Local Anaesthetic Agents †Anatomy Research Paper

Local Anaesthetic Agents – Anatomy Research Paper Free Online Research Papers Local anaesthetic molecules are made of an aromatic group linked to a basic side chain by an ester or amide bond. The side chain is basic because it is made of a secondary or tertiary amino derivatives. This typical structure is demonstrated by lignocaine, as shown in the adjacent diagram. These molecules are therefore weak bases, with pKa values in the range of 8-9, so they mainly exist as ions in body fluids at physiological pH. The only exception is benzocaine, where the amino group is attached directly to the aromatic side chain. Local anaestheics act by reversibly binding to the S6 transmembrane helical segment on any of the four domains of the sodium voltage-gated channel. The S6 segment possesses a binding site accesible only from the cytosol, therby physically blocking the entry of sodium ions into the axoplasm. As a result, the inward sodium current upon neuron excitation cannot exceed the outward potassium current, the membrane cannot be depolarised to threshold and an action potential cannot be initiated. This is effective only when the anaesthetic is in its ionised quartenary form. Therefore, the compound must be able to penetrate the hydrophobic lipid-rich axon membrane (and myelin sheath, if present) to act effectively; only the electrically neutral form of the anaesthetic can do so. Once in the water-rich axoplasm, the anaesthetic ionises, and subsequent binding is hence possible. Thus, it is the coexistance of the neutral and protonated forms of the anaesthetic in solution that allows for the â₠¬Å"bypassing† of the axolemma and the relatively rapid targeting of the voltage-gated sodium channels. Another beneficial feature of anaesthetics attributed to their mechanism of action is their preferential blocking of pain and autonomic neurons, while sparing those involved with coarse touch and movement. Myelinated neurons have a higher surface density of voltage-gated channels than the axolemma of unmyelinated neurons; therefore, they are less likely to be blocked when exposed to the same dosage level of anaesthetic. Axons with larger diameters are also less likely to be blocked than ones of smaller diameter because they can conduct passively over longer distances. Since nociceptive impulses are carried by A? (small myelinated) and C (unmyelinated) fibres, pain sensation is blocked more readily than other sensory modalities. Although all neurons in the region of anaesthetic introduction will be affected to a certain extent when considering the practical anaesthetic dosages used during surgery, this mode of action nevertheless ensures that the patient does not experience sensations of pain. Numerous varietes of anaesthetics show use-dependence: the more channels are open, the greater the block becomes. This is because the entry of the blocking agents is more probable with an open channel, that possesses a wider pore. Furthermore, due to the shape of the anaesthetic molecule, the equilibrium between the closed and inactivated states of the channel will be in favour of the inactivated state in the presence of the anaesthetic, thereby greatly reducing the probability of the initiation and propagation of action potentials. Since touch, pressure and pain sensory-neurons in the anaesthetised region will relay a train of action potentials during surgery, they are the most likely to be blocked as their voltage-gated channels will cycle through open and inactivated states. This mechanism contributes greatly to the overall blocking effect of the anaesthetic. Drug solubility and the presence of either an ester or amide bond are important factors when considering the required rate of onset and duration of anaesthesia. Ester-linked local anaesthetics, such as anethocaine, are rapidly hydrolysed by both plasma and liver cholinesterases, and so have a short biological-half life and blocking duration (about one hour). Amide-linked anaesthetics, such as lignocaine, can only be metabolised in the liver by N-dealkylation, and the resultant metabolites themselves are often anaethetically active. They are therfore more widely used due to their longer blocking duration (about 2 hours). Anaesthetic solubility can also be a determining factor when choosing an anaesthetic. Benzocaine is an unusual local anaesthetic of very low solubility, and so is used as a dry powder to dress painful skin ulcers: the drug is slowly released and produces long-lasting surface anaesthesia. Lignocaine, on the other hand, is often utilised in the form of its acid salt (us ually with hydrochloric acid) and so can be injected in an aqueous form during epidural and spinal anaestheisa for a rapid blocking effect. Lastly, all local anaesthetics used are stable when heated. This is necessary to ensure that sterilisation of the anaesthetic prior to introduction into the body is effective and does not alter the anaesthetic’s binding efficacy to sodium voltage-gated channels. Although local anaesthetics are administered in such a way as to minimise their spread to other parts of the body, they are ultimately absorbed into systemic circulation. Furthermore, local anaesthetics may be injected into veins or arteries by accident. The major unwanted side effect that may occur systemic toxicity, the risk of which increases when higher doses and larger areas are involved. Thus, they are capable of interfering with normal central nervous system function. At low doses, the main effect of the anaesthetic on the CNS is stimulation: this produces restlessness, tremor, and subjective effects ranging from confusion to extreme agitation. Higher doses can cause the tremors to progress to severe convulsions, and even higher doses produce CNS depression. The main threat to life at this stage comes from respiratory depression, because of the anaesthetic’s depression of the respiratory centre and/or phrenic nerve. To reduce the possibility of such effects from occurri ng, a cuff may be used to reduce anaesthetic systemic spread when introduced in the upper limb, or by introducing vasoconstrictors such as adrenalin and felypressin when dealing with the thorax. The risk of systemic toxicity is present if the cuff is released prematurely, or if the dosage of vasoconstrictor is to low. The only exception to this rule is cocaine, which produces euphoria at doses well below those that cause convulsions due to its specific blocking effect on monoamine uptake. Procaine produces especially prominent unwanted central effects, which is a reason for its replacement by lignocaine and prilocaine, whose central effects are much less pronounced. Local anaesthetics commonly affect the cardiovascular system when present in systemic circulation. They have negative chonotropic and inotropic effects on the heart: by inhibiting the inward sodium ion current, anaesthetics decrease the cytosolic concentration of sodium ions in cardiomyocytes, which in turn reduces intracellular calcium ion stores, and this reduces both the frequency and force of contraction. Vasodilatation of arterioles is due to the direct effect of local anaesthetics on vascular smooth muscle and the indirect inhibition of the sympathetic nervous system. The combined myocardial depression and vasodilatation produces a fall in blood pressure, which may be sudden and life threatening. Cocaine is an exception: it produces opposite effects, such as increased cardiac output and arterial pressure, and increased cardiac output because of its ability to inhibit noradrenalin uptake. Another common side effect restricted only to the use of local anaesthetics in spinal and epidural anaesthesia is postoperative urinary retention due to the block of pelvic autonomic outflow. Other side effects are more rare. Hypersensitivity reactions sometimes occur, usually in the form of allergic dermatitis (most frequently during surface anaesthesia in atopic patients), but rarely as an acute anaphylactic reaction. Other unwanted side effects are specific to particular drugs, such as mucosal irritation when applying cocaine, and methaemoglobinaemia when using large doses of prilocaine due to the production of toxic metabolites (the haeme iron is oxidised from the +2 to the +3 state and so cannot bind to oxygen: subsequent symptoms include fatigue, dizziness and cyanosis). This is why prilocaine is rarely used in obstetric analgesia. 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Free Essays on Marx, Durkheim, Weber Understanding Of Religion Within Society

Comparing and contrasting Marx’ belief on religion as a social opium, along with Emile Durkheim and Max Weber’s understanding and account of religion within society. How do we account for religion - its origin, its development, and even its persistence in modern society? This is a question, which has occupied many people in a variety of fields for quite a long time. At one point, the answers were framed in purely theological and religious terms, assuming the truth of Christian revelations and proceeding from there. But through the 18th and 19th centuries, a more "naturalistic" approach developed. One person who attempted to examine religion from an objective, scientific perspective was Karl Marx. Marx's analysis and critique of religion is perhaps one of the most famous and most quoted by theist and atheist alike. The most famous quote from the work of Karl Marx (and one of the most controversial statements in all of philosophy) is his frank assertion that religion "is the opium of the people" (141)*. This pithy comment is indeed a good summation up Marx’s straightforward appraisal of religion, which he said "eased pain even as it created fantasies" for those masses of oppressed workers suffering at the hands of a powerful few (141)*. As a functionalist, Marx insisted that religion does not exist independently, but only operates "to satisfy other needs or conditions" (158)*. He was convinced that "religion is so fully determined by economics that it is pointless to consider any of its doctrines or beliefs on their own merits" (138)*. For Marx, religion serves only to comfort and placate the poor and wretched, while simultaneously justifying and protecting the privilege of those in control, and therefore it "should not only be dismissed, but dismissed with scorn" (139)*. Marx imagined primeval communist societies in which all resources were owned jointly by the members of the community, a social organisation to which... Free Essays on Marx, Durkheim, Weber Understanding Of Religion Within Society Free Essays on Marx, Durkheim, Weber Understanding Of Religion Within Society Comparing and contrasting Marx’ belief on religion as a social opium, along with Emile Durkheim and Max Weber’s understanding and account of religion within society. How do we account for religion - its origin, its development, and even its persistence in modern society? This is a question, which has occupied many people in a variety of fields for quite a long time. At one point, the answers were framed in purely theological and religious terms, assuming the truth of Christian revelations and proceeding from there. But through the 18th and 19th centuries, a more "naturalistic" approach developed. One person who attempted to examine religion from an objective, scientific perspective was Karl Marx. Marx's analysis and critique of religion is perhaps one of the most famous and most quoted by theist and atheist alike. The most famous quote from the work of Karl Marx (and one of the most controversial statements in all of philosophy) is his frank assertion that religion "is the opium of the people" (141)*. This pithy comment is indeed a good summation up Marx’s straightforward appraisal of religion, which he said "eased pain even as it created fantasies" for those masses of oppressed workers suffering at the hands of a powerful few (141)*. As a functionalist, Marx insisted that religion does not exist independently, but only operates "to satisfy other needs or conditions" (158)*. He was convinced that "religion is so fully determined by economics that it is pointless to consider any of its doctrines or beliefs on their own merits" (138)*. For Marx, religion serves only to comfort and placate the poor and wretched, while simultaneously justifying and protecting the privilege of those in control, and therefore it "should not only be dismissed, but dismissed with scorn" (139)*. Marx imagined primeval communist societies in which all resources were owned jointly by the members of the community, a social organisation to which...

Roles of presidency in the United States Essay Example | Topics and Well Written Essays - 1000 words

Roles of presidency in the United States - Essay Example Thus, the first power that is vested in the presidency of the United States is the position of the commander in Chief of the Army and the Navy of the United States (Reagan, 7). Under this power, the presidency can direct that the USA enters into war with another country through commanding the army and the navy to invade the territory, although after the approval of the congress. The presidency is also the commander of the militia under different states, on the event that such militias have been called upon to the service of the United States. Under the powers vested in the presidency of the United Sates, the occupant of that position has the powers to pardon any offence against the United States, except under the case of impeachment (Grant, 47). The other power vested in the presidency in the United States is the powers to constitute a government and to spearhead the implementation of the government agendas. Thus, under these powers, the presidency plays the role of appointing the to p government officials who include the ministers responsible for different departments, as well as the appointment of the judge of the Supreme Court and the different ambassadors to various regions of the world, with the approval of two-thirds of the senate (Bumiller, 132). The presidency is also responsible for entering into treaties with different nations and other relevant authorities and organizations globally, backed by the consent of two-thirds of the senate.

Theorization & Generalization of Findings Article

Theorization & Generalization of Findings - Article Example Thus, Social Work Research is a means of providing a flexible system through which targets of a given Social Work projects can be analyzed, critiqued and evaluated in order to provide an opinion or view of the existing state of affairs in the status of a given community. The purpose of this paper is to critique a given article on the basis of standards, conventions, and ethics of Social Work Research presented by authoritative academics and researchers in the field. This will include a thorough review and analysis of the content of the article and how it meets the standards in the absolute and relativist sense. The article selected for this study is titled â€Å"Violence Exposure Among Children of Incarcerated Mothers† by Dana, D. DeHart and Sandra J. Altshuler which was published in the Child Adolescent Social Work Journal in 2009. As the title suggests, the article focuses on the social welfare of a class of people in society who need the help of social service providers and other social workers to gain a normal life – children of incarcerated women. Clearly, when a woman gives birth to a child in prison, the child is in a less than ideal social setting. Hence, there is the need for social workers in the community to find ways of ensuring that the child in question gets the right level of care and attention in order to grow to become a responsible adult. The title makes it easier for people searching the web to locate it because the words â€Å"violence†, â€Å"children† and â€Å"incarcerated mothers† are likely to be searched when anyone with a research interest needs to find an article with these features. This implies that it is conveniently titled and can be easily located. The title is also direct and straightforward because most thinkers can easily understand it and deduce a lot of meaning from it when they first see it.

Managerial Personality Essay Example for Free

Managerial Personality Essay The characteristics of a person’s personality determine his leadership capabilities. Leaders from around the world all have distinct characteristics which define their leadership style and abilities. In a corporate culture, these personality traits can be capitalized upon to direct an organization towards its goals and to do so requires an in depth understanding of the different styles of personality traits that define every individual. A grasp on this knowledge would allow any leader to have a huge impact on the culture and performance of an organization. An observation to be made is the leveraging of personality traits may be utilized in order to achieve corporate goals. To create a competitive advantage, management’s focus must be on cooperation and inspiration. A clear link exists between culture and performance, as shown by Mindy L. Hall (Hall, 2005.) A leader’s personality shapes the environment in which employees function, and can either inspire extraordinary results, or devastating outcomes. Hostile conditions in the workplace will cause anxiety, stress, lack of energy, disengagement, or high turnover. Subsequently, organizations with these issues experience a lower quality of output. This negatively affects the relationship between consumers and businesses, who may find the competition more appealing. A positive engagement between management and employees excite a higher level of performance. From this, a company experiences higher quality output and satisfied customers. A best way to manage a company doesn’t exist; it must be studied, understood, and honed to best match or shape the organization’s culture. The key issue to choosing the appropriate manager in any organization is appreciating what goals and desires are sought after. This report is focused primarily on management as leaders and employees as subordinates. However, it must be understood that subordinates can also play the role as leader in their own context, and it should be encouraged. For example, a group of four employees are assigned to a project. Among this group will emerge a leader who directs the mission to accomplish said assignment. Although this individual does not possess a management title he or she is still leading. That being stated, an organization must possess a deep understanding of its business culture, and employ these concepts when prospecting for competent employees and management. Furthermore, management can recognize certain personality traits among individuals in a team, and manipulate and combine them in a synergetic way. In general, the comprehension of the various personality traits can be used as a measurement of how an individual may respond and perform in an organization’s culture. However, there is much debate as to the extent to which personality can predict behavior, and the extent to which behavior arises from the dynamics of a given situation (Kendrick, Funder, 1991.) The key issues in a corporate context include the big five personality traits, Maslow’s Hierarchy of needs, attitude, and emotional intelligence. The Big Five Personality Traits General agreement exists among researchers regarding the big five personality traits. This model categorizes personalities into five distinct categories: Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness. An understanding of these categories often referred to as OCEAN, gives insight to an individual’s underlying personality and how an individual would react in day to day operations of an organization. However, research has shown situational factors play a role in how individuals move between the two extremes of each personality factor. Each factor is a range of two extremes, which most individuals lie somewhere in between. Given this fact, the majority of decisions made by people are representative of their fundamental personality traits. Only when abnormal or extreme situations arise does an individual shift towards the extreme of either end on one or more factors. Managers seeking to create a winning team would do well to not only understand his own personality type, but also individual team member’s personality types. Intimate knowledge of each person among a group will allow for a more harmonious and efficient team effectively utilizing strengths and mitigating weaknesses. Attitude Attitudes of managers and employees contribute greatly to the working environment. An attitude is a collection of beliefs and feelings brought on by life experiences or learned from others, and a positive or negative analysis of one’s environment. Similar attitudes of a leader and a team can create a positive working environment that flows all the way down to the end consumer. Leaders of an organization who commit to reinforcing positive attitudes contribute to a successful business model. Individuals who are satisfied with the work environment make their duties a part of life, and commit skills and knowledge to drive progress of a business. A study conducted by MBA’s and one professor from India, (Tandon, Mishra, Singh, 2011,) explored the relationship between attitude and how an organization perceives its position in society. The study begins by stating that business behavior has both economic and relational impact. Over recent decades there have been significant changes in the social expectation from business and managers. This study found that one’s personal beliefs, values, and attitude drive commitment to social responsibility. In this writing social responsibility can be thought of as organizational commitment or responsibility. The study took a specific look into how spirituality, materialism, relativism, and idealism discriminate between high and low corporate social responsibility (CSR).The study conducted found idealism and spirituality to have a positive influence on CSR, and materialism and relativism had a negative or less of an influence. This implies that managers with more of a concern towards society’s beliefs and values, and less towards material things, will have a greater concern towards creating a positive internal working environment. Moreover, a manager with this attitude may push subordinates towards the same ideals, which create a more efficient environment. In contrast, materialistic and relativistic attitudes contributed negatively towards CSR. This suggests that individuals with these attitude types can create an environment where monetary gain and possession of assets are the only goal, and right and wrong is near irrelevant. This mentality can have a devastating effect on society’s perception of a corporation. Moreover, the connection between working peers can be non-existent, and coordination would lack causing inefficiency. A manager’s attitude can bring about the benefits of a positive working environment by keeping a positive attitude towards a given position in an organization. An attitude based on working towards an end goal, which produces the greatest good for society and a corporation, would be an ideal mentality for any organization. Attitudes contribute to a successful business model because individuals who are satisfied make their duties a part of life, and commit their skills and knowledge to driving the progress and success of the business. Maslow’s Hierarchy of Needs Maslow’s Hierarchy of Needs is a theory of human motivation based on increasing levels of needs. This theory suggests that human needs are fulfilled one at a time by accomplishing basic needs and proceeding upwards towards advanced needs. Although there is much debate as to the accuracy of these levels research has suggested a correlation between the fulfillment of these needs and happiness. Managers with an understanding of what level individuals in a team are on can manipulate motivation techniques to stimulate productivity and efficiency. Maslow’s hierarchy can be applied to compensation, job design, management techniques, or anything that requires a higher level of motivation. Maslow’s hierarchy is a systematic way of thinking about the different needs employees have at any given point and explains different reactions they may have to similar treatment (Carpenter, Bauer, Erdogan, 2009.) The definition provided implies that each individual perceives needs differently, and managerial techniques in this context must be applied more specifically. For example, two employees receive a raise after a massive project was finished. The first employee is satisfied with the raise because her safety, and subsequently her physiological, needs had been fulfilled. The second employee felt his needs had not been satisfied. His goal in finishing the project was to prove his worthiness as a manager. His intention through his hard work was to climb the corporate ladder. He was looking to fulfill his esteem and self-actualization needs. Physiological needs are satisfied through compensation, since a paycheck allows individuals to find nourishment, shelter, etc. Compensation can satisfy more than one need, however. Safety needs can be satisfied through benefits such as 401K, health plans, or paid time off. In many ways, compensation satisfies both physiological and safety needs. In addition, organizations must take in consideration the physical safety of employees. Managers have a duty to enforce safety precautions where working conditions may be hazardous. When a position requires employees to take physical risk an organization is expected to protect workers from unnecessary harm, and to compensate for the higher risk. When feelings of anxiety are low safety needs have been fulfilled. Social needs can be met through satisfactory social interaction with others in which there is interaction. The goal in satisfying this need is to cause individuals to feel accepted and loved. In a business context there must be a focus on acceptance over love. Creating a friendly environment is a great start to satisfying this need. Company sponsored games, events, holiday parties, and other social activities are great examples of how to socialize a staff. Also, team meetings where the staff can voice their concerns or ideas can allow team members to better understand each other. Esteem needs can be satisfied after one feels she has been accepted into a group. These needs can be fulfilled through recognition. It must be stressed that individuals enjoy being praised for their accomplishments, but praise only works for a limited amount of time. Managers must look to promote individuals with a high need for esteem. A raise in position and pay communicates an achieved status, and reinforces her ability to achieve corporate goals. Esteem needs lead into self-actualization. This need lies on the top of the hierarchical pyramid. Similar to fulfilling esteem needs, self- actualization can be met by giving an employee more responsibility, greater challenges, or more stimulating opportunities. Self-actualization is characterized by an individual having met all previous needs, and is now using his or her full potential and capabilities. Maslow’s hierarchy is important for organizations to apply. Humans are motivated by particular needs according to their current life situations and future goals. Furthermore, individual needs are in accordance with cultural backgrounds such as race, religion, or country of origin. It must also be noted that individuals are not always striving to fulfill the same needs. The needs model must be applied on an individual basis. Managers who realize their needs are being fulfilled can be used as a resource for understanding their subordinates needs, and act accordingly. When an organization applies this model to a workforce there is an increase in job satisfaction and loyalty. Emotional Intelligence Emotional intelligence is the ability to control extreme changes in mood and emotions, and is a characteristic of an effective and competent leader. When a manager cannot control temporary emotions that are brought on by day to day interactions it can bring an entire organizations progress to a halt. Emotions are contagious and create a domino effect. Simply realizing when a certain emotion is present allows one to better handle temporary emotional fluctuations, while containing it as to not affect others. That being said, it is of utmost importance for a manager to possess a deep understanding of his or her own emotions (self-awareness), and how to deal with each. An individual who is self-aware is humble enough to accept constructive criticism and mature enough to address the areas of concern. The impact of hiring individuals with high emotional intelligence is high productivity and retention of high-quality employees. Golnaz Sadri, PhD, defines E.I. as the ability to accurately perceive emotions, access and generate emotions so as to assist thought, to understand emotions and emotional knowledge, and to regulate emotions so as to promote emotional and intellectual growth, (Sadri, 2012.) The ability to accurately perceive emotions allows one to recognize facial and bodily gestures, and interpret their meaning. A manager who has this ability can intercept other’s cues, or tells, that signal irritability. This skill is recognized as constructive when dealing with scenarios such as a team who can’t come to an agreement, a irate client or customer, or when negotiating. For the most part, emotional intelligence is a learned skill, and an indicator of useful experience. Conclusion Manipulating strong personality traits and striving to improve negative personality traits can have a huge impact on a manager’s career, and more broadly can impact a corporation in tremendous ways. Today manager’s has access to information to help them maximize team productivity using psychology. Using psychological strategies to hire the right employees and build teams is the competitive edge companies need in this tough economic climate. REFERENCES Camgoz, S., Karan, M., Ergeneli, A. (2011). Part II Leadership, Social Capital, and Personality: Relationship Between The Big Five Personality and The Financial Performance of Fund Managers. 15, p139 Carpenter, M., Bauer, T., Erdogan, B. (2009). Need-Based Theory of Motivation. In Principles Of Management (10th ed., p14.1) Hall, M. (2005). Shaping Organizational Culture: A Practitioner’s Perspective. 2(1), p1-16 Kendrick, D. T., Funder , D. C. (1991). Situation versus Personality Debate. Retrieved from http://wilderdom.com/personality/L6-3SituationVsPersonality.html McCrae, R., Costa, P. (1995). Domains and Facets: Hierarchal Personality Assessment Using The Revised NEO Personality Inventory. Journal of Personality Assessment, 64(1), p23 Pannapacker, W. (2012, April 15). Screening Out The Introverts. The Chronicle. Sadri, G. (2012). Emotional Intelligence and Leadership Development. 41(3), p536 Tandon, A., Mishra, S., Singh, E. (2011). What Discriminates The Prospective Manager’s Attitude Towards Corporate Social Responsibility? 10(3), p54-60 Whitbourne , S. K. (2010, October 19). The Neuroticism Paradox | Psychology Today.Psychology Today: Health, Help, Happiness. Retrieved from http://www.psychologytoday.com/blog/fulfillment-any-age/201010/the-neuroticis m-paradox Witt, L.A., Andrews, M.C. (2006). The Predisposition to Engage in Interpersonal Deviance at Work. pHR-F2

Executive Summary of Students Quietly Undertaking to Encourage Apt Lear

Executive Summary of Students Quietly Undertaking to Encourage Apt Learning SQUEAL LIBR/ARST 570: Management of Libraries and Archives Executive Summary This Project Management Plan is the result of the time and energy spent by the members of SQUEAL (Students Quietly Undertaking to Encourage Apt Learning), who have embarked upon the task of learning about management in an information environment. The path we have chosen is outlined in this document. SQUEAL is devoted to learning how to â€Å"work effectively within a larger organization and to assume managerial responsibilities,† and each of SQUEAL’s members works to achieve this goal through internal, external and personal factors. The Project Management Plan is a guide which SQUEAL has created for itself in order to accomplish our common goals in a timely and thorough manner. The Plan includes an Introduction, Goals and Objectives, a list of Deliverables, the Resources which Squeal has at its disposal, Constraints, Strategy and Actions, our Budget, Controls, a description of our Documentation process, the Review and Appendices. - 1 - SQUEAL LIBR/ARST 570: Management of Libraries and Archives Table of Contents Executive Summary†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.1 Table of Contents†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.2 Introduction†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..3 Team Characteristics†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦4 Ground Rules†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦...5 Goals and Objectives†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦...6 Deliverables†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦...10 Resources†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦...12 Constraints†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.14 Strategy and Actions†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..17 Budget†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦20 Controls†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..21 Documentation†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦...22 Review†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦...23 Appendix A- Gantt Chart†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦A Appendix B- Budget Time Sheet†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦B Appendix C- Time Sheet†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.C - 2 - SQUEAL LIBR/ARST 570: Management of Libraries and Archives Introduction Students Quietly Undertaking to Encourage Apt Learning (SQUEAL) is a dynamic team comprised of members Brooke Ballantyne, Andrea Freeman, Reece Steinberg and group leader, Carolyn (Cen) Campbell. SQUEAL was formed in January, 2005 in response to a Project Management assignment from Dr. Ken Haycock, ... ... Ending/Evaluation March 8th - April 6th $3,217 * The predicted budget was found by taking total estimated personnel hours multiplied by 20 and then adding all of the additional estimated costs from the Team’s Budget divided by 4. - 26 - SQUEAL LIBR/ARST 570: Management of Libraries and Archives APPENDIX C- TIME SHEET - 27 - SQUEAL LIBR/ARST 570: Management of Libraries and Archives Date Time Expended Details of Activity Total Hours in Phase 1 (Initiation / Concept): (aim for group: 24 individual: 6) timeline: January 10th - January 24th Total Hours in Phase 2 (Planning / Development): (aim for group: 48 individual:12) timeline: January 25th - February 21st Total Hours in Phase 3 (Implementation / Execution): (aim for group: 48 individual:12) timeline: February 12th - March 7th Total Hours in Phase 4 (Ending / Evaluation): (aim for group: 24 individual: 6) timeline: March 8th - April 6th - 28 - SQUEAL LIBR/ARST 570: Management of Libraries and Archives On Monday, January 24 2005, we, the members of SQUEAL, submit this Project Management Plan to Dr. Ken Haycock. All team members have contributed to the plan and agree to follow it to the best of our abilities.

Pelvic Inflammatory Disease

i) What causes PID and what happens to the body when someone gets it? Pelvic In?ammatory Disease (PID) occurs when an infection of the cervix, or to a lesser extent the vagina progresses into the upper genital tract, PRODIGY (2005). Warell (2003) de?nes an infection as an invasion of the body by harmful organisms (or pathogens) such as bacteria, fungi, protozoa or viruses. In the case of PID the two most common causes of the initial infection are the bacterium Chlamydia Trachomatis or Neisseria Gonnorhoeae.These two bacteria are most commonly referred to as the sexually transmitted infections (STIs) chlamydia and gonnorhea and are commonly passed through unprotected vaginal intercourse. Both infections present similarly, as in?ammations of the cervix and urethra with the associated symptoms of pain on urination and vaginal discharge. Some infected women however experience no symptoms (Caroline, 2008). Prodigy (2005) discusses how cervical mucus provides a relative barrier to the spre ad of the pathogens and the associated infections, but virulent microbes can traverse cervical mucus, which in any case, is lost during menses.Other factors that may in?uence the spread of bacteria up the genital tract are, pregnancy terminations and the complications arising from dilatation and currettage. Wyatt (2003), discusses, in reference to PID, how once an infection spreads beyond the cervix it can present in various regions of the genital tract: uterus (endometritis), fallopian tubes (salpingitis), ovaries (oophoritis), peritoneum (peritonitis). The assocaited infections/in?ammations can cause various symptoms: Pelvic or lower abdominal pain.Dyspareunia (pain during or after intercourse) Turbo-ovarian abscesses Abnormal vaginal discharge Pelvic peritonitis Perihepatitis (in?ammation of the peritoneum attached to the liver) The severity ranges from chronic low grade infection (with relatively mild symptoms) to acute infection (with severe symptoms) which may result in absces s formation. Salpingitis, or infection of the Fallopian tubes, is a particularly signi?cant feature of PID because of the long term effects after PID including infertility, ectopic pregnancy and pelvic pain.0% of women develop tubal infertility after a single episode, 20% after a second and 40% after three episodes (Prodigy, 2005). In summary PID is a collective term that encompasses a variety of infections of the upper female genital tract. ii) what investigations are considered at hospital and what medications might be prescribed? Warrell (2003), states that there is no symptom, clinical sign, or labratory result that is is pathognomonic (exclusive/unique) in the testing and subsequent diagnosis of PID.The hospital will therefore use a variety of investigations to rule out the likelihood of other diagnosis and allow the most appropriate treatment for cases of suspected PID. Wyatt (2003), advises Accident and Emergency (A&E) staff to ?rst consider whether a patient is presenting wi th any signs/symptoms of shock. If the infection has progressed and there are indications of sceptic or hypovalaemic shock such as tachycardia, pyrexia and assocaited blood pressure abnormalities then the initial treatment is to raise the patient’s legs, resuscitate with IV ?uids and immediately begin IV broad spectrum antibiotics.Sanders (2006) advises other routine tests to help with the differential dianosis for PID which include; appendicitis, endometriosis, ovarian cysts, ectopic pregnancy, other STIs, HIV, urinary tract infection. These tests include: Urinalysis which can to help diagnose and/or rule out the presence of a UTI. A vaginal swab picks up a sample of cells from the vagina which are usually sent to a laboratory for testing. A full blood count (FBC) tests the levels of red cells, white cells and platelets.Abnormalities in these readings can help differentiate between the presence of bacterial or viral infections and/or parasitic/fungal infections. Blood tests are limited in that they do not distinguish what has gone before from what is happening now however they can pick up HIV, hepatitis B and C, herpes virus and chlamydia. Wyatt (2003) also advises that a pregnancy test is needed and if positive, an ectopic pregnancy or other pregnancy complication must be considered. If the ectopic test is negative Ultrasound or endometrial biopsy examined for plasma cells is useful to increases the accuracy of diagnosis.Where symptoms are severe or if initial treatment is unsuccessful a laparoscomy may be considered (Simpson, 2005). Here a rigid viewing instrument called a laparoscope is used to view the inside of the pelvis and the abdomen through small abdominal incisions. The procedure is always performed under a general anasthetic. Among 814 women who underwent laparoscopy because of a clinical diagnosis of PID, 12 per cent had intra-abdominal conditions other than PID: ectopic pregnancy, appendicitis, ruptured ovarian cysts, and endometriosis (P rodigy, 2005).Medications are aimed at eradicating gonorrhea and chlamydia and recommended antibiotics include O?oxacin, Doxycycline and Metronidazole. Ibuprofen is a reccommended analgesia however the choice of analgesia and which route should be guided by clinicla judgement, Prodigy (2005). iii) Discuss Legal (authorised/permitted by law), Ethical (the philosphy of good/bad, right/wrong determined by our cultural/religious and philosophical beliefs) and Capacity (the power to learn or retain knowledge to understand the facts and signi?cance of your behaviour) issues surrounding Lizzy’s views and those of her mother.A signi?cant factor in Lizzy’s case is whether she has capacity. Capacity is de?ned as the power to learn or retain knowledge, and to understand the facts and signi?cance of your behavior (Gillick, 1986). Assessing whether Lizzy has capacity places a responsibility on the practitioner to provide her with suf?cient information to inform her fully of the cli nical importance of seeking immediate treatment. Then assessing whether she understands the risks involved and also if she is able to retain the knowledge long enough to make an effective decision.In the case of Gillick, the court held that children who have suf?cient understanding and intelligence to enable them to understand fully what is involved in a proposed intervention will also have the capacity to consent to that intervention. This is sometimes described as being ‘Gillick competent’. A child of under 16 may be Gillick competent to consent to medical treatment that requires their consent.If Lizzy is deemed Gillick competent and is able to give voluntary consent after receiving appropriate information, that consent will be valid and additional consent by a person with parental responsibility will not be required. It is, however, good practice to involve Lizzy’s family in the decision-making process, if she consents to her information being shared, DOH (200 9). Another challenge arises as Lizzy states her reason for not consenting to travel to hospital is that she is scared her parents will ?nd out about her sexual activity and drug abuse.When assessing capacity you should also ascertain if the patient is free from external pressure to make their own decision? In Lizzy’s case this appears in doubt as she has previously stated that she feels pressured by her mother. There is therefore an argument that Lizzy does not have capacity in these circumstances. There is also speci?c legislation on how to act when there is an issue of contraception , or sexual health in relation to children; Here it is advised that we should try to persuade Lizzy to inform her parents, or allow us to do so.If however she cannot be persuaded, advice and/or treatment should still be given if it is considered that Lizzy is very likely to begin or continue to have sexual intercourse with or without advice or treatment, and that unless she receives the advice or treatment then her physical or mental health is likely to suffer. This is very relevant in Lizzy’s case and poses an ethical question on whether or not to respect Lizzy’s request of con?dentiality between her parents.Each of these possibilities will challenge the practitioner and whilst it is essential that the law is followed it is important to adopt a dynamic approach to Lizzy’s situation and not forget that ultimately it is Lizzy’s ongoing health that is the priority in this situation. iv) discuss the psychological (affecting the mind) and/or social (living with others as oppose to in isolation – developing relationships) effects of peer pressure (social pressure by members of ones peer group to adopt certain values – to conform or to be accepted) in relation to underage alcohol abuse.Since 1990 the amount of alcohol consumed by 11 to 15 year olds who drink has doubled and there has been increases in the numbers of children admitted to hospital as a direct result of their alcohol consumption. Early age of starting drinking is associated with higher trends of alcohol dependence in adulthood and a wider range of other adverse consequences (Donaldson, 2009). Peers play an important role in the onset of drinking behaviours. The effect of peers has been shown to be particularly powerful when parent– adolescent relationships are poorer in quality (Donaldson, 2009).Kroger (2000) identi?es that Lizzy is at the stage of her childhood development where she is asking herself, â€Å"Who am I? † Here adolescents establish sexual, political and career identities and/or may be confused about what roles to play. Identity crises can create storm and stress for the young person. Sociological theory suggest that changes within social roles cause con?ict, e. g. girlfriend and daughter, schoolgirl and work experience. In addition mass media and peers can cause con?icting values for this age; a factor that may be affecti ng Lizzy evidenced by the posters on her bedroom wall.It can be a very dif?cult time for the young person going through this stage of development. Studies such as Adams et al (1994) have found that adolescents report an increase in the importance of peers in adolescence. The proportion of time spent with peers correspondingly increases. Peer relationships also become more intimate than those of preadolescence, with a new focus on sharing secrets and disclosing feelings. Peer groups assume particular importance.Although Lizzy’s alcohol consumption is a concern it could be argued that this is an essential stage in development and here adolescent’s will begin to question whether their relationships are bene?cial or not. It is therefore possible that Lizzy’s drinking is temporary and her self realization of its effects on her life play an important part in how she develops relationships later in her life. v) discuss the advice you would offer promoting the health (a ction to maintain the best possible health and quality of life) of Lizzy considering all the various aspects of this presentation for her future well being.Ambulance services in the United Kingdom are being compelled to move away from being a relatively uncomplicated patient transport system towards becoming part of a fully integrated, national healthcare service offering a holistic approach to patient care (DoH 2005, Ball 2005). Health promotion is the process of enabling people to increases control over, and to improve their health and heir-in health is de?ned as a state of complete physical, mental and social wellbeing (WHO, 1986).The ?rst action to address Lizzy’s health would be to ensure that Lizzy attends hospital. There is evidence from her observations that Lizzy could eventually enter into sceptic shock, which is potentially life threatening therefore this should be the ?rst priority above all other health promotion considerations. If it was unable to ensure this at the scene then Clincial telephone Advice desk should be contacted along with a Duty Station Of?cer and consideration to contacting Lizzy’s GP. Health Education is a process with intellectual, psychological nd social dimensions relating to activities that increase the abilities of people to make informed decisions affecting their personal, family and community well-being.This process, based on scienti?c principles, facilitates learning and behavioral change in both health and personnel and consumers, including children and youth (Ross, 1997). Of the three different methods of health education (Coercion, Persuasion or health empowerment) empowerment focuses on developing decision-making skills and the con?dence to bring about change; the decision on which health actions to adopt is the decision of the practioner.However Lizzy could potentially bene?t more from being given the tools to help herself in this situation and help develop the know-how to help herself at this critical stage of her adolescent development (Hubley, 2008). This is reinforced in the DOH (2006) paper (with relation to year groups 10 to 11 ((14-16 year olds)): pupils develop self awareness and con?dence needed for adult life, further learning and work. They have opportunities to show that they can take responsibility for their own learning and career choices by setting personal targets and planning to meet them.They develop their ability to weigh up alternative courses of action for health and wellbeing (DOH, 2006). The National Institute for Health and Clinical Excellence (NICE) has recommended that offering brief, one-to-one advice on the harmful effects of alcohol use, how to reduce the risks and how to ?nd sources of support is an effective approach for tackling harmful drinking among children and young people (Donaldson, 2009). Lizzy should be informed that contraceptive use in?uences PID rates. Barrier contraception reduces the risk of PID by preventing the acquisition of chlamyd ia and gonorrhea.Lizzy has used condoms however it is likely that she acquired PID on the occasions where she failed to use them (Prodigy, 2005). Another useful approach with considerable potential is that of information shops. These provide health promotion on an informal ‘drop-in’ basis from accessible loctions in high streets and communities (Hubley, 2008). Lizzy should be encouraged to improve her attendance at school; The contribution of schools to public health education and health are mutually reinforcing. Education and learning promote health literacy and an increased capacity to make informed decisions on health matters.A healthy child has a greater potential to bene?t from education than one who has poor health and misses schooling. Health promotion in education settings bene?ts public health in three ways: bene?ting directly the health of the child, promoting future health by providing the necessary understanding, skills values and competencies that they can use in later life, bene?ting the health of the community through the transfer of knowledge and skills from the school back into the home place and community (St Leger, 2001).

Dbq Ratifying the Constitution

D. B. Q. 4: Ratifying the Constitution The Constitution of the United States was written in 1787, yet there was a struggle for its ratification that went on until 1790. Members of Congress believed that the Articles of Confederation, the first government of the United States, needed to be altered while others did not want change. After the Revolutionary War, the people did not want a strong central government, because it reminded them too much of what they were trying to escape. Under the Articles, each state had their own laws, and the need for a new Constitution was desired by many.This desired Constitution created a huge dispute and an argument between people who wanted things to stay the way they were and people who urged to change the Articles. The people who desired change in government were called Federalists. James Madison, Alexander Hamilton, John Jay, and Ben Franklin were all a part of the Federalists. The Federalists believed that the economy was in turmoil because of the Articles (Doc 1). Under the Articles each state had its own currency which created a problem for interstate trade. Another issue that the Federalists had was that the rich were not making money.On August 1, 1786, George Washington wrote a letter addressed to John Jay stating that they â€Å"have errors to correct†. In saying this Washington agrees in the fact that the Articles needed to be revised. The Federalists believed that the government trusted the people with too many rights. The states were allowed to refuse the Federal government whenever they chose. The new country that was trying to establish themselves, weren’t united, but instead â€Å"thirteen sovereign, independent, disunited States† (Doc 3). The central government didn’t have enough power under the Articles.The Federalists believed that even though they didn’t want to be ruled again like they were under England’s rule, that it was necessary to have a strong central governmen t. Anti-federalists were the people who believed that the Articles were working perfectly fine and it would be unnecessary to change them. Two of the major leaders of this group were Patrick Henry and Thomas Jefferson, who was overseas during this time. The Anti-Federalists thought that under the Articles people had the rights that they rightfully deserved. Under the Articles, the poor people benefitted greatly.During the process of trying to get the new Constitution ratified the Anti-Federalists felt that under this new government the rich had all of the power instead of the people (Doc 5). Under the Articles the states had the power to make laws and do whatever they pleased, and to some of the states the idea of changing to a government that the central government had all the power was absolutely absurd. Other people felt as if the new Constitution had no separation of powers. They felt as if the branches had too much power and there was nothing keeping one branch from becoming to o powerful (Doc 2).The Anti-Federalists did not want to be in the same kind of government they fought so hard to get away from. The Anti-Federalists were also frustrated with the fact that the new Constitution laid out all the rules, but did not list any rights the people had. So Federalists came up with the Bill of Rights as a way to get the Constitution ratified. The Bill Of Rights lead the Anti-Federalists to be less fearful of the new Constitution (Doc 6). This guaranteed that the people would still remain to have rights, but the strong central government that the country needed would be approved and put into motion.The arguments over the ratification of the Constitution ultimately came to an agreement. The Federalists and Anti-Federalists came to many compromises during the process of getting the Constitution approved. The Federalists thought that the country needed a strong central government while the Anti-Federalist believed that the Articles were working okay. Eventually, b oth sides came to an agreement and ratified what the United States now knows as the Constitution, and over two-hundred years later the Constitution is still in effect.

Cadency, Marshalling, Arms for Women

Cadency, Marshalling, Arms for Women While the use of distinguishing symbols have been adopted by the worlds tribes and nations stretching back into ancient history, heraldry as we now define it first became established in Europe following the Norman Conquest of Britain in 1066, rapidly gaining in popularity during the end of the 12th and beginning of the 13th century. More properly referred to as armory, heraldry is a system of identification that uses hereditary personal devices portrayed on shields and later as crests, on surcoats (worn over armor), bardings (armor and trappings for horses), and banners (personal flags used throughout the middle ages), to assist in the identification of knights in battle and in tournaments. These distinctive devices, marks, and colors, most commonly referred to as coats of arms for the display of arms on surcoats, were first adopted by the greater nobility. By the mid-13th century, however, coats of arms were also in extensive use by lesser nobility, knights, and those who later came to be known as gentlemen. Inheritance of Coats of Arms By custom during the middle ages, and later by law through granting authorities, an individual coat of arms belonged to one man only, being passed from him to his male-line descendants. There is, therefore, no such thing as a coat of arms for a surname. Basically, it is one man, one arm, a reminder of the origin of heraldry as a means of instant recognition in the thick of battle. Because of this descent of coats of arms through families, heraldry is very important to genealogists, providing evidence of family relationships. Of special significance: Cadency - The sons in each generation inherit the paternal shield, but alter it slightly in a tradition known as cadency with the addition of some mark which, in theory at least, is perpetuated in their branch of the family. The eldest son also follows this tradition but reverts back to the paternal coat of arms upon the death of his father.Marshaling - When families were merged through marriage it was common practice to also merge or combine their respective coat of arms. This practice, known as marshaling, is the art of arranging several coats of arms in one shield, for the purpose of denoting the alliances of a family. Several common methods include impaling, placing the arms of the husband and wife side by side on the shield; escutcheon of pretense, placing the arms of the wifes father on a small shield in the center of the husbands shield; and quartering, commonly used by children to display the arms of their parents, with the fathers arms in the first and fourth quarters, and t heir mothers in the second and third. ​Bearing of Arms by Women - Women have always been able to inherit arms from their fathers and to receive grants of coats of arms. They can only pass these inherited arms on to their children if they have no brothers, however - making them heraldic heiresses. Since a woman usually did not wear armor in the Middle Ages, it became a convention to display the coat of arms of her father in a lozenge (diamond) shaped field, rather than a shield, if widowed or unmarried. When married, a woman could bear the shield of her husband upon which her arms are marshaled. Granting of Coats of Arms Coats of arms are granted by the Kings of Arms in England and the six counties of Northern Ireland, the Court of the Lord Lyon King of Arms in Scotland, and the Chief Herald of Ireland in the Republic of Ireland. The College of Arms holds the official register of all coats of arms or heraldry in England and Wales. Other countries, including the United States, Australia, and Sweden, also maintain records of or allow people to register coats of arms, though no official restrictions or laws are imposed on the bearing of arms. The traditional method of displaying a coat of arms is called an achievement of arms and consists of six basic parts: The Shield The escutcheon or field on which are placed the bearings in coats of arms is known as the shield. This comes from the fact that in medieval times the shield borne on the arm of a knight was ornamented with various devices in order to identify him to his friends in the midst of battle. Also known as a heater, the shield displays the unique colors and charges (lions, designs, etc. that appear on the shield) used to identify a particular individual or their descendants. Shield shapes may vary according to their geographical origin as well as the time period. The shape of the shield is not part of the official blazon. The Helm The helm or helmet is used to indicate the rank of the bearer of the arms from the gold full-faced helm of royalty to the steel helmet with closed visor of a gentleman. The Crest   By the end of the 13th century many nobles and knights had adopted a secondary hereditary device called a crest. Most commonly made of feathers, leather, or wood, the crest has traditionally been used to help distinguish the helm, similar to the device on the shield. The Mantle Originally intended to shield the knight from the heat of the sun and to ward off rain, the mantle is a piece of cloth placed over the helmet, draping down the back to the base of the helm. The fabric is typically two-sided, with one side being of a heraldic color (the principal colors are red, blue, green, black, or purple), and the other a heraldic metal (typically white or yellow). The color of the mantling in a coat of arms most often mirrors the main colors of the shield, although there are many exceptions. The mantle, contoise, or lambrequin is often embellished on the artistic, or paper, coat of arms to give prominence to the arms and crest, and is usually presented as ribbons over the helm. The Wreath The wreath is a twisted silken scarf used to cover the joint where the crest is attached to the helmet. Modern heraldry depicts the wreath as if two colored scarves had been braided together, the colors showing alternately. These colors are the same as the first named metal and the first named color in the blazon, and are known as the colors. The Motto Not officially granted with a coat of arms, mottos are a phrase which incorporates the basic philosophy of the family or an ancient war cry. They may or may not be present on an individual coat of arms, and are normally placed below the shield or occasionally above the crest.

How to Find Your GED Records

How to Find Your GED Records Every state in the U.S. has official General Education Diploma (GED) records for  everyone who  has earned a GED in that state. Records can be accessed by the GED holders themselves or by others who have obtained their consent. Reasons to Locate GED Records If you are applying for a job, for example, you will likely need to provide your GED completion date as verification of your education history. You may also need to provide this information as part of a background check if you volunteering at an organization. Finally, you may need to locate GED records if you are a hiring manager and you need to verify the information provided by a job applicant. How to Find GED Records Whether you need a copy of your own GED records  or you want to verify that a job applicant truly earned a GED, there are several steps you need to take: Determine in which state the GED credential was earned.Check the states education website to determine that states requirements for records requests.Get authorization from the GED holder. Most states require:Full name and all past last namesDate of birthSocial Security number (some require only last four digits)Date of records requestSignature of GED holderEmail or mailing address where verification is to be sentSend required information by whichever means the state requests (some have online request forms, but all require the GED holders signature). The turnaround time in many states is only 24 hours, but requests should be made as early as possible. Remember that the only information that will be sent is verification that an official credential was earned and the date on which it was earned. For protection of privacy, no scores are provided. Common Challenges In some cases, you may encounter challenges when you request GED records. Each state has its own guidelines for storing and accessing this information, and some are more compliant than others when it comes to granting requests. The date of testing may affect how easy it is to obtain GED  records. Recent records are more likely to be stored in a digital archive, accessible by computer, while older records are more likely to be found in a physical archive that is less easily searched. To help archivists locate older records, you should be prepared to provide as much information as possible, including past names. Fulfilling requests for older records may take additional time, even up to several weeks. You should take this into account when submitting a  records request. If you are looking for your GED records but missing some of the information listed above, you may still be in luck. In Texas, for example, File IDs are attached to records without  Social Security numbers. GED holders can work with the state education agencys help desk to find out their File IDs and access their complete records.

Case study analysis Essay Example | Topics and Well Written Essays - 750 words - 2

Case study analysis - Essay Example Jessica, in her description, stated the behavioural problems John underwent. According to her recount of events, John was not talking as early as the age of two. John is obsessed with his train toys and spends most of the time playing with them. Every time his mother changes his routine, he became completely agitated. He would even get displeased when interrupted to go to bed. John’s behaviour in school also worried her mother. He would invade other childrens playing spaces while at school, where he would scratch or bite them when frustrated. He also often licked playground equipment and doorknobs. John would exhibit varied reactions to signal what he wants. For instance, he once threw a temper tantrum in frustration that he would not have what he wants. Jessica was so worried about the inability of his son to express himself. Thus, she decided to contact our social working centre, whereby I was assigned to work on the case. Jessica reported that John lags behind his age mates in self-help skills. Recently, however, Jessica observed that John was succeeding in toilet training. He has been staying dry more often and would ask when he wants to visit the bathroom. Nonetheless, John still experienced accidents during the nights. His attempts to learn how to dress had been futile as he still put on clothes inside out. John, on a positive note, followed instructions, especially when told to stay indoors. Jessica discovered that John’s condition would trigger taunts and provocations from truants in the neighbourhood. One of the boys in the neighbourhood had been purportedly doing drugs. Jessica, therefore, felt that he would be a bad influence to his estranged son. Jessica mother firmly believed that John’s was a consequence of poor parenting. Her neglect of John and the physical abuses of his ex-husband may have contributed to John’s condition. As a solution, she believed that

UNIT 6 ASSIGNMENT FAMILY AND CHILD WELFARE Research Paper

UNIT 6 ASSIGNMENT FAMILY AND CHILD WELFARE - Research Paper Example Obstacles faced by clients in their bid to access services include poor transport network which hinders movement, lack of necessary facilities such as hospitals, schools and recreational services. Information barrier may hinder the clients from obtaining relevant information from the agencies. Some agencies do not conduct adequate follow-up with the clients thus hindering the effectiveness of the services being offered. There are a number of ways through which client care between different types of agencies can be improved so as to ensure proper delivery of services. One of the ways of improving service delivery is through case coordination which is composed of sharing of information, collaboration as well as communication among the management team, staffs and the clients between agencies involved in service delivery. The approach is composed of initiatives that are geared towards reduction of barriers towards service delivery, direct accessibility and increased linkages between agencies and the clients. Case coordination is makes service delivery to the clients more centered on them as it increases their ability to access service owing to the fact that their points of contact have been greatly improves. The process ensures increased accessibility of the case workers to their clients so that they can quickly deliver their services as well as issuing concrete report on areas that require quick inter vention. Case coordination enables the directors to obtain timely financial reports so that they can guarantee the agencies of continuous funding. The case managers who are charged with the responsibility of managing the agencies will be able to greatly increase their productivity since they will not a lot of administrative roles to play. The stakeholders in the agencies such as the policy-makers, service providers and case managers are charged with the responsibility of developing as well as designing od programs that are aimed