as, reliabi lity, value for money, honesty and professional expertise.It will also save money on marketing in the long run since customers stay loyal to a brand they know and trust. h) Website design and functionality East Side will have some presence on the internet. This will be a quite basic site which simply summarizes what we offer and where we are. The website will be very user friendly; there is a search facility where, if customers know the name or type of product they are looking for it can be easily found. We will promote our website by placing the address on all stationery and the company vehicle. ) Reasons why the promotional materials are appropriate The promotional materials will be appropriate since our target customers group is people aged between 18 and 40, these more mature individuals are more likely to read newspapers and search online for information. j) Measuring the success of promotions The success of East Side’s promotions will be measured by; the number of new e nquires received by phone or email, the number of new customers who visit the business and sales levels. The cost of each promotion will also be taken into account. If the cost is high but the benefit will be small, then an alternative method will be found.

Focusing, Positioning and calculating the size of cells Essay

Exercise 1: Focusing, Positioning and calculating the size of cells Under the ‘Try This’ tab, complete the puzzles (P1- P6) presented to bring the items into focus. Use the check lists to make sure you have completed all steps Under the ‘Try This’ tab, complete the measurement puzzles (M1-M3) and write the answers here: M1 = __150___ micrometers at __10x__Objective Power (scale is 1 unit = __10_micrometers) M2 = __8.0____ micrometers at _100x_____Objective Power (scale is 1 unit = _1.0__micrometers) M3 = ___2.0__ micrometers at __100x____Objective Power (scale is 1 unit = _1.0__micrometers) Exercise 2: Viewing a typed letter ‘e’ with your scope. Obtain the slide with an ‘e’ on it from the slide selections. Place the ‘e’ slide right side up on the stage with the letter ‘e’ over the hole in the stage. Using the techniques described in the ‘getting started tour’, focus on the letter on the lowest objective power. What do you notice about the orientation of the letter as you look through the microscope? In other words, how does the ‘e’ position compare to how it looks on the slide when looking at the microscope? Upside down At the lowest power, what is the total magnification of the image? 16x Adjust the position of the slide so that a portion of the letter is in the center of the viewing field. Now, rotate the next higher objective in place. If the image is not clear, use only the fine tuning knob to adjust. At 10x, what is the total magnification of the image now? 40x At 40x, what is the total magnification of the image now?160x At 100x, what is the total magnifi cation of the image now?400x Exercise 3: Human cheek cells. Your cheeks are lined with very thin cells that can easily be removed for viewing under a microscope. These cells are called epithelial cells and they line the outside and inside of your body. Cells are small, but large enough to be viewed with a light microscope. The following procedure shows how you would obtain these cells. However, since this is a virtual lab, the cheek cells have already been collected and stained. They are stained with methylene blue to view some sub-cellular parts. This is the actual procedure, but please proceed to placing the cheek smear slide on your ‘virtual’ microscope and bringing into focus. 1. Gently scrape the inside of your cheek with a toothpick. 2. Using a circular pattern, spread some saliva in the middle of a slide. 3. Place a small drop of stain on the saliva smear. The less stain you use, the better the results will be! 4. Place a cover slip on the stained smear. Knowing the objective scale in Exercise 2, estimate and record the diameter of a single cheek cell in micrometers. Diameter = ___4__________ micrometers What power of objective lens did you use? 100 What was the total magnification?400