The Experienced Touch at Heritage Christian Home

Statement of the problem The care and support for the developmentally disabled residents at Heritage Christian Home on Yorktown Road in Penfield, New York, is proving to be a jigsaw puzzle with regard to hiring of the staff to care for the disabled. The Home is faced with an acute shortage of labor force. This has forced the Home to embark on hiring older staff to serve the developmentally disabled.Advertising We will write a custom case study sample on The Experienced Touch at Heritage Christian Home specifically for you for only $16.05 $11/page Learn More This has so far seen the trend reverse in terms of hiring the staff. Fives years ago, a job that used to be done by fresh college graduates has now been taken up by old retirees who are over sixty five years. In the 1990s, the New York State Cares launched an initiative aimed at reducing the state’s 10,000-persons on waiting list for admittance to group homes. This move exacerbated faster growt h of care institutions. They have set up many homes within a short time. The process of recruiting these older counselors and other old staff has become expensive. The staffing crisis has compelled Heritage Christian Home to use very expensive advertising media like cable TV and radio as opposed to putting adverts in the classified section. The growth of homes has been blamed on this issue. Possible causes of the problem The possible causes of the problem can be identified. Firstly, nowadays, there is an illusion about the old staff at the facility from the residents about their services. Secondly, the demand for the old staff has increased. The reason cited for the increased demand for this group of staff is because of the setting up of many other organizations involved in the care of the developmentally disabled persons. Secondly, there is an illusion from the residents about the old having experience and parental skills as opposed to fresh graduates from college. Thirdly, with th e entry of other organizations in providing care, there is increased competition, thus making adverting for the recruitment of old staff become very expensive. Analysis of these causes or reasons behind the problem The feeling of the residents as depicted by the staff is testimony of their work. The state to some extend has contributed to the menace with the opening up of more homes. Examining the problem because of the high demand of the old, one can say the organizations should rethink the kind of staff to hire. However, the old care givers are favored at these homes because of their experienced touch, furthermore, they come with parenting skills. The global credit crunch could also be pushing the retirees to consider looking for gainful employment. On one hand, the move is welcome to hire the old, because it reduces the burden of supporting these old by the young. On the contrary, the retirees are seen as taking the jobs that would otherwise been held by fresh graduates from coll ege. Retirees can be supported by retirement schemes.Advertising Looking for case study on psychology? Let's see if we can help you! Get your first paper with 15% OFF Learn More Suggestions/recommendations The Home plays an important role in improving the quality of life of the developmentally disabled residents. The labor force crisis can be resolved by; hiring the young fresh graduates from college who are readily available; the exploration of other cheap avenues for recruiting these old people; offering internship opportunities to young fresh college graduates. This will enable them to work with the old experienced staff and learn the parental skills of caring for the developmentally disabled persons. These strategies can go along way in addressing the problem of increased demand of experienced old staff in these Homes. This case study on The Experienced Touch at Heritage Christian Home was written and submitted by user Emilie Chambers to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.

On My First Son by Ben Jonson Essays

On My First Son by Ben Jonson Essays On My First Son by Ben Jonson Paper On My First Son by Ben Jonson Paper This was frightening, because the Red Cross was the sign put on houses struck by the plague. And after few days he received a letter from his wife telling him that his son Benjamin had died. Johnson writes the poem as if he is talking to his son, and he assumes that the boy can hear or read his read. He calls him the child of his right hand both to suggest the boys worth and also the fact that he would have been the writers successor (the mage comes from the bible, it reflects on the way Jesus is shown as sitting at Gods right hand). The mood of this poem shows the somber and grief but on the other side it also shows a bright side how he loved his son. The atmosphere/tone is reflecting on him talking about his son, how his son was everything and he put his son In place instead of god. Beginning is sad as It shows straight away that he loves her but suggests that something bad has happened -death. A calmer atmosphere pervades n the last four line, where the poet Is in positive mood, seeing his son as his finest creation. The middle section from line 5 Is the most emotional one, but Johnson tries to be philosophical about his grief seeing death as an escape from a troubled world. This poem Is twelve-line long, and It Is written using Iambic pentameter, Johnson arranges the lines using six pairs of rhyming couplets. The middle section from line 5 is the most emotional one, but Johnson tries to be philosophical about his grief seeing death as an escape from a troubled world. There Is a lot of heart touching quotes In this poem. Johnson has used his language effectively, the second line Is really heart-breaking, my seine was too much hope of thee, loved boy. Johnson blames himself for the death of his son; he loved him too much and had high hopes for him. The whole of the second line as If Johnson writes as he Is talking to his son and thou wert lent to me suggest that his son was a gift from heaven. Will man lament the state he should uneven explains paradox, the boy Is going to escape the hardship life and the misery of aging. Rest In soft peace this quote proposes that his son has gone to a better place, euphemism makes death sound comforting. In conclusion On My First Son by Ben Johnson (1572-1637) By Aviva him talking about his son, how his son was everything and he put his son in place instead of god. Beginning is sad as it shows straight away that he loves her but in the last four line, where the poet is in positive mood, seeing his son as his finest creation. The middle section from line 5 is the most emotional one, but Johnson tries to This poem is twelve-line long, and it is written using iambic pentameter, Johnson There is a lot of heart touching quotes in this poem. Johnson has used his language effectively, the second line is really heart-breaking, my seine was too much hope of much and had high hopes for him. The whole of the second line as if Johnson writes as he is talking to his son and thou wert lent to me suggest that his son was a gift from heaven. Will man lament the state he should envied explains paradox, the boy is going to escape the hardship life and the misery of aging. Rest in soft peace this

Articulated Prepositions in Italian

Articulated Prepositions in Italian You’ve learned about prepositions like â€Å"a†, â€Å"di†, and â€Å"da†, but you’ve also been seeing ones that look like â€Å"al†, â€Å"del†, and â€Å"dal†. Are these the same prepositions, and if so, how do you know when to use them? These prepositions are called articulated prepositions, and they are formed when the simple preposition (like â€Å"su†) combines with a definite article (like â€Å"lo†), and form one word that looks like, â€Å"sullo†. Why Do Articulated Prepositions Exist? Despite the difficulty they add to all of the Italian grammar you have to learn, articulated prepositions are probably one of the reasons you like listening to Italian. They add a melodic flow to the language that makes Italian easier on the ears. What Do Articulated Prepositions Look Like? Below you’ll find a table with all of the articulated prepositions.   For example: Ho comprato delle uova. - I bought some eggs. Delle - di le Note: Pay particular attention to what happens when you combine the preposition â€Å"in† with a definite article as the form changes more dramatically than the others. Articulated Prepositions in Italian Definite Article A DI DA IN SU CON il al del dal nel sul col/con il lo allo dello dallo nello sullo con lo l all dell dall nell sull con l i ai dei dai nei sui coi/con i gli agli degli dagli negli sugli con gli la alla della dalla nella sulla con la l all dell dall nell sull con l le alle delle dalle nelle sulle con le Esempi: Vai al cinema? - You’re going to the movies?Vorrei tanto andare negli Stati Uniti! - I would really like to go to the United States!Ci sono tanti ristoranti sulla spiaggia. - There are a lot of restaurants on the beach.Uno dei miei amici mi ha consigliato di andare a Verona. Che ne pensi? - One of my friends advised that I go to Verona. What do you think?Mi piace leggere alla sera. - I like to read in the evening. Also, note that you only need to know how to change five of the seven prepositions into their articulated forms, with con typically only combining with il and i.   You never need to change â€Å"tra†, â€Å"fra† or â€Å"per†. When Do You Use Articulated Prepositions? When you do or do not use this form of prepositions can get tricky very quickly as there are often more exceptions than rules. However, there is one rule that tends to stay consistent. Typically, you would use articulated prepositions when the noun following whatever preposition you’re using requires an article, like â€Å"Che ore sono? - What time is it? → Sono le dieci. - It’s ten†. When you’re talking about time, the article is most likely needed. With that in mind, you would know to use an articulated preposition in this phrase: We’ll see each other at ten. → Ci vediamo alle dieci. Some expressions in Italian are also fixed and must include the articulated preposition, and you’ll often see this happen with locations. For example, â€Å"I’m going to to the dentist† would be, â€Å"Vado dal dentista†. It’s easier, however, to talk about when you should avoid using articulated prepositions. Here are the most common situations. DON’T use articulated prepositions before: A name, like â€Å"Luca†Names of cities, like â€Å"Boston†Fixed phrases, like â€Å"vacanza da sogno - dream vacation†

Eaarth by Bill McKibben - A New Devastated Planet Essay

Eaarth by Bill McKibben - A New Devastated Planet - Essay Example It should be noted that the author has a particular reason for adding another ‘a’ in the spelling, i.e. he considers that humans are not living on the planet Earth. Humans have over-populated the planet with increased global warming and testing nuclear bombs on earth. It is the pollution and industrial sweep that have actually made the frozen tips of mountains to melt down, causing increased sea levels leading to floods. There are many other reasons behind the global warming that have actually led the author to think of a title which has an additional ‘a’. (McKibben). The philosophy behind the entitlement of the book is not an illusion. The need of the hour is to address the climate change that is taking place with fast pace. It should be noted that Bill McKibben has also noted the fact in his work that it is already too late to make change, because the greatest damage that is likely to place is already underway. Humans have avoided the consequences a great deal, which is resulted in the present situation (McKibben). Bill McKibben has already been writing for many newspapers including The New York Times and Mother Jones etc. The subject matter of his writing has always been environment and nature. His first book was published in 1989 which remarkably educated people about climate change and its basics. His first book about climate change was more like an encyclopedia that was translated in many languages and published throughout the world. Despite the renounce of his book, the attitude towards climate change by major countries of the world remains avoidable. In other words it could be said that the book written on the subject of environment has been a part of encyclopedia but none actually tried to act on it (McKibben). It seems that Bill McKibben blames the bigger industries for the oil spills and ruining the marine life. There are many instances of his writing pieces that show anguish concern against the multinational organizations. According to his book Eaarth, it was noted that there are many oil companies that have marked increased profits within the time period of three years. This shows that companies are more interested to make maximum profits without having any considerations of the environment (McKibben). The philosophy of Bill McKibben is not any different than that of other environmentalists, such as John Muir and Edward Abby, but the approach is far effective than others. If we compare the written pieces of John Muir and Bill McKibben, it comes to understanding that John has rather discussed the beautiful scenarios of the planet E,arth whereas Bill McKibben shows the changing aspects of the environment that will not let the beautiful scenarios to remain seeable for the future generations (Muir). Readers of the essays by John Muir would surely understand the beauty of different parts of the world. The book takes the readers to the adventurous and beautiful ride to the world. But it should be noted tha t the climate change taking place in the world is deadly and can cause a number of fatalities such as volcanoes, tsunami, hurricanes and spread of deadly diseases which have already increased its toll (Muir). The philosophy of Bill McKibben is not just based upon writing implications but also practical intervening. Bill

Find a good website containing information about Louis XIV, the Sun Essay

Find a good website containing information about Louis XIV, the Sun King as a Dancer. (Middle Ages and Renaissance) - Essay Example also started and sponsored many schools and academies during his reign, to teach court dancers, who practiced this dance form under the tutelage of some of the best dancers and composers of those time. One particular thing about court ballet was that they were danced solely by men, without any participation of women dancers. This webpage is published by Maxine Mahon, the Director of California Ballet. California Ballet is a San Diego based ballet company, that promotes performances affiliated to the classical ballet art form. Thereby, the information given on this web page is credible and authentic. The intended purpose of the information given on this web page is to introduce the ballet lovers to the history of ballet art form. This web page being published on 24 May 2010, the information given on it could be deemed to be up to date. All the information regarding the role played by Louis XIV in popularizing court ballet is presented in an illustrative and objective manner. Overall, this webpage makes an interesting

Factors change Essay Example for Free

Factors change Essay After I have recorded all the results and written into tables, I used the data to make graphs, which are voltage against current. When I finished marking all the points on to the graphs, I put a line of best fit through. There are five graphs in total, each represents a thickness, on a graph there are five lines of best fits, and each represents a length of a thickness. Then I pick a point on the lines of best fits and calculate the gradient (resistance) by dividing the point on y-axis (voltage) by the point on the x-axis (current) as the ohms law states that V=IR. Finally, I have to draw five graphs to show the relations between length (on the x-axis) and resistance (on the y-axis). Also, I have to draw another graph to show the relations between thickness (on the x-axis) and resistance (on the y-axis). Evaluating Although the whole experiment has been going very well, but the results seems to show some bias or errors as in one or two of the graphs, the pattern is quite strange because some of the gradient (resistance) is not proportional to the lengths. Overall, the experiment can be said as a success. The aim of this experiment is to measure how the resistance change as the factors change. There are so many variables-temperature of surroundings, length, thickness, material, temperature of the wire, surface area, magnetic properties, coated or not and purity-that can be chosen to measure in this experiment. But in this experiment I am only going to measure two of them, which are length and thickness because these two are the easiest to measure and show the effects on the resistance. Prediction: The result should be showing that the resistance increase as the length or thickness increase. This happens because when length or thickness increases, the current will decrease. As the voltage wont change, if the current decreases, then the resistance will increase. Method: In the experiment I will need to use apparatus listed below.

Criticism of Religion in Voltaire’s Candide Essay -- Candide essays

Criticism of Religion in Voltaire’s Candide In his novel Candide, Voltaire often criticized religious beliefs of the times. His criticism of religion surfaces throughout the entire story. The kindness of the Anabaptist that Candide met showed the silliness of religious prejudices. The old woman's story of her father, Pope Urban X, and the life of wealth she lived as a child shows the corruption of the Catholic clergy. Finally, the conversation Candide and Cacambo had with the old man in Eldorado shows the benefits of a simple religion, a contrast of the European religions of the time. During the eighteenth century, the Anabaptists were often persecuted and hated because of their radical religious beliefs. Voltaire attacked this custom with his description of the kindness of an Anabaptist by the name of James. Candide found himself in Holland, a Christian country, with no food or work, so he asked one of the Protestant citizens for some bread. After Candide did not admit that the pope was the antichrist, the Protestant yelled at him, "You don't deserve to eat... go you scoundr...

Absorbent Mind essay Essay

Absorbent Mind Mind- â€Å"The human consciousness that originate in the brain & is manifested especially in thought, perception, emotion, will, memory & imagination. The collective conscious and unconscious process in a sentiment organism that directs & influence mental & physical behaviour.† Guideline by Navadisha Child’s aim:- Reproduction of adult or Self Construction In child development Physical characteristics always accompanied with psychological characteristics. One of these characteristics is ‘Absorbent mind’. Aim of first plane – Independence & Adaptation For Achieving aims Nature given a dynamic power to child in his first plane of development dynamic power-Absorbent Mind- Means – manner of absorption or absorb the idea of sequence or attitude towards the existance Purpose- 1 guiding for getting intelligence 2 help in creating behaviour by own (cause of not fixed) 3help in process of adaptation & self creation 1.Characteristics of absorbent mind:- (in first Plane i.e called fundamental creation in process of self construction Second embryonic life)) †¢ Universal †¢ Disappear at the age of 6 †¢ Works continuously even in sleeping †¢ Work tirelessly †¢ Can not withdraw or erase/convert/replace †¢ Instantaneous †¢ No capacity of discriminate & judgment/non selective †¢ Different form adult’s mind †¢ Adopt from purposeful environment – adaptation of language /movement/social behaviour/order †¢ Collecting raw food from environment †¢ Voluntary †¢ Not measurable †¢ No alteration †¢ Capturing everything †¢ No sequence †¢ Invisible †¢ Enthusiasm for absorption †¢ Permanent †¢ Propels by nature †¢ global Analogy:-sponge, camera, spotlight, photographic plate †¢ Difference between child’s mind & adult’s mind What derive these fundamental aspects:- 1. Link to love †¢ Born with love for environment †¢ Immerse himself with everything present there †¢ With open arms accepting the experience whatever is coming on their way †¢ Involvement with full of energy & enthusiasm †¢ Everything is wonder & glowing †¢ Inner urge( created by nature) in child force him towards work †¢ Inexhaustible work 2. conscious will arrived in 2.5yrs, nature reciedes 3. special kind of memory occurs I.e MNEME- unconscious memory 1. unique for 1st plane 2. Vital capacity 3. Limitless impulsive 4 power of retention (locked up for whole life) Absorbent mind is creative in nature which helps building the human characteristics without selection. Starts in the womb itself. Adaptation of environment:- Two phases |Birth to three |Three to six | |Unconscious phase |Conscious phase/conscious worker | |No will |Life begins again/ time of exploration –powers given by nature | |No intelligence |Will/intelligence takes place | |New child for new day |Capacity –choose/move/aware | |Creating unconsciously |concentration | |Certain adaptation in place- |integration(help in usage of capacities) | | |Exercise on real activities | Aspects of Adaptation (functions of absorbent mind):- |Acquisition of Movement |Acquisition of language |Acquisition of social behaviour | |Born with reflexible movement, Sucking , breathing,|Language creator |Emotions & emotional stablity | |rooting ,touching startled | |Safe & secure | |Voluntary movements-mind driven |Observe lip movements |Culture/intellectual | |Forms mental development |From sea of sounds-attracts towards human |Spritiual / time/ place | | |language | | |Focusing on human way of doing |tone |order | |Absorbs every movement present in environment/ base|Hearing/expressions /integration | | |is same | | | |Senses help in mental development |Absorb surrounding language | | |0-3 manner/ 3-6- decide to develop |Tool of gradually building language | | |Specific way of movement but base is same |3-6 – refine & use in own way |3-6 – incartion in conscious phase | Adult’s Role: Understand the role of absorbent mind in child’s development Help him to create great foundation in first stage of development 1. [pic]

Food Channels Culture in Pakistan

To make something palatable and delicious, all u need is some boneless chicken, some cheese, fresh cream and mushrooms, mix well and fry in plenty of olive oil. Serve in Italian crockery and garnish with French olives. Stay†¦Please doesn’t rush to the kitchen. I am only reminding you that this is the actual way of cooking, we hear these days. I am sure you all are well aware of the timings of your favorite and famous cooking shows. It is the time when every sister mother and possibly you too hang in front of TV set with a pen and note pad to note down the recipe of mouth watering dishes.By taking a U-turn from cultural Aloo Gosht, one might feel himself a part of this fashionable era. Food has always been a big part of the Pakistani culture, but with the current revolution in the means of media, the food industry in Pakistan seems to have exploded. Food is ubiquitous in Pakistan. Exclusive food channels are growing day by day which broadcast cooking shows throughout the d ay. Newspapers and magazines are filled with advertisements and recipes for food items.One might even get the impression that the Pakistanis live to eat, rather than the other way around. And yet, buried underneath this apparent feast of excesses, lies a shameful secret. Pakistan is the country where people are deprived of basic necessities of life; easy approach to food has become a misery. This is the time when the country has faced a catastrophic flood which has devastated 1/5th of the country and affected 20 million people. Food crisis are bigger then tsunami and millions of people have been starving.Still the motto of our cooking channels is â€Å"eat all; enjoy all†. The present state in which we survive, simplicity is the best policy. In the contrary the cooking channels promote extravagancy. Each program prepares three to six dishes at a time and also promotes the idea of starters and sweet dish along with the main meal. Separate meal for the children is out of questi on. By watching this, one may assume that the children are born to eat burgers, French fries, nuggets and drinks. The ingredients, used in cooking shows, compete the gold prices.Every meal starts with boneless chicken and ends up with the display of foreign crockery. The people, who can afford this, have their meals in five star restaurants or in the home, made by their cook. The rests stay desperate and heart broken. The channels claim that the way to win the goodwill of husband and in laws is through the kitchen. Obviously in a country like Pakistan nobody can deny the above statement but the question is what the husband would do when his wife will spend half of his month’s salary in her one day’s cooking experience.Ultimately the goodwill will convert to ill will. Our religion commands us to lead a simple life and Our Holy Prophet (Peace be upon him) is the best example of it. Hadith says that â€Å"Who ever adopts moderation can not be bankrupt†. In the curr ent scenario Pakistan can not afford such extravagancy. Cooking shows are not inadequate if they are really earnest in training women and society in simple and positive manner. Food is a basic human right and a necessity but eating food should not be a luxury.

Why Bloggers Should Care About Audience Fragmentation

Why Bloggers Should Care About Audience Fragmentation Media and audience fragmentation has been a source of worry for television and traditional media. There was a time when everyone in the nation sat down to watch the same shows at the same time. But now,  instead of a few television networks with a handful of programs that large swaths of the country would be watching together, there are now hundreds and hundreds of television channels and programs. And lets not forget that streaming services like Hulu or Netflix. The audience is now fragmented. Were not all on the same page, consuming the same content, understanding the same references. Theres more choice, and sub-groups are created based on their preferred choices. There is no longer one huge audience. There are many, many audiences.Audience fragmentation is generally heralded as a Bad Thing for traditional media. Is it bad for content marketing, too? Audience Fragmentation And Blogging When blogging started back in the mid-1990s, it was a bit like early television. There were a few blogs, and most tended to cover broad this is my life topics. There werent too many niche blogs (though there were a few). WordPress arrived on the scene in 2003, along with something else that changed the direction of blogging: AdSense. With the arrival of AdSense came the opportunity to make money through blogging instead of just using it to share an online journal.  By 2005, there were 32 million Americans reading blogs,  meta blogs (blogs that talked about blogging) were exploding in popularity, and people began to focus more keenly on how to make money blogging. By 2010, there were 152 million blogs. The ability to make money off of a blog necessarily led to niche blogs. After all, you could make more money through a tightly focused audience than a broad, general one with waxing and waning interest. Niche blogs, like cable networks and streaming video, led to fragmentation in blog readers.  Blog readers learned they could look for specific content that they had an interest in. Most werent reading general or personality-based blogs that didnt at least have an identifiable niche topic. Dont Panic About Audience Fragmentation Media analyst and blogger  David Brennan has a  less negative take  on audience fragmentation for traditional media. While Brennan acknowledges that there is no longer a few huge audience groups consuming the same media, he argues that fragmentation has allowed people who normally wouldnt watch television to start watching. Using two specific examples of people who might not have watched much television before, he concludes   that this particular audience has a passion which fragmentation-era broadcast TV can now satisfy; which has quietly resulted in significantly increased hours of viewing from the most unlikely audiences. In other words, audience fragmentation shattered the big generic audiences, but also brought in new media consumers who werent part of any audience at all. It helped  grow  media consumers.  Big general audiences tend to exclude the fringe audiences. Once fragmented, those fragments found each other, and the fringe audiences had a place to go. Instead of one way to reach one audience, there are now many ways to reach many audiences. If you wanted to, you could look at it as a sum zero game.

Case Study of diagnosis and treatment of Gout

Case Study of diagnosis and treatment of Gout A 50 year-old male presented for an evaluation of rapid onset of pain and swelling in his right toe. The patient reported that he had two similar previous episodes with the same symptoms lasting four to five days and was treated by emergency physicians. The patientà ¢Ã¢â€š ¬Ã¢â€ž ¢s past medical history is significant for hypertension and treated with Hydrochlorothiazide. The review of systems was negative for headache, fever, chills, rash, earache, sore throat, cough, rhinorrhea, vision changes, weight loss, or change in appetite or disposition. The patient was afebrile, and this blood pressure was slightly elevated. PHYSICAL EXAMINATION: General: The patient is a pleasant male who appears to be in no apparent distress. Vital Signs: blood pressure 123/48, heart rate 76, Temperature 38.3 and 98% on room air. HEENT: Extraocular muscles are intact. Pupils are equal, round, and reactive to light and accommodation. Neck: Supple. No jugular vein distention noted. No carotid bruits noted . Lungs: Clear to auscultation bilaterally. No wheezes, rubs or rhonchi. Heart: Regular rate and rhythm. Normal S1, S2. A 2/6 to 3/6 systolic ejection murmur at the right upper sternal border. PMI is nondisplaced. Abdomen: Notable for laparoscopy surgical wound. Positive bowel sounds. Extremities: MTP is red, hot and swollen. Neurologic: The patient is alert and oriented x3. No focal neurologic deficits noted. Pathophysiology Gout is an inflammatory disease characterized by the deposition of uric acid crystals in and around joints, subcutaneous tissues, and kidneys. Although men and women are equally affected by gout, men are six times more likely to have serum concentrations above 7 mg per dL. Gout typically occurs during middle age and is uncommon before the age 30 years old. Women rarely have gouty arthritis attacks before menopause 1. Clinical Presentation Gout attacks are usually associated with precipitated events. Patients usually present with rapid onset of severe pain, swel ling, redness, and warmth in one or tow joints. This pain and inflammation are caused by inflammatory response. Acute attack untreated attacks usually last two to 21 days depending on cases. There are four clinical stages of gout according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS). The first stage is known as asymptomatic hyperurecemia. During this stage, the patients can have an elevation of uric acid in the blood but they do not have any symptoms yet. After more and more urate deposits around a joint and if any trauma triggers the release of crystal into the joint space, patients will suffer acute attacks of gout. This second stage is known as acute gouty arthritis. The third stage, known as interval or intercritical gout, involves the interval between acute flare gout attacks with persist crystals in the joints. When crystals deposits continue to accumulate, patients are likely to develop chronically stiff and swollen joints. This stage is called chronic tophceous gout. Some permanent damage to affected joints and sometimes to kidneys can be seen. This advanced stage is relatively uncommon if patients receive proper treatment. Differential Diagnosis Gout in the elderly is often polyarticular and involves upper extremity joints (especially proximal interphalangeal joints and distal interphalangeal joints). Women present 70% of the time with polyarticular disease rather than the classic monoarticular arthritis seen in men. Gout can be mistaken for rheumatoid arthritis because tophi may resemble rheumatoid nodules and rheumatoid factors often become weakly positive as people age. It may be difficult to differentiate cellulitis or septic arthritis from gout, particularly when a fever, leukocytosis, redness, or desquamation is present. The term pseudogout, for calcium pyrophosphate deposition disease, belies the difficulty in clinically differentiating it from gout. For definitive diagnosis, joint fluid must be aspirate d for culture and a search for urate crystals.

Nobel memorial prize for economics 2009 elinor ostom Research Paper

Nobel memorial prize for economics 2009 elinor ostom - Research Paper Example In the context of the current global economic crisis that has been brought about due to a paradigm that celebrates unlimited growth and rampant misuse of the world’s resources, Ostrom’s work takes on a significance that goes beyond theory and if applied to the real world of ecosystems and how we can manage with the resources that have been bequeathed to us by nature, her work is indeed laudatory. Ostrom’s work is especially relevant when one considers the fact that our planet is in the throes of an ecological crisis due to climate change arising out of burning fossil fuels and that we as a species have used up most of the finite resources like oil, minerals etc. Hence, Ostrom’s pioneering work in the field of managing common pool resources can be said to be especially relevant for the times that we live in. To quote from a website that analyzed her work in the area of self governance and usage of common pool resources, â€Å"In general there are two main governance structures that are widely accepted in the literature; market or government oriented solutions. The eminent free-rider problem thwart social optimality when individuals do not coordinate their actions and cooperation cannot be accomplished internally. Ostrom argues against both of the external mechanisms and, through her extensive fieldwork, shows that self-governance is possible where communities develop their ruling systems to manage common pool resources. Her findings clearly indicate that rules imposed or dictated have little legitimacy and would be violated. On the contrary, when there is consensus on the governing principles or internal enforcement apparatuses people tend to obey them. This presentation aims to delve into more details of her criticisms of standard economic governance theories. Then, her contributions to collective decision making and her