Metabolism Diabetes - Free Essay Example

Sample details Pages: 7 Words: 2019 Downloads: 5 Date added: 2019/05/18 Category Health Essay Level High school Tags: Diabetes Essay Did you like this example? Metabolism is an essential process of chemical reactions, needed for energy, that occurs inside the cells that function throughout the body. One of the most widespread metabolic diseases is diabetes. Diabetes is considered a chronic disease with several pathogenic processes that, range from autoimmune destruction of the -cells of the pancreas with consequent insulin deficiency to abnormalities that result in resistance to insulin action (American Diabetes Association 2010, p. S62). My six-foot, 210 pounds, 77-year-old male client suffered major consequences from the deadly, chronic disease of diabetes. The cause of type one diabetes is an autoimmune disorder where there is an absolute deficiency in insulin ( -cells) secretion from the pancreas endocrine cells, also known as, the islets of Langerhans. Markers of the immune destruction of the -cell include islet cell autoantibodies, autoantibodies to insulin, autoantibodies to [the enzyme] GAD (GAD65), and autoantibodies to the tyrosine phosphatases IA-2 and IA-2 (American Diabetes Association 2010, p. S63). GAD65 and tyrosine phosphatases IA-2 and IA-2 are both antibodies that are used to diagnose type one diabetes. Type two diabetes is the most common type of diabetes and is referred to as, insulin resistant or non-insulin dependent. Don’t waste time! Our writers will create an original "Metabolism Diabetes" essay for you Create order Glucose is abundant throughout the blood and isnt taken up into the cells due to inability to use the insulin properly; yet, -cells are not destroyed in type two. Majority of people diagnosed with type two diabetes are obese. Gestational diabetes is defined as, any degree of glucose intolerance with onset or first recognition during pregnancy (American Diabetes Association 2010, p. S65). This type of diabetes is similar to type two; yet, when birth of the child occurs, the gestational diabetes usually disappears. Diabetes impacts many different processes that occur inside the body as well as outside. The things most impacted by diabetes, that have also caused a major toll on my clients body, are; nutrition, fluid and electrolyte balance, tissue-integrity, mobility, wound-healing, and perfusion. The biggest problems faced by upcoming diabetics today, according to Waqas Samis review article, Effects of diet on type 2 diabetes mellitus: A review, food choices, size of portions and sedentary lifestyle have increased dramatically that resulted in high risk of obesity (Sami 2017, p. 67). With diabetes, a bad nutritious pattern can lead to major complications. The most basic diet for diabetics is the consistent carb diet. This diet includes eating the same amount of carbohydrates at each meal. Usually, a dietitian will help pick out an amount right for the individual based on their blood sugar, weight, and activity levels. Many people fear that they will have to completely stop eating foods they love, when in reality, they just need to eat smaller portions or eat them less often. Fluid and electrolyte imbalances are another major concern for diabetic patients. An increase in blood glucose levels (hyperglycemia) causes the kidneys to work overtime to try and excrete the excess glucose. This excretion happens through urine, producing polyuria. When there is an increase in urinary output, there is also an increase in the amount of water and electrolytes lost, causing fluid and electrolyte imbalances. This is a major concern for my client who has chronic kidney disease (CKD) because, his kidneys do not filter as proper as a healthy individuals. Perfusion is, essential for the integrity of tissue and organ function (Levy et al. 2018, p.968). Chronic hyperglycemia can lead to vessel walls (and cell walls) stiffening and becoming rigid. Narrowing of the vessel walls lead to little or no perfusion of blood to the tissues. Complications of DM2 involve a myriad of comorbidities including the serious complications of poor wound healing, chronic ulceration, and resultant limb amputation (Okonkwo DiPietro 2017, p.1). My clients history of coronary artery disease (CAD) and peripheral artery disease (PAD) were the effects of blood vessel damage from chronic hyperglycemia and being a long-term smoker. This led to low perfusion to his tissues and organs, which caused them to start failing. Due to low oxygenation getting sent to the peripheral tissues, he started experiencing peripheral neuropathy. Peripheral neuropathy is nerve damage, usually to the hands and feet. This led to tissue integrity problems, such as diabetic pressure ulcers on his heels. Minor wounds often lead to chronic, nonhealing ulcers that are predisposed to infection (Greenhalgh 2003, p.37). With these ulcers forming, it created a higher need for those tissues to get oxygen; his vessels were too damaged to perfuse this oxygen needed to those affected tissues. Without any oxygen or blood circulating to those tissues, the ulcers couldnt heal fast enough causing progression of the infection, which led to hospitalization. When he was hospitalized, the ulcers on his heels had already become necrotic. This tissue death caused him a lot of pain which left him bedridden. Being bedridden leads to; no mobility, slower perfusion, slower wound healing, increased risk for more pressure injuries, and much more possibilities that cause this cycle to keep going. Diagnosis of type two diabetes, can be made with an A1C level of 6.5% or greater, a fasting plasma glucose level of 126 mg/dL (7.0 mmol/L) or greater, or a two-hour plasma glucose level of 200 mg/dL or greater during an oral glucose tolerance test with 75-g glucose load; however, testing should be repeated on a subsequent day to confirm the diagnosis (Pippitt Gurgle 2016, p. 106). As stated in the quote, these glucose readings should be abnormal on two different visits to ensure there was no error. These abnormal readings will usually be accompanied by symptoms of hyperglycemia such as; polydipsia, polyuria, and unexplained weight loss. When my client first was first admitted to the hospital his A1C was 8.0%, which means his average plasma glucose level was 183 mg/dL (10.2 mmol/L). With blood glucose levels this high, many complications can arise (like experienced with my client). Medications and lifestyle changes are the best way to avoid these issues. Oral medications, such as Metformin and Glipizide, are used in defense against hyperglycemia. Metformin is considered the agent of first line for treatment of T2DM, in the absence of contraindications (Mar ­n-Pe ±alver 2016, p. 359, 360). Metformin works by decreasing hepatic gluconeogenesis, which is the break-down of proteins to glucose. It also aids in the decrease of intestinal glucose absorption. A therapeutic outcome of Metformin is that it, decreases fasting blood glucose by approximately 20% and HbA1c by 1.5% (Mar ­n-Pe ±alver 2016, p.360). Glipizide is another anti-hyperglycemic drug that, [stimulates] pancreatic islet beta-cells, which increases insulin secretion (Elseviers Clinical Key, 2018). Injectable agents, such as insulin, are used for treatment of diabetes as well. There are four main injectable insulin categories; rapid-acting, short-acting, intermediate-acting (NPH), and long-acting. Short-acting and rapid-acting insulins are used for prevention of hyperglycemia following meals. NPH and long-acting insulins are used for basal insulin coverage over a longer period of time. Intermediate- and long-acting insulins can cause low blood glucose if they are absorbed too quickly. Insulin that is kept warm, rather than at room temperature, may also be absorbed too quickly by the body. Massaging the site of injection can also speed the absorption of insulin, as can exercise (John Hopkins University, Basal Insulins (Intermediate and Long-Acting)). Diet and exercise (weight loss) are the two most modifiable treatments for type two diabetes. With being an overweight diabetic, my clients first focus should be on his nutrition. Even small changes in ones diet can be effective. Diabetic dietary patterns, emphasizes a consumption of fat primarily from foods high in unsaturated fatty acids, and encourages daily consumption of fruits, vegetables, low fat dairy products and whole grains, low consumption of fish, poultry, tree nuts, legumes, very less consumption of red meat (Asif 2014, p.2). My client and I discussed the importance of maintaining a healthy and balanced diet to decrease the risk for any more diabetic complications. He was surprised to hear that fruits and vegetables had such a good impact on his health. After we finish discussing a good amount of healthy food options, he went on to state that he was going to include more fruits and vegetables in his everyday diet to better his health. He also stated that he was going to eat whole grain bread instead of white bread to ensure he received all the beneficial nutrients that isnt incorporated into white bread. A safe and effective range for weight loss is one to two pounds per week. Another way to calculate weight loss, other than a scale, is to count cut calories. According to Eve Guths research article, Healthy Weight Loss, A total of 3500 calories equals 1 pound of body weight. This means if you decrease (or increase) your intake by 500 calories daily, you will lose (or gain) 1 pound per week (Nabel 2010 ch.3). Losing weight and eating a healthy diet (cutting down portion sizes) are two modifiable factors discussed with my client about how to effectively improve his diabetes and its complications. I would like to see my client lose one pound a week until he reaches a healthy weight for his height. After he loses the appropriate amount of weight, I would like him to try and maintain that balanced weight to height ratio. This will allow him to improve his diabetic condition and improve his ability to have proper wound healing. Smoking cessation was another concern discussed with my client. According to the CDC, smokers are 30â€Å"40% more likely to develop type 2 diabetes than nonsmokers (Smoking and Diabetes 2018). Complications from smoking have increased his perfusion issues, oxygenation issues, and slow-wound healing process. Smoking causes, increased blood pressure and altered lipid profiles in smokers with diabetes [and encourages] development of insulin resistance syndrome, setting patients up for further cardiovascular problems (Sherman 2005, p. 202). Insulin resistance is a result from decreased absorption of insulin through subcutaneous tissue (from smoking), therefore, leading to an increase in insulin requirement. My client and I discussed the effects smoking had on his overall health and how it may worsen the complications he experiences from diabetes; such as, wound healing, perfusion issues, etc. We also went over many different types of smoking cessation techniques (classes, gum, patches, activities). He understood that quitting did not have to happen abruptly although, it had to happen sooner rather than later. My client had listed back to me the effects smoking had on his body and how it complicated his diabetes. After, he agreed to decrease the number of cigarettes he smoked each day, and to attend cycling classes along with indoor water aerobics to keep his mind busy and increase activity. Aside from smoking and diet, wound-healing was another topic discussed with my client. It was especially important due to the necrotic diabetic ulcers on his heels. If not treated quickly or appropriately, diabetic ulcers can become infected and may lead to amputation. I helped to educate him on the signs and symptoms of infection to decrease the possibility of serious complications, such as amputation. The treatment of diabetic wounds begins with preventative measures that include both controlling hyperglycemia and preventative foot maintenance (Greenhalgh 2003, p. 41). After a visit from the wound care nurse, we discussed the importance of maintaining a clean wound and eating a balanced diet, high in protein to prevent from further infection. Before I left, my client was able to correctly demonstrate the technique for cleaning his wound (starting from the middle and dabbing around in a circle to the edge) with a normal saline soaked gauze. Diagnosis of type two diabetes is increasing every day. People are getting diagnosed younger than 20! The health care system is coming up with more and more ways to try and help decrease this sky-rocketing rate. People are getting tricked into thinking some junk food is healthy just because of food marketing labeling it fat-free or sugar-free. What people arent realizing is that when food is rid of fat or sugar, it is replaced with something artificial or worse, just with a different name on the label. Following the safest and most effective practices, I was able to discuss these topics with my client and provide optimal care during my time spent with him. I allowed time for him to express his concerns and provided him with feedback/knowledge to lead him to a fast and healthy recovery.

A Critical Review of Animal Farm Essay - 1643 Words

A Critical Review of Animal Farm Once again, George Orwell shows his literary genius in writing. Through a brilliantly designed plot, the evidence for the horrors of totalitarianism, communism, and revolution have been shown. Throughout history, these types of events have destroyed societies, and George Orwell uses his strength in satire to show this. In someways, he even pokes fun at the communist regimes around the world by symbolizing them as animals. Truly, this book is not only serious in its message and theme, but it also gives a very entertaining story at the same time. Any astute reader will see why this book alone was able to propel Orwell into a life of prosperity and wealth (â€Å"Animal†). George Orwell ingeniously shows the†¦show more content†¦Orwell himself was actually a socialist. However, he did not agree with the way the totalitarian societies that were communist were run. Specifically, the policies of Joseph Stalin embodied his hatred (Allbery). Th ese beliefs are portrayed very well in Animal Farm. Animal Farm does not sacrifice its plot for political satire at all. In fact, the integrates plot completely into the story, starting with the exposition. At the beginning, Major, a very old boar living on Manor Farm, calls the farm animals together for a meeting of great importance. Respected throughout the farm for his wisdom and intelligence, he tells the animals about a vision he has when all animals would someday be free from human rule. A few days later, he dies. Awaiting the day when they may take over the farm, the animals are stirred into a rebellious fervor,. The initial incident is this rebellion they are waiting for. They overthrow Mr. Jones, their owner, and drive him out of the farm and down the road. They replace the sign for Manor Farm with a sign saying Animal Farm. For quite awhile after this, they begin running the farm as animals. Wanting all animals to be equal, the animals, specifically the pigs, set up laws f or themselves to follow. Jobs are given according to ability and type of creature that they are. Having great strength, the horses take the more physical jobs, such as plowing. The pigs are quite intelligent, so they begin to become the leaders ofShow MoreRelatedCritical Review of Animal Farm2575 Words   |  11 Pagesâ€Å"Animal Farm† Bibliography: Orwell, George. â€Å"Animal Farm.† New York: Penguin Books Ltd, 1989 Introduction and Summary: Animal farm is an animal fable with a deliberate purpose. 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U.S Economy Cause and Effect Free Essays

Essay #2 cause and effect essay. (1084) Â   Â   Â   Â   Â   Â   Â   Â   Â   Â   Â   Â   Â   Â   Â   Ben Soloviev As America is going through economical disfunction’s, Â  it is apparent that many people fear for losing their job because in such a depression it would make it impossible to be well off comfortably due to the demand of money needed for all the basic essentials especially in Orange County. Orange County happens the be one of the more expensive areas in the state and it is crucial to always have a steady income as life here is not cheap but well worth it. We will write a custom essay sample on U.S Economy Cause and Effect or any similar topic only for you Order Now Many Americans are in search for work and are struggling to make a living. As the job hunting goes on, many job opportunities are overseen to due to programs such unemployment. The percentage of unemployment has sky rocketed over the past few years leaving it up to us, tax payers with job to pay for such needs. Unemployment is not fair for all, most people would say. There are a percentage of people who truly have no other choice of surviving unless they depend on this crucial unemployment program. Although unemployment is crucial for some, it is not necessary for a portion of the people due to the simple fact that they are not trying hard enough to seek new job opportunities. Instead they a letting opportunities slide right past them every single day they are not looking for work. Many people depend on unemployment alone, because most people would prefer to get paid for doing nothing while they have the chance too. Many people take advantage of this privilege and only it do they follow. A huge downfall due to unemployment for us people with a steady income and a consistent employment is the fact that we have to pay for the unemployed. Hardworking people work to support themselves also end up paying taxes which a percentage of that goes to the unemployed. By increasing our taxes the government collects money all around. This dramatically decreases the standard of living for us citizens. Although unemployment has it’s pros and is a huge opportunity for people in struggles or going through loss of unemployment. It also puts a major dependability on hard working citizens who are forced to pay high taxes which a certain percentage are collected to pay for the unemployed. Many people abuse unemployment for as long as they can and only pretend to seek work but instead just prefer to do nothing but make something which not only is unfair but also not right. Unemployment not only affects certain individuals but it also puts a decrease on the standard of living here in the United states which affects everybody around us. How to cite U.S Economy Cause and Effect, Essay examples

Nightmare World Essay Example For Students

Nightmare World Essay Analasys of Nightmare WorldBy Luke MillerIn the essay, Nightmare World by Stanley J. Solomon, he talks about how a horror film is a safe place to confront fear and violence that pervades our life. Its the fear in our minds that we have, and it is the fear that we can release by watching a scarey movie. One thing that he doesnt discuss that I wish that he would have, is how he doesnt get into any different medias. Stanley J. Solomon really elaborates very well about how the American scarey movie is a great place to really let our fears out. It is a safe contained atmosphere where nothing physically negitive can happen to you. The scarey movie is really a rarity in todays society if you look in the past, there might not be as many scary movies, but in ratio to todays movies it is a lot higher. Just because therre is a lot more junk on the silver screen today. The visual images in a scarey movie really represents our fears in our minds. Like the huge shark in Jaws is a evil image that represents fear in our minds. But it is the fears in our minds that needs to be realeased. And that is where the horror film comes into play, giving us a safe enviornment to watch and release those fears. As compared to going out o a boat and trying to get as close as you can to death. For on reason it is a lot cheaper to spend your 6 dollars at a movie theater, compared to hundreds or thousands out on a boat in th e unpredictable atomosphere of the ocean. One person that could really bring out fears that lurk in the Nightmare World of our head, was Alfred Hitchcock. He would use a couple different kinds of danger to scare the veiwer. He would use the kind where the person that is going to get murdered doesnt even know that it is coming, but yet the veiwer can see it clear as day, and the viewer can almost predict how the victim is going to get murdered. The second type that Alfred Hitchcock was really great at, is where everyone knows that the victim is in trouble including the victim. It is really just a waiting game, as to when and how he/she is going to get killed. In most of these situatoins it is a helpless young attractive female who knows the killer is in her house and is just waiting to get slain. One movie that really portrays this well is the Scream triligy. On thing that Stanley J. Solomon never got around to in his essay is other forms of media that could be used to get into our own Nightmare World. He talks about how only movies can get our endorphons going, but what about a good book? I know that when I get involved in a good book that I totally block out everybody and everything else, just to focus on the book. One thing that a book can do for you, or you do it for yourself, is that with a book you can read the discription of the character, but you get to picture him/her in your own way in your head, which might let you get rid of some of the gears that we might have built up in our heads. Another media that really is just now getting exposed is books on tape. They let you totally relax to a reader which might even be the author, describe the story in his/her own thought and voice. Thus letting you totally relax into the story and hearing it the way that it was ment to be. This method of media would also allow you to release the hor rors of your own Nightmare World. .u8a67a9d0e80fc7e39298390ec05b16f1 , .u8a67a9d0e80fc7e39298390ec05b16f1 .postImageUrl , .u8a67a9d0e80fc7e39298390ec05b16f1 .centered-text-area { min-height: 80px; position: relative; } .u8a67a9d0e80fc7e39298390ec05b16f1 , .u8a67a9d0e80fc7e39298390ec05b16f1:hover , .u8a67a9d0e80fc7e39298390ec05b16f1:visited , .u8a67a9d0e80fc7e39298390ec05b16f1:active { border:0!important; } .u8a67a9d0e80fc7e39298390ec05b16f1 .clearfix:after { content: ""; display: table; clear: both; } .u8a67a9d0e80fc7e39298390ec05b16f1 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u8a67a9d0e80fc7e39298390ec05b16f1:active , .u8a67a9d0e80fc7e39298390ec05b16f1:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u8a67a9d0e80fc7e39298390ec05b16f1 .centered-text-area { width: 100%; position: relative ; } .u8a67a9d0e80fc7e39298390ec05b16f1 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u8a67a9d0e80fc7e39298390ec05b16f1 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u8a67a9d0e80fc7e39298390ec05b16f1 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u8a67a9d0e80fc7e39298390ec05b16f1:hover .ctaButton { background-color: #34495E!important; } .u8a67a9d0e80fc7e39298390ec05b16f1 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u8a67a9d0e80fc7e39298390ec05b16f1 .u8a67a9d0e80fc7e39298390ec05b16f1-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u8a67a9d0e80fc7e39298390ec05b16f1:after { content: ""; display: block; clear: both; } READ: Antisocial personality disorders EssayAll together many different things contribute factors to our nightmare world. But most importantly, we can release all of these fears in the safe envirnment of our own heads. English Essays

The Painting of the Sistine Chapel Essay Example For Students

The Painting of the Sistine Chapel Essay The basic mindset that Michelangelo had while painting the ceiling was extravagance and perfection. The ceiling had originally been painted with a blue sky and gold stars. That was Michelangelo starting canvas. Michelangelo realized that he needed help with this project. No one could paint that big of an area by themselves (or so he thought). Once he rounded up a dozen or so up and coming artists he had to deal with the problem of finding a way to get 60 feet in the air. He hired a skilled architect to build a special scaffolding. The architects idea for the scaffolding was to hang it from the ceiling by four big heavy ropes. Michelangelo discarded this idea because it would put four large holes in his final work. He then drew the plans tort the scaffolding himself. He had a set of zigzag stairs that led to the scaffolding which was supported from the sides of the chapel, This allowed him more room to work, and didnt interfere with the ceiling. The next step was to find a medium of paint to use on the chapel ceiling, He started painting the chapel by laying down a base of plaster then painting over it. We will write a custom essay on The Painting of the Sistine Chapel specifically for you for only $16.38 $13.9/page Order now Soon, he realized that the moisture in the walls caused mold to grow which then softened the plaster causing it to crumble. This was a disappointing setback for Michelangelo, but his most trusted assistant, Jackpot L Indian, developed a new plaster that would not retain moisture. This allowed the painting to continue. Soon after Michelangelo was back on track he realized that he could not trust any assistants to do the painting besides Alnico. He locked the rest of his assistants out of the chapel and continued his painting at a much slower pace. This angered the Pope who was already becoming very impatient with Michelangelo. The two of them fought day and night about the painting. This fighting resulted in Michelangelo aging an unannounced leave of absence. The Pope then spent many resources to hunt down Michelangelo and force him to finish the ceiling. After many months of searching, Michelangelo returned on his own will to finish what he started. As the days went by Michelangelo made great progress, but also realized that his vision was slowly deteriorating, Before he could finish the ceiling he was hospitalized. One day the Pope came to visit him and ask it he was going to finish the ceiling. When Michelangelo said no, the pope cleverly said, then I will have Retreat finish the ceiling tort you, after all he has mastered your technique As soon as Michelangelo heard these words he jumped out of bed, and quickly finished the ceiling, and for once, he pleased the Pope. As soon as Michelangelo heard that the popes idea for the ceiling was to just have the twelve Disciples on the ceiling, he knew he was going to have to use his imagination and come up faith a amazing design worthy of the beautiful chapel Michelangelo was a devout Christian and he had a great knowledge of the stories of the Bible. With this knowledge he selected some Of the most interesting stories from the Bible and decided to interpret them into paintings. Here was his layout Of the Sistine Chapel ceiling. Although the ceiling seems very random, almost as if it were a collage, Michelangelo had a method to his madness and the painting came together very well. The most famous scene from the ceiling is God giving life to Adam. I dont have a favorite section. To me they are all works of art in their own. Michelangelo seemed very intrigued by the story of Noah. .uad7c624d610a13a50ec61930782cafad , .uad7c624d610a13a50ec61930782cafad .postImageUrl , .uad7c624d610a13a50ec61930782cafad .centered-text-area { min-height: 80px; position: relative; } .uad7c624d610a13a50ec61930782cafad , .uad7c624d610a13a50ec61930782cafad:hover , .uad7c624d610a13a50ec61930782cafad:visited , .uad7c624d610a13a50ec61930782cafad:active { border:0!important; } .uad7c624d610a13a50ec61930782cafad .clearfix:after { content: ""; display: table; clear: both; } .uad7c624d610a13a50ec61930782cafad { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .uad7c624d610a13a50ec61930782cafad:active , .uad7c624d610a13a50ec61930782cafad:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .uad7c624d610a13a50ec61930782cafad .centered-text-area { width: 100%; position: relative ; } .uad7c624d610a13a50ec61930782cafad .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .uad7c624d610a13a50ec61930782cafad .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .uad7c624d610a13a50ec61930782cafad .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .uad7c624d610a13a50ec61930782cafad:hover .ctaButton { background-color: #34495E!important; } .uad7c624d610a13a50ec61930782cafad .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .uad7c624d610a13a50ec61930782cafad .uad7c624d610a13a50ec61930782cafad-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .uad7c624d610a13a50ec61930782cafad:after { content: ""; display: block; clear: both; } READ: A Portrait Of A Young Man EssayHe dedicated three whole panels of the ceiling to Noshs adventure during the flood. The Drunkenness of Noah, The Flood, and The Sacrifice of Noah. The border tooth ceiling consists of the Evolve Disciples. This is ironic because although they were planned to be the main touch tot the ceiling they ended up at the edges, and not in the glory of the center. Overall the ceiling was divided into 33 sections. The number three was very symbolic tort Michelangelo, and no one knows for sure why. Here are some examples. 3 panels on the ceiling, 333 figures on the ceiling (so says Michelangelo) and lastly Michelangelo also said that he worked for 13:33 minutes on the ceiling every day. The 33 panels consisted of the 12 apostles, and 21 biblical stories. The ceiling avgas under much scrutiny because it showed God in human form. The priests disapproved of this, but, for once, the Pope came to Michelangelo defense and asked the priests to respect the amazing ivory of art. Today the ceiling is not on public display in the city of the Vatican because of its delicacy. It has undergone many reconstruction phases, and, like many Other ancient wonders, is deteriorating. The ceiling is heavily protected and only a selected few people are allowed into the chapel. Before they enter they are screened for many harmful materials such as, hairspray, certain clothing materials, and even DUST! All of these precautions are to help protect the raucous work of art, and allow generation upon generation to gape at its beauty. With the renaissance came many great works of art and many great artists. Michelangelo was one of the few of these revolutionary artists that could compare to the mind of Leonardo Dad Vinci. He was also the painter of the only piece of art that can think of that even comes close to rivaling the Mona Lisa. That would of course be the ceiling of the Sistine chapel. With tour years tot work and countless hours of painting, turmoil, and failure, the ceiling was completed, and will remain one of the most respected, and admired paintings of all time.

Machiavelli and Socrates

Everyone has their own philosophies to deal with life as it is thrown at them. Machiavelli and Socrates offer guidance to societies so they may succeed, as noble rulers. Machiavelli gives his go get them attitude to help maintain power, which I agree with, and Socrates lays out his ideas of enlightenment to rule. Michiavelli gives great advice for someone living in America in the year 2000, so that they my gain and maintain power. As a whole Americans need to embraces the ideas of Socrates to be wise and just leaders. I support Machiavellis way of dealing with the way people really behave, and how the world is. It makes more sense, to deal with people and situations of the world in their natural state. Attempting to change people that are set in their ways is much more difficult, than just handling people in a way that they are accustom to. Humans feel safer when they follow actions that have already been proven successful, outsiders should work with them by what that group knows. Machiavelli says, since men almost always tread the paths made by others and proceed in their affairs by imitation, although they are not completely able to stay on the path of others nor attain the skill of those they imitate, a prudent man should always enter those paths taken by great men and imitate those who have been most excellent, so that if ones own skill does not match theirs, at least it will have the smell of it (Machiavelli, 20). This is relevant because in society citizens tend to pass on teachings to the next generations, and to behave as they did to continue their customs. Thus in trying to deal with people, you should also understand where they are coming from in their actions. When a person attains a high position of authority, it is truly better for them to be feared than loved by their subjects. For the leader to maintain their position they need to be...

American Studies Movie Review Example | Topics and Well Written Essays - 500 words

American Studies - Movie Review Example The title of the film, as well as the term used to describe its characters, is disturbing, although it is the term that circus performers have traditionally used to refer to themselves. There is much about the film that is disturbing, and not just because it is a horror film. Joan Hawkins (1996), in her discussion of the film, treats the two most obvious identify features, disability and gender. Because identity is more complicated than that, however, I would include race, although I agree with Hawkins’ interpretations. As Douglas C. Baynton (2001) has rightly points out, â€Å"Disability has functioned historically to justify inequality for disabled people themselves, but it has also been done so for women and minority groups† (33). I would say that the characters in â€Å"Freaks† consider themselves a race of people, the membership of which depends upon their status as people with disabilities. When the freaks decide to accept the trapeze artist Cleopatra into their community, even though she is â€Å"normal,† they perform an elaborate, religious-like ceremony to commemorate it.

Noise is the enemy of communication Article Example | Topics and Well Written Essays - 500 words

Noise is the enemy of communication - Article Example Claude’s discovery has impacted the modern world since it is the basis of all communication that exists today. The challenge of noise had was a big limitation during World War II but he managed to solve the problem by developing a universal communication method where all people could understand one another. During the World War II, the military utilized radio communication, which was one of the factors that made the war push to all corners of the globe. There were significant advancements in Cryptography since I was necessary to send messages very fast and keep them secret. Airplanes were being used in the war and there was need to be able to detect them before they appeared in the horizons. Claude was designing a mechanism to perform this role. He was also determined to device a means of shooting down a plane immediately it appeared (Andrew, 2012). He managed to make a breakthrough but it was not useful since it was not accurate. The challenge made him and others think of information propagation after the war. He was torn between, radar signals, phone calls, television and videos since he wanted an accurate method of communication. Having a perception that noise was not favorable for communication, he was focused on storing and transmitting information that rejected noise. He knew that communication was equally challenging as mathematics and engineering and hence focused a lot on his mission. His basic idea was that any mode of communication should have minimal uncertainty for it to be effective. He understood that here being many languages, some words had a lot of meaning to some people than others. Shannon discovered that establishing various codes and symbols would solve the problem and people speaking diff languages could understand each other well. His discovery was a unifying factor since the world war involved different people and they had no common communication language. Shannon coding systems was based on reducing

Lifelong Learning Essay Example | Topics and Well Written Essays - 1000 words

Lifelong Learning - Essay Example It may be present at birth or have been caused by any kind of trauma or sickness. The consequences involve a lag between the affected person’s traits or abilities and the standard aptitudes. Some causes are nutrition problems, brain injury, and drug abuse. Regarding diagnosis, the symptoms commonly appear within infancy stage. Delays in the different developmental stages must first be referred to specialists such as pediatricians. One of the tests usually employed in diagnosing is Battelle Developmental Inventory (Hughes, 2012). Different skills like communication, motor, and adaptive are evaluated. The findings should also be confirmed by several experts. Early intervention is crucial in overcoming or lessening the severity of delays. Therapies are usually more helpful if utilized promptly. For instance, as much as 50% of children with ASD (Autism Spectrum Disorders) can be ready for inclusive education due to early intervention (Blessing, 2012). Common therapies are physical , occupational, and speech. Other kinds of therapies that may be useful are play, music, water, and many others. The main priorities for intervention are the main aspects in a person’s development such as physical, cognitive, communication skills, social and emotional, as well as self-help and independence skills. Plans of actions are established to cater to the milestones in the different areas like eating independently, completing puzzles, having basic vocabulary or sign language, identifying emotions, and walking up and down the stairs. The progress in the aforementioned dimension will significantly help the child adapt to the general challenges in the society. The government has educational programs conceptualized for learners with specific needs. â€Å"Young children who qualify for special education are entitled to free, appropriate, public education (FAPE)† (p.5). Moreover, a least restrictive environment (LRE) is provided to maximize learning. Hence, exceptiona l learners can study at home or in other community areas where they can comfortably study. Appropriate learning aids are also used in respect to their availability in the community. For instance, a tutor may visit the home and coordinate with other kinds of service providers. The progress will be then regularly reported to the family and other individuals involved. Furthermore, the Individualized Education Program or IEP and Individualized Family Service Plan or IFSP are used to fit the curriculum to the child. This way, children with unique ways of learning will have optimal support and opportunity to improve. Furthermore, there are services for the young exceptional learner. Early intervention services must be coordinated with the other staff providing assistance. One of the most common services is â€Å"Head Start†. It benefits children from financially disadvantaged standings (Hardman, 2011). It was originally founded in 1965 as a summer school that intended to help child ren cope with their academics. The program expanded over the years. At present, head start offers scholarships to deserving children with special needs. There are also non-government organizations that are active in providing service. Most assistance is grounded on inclusion and self-empowerment. The goal of the groups is not just to give support but to also guide the children to help themselves. Day services otherwise known as day centers provide preparation life

Strategies to Reduced Diabetes Appointments

Strategies to Reduced Diabetes Appointments 1 Introduction The aim of this project is to reduce the number of appointments that those on the diabetes register need to attend by offering a â€Å"one stop shop† for both retinal screening and diabetic review. The surgery I work in is demographically situated in one of the most deprived areas in the UK and typically the patients attending are those who make poor lifestyle choices and fail to attend appointments, they may be classed as hard to reach, homeless and vulnerable patients with complex needs. Aims and Objectives My intention was to improve on the number of diabetic patients attending their appointment for retinal screening and for their annual diabetic review in order to capture them and integrate them into local services for diabetes care. Objectives involved improving communication with the diabetic retinal screening service, an audit and inspection of available rooms at the GP surgery to allow for retinal screening to be performed at the surgery, and the development of a patient letter and protocol to promote a consistent approach for patients to be recalled and reviewed. This change in practice would enable the surgery’s hard to reach and vulnerable patients to attend for one appointment where they could receive their retinal screening and their diabetic review at the same appointment. Background Information The most serious complication affecting the eye for people with diabetes is the development of diabetic retinopathy. A delicate network of blood vessels supplies the retina with blood. Diabetes affects these tiny blood vessels of the eye and if they become blocked or leak then the retina, and possibly the vision can be affected. The Royal National Institute of Blind People (RNIB) estimate that forty percent of people with type 1 diabetes and 20 per cent with type 2 diabetes will develop some sort of diabetic retinopathy. Diabetic retinopathy progresses with time but may not cause symptoms until it is quite advanced and close to affecting the person’s sight. The duration of diabetes is the most important factor that predicts whether a person develops diabetic retinopathy as well as poor glycaemic control. The United Kingdom Prospective Diabetes Study (UKPDS 1998) and the Diabetes Control and Complications Trial (DCCT 1993) showed that improved glycaemic control reduced the development and progression of retinopathy. This demonstrates that glycaemic control is significant in reducing a person’s risk of developing diabetic retinopathy and by combining the retinal screening with the diabetic review, it was anticipated that improved glycaemic control could be discussed at an appropriate time as most people would consider maintaining their eyesight as significant. A study by Jones, Hepburn, Man, Ridout and Gable (2011) demonstrated that diabetes care in the community is not always flexible enough to accommodate the needs of vulnerable people with complex needs however, type 2 diabetes mellitus (T2DM) complications are often avoidable through adequate care and therefore there has been an increase in programmes to improve the quality of routine care received by people with T2DM (Stribbling 2013). The importance of targeting non-attenders is significant in order to attempt to reduce complications. Diabetes is associated cardiac and cerebrovascular disease, as well as small vessel disease that can result in blindness and renal failure (Fowler 2008). Good glycaemic management reduces the risks of complications, why is why it is important to make every effort to reach the non-attenders (Thomas 2012). Socio-economic deprivation is one of the main reasons people are unable to attend appointments for health care. Deprivation is strongly associated with the development of diabetes and the complications associated with it. People on a low income may not be able to access public transport, they may not class their own health as priority and those who have substance misuse issues may use their money to buy illicit drugs instead of using the money to buy healthier food or for getting to and from appointments. Research by Mitchell, Malone and Doebbeling (2009) demonstrated that individuals with substance misuse disorders and mental health problems were significantly less likely to receive retinal screening or foot sensory examination even though those with a mental disorder had significantly more out-patient visits. This researched concluded that there was strong evidence to support inequalities in medical care for those people with a mental health problem or a substance misuse disorder even though the nature of these diagnoses increased the risk of them developing T2DM and complications from it. In consideration of the practice population where I work, there are a high proportion of people with mental health issues, drug misusers and a few homeless people. I also work in a deprived area which alerts me to acknowledging the problems these people face on a day to day basis and realising that health is not top of their daily agenda. It has highlighted that the evidence is present to facilitate a change in practice to allow for improved access to health care and to perform as many health assessments as possible in one session. Overview of audit The audit undertaken earlier in the year was performed by analysing the number of people with diabetes attending appointments for annual retinal screening (see appendix 1). I then divided the results down further to encompass age groups and gender. The middle age range had the highest number of non-attenders and more males than females failed to attend their appointment. The number of people attending for retinal screening was considerably higher than anticipated, and in comparison to those attending for other areas of their diabetes care, which identified an opportunity in modifying appointments. The audit highlighted that patient’s rank their eyesight as very important compared to other aspects of their diabetes review and I considered how I could change this behaviour and allow for the patients diabetic review to be performed at the same time as retinal screening. This recognised that there needs to be a more robust system in place as this type of complication can only be detected by a detailed examination of the eye at attendance of the retinal screening programme. Attendance issues may be improved upon by combining appointments and therefore, in conclusion, communication between departments needs to be more effective ensuring that diabetic patients can be recalled for both review and screening and a protocol for patients who do not attend needs implementing. Action plan My initial action was to ensure that the diabetes register at the practice was up to date and that all patients over the age of twelve years had been referred to the screening service. I performed this audit by reviewing the diabetic register on Systmone including any new patients and systematically checking through the patients computerised notes to establish whether referrals had indeed been made and read coded onto the computer. For patients who had not been referred for retinal screening, a referral form was completed and faxed over to the screening service. Local diabetic eye screening services need to be informed of everyone who is newly diagnosed as well as those people with diabetes who have moved into the area or changed GP practice. Once this was complete, I contacted the retinal screening service via email to ask whether it would be a feasible option for them to batch appoint several of the surgeries patients together on the same morning or afternoon to allow for sufficient patients to make it cost effective for a full session. The retinal screening took place at a different GP surgery and I therefore needed to contact the practice manager to request permission for the use of a room in order to be able to review the patients at the same time as the retinal screening appointment. This would mean I would have to travel and see patients at the other surgery and it was recognised that both cost effectiveness and productiveness would be improved by consulting with several patients within one session. Unfortunately, rooms were very limited at the other surgery and therefore this option was taken out of the equation as it was not possible to agree a solution. I reconsidered the idea and emailed the screening service again to ask the standards and measurements needed for a room for retinal screening. I was informed that the room needed to be at least three metres in length with a desk and two chairs, a computer, and access to an electricity supply to extend to the car park where the screening van would be located. My surgery often hires vacant rooms out to other services and therefore, I discussed this with the centre manager who approved an inspection by the retinal screening service to establish whether the surgery had a suitable room. This was arranged for the screening service to attend the surgery and review all of the available rooms. Two gentlemen from the screening service attended the surgery together with the screening vehicle to inspect the rooms available and to establish whether it would be feasible to park, connect to an electrical supply and be allocated a suitable room for screening purposes. They were shown around the majority of the rooms within the surgery and decided that one of the rooms at the front of the building was suitable; the screening van could be parked at the front of the building allowing suitable access to an electrical point. We therefore had an agreement with the retinal screening service for them to perform the screening procedure within the patient’s own surgery. It was agreed that a nominated person from the retinal screening service would send, via email, a list of patients whom they were inviting for screening, directly to the practice, six weeks in advance of the appointment. This would allow time for the practice to invite the patients to attend for any blood tests needed prior to their diabetic review. The surgery would then send a letter to each patient informing them that their diabetic review would be performed immediately after their retinal screening. For the appointment system to be robust, an educational session was delivered to other nurses and reception staff to inform them of the change in practice and the reasons behind this change. This was to attempt to engage all staff to work effectively in this process and to discuss any problems or ideas. Appointment length for the diabetes review was agreed to be thirty minute duration. There was a discussion featuring the implication for the Quality and Outcomes Framework (QoF) figures, and consequently monetary reward for the practice, and that retinal screening is an annual procedure. Patients are sent a leaflet regarding screening with their retinopathy screening appointment. Following this, a prototype patient letter was devised for the practice to allow for consistency in appointing patients. The letter included the patient’s appointment time and date for their retinal screening and their diabetic review. The letter also advised patients of the risks of complications from diabetes and the importance of attendance. The letter was produced (see appendix 2) and this was evaluated and discussed at the next patient participation group which is only small but includes one person with diabetes. Following approval of the appointment letter, a protocol (see appendix 3) was formulated to encompass all stages of the appointment process and ensure consistency. Results The educational session took place and was attended by the practice nurses, reception and administration staff within the surgery. This was performed by discussion to allow for interaction of all staff members. The GP was unable to attend and this was discussed with her at another time. Feedback was positive and it was judged by the staff members to facilitate an improvement in patient care and improvement in appointment attendance. No problems were foreseen although it was recognised that if a patient failed to attend, it was mean a large portion of clinic time had been wasted. This time could be used to attempt to contact the patient by telephone to discuss diabetes care if necessary via a telephone consultation. The â€Å"one stop shop† was perceived as a significant initiative in improving appointment attendance by the patient participation group. It was seen as something that would benefit patients rather than benefitting the surgery. As a representative group of patients, they highly recommended the implementation of the change in practice. This was seen as a successful challenge within the practice considering our patient population. At the time of writing, I am awaiting the initial list of patients from the retinal screening service in order to be able to appoint people into this new project. Discussion Equality of access should be a priority for all NHS services (DoH 2008). Vulnerable people with complex needs should still be entitled to quality health care as it is these patients who may lack the knowledge, skills and support to manage their condition (Thomas (2012). Reflecting on the patients I care for, there is a high incidence of vulnerable people, substance misusers, and homeless, those on a low income or out of work, mental health and learning disability issues. These are often hard to target patients who repeatedly fail to attend appointments. The Quality and Outcomes Framework (QoF) rewards surgeries for achieving set outcomes for diabetes however surgeries such as the one where I am employed, often miss out on vital funds. This is not through the absence of working extremely hard to reach the targets but through patients not attending their appointments. Deprivation is strongly associated with the risk of developing diabetes and its complications. Diabetes UK (2006) reported that people living in derived areas were two and a half times more likely to develop type two diabetes. This was further reported by Diabetes UK (2009) who added that people in the most deprived areas are twice as likely to develop complications of diabetes compared to those in the least deprived areas. Around 500 people a year experience loss of vision due to diabetic retinopathy and maculopathy at a level where it could be registered as a disability (Health and Social Care Information Centre (HSCIC) 2014). Diabetic patients are also at risk of developing cataracts or glaucoma. Diabetes UK (2013) in their mission statement declare the key points are Diabetic retinopathy is the most common cause of sight loss in the working age population All people with any type of diabetes are at risk of developing retinopathy. Those most at risk are those who have had diabetes for a long time and/or who have poorly controlled diabetes and hypertension The NHS Diabetic Eye Screening Programme aims to reduce the risk of sight loss among people with diabetes by the early detection and treatment Screening is offered annually to all people with diabetes aged 12 and over A study by Waqar, Bullen, Chant, Salman, Vaidya and Ling (2009) into the cost implications of non-attendance at a retinal screening programme demonstrated an association between non-attendance and socioeconomic deprivation. The study divided the results down further into first and second did not attend (DNA) appointments. They discovered that sending out repeat reminders to patients resulted in a significant reduction in non-attendance rates. In the area where the study was performed on a total of 22,651 people, they declared the total cost by lost earnings from missed appointments to be almost eighty thousand pounds. Therefore failure of attendance at retinal screening appointments impacts enormously on Trust budgets. Having the knowledge that DNA rates increase within areas of deprivation indicates that people in these areas need different ways of encouraging them to attend appointments. This group of patients needs targeting more aggressively and may need further reminders of their appointments. My vision for the patients that are registered with my practice is one that will encourage attendance by providing a service that will encompass the majority of components needed for a full diabetic review within one session. My feelings are that this will improve patient attendance as the patients will not have to attend multiple appointments or visit another surgery for their retinal screening. This will reduce time constraints and patients expenses should they need to use public or private transport. People leading chaotic lives tend to focus their day very differently to others and by generating one appointment instead of two may support these people to make an effort to attend one session. I consider the strength of this change in practice focuses on the idea of only one appointment. This appears to be confirmed by the reaction of other members of staff and the patient participation group. I remain optimistic that this will improve patient attendance and therefore patient care and improved health outcomes with a reduction in complication rates. The ability for retinal screening to be performed at my practice was paramount to this change in practice and continuing effective communication between the surgery and the retinal screening service must be maintained. I do not feel there is a particular weakness with the method, however the only drawback I can foresee is that if patients continue to DNA the new appointment then it will lead to a large amount of wasted appointment time. I anticipate that the audit next year will highlight an increase in uptake of appointments. If attendance for retinal screening remains at the level that occurred during the audit, this should reflect upon the attendance for diabetic reviews also. If successful, this may be a model of care that other practices may wish to replicate should they have available facilities at their surgery to accommodate the retinal screening service. Student number DDNL04004

Faith Evans :: essays research papers

In spite of the fact that Faith Evans carved out a recording career in her own right, her name will forever remain linked in the minds of many to her late husband the Notorious B.I.G. Evans was an active session singer and songwriter before signing her own solo deal and marrying Biggie, and while she never matched the level of his stardom, she continued to come into her own as a vocalist in the years after his untimely death. Faith Evans was born on June 10, 1973, and grew up in Newark, NJ, where she began singing in church at the mere age of two. A high school honor student, she sang in her school's musical productions before winning a full scholarship to Fordham University. After just one year, though, she left college to put her jazz and classical training to use in the field of contemporary RB. It didn't take her long to find work and over the next few years, she sang backup and wrote songs for artists like Hi-Five, Mary J. Blige, Pebbles, Al B. Sure, Usher, Tony Thompson, and Christopher Williams. Thanks to her work on Blige's 1994 sophomore effort, My Life, Evans met producer/impresario Sean "Puffy" Combs, who signed her to his Bad Boy label. In 1995, Evans released her debut album, Faith, which went platinum on the strength of the hit RB singles "You Used to Love Me" and "Soon as I Get Home." The same year, she met fellow Bad Boy artist the Notorious B.I.G. (some accou nts say at a photo shoot, others a phone conversation) and married him after a courtship of just nine days; shortly thereafter, she guested on a remix of his smash single "One More Chance." Over the next couple of years, Evans continued her behind-the-scenes work, performing and writing for records by the likes of Color Me Badd and LSG. She and Biggie also had a son, Christopher Wallace Jr., in late 1996; however, by that point, their marriage had already become strained. Biggie had publicly taken up with rapper Lil' Kim and rumors had been spreading about an Evans liaison with Biggie's rival 2Pac (alluded to on 2Pac's venomous "Hit Me Off"). The couple had unofficially separated when Biggie was shot and killed in March 1997. A grief-stricken Evans was prominently featured on the Puff Daddy tribute single "I'll Be Missing You," which with its cribbed Police hook zoomed to the top of the charts and became one of the year's biggest hits.