Parkinsons term paper Essay Example for Free

Parkinsons term paper Essay Parkinsons disease is characterized as a degenerative disorder of the central nervous system which is understood to persist and continually worsen over time. It is the second most common neurological disorder. Parkinson’s disease affects approximately one million people within the United States. This disorder progresses slowly and is unique in the sense that Parkinson’s disease can be caused by genetics among other things. Parkinson’s disease is well known for its characteristic tremors, stiffness, and difficulty with speech in the patients it affects. Parkinson’s disease is caused by diminishment of the substantia nigra in the tegmentum which controls motor functions within the body. This disease is classified as a basil ganglionic disorder which causes a breakdown of dopamineric neurons in the substancia nigra, located in the midbrain. The substancia nigra is composed of neuromelanin which pigments the substancia nigra and gives it its darker characteristic. The neuromelanin also connects to the motor cortex which is responsible for one’s motor control and balance. The chemical dopamine is created in the substantia nigra. The basil ganglia receives inputs from the motor cortex, the association cortex, and the substancia nigra. The basil ganglia then sends messages to the motor cortex by way of the thalamus. With Parkinson’s disease, the nigral neurons are damaged, which causes the neuromelanin to be free to move into the adjacent tissue where it is phagocytosed and moved away by macrophages. This degenerative process not only destroys the process of creating dopamine, but it also causes the pigmentation of the substancia nigra to change and become lighter in appearance. The lack of dopamine-related input from the substantia nigra negatively changes the equilibrium of the output from the basil ganglia to the motor cortex. This alteration in the equilibrium then causes the symptoms related to Parkinson’s disease. The d irect cause of Parkinson’s disease remains a medical mystery, but many factors can participate in determining whether one is susceptible to developing Parkinson’s disease in  the future. The exposure to specific toxins in the environment and various environmental factors has the possibility of playing a role in those who were diagnosed with Parkinson’s disease. Another possible cause of Parkinson’s disease is the role of one’s genetics. It is found that certain mutations can give rise to Parkinson’s disease, although this is uncommon. The brains of patients with Parkinson’s disease change as the disease progresses. Lewy bodies are microscopic markers that characterize the presence of Parkinson’s disease within a patient. They are abnormal microscopic protein deposits that form in the brain and play a role in disrupting the brain’s normal functions. This disruption causes deterioration. Lewy bodies contain A-synuclein which is a protein that cells cannot break down. Early indicators of Parkinson’s disease include tremors or shaking which can reside in one’s finger, thumb, hand, lip, or chin, though shaking is normal after extensive physical activity, injury, or may be due to medications. If one’s handwriting begins to appear smaller over a short period of time, it could be a warning sign of Parkinson’s although one should not base their self-diagnosis upon handwriting, for handwriting can change as one advances in age, but this happens over time and not suddenly. A loss of smell in specific foods can be an indicator, but a loss of smell can also be related to the possession of the common cold or the flu. Another early sign may be sudden movements while sleeping such as falling out of the bed or kicking and punching. It is important to understand that people on occasion may experience difficulty sleeping. Chronic stiffness can be a sign, but this symptom can also be caused by an injury or arthritis. If one is experiencing constipation on a daily basis, this can be considered a sign of Parkinson’s disease, although a lack of fiber in one’s diet or medications can determine the moving of one’s bowels. Having recently possessed a soft o r low voice is an indicator unless one has a chest cold or other virus. If one has the appearance of a masked face, a blank stare that persists, or undergoes a long duration of time without the action of blinking, these may be precursors to having Parkinson’s disease. Feeling dizzy or fainting can be signs of low blood pressure and may be connected to Parkinson’s disease along with the inability to stand up straight. There are many Parkinson’s-related symptoms that are known today. The most obvious of symptoms is a resting tremor. A shaking, or tremor, normally starts in one’s  limb, and it is often located on a hand or fingers. This resting tremor usually stops when the patient is voluntarily moving the limb affected by the tremor. A â€Å"pill-rolling† tremor is common and is characterized by one rolling one’s thumb and forefinger. These tremors can be noticed when the limb is even at a relaxed state. Due to the tremors and inability to control certain motor functions, writing can become difficult for patient s with Parkinson’s disease. It is noted that when writing, those effected with Parkinson’s disease posses handwriting that is characteristically small. Bradykinesia, or a slowing of movement, can be present. Parkinson’s disease has the ability to cause one to move slower which can make simple every-day tasks a challenge. With bradykinesia, one’s steps may become smaller in distance when being mobile, and one’s feet may begin to drag when walking. Excessive muscle tone or hypertonia may be prevalent in patients with Parkinson’s disease and will manifest itself as stiffness or rigidness which causes pain and a loss in one’s range of motion. Parkinson’s disease patients may experience posture impairment and balance, for a patient’s posture can become stooped, and balance can be lost. Patients diagnosed with Parkinson’s disease may experience a loss in their autonomic functions which include and are not limited to smiling, swinging one’s arms while walking, and blinking. This loss in autonomic function caused a select number of patients to stop using their hands while speaki ng in normal conversations. Speech changes can affect those living with Parkinson’s disease. One may speak out of rhythm in such a way that it may sound soft, quick, hesitant, monotone or slurred. Diagnosing Parkinson’s disease is not a simple process, for a test for Parkinson’s disease does not yet exist. In order to be diagnosed with Parkinson’s disease, a neurologist must first obtain a detailed medical history of the patient being diagnosed, a review of the patient’s signs and symptoms, a physical examination, and a neurological examination. Tests to exclude other conditions may be ordered to ensure proper diagnosis of the disorder. Once a patient has undergone sufficient testing and examining, the doctor may prescribe the patient the medication carbidopa-levodopa, which is a Parkinson’s disease medicine. If the patient improves considerably while on the medication, this often confirms a Parkinson’s disease diagnosis.  There exists a wide-range of treatments for patients that suffer from Parkinson’s disease from drug treatments to surgical treatments. The pharmacologic approach for those with Parkinson’s disease aims to increase the lack of dopamine in the patient’s basil ganglia. L-dopa or Levodopa is a drug that can cross the blood-brain barrier. The brain can convert this drug to dopamine. Carbidopa can also be prescribed to patients afflicted with Parkinson’s disease. Carbidopa is a decarboxylase inhibitor and, when taken with levodopa, can aid levodopa from converting to dopamine outside of the brain. The combination of medications allows for more levodopa to reach the brain which ultimately increases the brain’s supply of dopamine. These two medications decrease the side effects which are caused by an increased amount of dopamine outside of the brain. They reduce the supply of â€Å"free† dopamine from residing outside of the brain. An excess of dopamine outside of the brain could result in low blood pressure, vomiting, and nausea. Other medications include dopamine agonists which directly stimulate nerve receptors inside of the brain which are usually stimulated by dopamine. In contrast to the medication levodopa, dopamine agonists do not convert into dopamine but rather behave like dopamine. Dopamine agonists are utilized in patients that are in the early stages of Parkinson’s disease and may be added to a treatment plan along with levodopa in the later stages of Parkinson’s disease. It may also be added when levodopa alone cannot sufficiently manage the patient’s symptoms or when the patient has severe motor fluctuations. Side effects associated with levodopa-carbidopa include dizziness upon rising, confusion, nausea, movement disorders, and hallucinations. Side effects commonly associated with dopamine agonists are vomiting, nausea, and orthostatic hypotension. Surgical treatment options are available for those who suffer from Parkinson’s. These surgical treatments are intended to control symptoms related to Parkinson’s disease patients who do not positively respond to medications. One of the surgical treatments crea tes a lesion in specific portions of the thalamus within the midbrain which become overactive in Parkinson’s disease. A reversible procedure that can be used on patients diagnosed with Parkinson’s disease is deep brain stimulation, or DBS. With this procedure, electrodes are implanted into exact locations. These locations are treated then with pulses of electrical currents. Why deep brain stimulation works is unknown. Medical  experts believe that the current could be activating, affecting, or inhibiting synaptic transmission onto neurons in the vicinity of the electrodes. The future prospects for a cure for Parkinson’s disease are promising, for the medical community has begun to identify the genetic causes linked to Parkinson’s disease. This allows the medical community to expand animal models of Parkinson’s disease. These will be highly useful in the process of understanding the pathogenesis of the disease and will be useful in further testing the neuroprotective therapies which can potentially aid in the fight against the progression of Parkinson’s disease. A different potential approach in the future would be to engage in the replacement of lost neurons via transplantation, which would be highly difficult and tedious. Overall, Parkinson’s disease is well on the way to being better understood and through this und erstanding scientists will be able to directly identify the source of this disease and eventually find a method that directly cures this disease. References Etiology. (n.d.). Merriam-Webster. Retrieved March 13,2014, from http://www.merriam-webster.com/dictionary/etiology Welcome to the Purdue OWL. (n.d.). Purdue OWL: APA Formatting and Style Guide. Retrieved March 13, 2014, from https://owl.english.purdue.edu/owl/resource/560/01 Parkinson’s: Symptoms Types. (n.d.). WebMD. Retrieved March 13, 2014, from http://www.webmd.com/parkinsons-disease/guide/parkinsons-symptons-types Parkinson’s disease. (n.d.). Complications. Retrieved March 13, 2014, from http://www.mayoclinic.org/diseases-conditions/parkinsons-disease/basics/complications/con-20028488 Parkinson’s Disease. (n.d.). Parkinson’s Disease. Retrieved March 13, 2014, from http:// courses.washington.edu/conj/bess/parkinsons.html Nisipeanu, P. (n.d.). Parkinson’s Disease: Diagnosis and Clinical Management. Adverse Effects of Dopamine Agonists. Retrieved March 13, 2014, from http://www.ncbi.nih.gov/books/NBK27800/ Levodopa Medicines for Parkinsonâ€℠¢s Disease. (n.d.). WebMD. Retrieved March 13, 2014, from http:// www.wbmd.com/parkinsons-disease/levodopa-medications-for-parkinsons-disease Dopamine Agonists for Parkinson’s Disease. (n.d.). WebMD. Retrieved March 13, 2014, from

Robotic Surgery Disposal Essay Example for Free

Robotic Surgery Disposal Essay What is the Environmental Collateral Effects of Minimally Robotic Surgery? Two small studies have looked specifically at differences in communication between laparoscopic and robotic surgery. Both studies found a significant increase in oral communication between the surgeon and the rest of the team in robotic surgery, particularly in relation to the orientation and localization of organs and the manipulation of instruments, with the effect found to be more pronounced in teams that have less experience in robotic surgery. If use of robotic surgery interferes with standard practices of coordination among the OT team, the achievement of seamless, efficient, and timely teamwork may be hampered. It is important to understand any change in communication patterns because of the well-documented relationship between communication and patient safety, with failures in communication and teamwork being identified as key factors in adverse events in the OT. Communication and teamwork around robotic surgery are likely to be influenced by processes associated with the introduction of robotic surgery, such as training and changes in team structure, but equally the integration of robotic surgery in surgical practice may be dependent on the extent to which it is consistent with existing practices for coordination. How is Robotic Surgery Disposal conducted? For robotic surgery to provide the most benefit for patients, it is first necessary to understand the organizational and social factors that support the successful integration of robotic surgery, by which we mean that it becomes embedded into surgical practice, being used routinely and successfully for surgical operations where it offers advantages to the patient. It is also necessary to understand the impacts of robotic surgery on communication, teamwork, and decision making in the OT and how OT teams manage those impacts. Robotic-assisted surgery has evolved over the past two decades with constantly improving technology, assisting surgeons in multiple subspecialty disciplines. Patient positioning requirements can cause significant physiologic effects and may result in many complications. Good communication among team members and knowledge of the nuances of robotic surgery have the potential to improve patient outcomes, increase efficiency,  and reduce surgical and anesthetic comp lications. Robotic surgeries of long duration are associated with both increased risks to patients as well as distinct challenges for care providers As robotic surgery is increasingly utilized, operations with long surgical times may become more common due to increased case complexity and surgeons overcoming the learning curve.

The Over-diagnosis of ADHD

The Over-diagnosis of ADHD A simple way to describe Attention Deficit Hyperactivity Disorder is that it is a brain based condition where there is an imbalance of the brains chemicals dopamine and noradrenaline, these chemicals being responsible for self-control and slowing down of impulses (Green and Chee, 1997: 3). Because of the slight imbalance of these important chemicals, people with ADHD will experience impulsive, hyperactive behaviour as well as inattentiveness with short term memory and in some cases, learning difficulties. Although doctors and scientists have more information about the causes and treatment of ADHD today, there is an interesting history around this disorder which had many different theories and beliefs. Discovered over one hundred years ago, Attention Deficit Hyperactivity Disorder is not a recent medical discovery. It was first described in about 1902 by George Still, an English paediatrician, who had observed a group of patients and recognised them as being inattentive, over active and suffering from a lack of moral control (Green and Chee, 1997: 10). After George Stills discovery, many controversies followed. It was believed that ADHD was a result of brain damage, but when doctors realised that most children with ADHD had no brain damage, that idea was discarded. ADHD was then called Hyperactive Child Syndrome, where all the focus was on hyperactivity. In addition to this, Dr Ben Feingold researched a link between ones diet and hyperactivity, but this controversy was soon proven to not have much effect. Today, it is known that ADHD is strongly hereditary and is, as mentioned before, believed to be caused by the imbalance of dopamine and noradrenaline chemicals in ones brain. This subtle difference in the brain causes ADHD, as inattentiveness and hyperactivity, and can display itself through a number of different symptoms. There is not one definite test for ADHD, but rather a series of steps to go through which help to make the final conclusion in diagnosing ADHD. As ADHD is a common condition, doctors need to be certain when assessing a child for ADHD. Some simple symptoms of the disorder are; disorganisation, restlessness, fidgeting, clumsiness, forgetfulness and being easily distracted. Although every person does experience at least one or more of these symptoms, it does not necessarily mean that they have ADHD. People with ADHD will experience these symptoms, but at a far greater level of severity than those without the disorder would, and with negative outcomes because of the severity (Green and Chee, 1997; 227).Therefore, focusing on the simple symptoms of ADHD is what often leads to an over diagnosis of the disorder, such as if a child has a lot of energy and doesnt like to sit still, the child may just be an active child and will not necessarily have ADHD. As Dr Sam Goldstein says, just as not every sneeze is indicative of a cold, so too not every restless, impulsive and inattentive behaviour is indicative of ADHD. (Goldstein, 2004: 7) shows how easily one can confuse normal behaviours with the simple ADHD behaviours, leading to an overdiagnosis of the disorder. When observing a child for ADHD, tests must be done and observations will be made according to the DSM-IV criteria to make a correct diagnosis of ADHD. There are two main features of ADHD, these being inattention and hyperactivity-impulsivity. Under each feature there are diagnostic criteria which need to be addressed when assessing a child who possibly has ADHD. These criteria are called DSM-IV, which stands for Diagnostic and Statistical Manual of Mental Disorders, fourth addition. Under the inattention feature, DSM-IV symptoms include; not paying attention to detail, difficulty focusing and keeping attention on tasks, not listening or following instructions, poor organisational skills, being easily distracted, very forgetful and often losing important items. The hyperactivity-impulsivity feature is arranged under two different subheadings but these are both very closely linked. Hyperactivity DSM-IV symptoms include fidgeting with hands and feet, often leaving ones seat, excessive running and climbing in inappropriate situations, difficulty engaging quietly in relaxing activities, always has endless energy and talks excessively. T he impulsivity criteria include blurting out answers, difficulty being patient and interrupting and intruding on others. Using these criteria, further steps are then taken to make a diagnosis of ADHD. When making the diagnosis of ADHD, there are a number of steps to follow to make sure of an accurate diagnosis. Dr Christopher Green (1997: 61) states that there are four simple steps to diagnosis; firstly to look for alarm signals any behaviours or symptoms that could indicate ADHD. Secondly, to exclude ADHD lookalikes- the behaviours or disorders that are often confused with ADHD. Thirdly, to use objective pointers towards the diagnosis, such as tests and questionnaires, and lastly, to take a detailed history of the child being assessed and link it to ADHD subtleties, discover if the child had any noticeable signs of ADHD growing up. The DSM-IV criteria to determine ADHD can only be used to make a diagnosis if six or more of the symptoms under each subheading (inattention, hyperactivity and impulsivity) are experienced or displayed consistently for six or more months, and are not at an age-appropriate developmental level. From this observation, a series of tests will be done to he lp make the diagnosis. Children believed to have ADHD must take a series of tests once the DSM-IV criteria have been observed appropriately, starting with the standard intelligence test. The standard intelligence test will then be followed by specialised subject tests, for example maths, reading and writing, just to name a few. These tests will be monitored by a psychologist who will observe restless or inattentive behaviour. This observation can sometimes be misleading though, as some children are able to focus in a quiet environment, but cannot focus in a noisy classroom environment (Green and Chee, 1997: 67). After ADHD has been identified from this test, children will take a test of attention and persistence to indicate the main areas of weakness caused by ADHD. This final test will help make the final diagnosis of ADHD and will help indicate the right medication to give. Although these tests are the most accurate in diagnosing ADHD, there is still some controversy around whether ADHD is in fact being overdiagnosed. There is a common belief that ADHD is over diagnosed (Sciutto and Eisenberg, 2007: 106). For ADHD to be classified as overdiagnosed the number of false positives, people diagnosed with ADHD who should not be, must be far more than the number of false negatives, people with ADHD who are left undiagnosed and untreated. ADHD is one of the most common childhood disorders (Sciutto and Eisenberg, 2007: 106),with three to seven percent of school children meeting the ADHD criteria. A CNN online poll in 2002 showed that seventy six percent of the people who responded to the poll believed that ADHD is an over diagnosed disorder (Sciutto and Eisenberg, 2007: 106). A recent study in 2007 (Sciutto and Eisenberg, 2007: 108,109) focused on looking at evidence for and against the overdiagnosis of ADHD. An area of this study looked at factors that could contribute to a false diagnosis of ADHD, the first factor being comorbidity, many children diagnosed with ADHD also meet the criteria for another psy chiatric disorder and these symptoms overlap with ADHD symptoms, therefore resulting in an incorrect diagnosis. Another factor is diagnostic inaccuracy. Many children are given a diagnosis of ADHD after an initial, brief assessment, but then when evaluated properly on a second occasion, only a few children are given a final and accurate diagnosis of ADHD. A reason for this diagnostic inaccuracy is that some psychologists do not follow the correct diagnostic program and only briefly take in to account the DSM-IV criteria. The other area of this study focused on factors that could contribute to false negatives in ADHD, people with ADHD who are undiagnosed and untreated for it. The key area was aimed at gender differences, which showed that girls with ADHD are more commonly under diagnosed. The reason for this is because girls with ADHD are more likely to internalize their symptoms and are less hyperactive and disruptive but struggle more with inattentiveness. The conclusion of this st udy showed that there is not enough evidence to claim that ADHD is overdiagnosed, so is therefore not classified as overdiagnosed. Although this is just one study, there are other controversies around if ADHD is over diagnosed or under diagnosed and this applies to both children and adults. In earlier years, research shows that ADHD was mostly found in children but more recent studies show that adults can suffer from the disorder too. One of the most common statements made about ADHD is that children with ADHD will outgrow the disorder by the time they reach adulthood. But most children do not outgrow their ADHD (Marsh and Wolfe, 2007/2010: 136). Although the symptoms and signs may be worse as young children and then lessen with age, they do not disappear completely (Green and Chee, 1997: 192). In some cases noticeable signs of ADHD may be present during infancy, however one cannot be certain as there are no valid methods of identifying ADHD before the age of about three years old. Symptoms often become more evident as children move into preschool, at about three or four years old. These include acting without thinking, working and moving fast, roaming around and disrupting other children. If children display these symptoms for one or more years then they will more than likely continue with these difficulties as they grow older. When children move into higher grades at school, inattentive symptoms will start to become more evident. The early grades of junior school are the most common years in which diagnosis of ADHD occurs. The hyperactive behaviours experienced in preschool normally continue for a few years but gradually lessen. As previously mentioned most children with ADHD do not outgrow this disorder, about fifty percent of children display ADHD characteristics into adolescence (Marsh and Wolfe, 2007/2010: 136). In some cases, the problems as a result of ADHD get worse, and most ADHD teenagers present problems in emotional, behavioural and social spheres of development. These problems are often carried on to adulthood and present problems later on in life. The impairments in developmental areas during childhood and adolescence present themselves as problems in adulthood life. Some children can grow out of ADHD, although the majority do not and therefore learn to cope with it as they become older. Some symptoms of ADHD in adults include; restlessness, being easily bored, constantly seeking exhilaration, may experience work difficulties, depression, low self-esteem, substance abuse and personality disorders (Marsh and Wolfe, 2007/2010: 136). Many adults who have ADHD have never been diagnosed with the disorder and consequently feel there is something wrong with them, leading to frustration and additional problems mentioned above. If undiagnosed or left untreated, adults with ADHD will more than likely have negative health and mental problems, work and financial problems and relationship stability problems (Smith and Segal, 2012). There is still on-going research around the controversy about ADHD in adults. There are a number of ways for people with ADHD, both adults and children, to help deal with the disorder, which leads to the next controversy how to treat ADHD. There is no cure for ADHD; however there are various approaches to treating people with the disorder which enables them to live an easier life (Mash and Wolfe, 2010: 149). Although highly controversial, stimulant medication proves to be the most common way of treating ADHD (Robinson, Smith, Segal and Ramsey, 2012) and as it was the first type of medication to treat children with ADHD, it is the most trusted (Barlow and Durand, 2012: 490). Two stimulants are proven to be the most common and effective, one being Methylphenidate, for example Ritalin and Concerta, and the other being Dexamphetamine. Stimulants, otherwise known as psychostimulant drugs, are effective because they regulate the slight imbalance of dopamine and noradrenaline in an ADHD childs brain. This therefore allows the children to be able to focus on tasks that they could not focus on when untreated and shut out distractions as well as thinking before acting (Green and Chee, 1997: 125). Another positive about stimulant s is that they can be used on children and adults of any age, but should only be used on very young children if extremely necessary (Green and Chee, 1997: 161). Although the proven short term benefits of using psychostimulant drugs are positive such as reducing restlessness and allowing children to listen better, which evidently show the reasons for using these drugs, there are arguments against using the drugs which, for example, arise from the negative side effects which are likely to be experienced when taking the medication. There are many controversies around using psychostimulant drugs to treat ADHD but one of the most understandable reasons for any controversy around using these drugs is because of the negative side effects. These side effects are explained by Eric Mash and David Wolfe as reduced appetite, weight loss, slowing of expected gains in height or weight, increase in heart rate and blood pressure, or problems falling asleep. (Mash and Wolfe, 2010: 144). Comprehending that these are only the proven short term side effects of the drugs, the other controversies arise because there are unknown long term side effects that could be a consequence of using these psychostimulant drugs. A common area of concern for parents and another of the controversies surrounding the use of stimulant medication is the possibility of children becoming addicted to the drugs. Dr Christopher Green and Dr Kit Chee responded to this concern by saying that when a stimulant is effective it brings the child into harsh real ity. No one ever got addicted to reality. (Green and Chee, 1997: 160). This quote gives one an understanding that the possibility of becoming addicted to the stimulant medication is unlikely, but this only refers to the people who are actually prescribed by a doctor to the medication. However these stimulant drugs are becoming increasingly available to the public for anyone to purchase, and in this regard are being used and abused by many adolescents and young adults who do not need the medication, as they help enhance academic performance. In this case, where medication is used when not needed, the topic of addiction becomes a reality (McCarthy, 2010). Even with the negative aspects, psychostimulant drugs still remain the most popular in treating ADHD today. The other medication to take into account when looking at treatments for ADHD is the non-stimulant medication. Although not as commonly used as the psychostimulant drugs are, non-stimulant medication can also be considered for the treatment of ADHD. Often non-stimulant medication is only considered when the stimulant drugs are not effective (Green and Chee, 1997: 125). Atomoxetine, with the brand name Strattera, is the first non-stimulant ADHD treatment drug to be FDA (Food and Drug Administration) approved (Low, 2009). The reasons why many people believe that the non-stimulant medication is better than using psychostimulant medication is because Atomoxetine does have any indications of becoming addictive, whilst many believe that stimulant medication has the characteristic of becoming addictive. It is also believed to have a longer lasting effect than stimulant medication (Low, 2009). The other non-stimulant drug which is commonly used is the tricyclic antidepressant, Tofranil. This medication may be used when the person being treated does not react well to stimulant medication, or has signs of depression combined with ADHD. This non-stimulant medication may take longer to take effect on the patient, but also has a longer lasting effect than stimulant medication does (Low, 2009). Both of these non-stimulant medications have similar side effects, but debatably not as severe as the side effects of stimulant medication. For the majority of people affected with ADHD, non-stimulant medication does not work and they therefore resort to using psychostimulant drugs. Using these psychostimulant drugs, combined with behaviour development, is possibly the most helpful treatment of all. This combined treatment of stimulant medication and behaviour development is known as multimodal treatment. It is believed that before medication is prescribed, therapy and help should be given to the areas in which children with ADHD are struggling. After the weaknesses are found, the family should be educated about ADHD so that they are aware with what they are exposed to and how to deal with tough situations as a result of their child having ADHD when faced with them, such as helping their child work through a task that they are struggling with. Once the ADHD child is getting the help he or she needs, then medication will be prescribed in order to help the child focus (Green and Chee, 1997: 230). The one negative aspect about this progress of treatment is that it is quite expensive and therefore not everyone will be able to benefit from it. With all of the possibilities of treatment taken into account, it is evident to conclude that although highly controversial, psychostimulant d rugs remain the most efficient medication to use when treating children and adults for ADHD. Taking into account all of the controversies surrounding Attention Deficit Hyperactivity Disorder it is clear that there are definite sides to arguments in the areas of diagnostic criteria and whether ADHD is underdiagnosed or overdiagnosed, ADHD in children as well as adults, and the treatment of the disorder. Looking at the diagnostic criteria and studies around overdiagnosis, research confirms my opinion that ADHD is not overdiagnosed, but in some cases it is misdiagnosed as many other psychiatric disorders share the same symptoms as ADHD which leads many people into believing it is overdiagnosed. Researching the occurrence of ADHD in adults as well as children concludes that ADHD in adults is very common, but is not recognised as much as ADHD is in children. Regarding the treatment of ADHD, my side taken in the debate leans towards the use of multimodal treatment, therefore supporting the use of psychostimulant drugs. Research in the area of psychostimulant drugs has shown that t hey have the most effect with helping children and adults focus on tasks and to restrain hyperactive behaviour, without endangering the patients life. Personal experience with psychostimulant drugs also accounts for my reasoning in supporting these drugs for the treatment of ADHD. The controversies surrounding ADHD all have valid points, and each individual has motives to stand behind their belief in a side of an argument. I have looked at all debates around each controversy and made a decision of where I stand based on my views around each controversy, which have been explained above.

Imperialism :: essays research papers

‘Examine the Causes of European Imperialism After 1870’ European control and power over other nations was not a new ideal prior to 1870; in fact the process was in place as early as the 14th century. Disease and geography are only two of the factors that prevented European colonisation until the 19th century. Many factors led to the massive rise in imperialism after 1870, both internal and external. European imperialism stems from the capitalistic greed for cheap raw materials, advantageous markets, and good investments. These ideas motivated the search for new markets because Imperialists would rather invest in new markets rather than raise wages of domestic workers. Not only was the cheap production of goods a motivating factor, but the quest for markets to sell manufactured goods contributed as well. Going along with this greed was the drive to expand authority by land acquisition or economic and political control over other nations. The quest for economic domination and advantage Europeans often denied the capitalistic greed as a factor in the cause of imperialism and had other ways of defining the motivation. Many stated that Imperialism was the natural effect of the idea of ‘survival of the fittest.’ This is best represented by Rudyard Kipling in the book ‘White Man’s Burden,’ which describes the notion that European Imperialism was simply the natural way that stronger nations gained power and those unable to keep up would be taken over. The Industrial Revolution also played a huge role in European imperialism. European nations had ease dominating non-Europeans due, in part, to the power retained from industrialisation. The Industrial Revolution provided tools such as guns, railway systems, steamships, and others, making it easier to overcome nations with less technology.

The Pros and Cons of Collective Bargaining Essay -- Collective Bargain

　Discuss the pros and cons of Collective Bargaining and explain their significance for improvements in labour productivity. 　　 　　â€Å"Collective bargaining can be defined as a process whereby trade unions, representing workers, and employers through their representatives, treat and negotiate with a view to the conclusion of a collective agreement or renewal thereof.† (Morris L. 2002). Collective bargaining may also include the process of resolving minor or major conflicts between labor and management or their agents. Therefore it essentially can be seen as a mutually recognized system of industrial jurisprudence creation. Collective Bargaining can act as an introduction to civil rights in the respective industry, but that can only happen if management is conducted by rules and regulations an not by arbitrary decision making processes. It defines and restricts the traditional authority exercised by management by the establishment of rules. 　　 　　Collective Bargaining has a number of objectives that are geared towards work life improvement. The first objective of collective bargaining is Workers’ participation, in the organizational decision-making. collective bargaining gives the worker an opportunity to participate in some areas of company direction such as the formation of rules and regulations. Participation leads to the enhancement of the quality of the enterprise condition thorough the employees’welcomed productive suggestions, as the are the ones who are familiar with the actual working realities of the enterprise. This also can assist in the boosting of the employees’ morale, self-esteem and cense of belonging, thus leading to an enhanced feeling of commitment to the organization. The second objective is the resolution of ind... ...e-of-collective-bargaining.html>. http://www.shvoong.com/business-management/human-resources/1923283-collective-bargaining-objectives/#ixzz30HKnBRdH References Dessler,G. and Varkkey,B. (2009) Human Resource Management. Eleventh Edition.Pearson Education. Howell, C. (2007) Trade Unions and the state: The Construction of Industrial Relations Institutions in Britain, 1890-2000. Princeton University Press Khan, J. and Soverall, W. (2007) Gaining Productivity. Arawak publications. Morris, R. L. (2002)"Chapter 2 The Collective Bargaining Process." New Issues in Collective Bargaining: A Caribbean Workers' Education Guide. Port of Spain: ILO. Pp 12-22. Print. Salamon, M. (2000). Collective Bargaining. In: Harlow: Financial Times Prentice Hall (ed), Industrial Relations: Theory and Practice. 4th ed. (pp.321 - 368.) England: Pearson Education Limited.

Biography of Charles Cromwell :: English Civil War Generals Military Essays

Biography of Charles Cromwell As a general on the parliamentary side of the English Civil War vs. Charles I, Cromwell helped bring about the overthrow of the Stuart monarchy, and he raised his country's status to that of a leading European power since the death of Queen Elizabeth I. Being a man with strong character made him one of the most remarkable rulers in modern European history. Although he was a convinced Calvinist he believed deeply in the value of religious toleration. Cromwell's victories at home and abroad helped to vitalize a Puritan attitude of mind, in Great Britain and in North America, which has continued to influence political and social life until recent times. (Gaunt, 1996) Cromwell, the only son of Robert Cromwell and Elizabeth Steward was born in Huntingdon, England in 1599. His father, who was active in local affairs, had been a member of one of Queen Elizabeth's parliaments. Robert Cromwell died when his son was 18, but his widow lived to the age of 89. Oliver went to the local grammar school and then for a year attended Sidney Sussex College, Cambridge. After his father died he left Cambridge to go care for his mother and sisters but it is believed that he studies at Lincoln's Inn in London, where gentlemen could acquire a smattering of law. In 1620 he married Elizabeth, daughter of Sir James Bourchier, a merchant in London. They had five sons and four daughters. (Kathe, 1984) Both his father and mother were Protestants who had profited from the destruction of the monasteries during the reign of King Henry VIII, and they probably influenced their son in his religious upbringing. Both his schoolmaster in Huntingdon and the Master of Sidney Sussex College were enthusiastic Calvinists and strongly anti-Catholic. In his youth Cromwell was not very studious, since he enjoyed outdoor sports, such as hunting; but he was an avid reader of the Bible, and he admired Sir Walter Raleigh's The History of the World. Cromwell learned that the sins of man could be punished on earth but that God, through His Holy Spirit, could guide the elect into the paths of righteousness. (Kathe, 1984) In the early parts of his married life Cromwell, like his father, was quite conscious of his responsibilities to his fellow men and concerned himself with affairs in his native fenlands, but at the same time he had a spiritual and psychological struggle which confused him and damaged his health.

How Does Advertising Affect Food Choices Essay

When asked how people make food choices, many people say taste is the number one factor. Flavor, aroma, appearance and texture all work together to impact what you choose for your daily meals and snacks. However, decisions about food go beyond taste and smell, reflecting a complex web of social, environmental and economic influences adults and children may not even be aware of. We develop food preferences based on our family, region / country where we live, cost of food, and mainly how food is marketed / advertised to us. These days children on average are spending 53 hours a week in front of a screen and hence this has a definite impact on kids health and wellness. Exposure to food advertising is one of the powerful forces driving the relationship between screen time and obesity. More specifically, exposure to advertising may be altering children’s food intake. Children and adolescents are inundated with advertisements which promote unhealthy foods and beverages. It is estimated that US food and beverage companies spend roughly $2 billion each year to market their products to kids. The largest proportion of advertising expenditures – roughly 40% of all money spent on food and beverage advertising – came from fast food restaurants, followed by carbonated beverages (22%). By comparison, advertising of fruits and vegetables accounts for just 0.4% of all advertising dollars. Just 0.4% for advertisement of healthy food. TV advertising remains the primary channel through which companies reach children and adolescents. Advertising can have a powerful, subconscious affect on food choices for both adults and children. For example, according to research, TV commercials for snack foods increase consumption of these foods before and after airing. Early research has demonstrated that children exposed to food advertising consumed more total food energy compared to exposure to non-food advertisements. Elementary-school aged children consumed 45% more snack foods after watching a short cartoon which contained a food advertisement compared to children who watched the same cartoon with advertisements for other, non-food, products.