Perceived risk & gambling Essay Example for Free

Perceived risk gambling Essay As of 2008, there were more than 2,000 internet gambling sites worldwide; with combined revenue of these websites being estimated to be north of $18 billion (Overview of Gambling Regulations, 2008). Due to its obscene rate of growth, potential harm to its consumers and growing ease of accessibility, internet gambling is viewed by many as a major cause for concern. Don’t expect the apprehension towards online gambling to ease up any time soon. Casinos, of both the online and brick-and-mortar variety are expected to aggressively increase their marketing budget over the next half decade. With online gambling recently legalized in Nevada, and many states preparing to follow suit, Simon Holliday, director at H2 Gambling Capital predicts that nearly $4 billion could be spent by the internet gaming sector over the next five years (Jackpot! , 2012). The Gambling Act of 2005 was introduced to modernize gambling regulations. The act brought increased marketing freedom for gambling companies, but only along with responsibility regarding the advocacy of the potential dangers of addiction. It also required the implementation of Corporate Social Responsibility (CSR) policy and the anticipated goal was to introduce, acknowledge and bring to light to substantial harm which can stem from problematic gambling. According to the Gambling Act of 2005, in order for a company to obtain their license and legally operate in the marketplace they had to ensure that: i. Gambling is conducted in a fair and open way; ii. Children and other vulnerable people are protected from being harmed or exploited by gambling; and iii. Assistance is made available to people who are, or may be, affected by problems related to gambling. (GamCare: gambling research, education treatment) With the changing landscape in the industry, it is fair to question whether these regulations are still relevant, and more even importantly, whether companies are still operating within the bounds of the Gambling Act of 2005. Technological advances have led to online websites readily available around the clock, potentially made gambling available to minors (via online casinos, online sports betting) and lost control of potential hazards concerning online users, those being: sobriety (users drunk/high while on a online gaming site); awareness (many ads online promoting gambling, very few raising awareness); and whom is using the sites (minors, youth, seniors, or problematic/addictive users). All of this unsurprisingly raises concerns regarding whether the current regulations are equipped to handle both current and future gambling disputes. Gambling consumption has no doubt increased over the past decade, and will continue to do so for the foreseeable future as regulations are expected to loosen while the marketing budget of online casinos are expected to abruptly expand (Jackpot! , 2012). The bulk of the marketing expenditures will be geared towards youth via interactive media sources; interactive online ad-agencies figure to be the main beneficiary. Though casinos will continue marketing to those who frequent physically existing casinos (a crowd mainly over 50) via television, magazine and billboard advertisements, the majority of the expanded marketing budget figures to be aimed at online users – the vast majority of which are in their 20’s (Jackpot, 2012). There seems to be an array of ethical concerns tied into all of this – whether children and â€Å"other vulnerable people† are still protected from potential harm, how readily available is assistance to those who are affected and is it being outweighed by the onslaught on pro-gambling marketing, concerns regarding online gambling (sobriety, minors, problem identification), and ultimately whether the advocacy is still a priority. A widespread fact in the gambling industry is that 20% of the gambling population accounts for 80% of the gambling industry’s revenue (Galanda, 2007), essentially implying that when evaluating the entire gambling population, 20% are pouring a considerable amount of money into the industry and could potentially be labelled as problematic gamblers. With casinos paying more money and attention to marketing, and marketing research, they are able to identify the age, demographics, frequency and income of their market. Via frequent gambler cards, visas and other channels (surveys for points/credits, casino identification/reloadable slot cards), casinos are able to pick and choose who they zero their marketing efforts in on, whether that be seniors, twenty-somethings or potentially the 20% we earlier identified as problematic gamblers. Corporate Social Responsibility (CSR) was incorporated into the Gambling Act (2005) as a means of regulatory control and functions as a built-in, self-regulating instrument intended to designate ethical standards to which companies must adhere to. Gambling companies possessing information about their customers, and using this information to formulate a marketing strategy and plan, raises ethical concerns and seeds the question of whether this type of behaviour corresponds to the regulations and ethical policies within CSR. Three main differences between gambling now and nearly a decade ago when the Gambling Act was introduced are: (1) distribution channels have increased accessibility to gambling and exposure to gambling promotion; (2) the technological innovation developed by online casinos is tremendously exceeding government control efforts; and (3) gambling has simply become an international phenomenon – the gambling population is aggressively expanding (Social Marketing Problem Gambling, 2011). Though the effects and consequences of problem gambling are more extreme and common than ever, the reasons described above explain why it is so difficult for government to control the issue, and moreover why the trend is currently liberalizing ideologies rather than attacking the corporations and addressing the underlying issues.

The Blood Clotting Cascade Biology Essay

The Blood Clotting Cascade Biology Essay von Willebrand Factor is a large multimeric clotting protein which plays a significant role in the process of blood coagulation. It is mainly secreted by the vascular endothelial cells and also by megakaryocytes in the bone marrow. The vWF performs two important functions in the process of blood coagulation, and thats why it is very important. First, it is responsible in bringing together the elements to form the primary hemostatic plug. It serves as an anchor for platelets at the site of injury in the blood vessel. Second, it acts as a protective chaperone for Factor VIII, to avoid lysis by proteolytic agents in the blood. The Factor VIII also released by vWF at the site of injury, whereby it brings about the completion of the Intrinsic Pathway of blood coagulation, and seals the site of injury with Fibrin. von Willebrand Disease (vWD) is the most common inherited bleeding disorder in human beings the world over. Although, mutations in the vWF gene are responsible for the type of vWD in a patient, the transmission of vWD to the next generation is not solely linked to the vWF gene, but involves linkages with other genes such as the ABO blood type genes. The gene that encodes von Willebrand Factor is present on the short chromatid of chromosome 12, and is 178kb long with 52 exons or coding sites. Most of the exons are small, some as small as 41 base pairs (Schneppenheim, 2011). Exon 28, which has 1379 base pairs, is the largest. Mutations in the genes encoding vWF are primarily responsible for most vWD cases. Mutations can cause qualitative or quantitative deficiencies of vWF. Mutations in the vWF gene and the vWD that is attributed to the mutations are shown in Figure 1. C:UsersTj WorkDropboxTjBlood SensorThesisvWF Domains rot.jpg Figure : Upper panel: vWF Exons coding for the domains; Lower panel: Locations of mutations and their corrseponding vWD types The multimeric von Willebrand Factor contains identical subunits of 250kDa each. These subunits dimerize (into 500 kilo Daltons subunits) and then multimerize into clusters greater than 10 mega Daltons in weight (Sadler JE, 2006). The vWF performs two functions serve as an anchor for binding platelets to the site of injury and bind to and stabilize Factor VIII from degradation by proteases in the blood and presenting it only at the site of injury. A vWF monomer has a repeated domain structure S D1 D2 D D3 A1 A2 A3 D4 B1 B2 B3 C1 C2 CK (Figure 1). The monomer is 2813 amino acids long. At the N-terminal is the 22 amino acid long signal peptide. Domains D and D3 are specific to Factor VIII binding. Platelets bind to vWF at its A1domain with their Glycoprotein (GP)-1b surface receptors. The A3 domain is specific to collagen, predominantly type III (J. Siekmann, 1998). Thus, domains A1 and A3 are necessary and must be fully functional to form the primary hemostatic plug in the process of coagulation. Figure 2: Domains of vWF protein, (U.S. Department of Health and Human Services, 2007) Overview of the clotting cascade A brief overview of the blood clotting cascade is necessary to understand the function of vWF in the process of clotting. The process of blood coagulation involves platelets and clotting proteins. At the site of injury in a blood vessel, the subendothelial collagen (types I and III) in the extracellular matrix of the blood vessel is exposed to blood. vWF that is present in the blood binds to the exposed collagen with its A3 domain. The flow of blood causes the multimers of the anchored vWF to unfold and expose the sites of platelet binding on the A1 domain (Figure 2). The platelets bind to this domain with their Gp-Ib receptor proteins present on the platelet cell surface. The binding of platelets to vWF activates them and a chemical messenger Thromboxane A2 is released by the platelets. Thromboxane A2 at the site of injury attracts more platelets in the blood, and aids in platelet aggregation. Platelets flowing in the blood stream bind to the activated platelets with a surface prot ein Gp IIb/IIIa. Fibrinogen (Factor I) is present in between the GP-IIb/IIIa receptors of two platelets. Thus, a primary hemostatic plug, though weak in strength, is formed. Figure 3: Sequence of events of blood coagulation due to vWF (U.S. Department of Health and Human Services, 2007) The unfolding of the multimers of vWF also releases Factor VIII at the site of injury. In the Intrinsic pathway of coagulation, Factor VIII is essential in catalyzing the conversion of Factor IX to Factor X, and eventually, prothrombin is catalyzed to from thrombin. Thrombin catalyzes the conversion of Fibrinogen (Factor I) into Fibrin. The fibrin forms a thick proteinaceous mesh, which seals the loss of blood from the blood vessel, this completing the process of hemostasis. Tissue repair and wound healing ensues. von Willebrand Disease von Willebrand Disease (vWD) is a deficiency of von Willebrand Factor. Based on the quantitative and qualitative deficiency, it is classified into subtypes. Combinations of assays are done to detect vWF levels in human plasma. Results of these tests report vWF levels in International Units per deciliter (IU/dL). The plasma concentration of vWF in healthy individuals is reported to be at around 10Â µg/mL (Mannucci, 1998), and the corresponding IU measurement is 100 IU/dL. The classification of the vWD types is based on the criteria developed by the vWF Subcommittee of the International Society of Thrombosis and Haemostasis at Carrboro, North Carolina, USA in 1994. Annual meetings are held by ISTH to review diagnosis and management guidelines for vWD by experts all over the world. The standard guidelines for the diagnosis and treatment of vWD in the USA is based on the vWF Report by the National Heart, Lung and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services, which was released in 2007 by the expert panel on vWF, chaired by Dr. William L. Nichols, Jr., M.D. The ISTH holds annual meetings all over the world to discuss updates on vWD. The first vWD classification by the ISTH in 1994 was based on information about mutations on the vWF gene. However, because it was appropriate to only a small population of the human race, it was overruled in 2006 and was replaced by the new method based on response to treatment with DDAVP or other blood based therapeutics. vWD is classified based on qualitative and quantitative deficiencies. Partial quantitative deficiency is type 1 vWD and total quantitative deficiency is type 3. Qualitative deficiency is type 2, and is subdivided into types 2A, 2B, 2M and 2N based on the functions of the vWF which are affected. Quantitative deficiencies of vWF are discussed first types 1 and 3 vWD. The main laboratory tests to analyze vWF in patient samples are vWF:Antigen activity (vWF:Ag), Factor VIII: Coagulation activity (FVIII:C) and vWF: Ristocetin Cofactor activity (vWF:RCo). Type 1 vWD A patient with partial quantitative deficiency of vWD is diagnosed as type 1 vWD. The level of vWF in the plasma, though low, can still carry out the formation of the primary hemostatic plug, and also protect Factor VIII. In most type 1 vWD cases, Factor VIII levels are very mildly affected. It is hard to accurately diagnose type 1 vWD because, the vWF levels also depend on the ABO blood grouping. The average vWF level in healthy individuals with blood type O is about 75 IU/dL. It is reasonable to classify the condition of a patient with less than 20 IU/dL vWF level as type 1 vWD because this indicates a probable hereditary mutation. The vWF:Ag and vWF:RCo tests show similar reductions in vWF activity for type 1 vWD patients compared to the reference plasma by ISTH (U.S. Department of Health and Human Services, 2007). Type 3 vWD When the vWF activity of a plasma sample is less than 10 IU/dL, it is classified as type 3 vWD.84-86 Major mutations such as frameshifts, large deletions, splice-site mutations, and missense mutations can be causes for type 3 vWD (U.S. Department of Health and Human Services, 2007). Sometimes, clearance of vWF from the blood stream due to autoimmune disorders can decrease vWF quantity in the blood to type 3 levels of vWD. This is also one of the causes of of Acquired von Willebrand Syndrome AVWS. Type 2 vWD Type 2 vWD is a qualitative deficiency of vWF, where, although the vWF may be produced in normal quantities, fails to perform its tasks effectively. Based on the defect in the von Willebrand Factor, it is mainly classified into types 2A, 2B, 2M and 2N. In type 2A vWD, the vWF platelet binding activity is decreased due to the absence or deficiency of high molecular weight multimers of vWF. There is a sharp fall in the vWF:RCo activity, but not much decrease in vWF:Ag and FVIII:C activity. This is because the vWF is still able to bind to Factor VIII. (Ruggeri ZM, 1980) The high molecular weight multimers are either degraded by proteolytic enzymes in the blood or have not been produced due to mutations in the exons of the vWF gene that code for the A2 and/or the D3 domain. (Schneppenheim R, 2001), (Sutherland JJ, 2004) . Type 2B VWD is characterized by an abnormal increase in the vWF-platelet binding affinity, which leads to depletion of large, functional VWF multimers, and also a fall in platelet numbers (Zimmerman TS, 1986) The platelets circulating in the blood stream are blocked with the mutant vWF, due to which, there is a great difficulty in the formation of the primary hemostatic plug. Thus, thrombocytopenia ensues, along with increased Ristocetin Induced Platelet Aggregation (RIPA) even at low concentrations of Ristocetin. Mutations in the A1 domain are responsible for type 2B vWD (Huizinga EG, 2002). In type 2M vWD the vWF platelet binding activity is reduced. But unlike the type 2A vWD, there is no decrease in the quantities of high molecular weight multimers. This phenomenon is only due to a decreased affinity to the Gp-1b receptors on the platelets (Ginsburg D, 1993), (Schneppenheim R, 2001), (Meyer D, 2001), (Rabinowitz I, 1992) (Mazurier C, 2001). The vWF:Ag, vWF:RCo and FVIII:C activities in types 2A and 2M vWD are similar. They can only be diagnosed based on high resolution gel electrophoresis images. (Meyer D, 2001). Another phenotype of type 2M vWD is the failure of vWF to bind to collagen in the extracellular matrix of the vascular sub-endothelium. vWD type 2N is due to the absence of vWF-Factor VIII binding. This is due to mutations in the D and D3 domains of the vWF protein (Ginsburg D, 1993), (Mazurier C, 2001). The laboratory tests for this type of vWD indicate normal levels for vWF:Ag and vWF:RCo tests, but the FVIII:C activity is only about 10% of normal levels. Acquired von Willebrand Syndrome Acquired von Willebrand Syndrome (AVWS) is type of vWD which is not genetically linked. There are three mechanisms by which it is manifested: Autoimmune reactions against vWF, Increased proteolysis of vWF by a protease ADAMTS13 (A Disintegrin And Metalloproteinase with a ThromboSpondin type 1 motif, member 13), or abnormal increase in the binding affinity of vWF to platelets or other cell surface receptors (U.S. Department of Health and Human Services, 2007). Diagnosis of vWD The diagnosis of von Willebrand Disease and its sub-type is made based on an initial review of previous health conditions and familial history of bleeding disorders, which is done in the clinic, and then obtaining plasma samples of the patient for laboratory tests.

Advertising Analysis :: Adverts, Advertisements

We see them in the subways, bus stops, magazines, and television, but what do they mean? How do they manage to catch our attention? Advertisements often find ways to sell their products by psychologically manipulating people. The advertising industry makes us envious of others and convinces us to be unhappy with what we have (Valko). Steve Madden ads usually feature women with absurdly large heads and hourglass bodies which try to force the audience to wonder what the ad is about. One of these odd ads appears in the March/April 2001 issue of Twist Magazine. It features a young woman with a big head helplessly running, as an airplane zooms over her at an abandoned airport. There are three characteristics within the ad that contribute the whole idea that Steve Madden shoes, clothes and accessories will improve your self image. The main purpose of Steve Madden ads is to suggest to its viewers that they will feel good about themselves by wearing his products. The model’s big head conveys self-esteem and self-pride and she challenges the consumer to look as good as she does. The young woman wears a face of apprehension and is running away from her old self to start her new confident life with Steve Madden products. The sleek black leather jacket on top of a sexy white shirt, short enough to reveal her stomach and curvaceous hips together with her tight low rider blue jeans, black pointy high boots, and trendy black bag complete her fashionable outfit. The embellished woman’s physique is aimed to appeal to women and girls between the ages of 16 through 25 in search of funky, hip, sexy clothes. Steve Madden likes to think of his clothes of as being distinctive and he illustrates his idea by setting an abandoned airport as the background for the ad. There is not a body in sight as the model runs across the old gum stained pavement. This calls attention to the idea that by wearing Steve Madden buyers isolate themselves from everyone else. She is too proud and conceited and cannot imagine being compared to anyone else. The Steve Madden logo in the ad also contributes to the main idea of the ad. It could have been anywhere on the page, why the sky? . Steve Madden ads always have their logos imprinted on the sky to imply that the â€Å"sky is the limit† with Steve madden products (Liza). Advertising Analysis :: Adverts, Advertisements We see them in the subways, bus stops, magazines, and television, but what do they mean? How do they manage to catch our attention? Advertisements often find ways to sell their products by psychologically manipulating people. The advertising industry makes us envious of others and convinces us to be unhappy with what we have (Valko). Steve Madden ads usually feature women with absurdly large heads and hourglass bodies which try to force the audience to wonder what the ad is about. One of these odd ads appears in the March/April 2001 issue of Twist Magazine. It features a young woman with a big head helplessly running, as an airplane zooms over her at an abandoned airport. There are three characteristics within the ad that contribute the whole idea that Steve Madden shoes, clothes and accessories will improve your self image. The main purpose of Steve Madden ads is to suggest to its viewers that they will feel good about themselves by wearing his products. The model’s big head conveys self-esteem and self-pride and she challenges the consumer to look as good as she does. The young woman wears a face of apprehension and is running away from her old self to start her new confident life with Steve Madden products. The sleek black leather jacket on top of a sexy white shirt, short enough to reveal her stomach and curvaceous hips together with her tight low rider blue jeans, black pointy high boots, and trendy black bag complete her fashionable outfit. The embellished woman’s physique is aimed to appeal to women and girls between the ages of 16 through 25 in search of funky, hip, sexy clothes. Steve Madden likes to think of his clothes of as being distinctive and he illustrates his idea by setting an abandoned airport as the background for the ad. There is not a body in sight as the model runs across the old gum stained pavement. This calls attention to the idea that by wearing Steve Madden buyers isolate themselves from everyone else. She is too proud and conceited and cannot imagine being compared to anyone else. The Steve Madden logo in the ad also contributes to the main idea of the ad. It could have been anywhere on the page, why the sky? . Steve Madden ads always have their logos imprinted on the sky to imply that the â€Å"sky is the limit† with Steve madden products (Liza).

Easy And Difficult Works In Ed :: essays research papers

According to the article "When Does Education Stop?" it stated that a young man interviewed the author, James Michener, and bellyaching about writing a three thousand words paper which is about James’ book. Because the young man sounded whimpering, James started to talk about his own experience of writing millions words paper. He mentioned that young people should realize that they have to put many efforts in order to achieve their goals. Also, men and women should know that they would face the difficult tasks before they success. Besides, no college can educate people with all they want, and all they need in the future. Although people study literature, logic or history probably have a fewer job opportunities, these fields actually have more wide job opportunities in the future. In addition, the schools are not a relax place. In stead of it, these schools are the places to train people. Therefore, if professors do not give many works for students to study, they s hould quit those professors or schools and seek others who have harsh teaching rules. The changes of the social structure caused people tend to learn the high technology instead of studying arts or literature. Some scholars think that people don’t know how to write a good paper, or a nice article because people think it’s too tedious that takes a lot of time to write, to research, and to edit. People love to look for material satisfaction, or participate with things which they are interested in. Therefore, they probably don’t want to spend much time to devote in studying. In my opinion, either having a lot of works or less works has it’s own advantages and disadvantages which depends on person’s own interests. People usually get different kind of benefits from various things, and it’s hard to determine which is better or not. According to the author, people avoid doing difficult tasks; instead, they just complain about those works. The hard works can develop people’s own knowledge, and that can train their brains to think deeper. People will have better abilities to face the future problems. The more experience people have in college, the better performances they can achieve in the society; for example, the biology students have to do a lot of lab works before they become a medical student even a doctor. If they don’t make any experiment before they become doctors, they probably will make many mistakes during the operation.

The Dobe Ju/ hoansi Essay example -- essays research papers

The Dobe Ju/' hoansi   Ã‚  Ã‚  Ã‚  Ã‚  Ch 10: The Ju/' hoansi & their neighbors o  Ã‚  Ã‚  Ã‚  Ã‚  The Ju/'hoansi share the Dobe area with the Herero and Tswana pastorals. o  Ã‚  Ã‚  Ã‚  Ã‚  They grow crops and have herds yet are all based on kinship and are don't have developed markets or governments. o  Ã‚  Ã‚  Ã‚  Ã‚  Herero's are the largest groups of in the Dobe area. They are Bantu speaking people. o  Ã‚  Ã‚  Ã‚  Ã‚  Were influenced by the German missionaries who pushed them out of their land. They attacked colonists and Germany declared war, ultimately killing 60% of them. o  Ã‚  Ã‚  Ã‚  Ã‚  Working on Herero cattle posts is major source of employment of the Ju. o  Ã‚  Ã‚  Ã‚  Ã‚  With the H& T's came major ecological changes. o  Ã‚  Ã‚  Ã‚  Ã‚  Wells were deepened to ensure water supply for stock and were also fenced in. o  Ã‚  Ã‚  Ã‚  Ã‚  Has created more sanitary water but less is available. Goats have also destroyed the grass. And each cattle post now has a permanent population of houseflies. o  Ã‚  Ã‚  Ã‚  Ã‚  Working for the Herero's gives a Ju a donkey to ride as well as an outfit. Wages are minimum but it offers a calf in the long run and ability to offer relatives hospitality. o  Ã‚  Ã‚  Ã‚  Ã‚  Intermarriage is common with Ju women marry Black men. o  Ã‚  Ã‚  Ã‚  Ã‚  Advantages- Ju woman are in the ar...

Nursing Process Essay

The client is a 70 year old, Caucasian male who is a retired siding salesman from Riverside, IA, who has an extensive history with Paralysis agitans (Parkinson’s disease). The client was first admitted to the long term care facility in December 2012. The client explained that he came to be at this facility after â€Å"already being in two places like this†. He was removed/discharged from the last long-term care facility for being what he called â€Å"disruptive†. The client described the staff at the last facility as not very kind to the residents. There was an incident where the drugs that were prescribed to the client made him hallucinate and he became unruly with the staff and was restrained and taken to the hospital for evaluation. He was then transferred to this long term care facility. Wanting to gather the client’s health history, an interview was scheduled. In starting the interview with the client, he was asked if he would be comfortable with being asked some questions and was informed that he did not have to answer any questions that he was uncomfortable with. Due to the client’s paralysis agitans and his muscle weakness he is primarily in a wheelchair. The client was asked if there was anything that he needed before starting and if he would prefer the door be closed or the curtain be drawn for privacy, he stated that wasn’t necessary. It was observed that the client had tremors in his right hand and arm. A few minutes after sitting down, the client asked for help moving his hand that was resting on the bed to the arm of his wheelchair; in doing this it seemed to help calm the tremors. When speaking with the client, he is of sound mind and has a sense of humor. This indicates that the client’s paralysis agitans has not affected the area in the right hemisphere of the brain that controls personality. The client noted that he was in respectable physical health until 1996. He then explained that in the spring of 1996, while he was running he suffered from a TIA (Transient Ischemic Attack). The client sought out professional answers from 5 specialists and was diagnosed with Paralysis agitans. The client conveyed this was a concern he had because his father also had Paralysis agitans. The client describes that the Paralysis agitans has  progressively become worse over the past 18 years. It was observed that his speech was slow and monotonous. The client spoke in a low and discreet volume. A lack of facial expressions was also noticed. The client can walk with the assistance of a walker but is generally in a wheelchair. Name of Drug Dosage Route Time Related to Carbidopa-Levo 25 100 tab Orally TID Paralysis agitans Comtan 200 mg tablet Orally TID Paralysis agitans Seroquel XR 50 mg tablet Orally In the afternoon Nonorganic psychosis He is prescribed 3 tablets to be taken orally 3 times a day Carbidopa-Levodopa 25-100 (25 mg of Carbidopa and 100 mg of Levodopa) for paralysis agitans. He is also prescribed 200 mg of Comtan to be taken orally 3 times a day for paralysis agitans. These drugs raise the level of dopamine in the brain. A side effect of having elevated levels of dopamine in the brain is psychosis. The client is also given 50 mg of Seroquel XR orally in the afternoon to alleviate his nonorganic psychosis. It is documented in the client’s chart that there are symptoms of sleep apnea. When asked, the client stated that he was unaware of having that condition. The client does not use a continuous positive airway pressure (CPAP) machine  while sleeping at night. When talking more in depth about sleep patterns and concerns the client stated that he gets approximately 8 hours a sleep a night, this is without any help from sleep aids. When speaking of his bedtime rituals he said that he does have two beers, back to back, at night right before bedtime, while watching television. He does not have difficulty falling asleep but did claim that he sometimes has a hard time staying asleep at night. When questioned about taking occasional naps throughout the day he stated â€Å"depends on if I’ve been up all night†. The client then explained that it is the noise level at the long term care facility that keeps him awake. When inquiring about the client’s family he stated that he has been married for 48 years and has two children, a son who is 44 years old and a daughter that is 39 years old. The client also has seven grandchildren. When asked what he likes to do in his spare time he replied that he loves spending time with his wife and children. He stated that before coming to this long term care facility he enjoyed playing card and gambling. He now plays computer games for fun, when his wife is there to help him. The client explained that he has a â€Å"little bit† of high blood pressure and it was noted in his chart that he is given an 81MG Aspirin daily for atrial fibrillation. Aspirin 81 mg Orally o.d. A-fib Acetaminophen 325 mg Orally Every 6 hour Pain He has no history of heart surgeries or surgeries of any kind. The client reported that he has never had rheumatic fever. When asked about blood clots, the client responded that he believes that his TIA in 1996 was a result of arterial emboli. The client claims that sometimes he has numbness in his legs and his hamstrings tighten up and it can be painful. He stated that he will ask for his prescribed 650 MG of acetaminophen for the pain. When speaking about everyday stresses with the client, he stated that he doesn’t have a lot of stress but gets irritated when that staff turn on the lights every morning at 6:30 am. When asked if there was anything that he does when he notices that he is stressed, the client mentioned that when he was younger he would travel to Vedic City in Iowa and practice with the Maharishi meditating. He says that meditating has been very helpful in his adult life. The client also mentioned that he liked to follow the Maharishi lifestyle and eat only organic foods but it is not possible to follow that when residing at a long term care facility. Other things that he does to distress are look at his pictures that he has on his shelf in his room. The one that helps him the most is a black and white picture of him in a small airplane with his flight instructor standing on the wing. The client use to pilot planes when he was younger. When the client was asked if he was religious and he explained that he is Methodist but hasn’t been to church in about 5 years. He did state that he does pray occasionally. The client stated that is not afraid of dying but he is afraid of falling. He then joked that maybe it’s not so much the falling but maybe it’s the landing. When assessing the client’s vitals it was noted that he has slightly elevated blood pressure of 129/84 and could be cause for concern of pre-hypertension. Metoprolol tartrate 25 mg Orally BID Hypertension It is noted in his chart that the client is given a 25 mg tablet of metoprolol tartrate orally twice a day for hypertension. His respirations were within normal range at 18 respirations per minute. SaO2 was at 86%. The client’s temperature was taken orally and was 97.6  °F. The client is 6 feet and 1 inch tall and weighs 257 lbs. The client has a BMI of 33.9. The client received a vaccination for influenza on 10/16/13. The clients chart states that he requires assistance with many daily activities. He is dependent on help with dressing, and bathing. When asked, the client stated that it is challenging to get dressed and undressed due to the stiffness in his arms and legs. The client is on a regular diet and states that he  doesn’t have any difficulty swallowing foods and doesn’t require help with feeding. When asked about appetite he said that sometimes he doesn’t have much of an appetite but he believes that is due to the medications that he is taking. The client explains that he is not aware of having any food allergies. He also stated that after eating he does not experience sensations of nausea/vomiting, but does encounter heartburn/indigestion occasionally, which he takes 30 ml an antacid suspension. He is also given one multivitamin orally daily for supplement. Antacid Suspension 30 ml Orally Every 6 hours Supplement heartburn Multivitamin 1 tablet Orally o.d. Supplement When the client was asked about dentures he stated that he does not have dentures even though dentures were noted in his chart. He states he needs aid in transferring from bed to a chair and with toileting. When asked about the character of his stools he explained that both consistency and color were normal. The client also stated that he does not need the help of laxatives. Noted in the client’s chart he is given a 100 mg capsule of Docusate sodium orally 2 times a day to help with constipation. Docusate sodium 100 mg capsule Orally BID Constipation The client does not have any history of kidney or bladder disease. He claims that the frequency, amount and color of his urine are normal. He also claims that he does not have any difficulty voiding and there is no pain or burning while urinating. According to the CNA, the client is able to stand,  holding the hand rails, while urinating. It is noted in the clients care plan that he is urinary incontinent which is related to impaired mobility and PRN straight catheter needed for intermittent retention secondary to BPH. The client is given one 0.4 mg of Tamsulosin HCL orally a day for BPH (benign prostatic hyperplasia). Tamsulosin HCL 0.4 mh Orally o.d. BPH The client needs assistance with bathing as well. The client also has a DNR order. Parkinson’s disease (paralysis agitans) is a progressive disorder of the nervous system that affects ones mobility. According to Hubert and VanMeter, Parkinson’s disease is a â€Å"dysfunction of the extrapyramidal motor system that occurs because of progressive degenerative changes in the basal nuclei, principally in the substantia nigra.†(UMMC, 2012) The substantia nigra is the primary area of the brain that is affected by Parkinson’s disease (PD). (UMMC, 2012) The substantia nigra is comprised of a specific set of neurons that send chemical signals, called dopamine. Dopamine then travels to the striatum, responsible for balance, control of movements, and walking, by means of long fibers called axons. (Okun, 2013) These regular body movements are controlled by the activity of dopamine on these axons. With PD the neurons in the substantia nigra break down and die causing the loss of dopamine, which in turn causes the nerve cells in the striatum to trigger excessively. The excessive firing of neurons makes it impossible for one to control their movements, a sign of Parkinson’s disease. (Okun, 2013) According to the Parkinson’s disease Foundation (2014): As many as one million Americans live with Parkinson’s disease, which is more than the combined number of people diagnosed with multiple sclerosis, muscular dystrophy and Lou Gehrig’s disease. Also approximately 60,000 Americans are diagnosed with Parkinson’s disease each year, and this number does not reflect the thousands of cases that go undetected. An estimated  seven to 10 million people worldwide are living with Parkinson’s disease. Incidence of Parkinson’s increases with age, but an estimated four percent of people with PD are diagnosed before the age of 50 and men are one and a half times more likely to have Parkinson’s than women. (p 1) Since PD is a progressively degenerative disease the signs and symptoms change over time and vary from person to person. A widely used clinical rating scale is the Hoehn and Yahr scale (HY); this helps to identify signs and symptoms in the various stages of Parkinson’s disease. (MGH, 2005) Early stages, like HY’s stage one, of Parkinson’s disease the symptoms are usually mild and appear unilateral. There may be changes in facial expressions, posture and locomotion; these symptoms are usually untimely and bothersome but not disabling. As the disease progresses, into stage two of the HY scale, it may begin to affect ambulation and be noticeable bilaterally with minimal disability. (MGH, 2005) As symptoms worsen, as in stage three of the HY scale, there is considerable slowing of body movements, early impairment of equilibrium with walking and standing and generalized dysfunction that is moderately severe. The Hoehn and Yahr scale’s stage four explains that signs and symptoms are severe but the person can still walk to a limited extent. (MGH, 2005) Rigidity and bradykinesia become factors in mobility. In stage five the person is unable to walk or stand so is bedridden or confined to a wheelchair. This stage is referred to as the â€Å"cachectic stage †. Constant nursing care is required in stage five (Costa and Quelhas, 2009). There are many complications that are associated with PD; one can be difficulty swallowing (dysphagia), likely due to the loss of control of muscles in the throat. (UMMC, 2012) Drooling can occur since saliva may accrue in the mouth due to dysphagia. Difficulty swallowing can also lead to malnourishment, but also poses a risk for aspiration pneumonia (Leopold and Kagel, 1997). Constipation can be another complication as to the slowing of the digestive tract. Parkinson’s disease can also cause urinary retention and urinary incontinence. Dementia and difficulty thinking comes in later stages of PD. (University of Maryland Medical Center, 2012) Depression is very common in patients with Parkinson’s. The disease process itself causes changes in chemicals in the brain that affect mood and well-being. Anxiety is also very common and may be present along with depression (University of Maryland Medical Center, 2012). Sleep problems  and sleeping disorders are also associated with PD, with this comes fatigue. Some patients may experience feeling light headed when standing due to the drop in blood pressure (orthostatic hypotension). Pain can also be another symptom related to Parkinson’s disease (Okun, 2013). There is not yet a cure for Parkinson’s disease but there are treatments that can help alleviate the symptoms. The most commonly used is drug therapy. Medications can help with difficulty with movement, walking and controlling tremors by increasing the brains amount of dopamine. (University of Maryland Medical Center, 2012) The most common and most effective Parkinson’s disease drug is Levodopa. This is a natural chemical that passes into your brain and is converted to dopamine (Okun, 2013). There is also surgical procedures available, deep brain stimulation. With this procedure the surgeon implants electrodes into a specific location in the patient’s brain. A gen erator is implanted in the patient’s chest, which is attached to the electrodes. This generator sends electrical impulses to the patient’s brain, which may lessen the symptoms of Parkinson’s disease. (University of Maryland Medical Center, 2012) Other ways that help control the effects of PD is a healthy diet. Constipation is a complication associated with PD, so a diet that is balanced with whole grains, fruits and vegetables helps to manage this complication. Balance, coordination, flexibility and muscle strength deteriorate with PD so, exercise is encouraged. Exercise also helps with decreasing anxiety and depression. The client exhibits many of the discussed signs and symptoms of Parkinson’s disease. The client experiences resting tremors, bradykinesia, mask like face (hypomimic), slowed speech and is in a wheelchair. He scores very poorly according to the Hoehn and Yahr scale. The client is on medications to help diminish the signs and symptoms of Parkinson’s disease. Impaired physical mobility level 3, related to bradykinesia, ak inesia, neuromuscular impairment motor weakness, pain and tremors. (Berman & Snyder, 2012) Evidenced by lack of decisive movement within physical environment, including movement in bed, transfers, and ambulation. Limited range of motion (ROM). Decreased muscle stamina, strength and control. Limitation in independent, purposeful physical movement of the body and impairment unilaterally on the right side. Due to the muscular and neuromuscular weakness related to Parkinson’s disease, evidenced by it being difficult for the patient to ambulate. The client has a defect of extrapyramidal tract, in the basal ganglia, with loss of the neurotransmitter dopamine. (Berman & Snyder, 2012) Classic triad of symptoms: tremor, rigidity, bradykinesia (Jarvis, 2012). Tremors associated with paralysis agitans make it difficult maneuver. Tremors cease with voluntary movement and during sleep (VanMeter and Hubert, 2014). Immobility is an expected human response to Parkinson’s disease. The client’s immobility puts him at risk for thrombophlebitis, skin breakdown, pneumonia and depression. Immobility impedes circulation and diminishes the supply of nutrients to specific areas. As a result, skin breakdown and formation of pressure (decubitus) ulcer can occur (Berman and Snyder, 2012). Immobility also promotes clot formation. Self-care deficits related to neuromuscular impairment, immobility, decreased strength, and loss of muscle control and lack of coordination, ridgity and tremors. Self-care deficits, dressing, hygiene and toileting, evidenced by tremors and motor disturbance. The client lacks the ability to cleanse his body, comb his hair, brush his teeth and do skin care. . The client is also unable to dress himself satisfactory. He does not have the capability to fasten his clothes. The patient is assisted with ADL’s. Patient is incapable to bathe, dress or brush teeth without aid. Patient occasionally needs assistance with feeding. Assistance is also required with toileting. Aid is needed with ADL’s because of the lack of coordination and for safety. This nursing diagnosis is important because it ensures hygiene, improves quality of life, and promotes dignity, self-worth, independence and freedom. Risk for falls related to decreased mobility, a nd unsteady gait secondary to sedentary lifestyle and Parkinson’s disease. Patient uses a wheelchair and ambulates with a walker. Patients gait is impaired due to Parkinson’s disease. Festination, or a propulsive gait (short, shuffled steps with increasing acceleration), occurs as postural reflexes are impaired, leading to falls (VanMeter and Hubert, 2014). Falls also result in psychological implications for the patient with a decrease in self-confidence and a fear of further falls. This contributes to a decrease in mobility and culminates in a significant reduction in quality of life (Jarvis, 2012). Impaired bowel elimination/constipation related to medication, physical disability and decreased activity. Evidenced by the client not passing stools daily. Medications prescribed to patient for Parkinson’s disease attribute to constipation. The patients experience with immobility is also a  contributing factor for constipation. This nursing diagnosis is important because it allows nursing staff to monitor the patient’s bowel movements and avoid fecal impaction. Imbalanced nutrition less than body requirements related to tremors, slowing the process of eating, difficulty chewing and swallowing. Evidenced by the client occasionally needing assistance with eating. Pressure sores develop more quickly in patients with a nutritional deficit. Proper nutrition also provides needed energy for participating in an exercise or a rehabilitative program. The goal is to optimize the client’s nutritional status. Impaired verbal communication related to decreased speech volume, decreased ability to speak, stiff facial muscles, delayed speech, and inability to move facial muscles. Evidenced by lack of expression on the client’s face, client’s hindered speech. Loss of dopamine can affect the facial muscles, making them stiff and slow and resulting in a characteristic lack of expression. Speech impairment is referred to as dysarthria and is often characterized as weak, slow, or uncoordinated speaking that can affect volume and pitch. Difficulty speaking and writing because of tremors, hypophonia, and â€Å"freeze† incidents. This is an expected consequence of Parkinson’s disease. Nursing Care Plan- Alteration in impaired physical mobility- Parkinson’s disease Related to: Goals Intervention Bradykinsia Client will use a walker to go to breakfast in the mornings and not need assistance with transfers. Client will be able to perform all active ROM by 3 months Examine current mobility and observation of an increase in damage. Do exercise program to increase muscle strength. Perform passive or active assistive ROM exercises and muscle stretching exercises to all appendages. To promote increased venous return, prevent stiffness, and maintain muscle strength and endurance. Without movement, the collagen tissues at the joint become ankylosed (permanently immobile) (Berman & Synder, 2012) Akinesia Client will gain power of voluntary movements. Joint contractures will not occur. Assess the possibility of deep brain stimulation. Refer to physical therapy. When the muscle fibers are not able to shorten and lengthen, eventually a contracture forms, limiting joint mobility (Berman & Synder, 2012) Tremors Client’s tremors will decrease. Encourage deep breathing, imagery techniques and meditation. Encourage holding an object in hand Suggest holding the arm of the chair. Stimulating the brain by concentrating on breathing may cease tremors. (www.theparkinsonhub.com) Pain Client will not experience pain >4 on a scale of 0-10 Before activity observe for and, if possible, treat pain. Assess patient’s willingness or ability to explore a range of techniques aimed at controlling pain. Administer pain medication per physician orders. Encourage/assist to reposition frequently to position of comfort. Pain limits mobility and is often exacerbated by movement. (www.ptnow.org) Nursing Care Plan- Alteration in Skin Integrity, Impaired: Risk for – Pressure Sores; Pressure Ulcers, Bed Sores; Decubitus Care Related to: Goal Interventions Rationale Neuromuscular impairment Client will be free of any pressure ulcers for length of long term stay. Monitor site of skin impairment at least once a day for color changes, redness, swelling, warmth, pain or any other signs of infection. Pay special attention to high risk areas and ask client questions to determine whether he is experiencing loss of sensation. Apply barrier cream to peri area/ buttocks as needed. Use ROHO cushion on wheelchair. Checking skin once a day will ensure that skin stays intact. (Jarvis, 2012) Immobility Client will be able to express s/s of impaired skin. Teach skin and wound assessment and ways to monitor for s/s of infection, complications and healing. Use prophylactic antipressure devices as appropriate Early assessment and interventions may help complications from developing. To prevent tissue breakdown. (Jarvis, 2012) Nursing Care Plan- Self Care Deficits Related to: Goal Intervention Rationale Immobility Client will assist with bathing, grooming, dressing, oral care and eating daily. Assist client with bathing, grooming, dressing, oral care and eating daily. Use high back wheelchair. The effectiveness of the bowel or bladder program will be enhanced if the natural and personal patterns of the patient are respected. Loss of muscle control and lack of coordination Client will improve muscle control and coordination in all extremities for the length of long term stay. Client will walk to dining room and in hallways- 5 mins a day 5 days a week. Use consistent routines and allow adequate time for patient to complete tasks. Assist client with ambulation. This helps patient organize and carry out self-care skills. Tremors Client will be able to assist with dressing. Provide appropriate assistive devices for dressing as assessed by nurse and occupational therapist. Encourage use of clothing one size larger. Teach and support the client during the client’s activities Apply extensions on breaks with ball grips The use of a button hook or of loop and pile closures on clothes may make it possible for a patient to continue independence in this self-care activity. Ensures easier dressing and comfort. Grips will be easier to grasp with tremors. Neuromuscular impairment Client will be clean, dressed, well groomed daily to promote dignity and psychosocial well-being. Assist with shower as needed. Assist with daily hygiene, grooming, dressing, oral care, and eating as needed. This promotes dignity and psychosocial well-being. Nursing Care Plan- Falls, risk for Related to: Goal Intervention Rationale Decreased muscle tone Client will express an understanding of the factors involved in possible injury. Educate the client about what makes them at risk for falls. Bed should be in lowest position. Provide assistance to transfer as needed. Reinforce the need for call light. If the client is educated and shows an understanding of the factors involved with falls, they are less likely to fall. Prevent fall. Nursing Care Plan- Impaired Bowel elimination/constipation Related to: Goal Intervention Rationale Inactivity, immobility Client will have soft formed stool every other day that are passed without difficulty. Encourage physical activity and regular exercise. Adjust toileting times to meet client’s needs. Report changes in skin integrity forum during daily care Ambulation and/or abdominal exercises strengthen abdominal muscles that facilitate defecation. low-fiber diet Evaluate usual dietary habits, eating habits, eating schedule, and liquid intake. Initiate supplemental high-protein feedings as appropriate. Change in mealtime, type of food, disruption of usual schedule, and anxiety can lead to constipation. Proper nutrition is required to maintain adequate energy level. Diminished muscle tone Encourage isometric abdominal and gluteal exercise Apply skin moisturizers/barrier creams as needed To strengthen muscles needed for evacuation unless contraindicated. (http://www.gutsense.org) Medications Encourage liquid intake of 2000 to 3000 ml per day To optimize hydration status and prevent hardening of stool (VanMeter & Hubert, 2014) My thinking about my resident has definitely changed since the initial day when I conducted a health history assessment on him. I knew that first day that I was going to appreciate getting to know this resident because of how smoothly the conversation flowed. This resident had some amazing stories to tell. I absolutely adore that fact that he and his wife have been married for 48 years. I enjoyed listening to him remember what life was like before being diagnosed with Parkinson’s disease, it appeared to lighten his spirit. I feel very fortunate to have been given the opportunity to care for such a genuine soul. My whole clinical experience was a positive one. I realized that if I lacked the knowledge about a particular task to ask for help. I liked the fact that clinicals was hands on and that I gained experience in a long term health care facility. Another thing that this clinical rotation  taught me was that it takes an exceptional type of person to go into geriatric nursing. Probably the number one thing that I’m going to take away from this clinical experience is the total importance of dignity. I too will be old someday and I applied the golden rule to this experience. I treated others as I want to someday, and hopefully, will be treated. What a fantastic learning experience. References: Berman, A., & Snyder, S. (2012). Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice. Upper Saddle River: Pearson Education. Coleman, J., (September 1, 2013) Meditation & Mitigating Parkinson’s Symptoms. Retrieved from http://www.theparkinsonhub.com/your-quality-of-life/article/meditation–mitigating-parkinsons-symptoms.html Costa, M. & Quelhas, R. (2009). Anxiety, Depression, and Quality of Life in Parkinson’s Disease. The Journal of Neuropsychiatry and Clinical Neurosciences 2009; 21:413-419. Jarvis, C. (2012). Physical Examination & Health Assessment. St. Louis: Elsevier Kegelmeyer, D., (July 1, 2013) Functional Limitation Reporting (FLR) Under Medicare: Tests and Measures for High-Volume Conditions. Retrieved from http://www.ptnow.org/FunctionalLimitationReporting/TestsMeasures/Default.aspx Leopold N., Kagel M. (1997). Pharyngo-esophageal dysphagia in Parkinson’s disease. Dysphagia 1997; 12:11–18 Massachusetts General H ospital (MGH) (May, 2005) Hoehn and Yahr Staging of Parkinson’s Disease, Unified Parkinson Disease Rating Scale (UPDRS), and Schwab and England Activities of Daily Living. Massachusetts General Hospital. Retrieved March 2, 2014, from http://neurosurgery.mgh.harvard.edu/functional/pdstages.htm#HoehnandYahr Okun, M. (2013). Parkinson’s Treatment: 10 Secrets to a Happier Life. CreateSpace Independent Publishing Michael S. Okun M.D. Parkinson’s disease Foundation (2014, March) Understanding Parkinson’s. Parkinson’s Disease Foundation. Retrieved March 2, 2014, from http://www.pdf.org/en/understanding_pd University of Maryland Medical Center (2012, September) Parkinson’s disease. University of Maryland Medical Center. Retrieved March 2, 2014, from http://umm.edu/health/medical/reports/articles/parkinsons-disease#ixzz2upFLCggw VanMeter, K. C., & Hubert, R. J. (2014). Gould’s Pathophysiology for the Health Professions. St. Louis: Elsevier.

Is Scientific Progress Inevitable? Essay

I read the article â€Å"Is Scientific Progress Inevitable?† which was written by Andrew Irvine on 2006. It was published in the book In the Agora: The Public Face of Canadian Philosophy. The main idea of the article is scientific progress is not inevitable. At the first part of the passage, the author used his own his experience that he took his daughter to see a medicine wheel; he used what he saw to let us know these structures have been there for thousands of years and human beings are fragile. Furthermore, he used some facts that ancient people may use their unique ways to record summer solstice rather than today’s high astronomical knowledge. As he said â€Å"scientific knowledge is not inevitable† (para.12), there is no guarantee that scientific progress will keep increase, as long as we have the belief to live better, the scientific progress is not essential or necessary. Critique This article was written by Andrew Irvine who is a professor of UBC at department of philosophy (Irvine, 2012). The title of the passage makes readers to think of scientific progress is not inevitable, however, without technology, we cannot live in this highly developed world. The book In the Agora: The Public Face of Canadian Philosophy was edited by Andrew Irvine and John Russell; it is a book which collects many Canadians philosophers’ article and enriches our world by their Philosophical thought (University of Toronto Press Publishing, 2013). However, we are living in a developing world, as long as we want to live better, the scientific progress will remain non-inevitable. Electronic products for example, cellphones have been part of our live for few years, everybody has a cellphone to communicate to each other conveniently. But ancient people can only communicate each other with their voice or gesture, they cannot reach somebody who is far away from them. With the scientific results, we can use electronic products to talk and see people thousands of miles away from us. In the article, the author mentioned that some ancient culture may use their own way to figure out summer solstice like the sun dance (Irvine, 2006, pp338-339).