Pathological gambling intervention Essay

When looking at pathological gambling we ask ourselves how someone gets to the point of addiction. In that regard there are both internal and external factors, beahior and environment related aspects leading to someone’s impulsive urge to gamble. Speaking of which, impulsivity can be a direct factor of a pathological gambler, Impulsive people are naturally more prone to gambling problems because of their nature and personality. That is not to say that all impulsive people will develop gambling habits or problems but they could if the right factors were in play at the right times. Inability to control impulses and also inability to delay gratification are two major impulsivity-related symptoms of pathological gamblers (McCormick & Taber, 1988). Other behavior factors include, coping strategies, high stress levels, family history, gender as males tend to be more prone to this affliction and â€Å"Pathological gamblers have been known to also exhibit antisocial behavior which is related to the impulse control disorder causing antisocial behavior such as exhibited in antisocial personality disorder† (Slutske et al. , 2001). The environment one grows up in Also plays a valuable role in understanding gambling. It’s a common misconception that pathological gamblers are only those that are near major casinos. That can be a tendency but in todays society technology has opened the door to universal in gambling before impossible. With computers and the internet people are now able to gamble straight from their homes on sports, online poker, etc. This boom in technology has allowed more people, from more places and economic statuses and younger ages be able to easily get involved in gambling. Our group even met a professional gambler who would have all of his bets placed on his computer before noon and then do nothing the rest of the day. Technology has extended the reach of gambling to social circles that before may have not been affected. Predisposing, Reinforcing, Enabling Factors Predisposing factors are what set someone up with the highest chances of being a pathological gambler. An addictive personality makes anyone more susceptible as well as having addictions or just gambling itself run in the family. A persons level of impulsivity is also a huge factor, an impulsive person is more likely to give into reckless decisions and follow the activities that give a rush sensation. Impulsive people have problems with delaying gratification making addictive and compulsive tendencies stand out. †Pathological gambling is a problem of impulse control. The more accessible gambling is, the harder it is to maintain the control. †(3) Predisposing factors can also be socioeconomic status, does one have the funds to feed the addiction, or did one one grow up in rough situations and use gambling as a crutch or coping strategy, the factors are vast and varying. Environment as brought up by the last quotation can also be a predisposing factor. Does one have access and how easily plays into an addiction. The closer one is to gambling the more likely they will partake. That used to entail how close someone was to casinos or legal areas of gambling and in many cases still does as more areas are becoming gambling friendly and more funerals pop up in for example, Oklahoma, Louisiana and Missouri, However with technology and the internet, access has become easier for all regardless, of location, sex, race, or economic status. With gambling there are different stages, stages that can reinforce the behavior because despite popular belief many gamblers are reinforced even when they don’t win. â€Å"WINNING PHASE Here the gambler is winning more than losing, has achieved a minimum of one big win. This early big win, bolsters the confidence of the gambler, causing ego to inflate, superior thinking and feeling over other participants. The gambler in this phase begins to spend more time gambling, is gambling for and with larger amounts of money. Winning streak begins to wane, losses start. LOSING PHASE In the losing phase, the gambler begins betting even larger amounts. The gambler accepts the fact that these losses are part of the game. The gambler bets on the long shots, knowing chances are not good for winning, however will pay big if win occurs. The gambler is now losing more than winning. In an attempt to gain back the money lost, the gambler spends more time gambling. Gambler must frequently lie to family, friends, employer, even casinos to convince them that the gambler is still a happy person and all around good person. Deep financial troubles begin. Using lying techniques, the gambler is able to convince employer, family, etc. , of some type of cataclysmic disaster, which requires a borrowing of large amounts of money. Soon the gambler is using this bailout to gamble more. The gambler life has now become unmanageable, family life is increasingly difficult, with deterioration occurring. DESPERATION PHASE During this phase, the majority of the gambler’s time is preoccupied with gambling on all levels. The gambler has no control over the gambling, to alleviate the inner pain, the gambler gambles, knowing the odds of wining are gone, and it does not matter. Lying is out of control. The gambler has one focus and one goal†¦get money in which to gamble with regardless of costs. Family life has deteriorated to the point of non-existence. Illegal activity is now a norm. †(paraphrased from Journal of Addictive Disorders) These phases help explain the reinforcement of pathological gambling along with more well known factor such as the adrenaline rush, the gamblers fallacy, instant gratification and payout. Enabling factors help keep a pathological gambler stuck in their ways and should be avoided as much as possible. Enabling factors can include dwelling on regrets, the focus of could’ve beens. (Pathological Gambling Resources) Looking for quick fixes for gambling addiction can also end up making the problem worse, pathological gambling is an illness that needs in depth treatment and support to be overcome, not a quickfix as those never entail the lifestyle change necessary to change an addicts life. Excluding those afflicted from normal activities or interactions as punishment or a means to help is also a counter intuitive strategy, Addicts need love and support and pushing them away may only compound upon the problem. Furthermore â€Å"Enabling is when you do anything that helps the gambler to continue with his addiction. For example, if you pay his bills for him, lend or give him money, you become an enabler. If you lie to help him cover his lies, you are an enabler. Or if you offer ultimatums in order to control his behavior, you are an enabler. Even if you in any way, directly or indirectly, make it easier for him to continue with his compulsive gambling, you are an enabler. †(Nguyen) Just like an accomplice is guilty in a murder an enabler is guilty through association. Although these may relieve the problem temporarily in some situations, it is always adding to the problem and hurting the addict. Goals And Objectives Our goals are a little more long-term related and the objectives are more specific short term goals. We are focusing more on educational endeavors for the families and friends of the afflicted as this builds the supportive environment necessary to truly help pathological gamblers. Our goals will focus on creating an increase in awareness in the Austin area of pathological gambling, it’s causes and effects, on individuals as well as the community as a whole. We want to create larger supportive environment in the community through the families and friends of the afflicted primarily through educational and awareness increase regimes. As well as provide increase in overall education on the matter for the community, even those not directly affected. As previously mnetioned these goals are broad and wide reaching. Our objectives however are more specific. We want to introduce educational, communication and family based interventions for the increase in awareness of pathological gambling. We will also work with the community and families to ensure interventions are done correctly and effectively fulfilling the needs of the afflicted and their loved ones. Finally but not least in importance we want to gain access to funding and support that will help establish effective educational based, wide reaching and successful intervention programs and learning processes.

The professional teacher in classroom, school, and society

Introduction:By the 1970s, large authoritiess were criticized about interfering the function of markets and the ability of the persons to run their ain personal businesss. Managerialism and marketization of the public services was the chief impression of ‘new public direction ‘ . In order to better the efficiency and effectivity in the populace sector, different schemes such as internal audit and quality confidence have been introduced. ( Aucoin, 1990 ) As instruction is one of the cardinal public services in Hong Kong, it can non hedge from the tidal force of marketization. The reform is related to the transportation of duty from the authorities to the school. In other words, there is a alteration in the nature of the authorities engagement with a position to going more competitory and providing for the demands in the market, and the ever-changing universe. Efficiency, answerability, quality and efficient usage of resources have become the ‘yardstick ‘ in mea suring the public presentation by society, authorities and schools. Those standards have made a great impact on instruction at all degrees. Policy of Decentralization in Schools: In an effort to advance ‘quality instruction ‘ in schools, Hong Kong authorities introduced the thought of a school-based direction theoretical account with a position to conveying about decentalisation. This policy based on an premise: when a market mechanism is in topographic point in the instruction system, s chools will go antiphonal and accountable to the populace, and therefore will choose for better-quality public presentation. ( Brown, 1995 ) Decentralization allows schools flexibleness to apportion resources. Marketization enhances the power of parents as they provide the demands. Diversity of school was decreased and hence the competition between schools is violent. The functions of instructors and pupils have to alter harmonizing to the above-named factors. Fig. 1 Marketization theoretical account ( Modified from Ball )Parental pick:Parental pick is one of the cardinal influences of the educational market. Restructuring instruction by the authorization of parents and pupils through picks in instruction is the cardinal thought under acceptance of a market-oriented attack. In Hong Kong, most of the parents are fond of English Medium Secondary Schools because they believe in the myths of better educational services inside them. ( Band1c†Ya ®Ã‚ ¶e†¢Ã‚ ·a„†ºa‚?c µÃ‚ ±e†¹Ã‚ ±a? ­ , 2010 ) Presently, instruction is considered as a sort of commercial merchandise instead than larning to larn. The whole schooling system can be regarded as a trade good market controlled by civilization of quality. Furthermore, schools are the mills for â€Å" value-addedness † while the pupils ‘ acquisition results are the trade goods within the market. Parents are the goaded force and exert great force per unit areas to school in order to bring forth better reactivity and academic effectivity. ( e ¶Sa ¤se†¹Ã‚ ±?-†¡c? ­ e ¶Sa?-a ®Ã‚ ¶e†¢Ã‚ ·e § , 2008 )Diverseness:In the aftermath of the economic restructuring of Hong Kong into a service economic system, there was a great alteration of the prevocational and secondary proficient schools in 2000. Education and Manpower Bureau revamped and enriched the proficient course of study by stressing more on concern and technological facets every bit good as linguistic communications. ( Education Department, 1997 ) The differences between secondary proficient schools and mainstream secondary schools became bleary. Furthermore, inclusive instruction is introduced and implemented. Students with particular educational demands ( SEN pupil ) are encouraged to have instruction in ordinary schools every bit far as possible. This policy increases the learning diverseness of pupils inside chief watercourse schools. This follows with increasing of demands of resources and teacher re-training. In world, nevertheless, there is unequal support and resources. Under inclusive instruction system, schools can merely have $ 10,000 subsidies for every SEN pupil. Compared with the original system, schools can enroll one instructor and learning aid for every 15 SEN pupils. ( ez?a†¢Ã¢â€ž ¢e‚?eaS?a? §a ¤sca °Ã¢â‚¬Ëœ , 2005 ) Merely 6 % of instructors agree with adequate support under the bing system. ( Education Convergence, 2002 ) In the past 15 old ages, the diverseness of school is reduced due to revamping secondary proficient schools and inclusive instruction. More and more schools became mainstream schools. Normally, those schools focus on academic facets instead than developing pupil ‘s possible since academic accomplishment of pupils is an of import public presentation index under cognition base society. Students ‘ endowments are ever buried.Competition:Under marketization, competition becomes much more serious than earlier. From the fact that the figure of pupils entry to secondary one lessening dramatically ( a? ­a ­?aae ·?a?†¦e ©sa , 2010 ) , schools which did non get adequate figure of pupils might be closed by the authorities. In order to hedge from this procedure, different schools principals utilizing different schemes to pull pupils to analyze their school. The schemes including give different subsidy or even hard currency to the new pupils. Harmonizing to the research ( e ¦Ã¢â€ž ¢Ã¢â‚¬ ¢Ã¢â€ž ¢e‚?a °Ã‚ ­aaâ€Å"?a?†Ã¢â‚¬ ¢Ã¢â€ž ¢a? «a ·?aeY? , 2010 ) , some instructors were forced to advance the school. The promotional activities including be aftering different activities, some even serve as salesmen on the street to advance the school. We believed that these should non be the responsibilities of instructors. The direct result is teacher can non pass equal clip on the lesson planning or fixing resource for pupils. This implies that learning quality in footings of pupil larning result may deteriorate due to the deficit of readying. Second consider competition between pupils. Hong Kong is a cognition based society. Under the construct of marketization, educational success implies competiveness, which farther elaborates to money and high socio-economical degree. We argued that the ultimate end of instruction should non be served as a tool to mount up to higher socio-economical degree. If marketization continues, the purposes of instruction would go training pupils to accomplish academic success merely and in uniformity. We argued there would be two possible result of this uniformity. The first result is we would lose out value instruction. Previously school non merely concentrate on academic country, but besides the whole individual development of pupils. Teacher can hold flexibleness to learn different country of cognition, but non constrained to the examinational stuffs. But under marketization, we focus on the acquisition result and competiveness between pupils instead than value. It seems that the value instr uction is no longer of import in the modern society. Therefore we argued this may be one of the accounts of the happening of different societal issues. The 2nd possible result of uniformity is the changing of features of pupils. After marketization, we focus more on competition every bit good as public scrutiny. Therefore different accomplishments such as communicating or coaction may be omitted in the course of study. From the illustration of the maestro alumnus in Chinese university, this indicated that our current educational system maintain preparation pupils in this mode. ( a? ­a ¤Ã‚ §c? ©a? «200? ¬?e ¦Ã¢â‚¬ ¹a ·?a ¤Ã‚ ±?†¢- , 2011 ) This in bend pupils can merely execute good in the test merely, but can non use the cognition in the existent state of affairs or utilizing different accomplishments to work out jobs.The effects of the reform of educational system on instructors:In fact, the work load of instructors was really high before the reform of educational system. Teachers have more than 30 periods per hebdomad and it was one of the highest Numberss around the universe ( Cheng, 2004 ) . Furthermore, the figure of pupils per category normally is really high and it is about 40 per category. It may to a great extent increase the work load of instructors. Under the reform of the educational system, the work load of instructors is farther increased. In the yesteryear, the instructors could still manage their work. It was because of the standardised course of study, lower in-class diverseness of pupils and the comparatively teacher-centered instruction manner. However, under the reform of the educational system, the stria of pupils was changed from 5-band system to 3-band system. In other words, the intra-school diverseness of pupils became much higher. This may ensue in the dramatic addition in the trouble and cost of learning and direction of schools. Ultimately, instructors have to pay more attempt to cover with the jobs in learning, conselling and resources allotment. As the diverseness of pupil additions, the original high quality schools and pupils become second-rate since the resources have to be shifted to cover with the jobs of less able pupils. As mentioned antecedently, inclusive instruction is one of the of import policies under the reform of the educational system. It aims to include some SEN pupils into the normal categories so that SEN pupils can accept the legitimate instruction. This may increase the intra-school diverseness of pupils and the operating cost of schools. Besides, excess back uping resources should be needed. However, a batch of schools do n't run into the standards to suit the SEN pupils and are forced to make so. Under the state of affairs of high work load and ‘big category ‘ , instructors really have non adequate clip and energy to take attention of the SEN pupils. As a consequence, the SEN pupils finally get no benefit. The reform of educational system involves the alteration in the instruction schemes and the usage of the instruction tools. In order to do the instruction more effectual, instructors have to take a batch of preparation classs about the alteration of the course of study, the application of information engineering and etc. Besides, some instructors have to complete the graduate student sheepskin of instruction. Teachers have to pay excess clip and energy on their surveies. In add-on to the work load and day-to-day responsibilities in school, instructors may experience collapsed. As a consequence, the success of the reform of educational system may be hard to be achieved since instructors really have no clip and energy to take attention of the diverseness of the ability of pupils and aid pupils ‘ growing.Decision:In decision, marketization have its ain advantages such as bettering efficiency of acquisition and instruction in footings of larning result. Nevertheless, the purposes o f instruction and value instruction are neglected in the current marketized educational system. We believed that the disadvantages overwhelm the advantages and this is non a good pattern to our following coevals. Entire words: 1675

Narayan's argument is stronger and more valid than Rushdie's Essay

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'The displacement of poetry by the novel suggests that the novel more Essay

'The displacement of poetry by the novel suggests that the novel more successfully reflects the spirit of the age.' Do you agree Discuss, in relation to ONE po - Essay Example Poems today can mostly be heard in poetry readings; so few are its enthusiasts in bookstores. This is basically the question that this paper aims to answer. We begin by defining what a novel and a poem is (i.e. their form and structure) followed by a discussion on the Victorian Era which is agreed to be the period where the novel has displaced poetry. In this section, we will be delineating how this change was brought about. We then proceed to a discussion of one the more popular Victorian novel which is the Great Expectations and the major poems of Christina Rossetti. Then by contextually analyzing the works a decision on whether the novel reflects more successfully the spirit of the age will be arrived at. Borrowing Percy Lubbock’s definition, Dr. Agatha Taormina sets out the definition of the novel as â€Å"an imaginary work in prose of a considerable length, which presents as real certain characters living in a given environment and describes their attitudes, fate, and adventures†. It is a fiction in prose with over 50,000 words. (NVCC Onlie, 2007) Poetry is considered to be a form of art wherein language is creatively used for its aesthetic qualities. It uses particular forms and conventions to expand the literal meaning of the words and to invoke emotional or sensual responses. That is most words are chosen to denote an idea figuratively. This use of words often leads to ambiguity, symbolism, irony and other style which makes open to multiple interpretations. Although our general idea of a poem is that it is a rhyming and regularly metered composition, there are those forms such as Beowulf which makes use of rhythm and euphony. Poetry also uses devices such as assonance, alliteration and rhythm to achieve musical or incantatory effects. The structure is stanza-paragraph where each stanza may or may not have a defined meter length. Under

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Project Implementation Plan Essay Example for Free

Project Implementation Plan Essay In a project the communication level is a very important part from the beginning to the end of project close out and completion stage. This method in the plan is extremely necessary and it is a needed tool that helps assist the project team, the stakeholders, and the executive team of Enterprise. This tool is effective and it makes sure all members involved with the project is on the same level of understanding, it makes sure all involved stays updated on the project, knows what is going on in the project, and it helps keep the project information together. â€Å"One of the primary jobs of a project manager is to manage the trade-offs among time, cost, and performance† (Gray Larson, 2006, p. 103). A project manager must ensure that he keeps everybody inform about the latest development of the project; thereby gives sense of belonging to every member of the project team as well as the sponsor or customer. Within this project, the communication plan is the key element that is designed to help assist the project team, stakeholders, and the executive team aware of any progress, and to help keep up with the status of the progress in the process. The plan of communication design help keep all members of the project aware of the progress and the status of the project, it helps everyone stay informed and connected in the project, and it gives information regarding any matters of urgency that are crucial within the project progress. The purpose of this  communication plan is to make sure all key aspects and elements of the communication strategy are documented and implemented successfully in the project. The strategies implemented include: frequency, method of delivery, recipients, and owner. The frequency in this communication plan entails scheduled meetings and how often they are being scheduled, it explains the project progress and all important information needed to help assist with the project deliverables which helps keep all the members aware of everything needed to meet the objectives of the project while keeping everyone on the same level of understanding. The team will have meeting on the status and progress of the project deliverables scheduled throughout the project as needed. Method of delivery is the avenue in which the reports or minutes of all the meetings will be disseminating to all the participants. The method adopts for the purpose of this project is through email, in person, and paper copy. The recipients in this project are project team, enterprise executive and potential stakeholders in the project outcomes. These are the people that directly are involved in carrying out activities in this project. The format is in regards to the style adopted to see the communication being effective as the project progresses. These are important elements needed to help achieve the project objectives and deliverables which keep all members connected, informed, and constantly communicating. The training, development, and overall retention and selection practices helps manage challenges (McNamara, 2011). The channel of communication for the purpose of this project will be formal in nature. No informal meeting will be allow or reckon with, all information must be well documented with proper references. Verbal and written communication is needed in as much it does oblige with the communication plan designed for this project. It is essential to the elements of the project success that all stakeholders involved have to follow the rules as contains in this communication plan because this will help track any issues as regards the scope, schedule and cost of this project. The project manager is in charge of clarifying any elements in this communication plan, and all concerns need to be addressed to the project manager. PROGRESS MEETING AGENDA Introduction Review meeting times Project progress update Contingency modification Request for information Scope performance Budget performance Project Schedule Owner items Next meeting date PROGRESS MEETING AGENDA Meeting agenda are guidelines that help modify and keep focuses of the issues to be discussed. The elements are tools that write down everything that needs to be achieved after a meeting. In the case of this project, many items have been identified and pencil down for this purpose of this meeting. They are introduction, review of last meeting minutes, project progress update, contingency modification, request for information, contractor update about scope performance, budget performance, and project schedule, also identified are owner items, and next meeting date. Introduction gives every participant in the meeting the ability to tell people who they are, what they are doing and their contribution or job function as related to the on-going project. This process brings everyone together on the same page and it helps members get to know one another and form an effective working relationship. Review last meeting minutes is an important element in this process that explains all the activ ities of previous meeting if there is any out loud so that everyone clearly hears and knows what is going on in the project. This allows all members to know what has been said, what needs to be done, and it helps to go over everything about the agenda of the day. Progress update is the most important aspect of this process. All the major stake holders furnish the house with comprehensive update of what happen to the project since last meeting. This must cover the areas of what was identified in the previous progress meeting as well which helps keep all members of the project on the same level of understanding what has happened, is happening, and will happen in the next meeting. Contingency modification is when things happen unexpectedly during the activities of the project needs to cater for. This should bring attention to the house if there is any  contingency or not, and if there is any, what is the solution put in place to address this contingency. Request for information is where information that needs immediate attention of project team is discussed. The information here could be result of specifics action that was previously talked about in the past meetings. Contractor update is when the contractor gives detail reports of the project or major portion of the project to the sponsor or customer. The parameter that the report of contractor will focus on must include project scope performance, project budget performance and project schedule. Owner items explain what the owner has observed within the project. He or she explains whether or not the project is going as scheduled? Is the project still running within the budget and are specifications being met? This is a means that the owner talks extensively about what he or she has observed and what changes he or she wants to see before the next meeting. Next meeting date is where the current meeting is adjourned and the next progress meeting date is announce to everybody. The date, the time and the venue of the meeting will be known to everybody. The next meeting helps prepare all members for the future meetings and the aspects of these meetings that are important and essential to the success of the project. PROJECT CHARTER PURPOSE The project charter defines the scope, objectives, and overall approach for the work to be completed. It is a critical element for initiating, planning, executing, controlling, and assessing the project. It should be the single point of reference on the project for project goals and objectives, scope, organization, estimates, work plan, and budget. In addition, it serves as a contract between the Project Team and the Project Sponsors, stating what will be delivered according to the budget, time constraints, risks, resources, and standards agreed upon for the project.

Neuroimaging Research To The Understanding Of Psychopathology Psychology Essay

Neuroimaging Research To The Understanding Of Psychopathology Psychology Essay Over the last ten years, neuroimaging techniques has been employed to an ever increasing extent in the investigation of the biological substrates of psychopathology (Malhi and Lagopoulos 2008). Non-invasive brain imaging techniques such as PET and fMRI have been successfully applied in the localization of sensory functions (van Eijsden et al. 2009). For more complex psychological processes such as language, fMRI is now used to guide surgical decisions regarding hemispheric dominance in patients with refractory epilepsy (van Eijsden et al. 2009). Although still in its infancy (Crowe and Blair 2008), neuroimagings existing contribution has been hailed as significant (Linden 2008, Radaelli et al. 2008). Reliable biomarkers are not known for most, if not all psychiatric disorders (Linden 2008). Limited knowledge concerning the aetiological mechanisms underlying disorders thwart efforts at primary prevention and hamper secondary prevention due to the lack of reliable, comprehensive prognostic markers (Glahn et al. 2008). The lack of pathognomic neural markers, difficulties achieving clinical consensus regarding diagnostic definitions and symptom heterogeneity within the existing diagnostic entities have encouraged neuroimagings pursuit of biomarkers and endophenotypes (Malhi and Lagopoulos 2008); (Pan et al. 2009). The research agenda for DSM V underscores this theme working towards an aetiological and pathophysiological based diagnostic system rather than the current symptom and syndrome based approach (Pan et al. 2009). Neuroimagings contribution may be through refining, validating and augmenting existing diagnostic classifications or replacement of the existing phenomenologically d erived system with neuroanatomically defined biomarkers (Malhi and Lagopoulos 2008). Neuroimagings contribution may be constrained by limited knowledge regarding interregional connectivity and interactions within the brain (Honey et al. 2002). Furthermore, the pathways by which genetic and environmental risk factors interact and impinge upon behaviour ultimately manifesting as pathological symptoms is largely unknown (Glahn et al. 2008). Complexity is increased further by consideration of the points of discontinuity between psychopathology and normal variation (Glahn et al. 2008). To date, the majority of neuroimaging research has attempted to correlate functional, structural and chemical abnormalities of the brain with the presence and/or severity of symptoms (Radaelli et al. 2008). Critics argue that neuroimaging research encourages a segregationist approach to psychopathology, attempting to map complex functions onto discrete, localized brain areas (Honey et al. 2002). This tendency has been influenced by assumptions within cognitive psychology (van Eijsden et al. 2009), namely that mental functions are comprised of modules with identifiable, specific cognitive content processed by a computer like brain (van Eijsden et al. 2009). Thus, elements of psychological function are assumed to activate specific, reproducible brain regions, a model known as massive modularity(van Eijsden et al. 2009). Traditionally, neuroimaging techniques have been categorized according to their data acquisition methodology, focusing upon structure, function, connectivity, electrophysiology or underlying chemistry (Pine 2006). Recent advancements in multimodal imaging (MMI) enables an admixture of approaches attempting to integrate the strengths of different techniques (Malhi and Lagopoulos 2008). Rather than detecting actual neural transmission, fMRI relies on the paramagnetic properties of deoxyhaemoglobin, providing an indirect measurement of the coupling between neural activity and blood flow (Malhi and Lagopoulos 2008). Similarly, PET is an indirect measurement of neural activity measuring blood flow, metabolism or ligand-receptor interactions of particular neurotransmitters (Zimmer 2009). Compared with SPECT, PET offers increased spatial and temporal resolution and permits imaging of a greater range of brain activity than SPECT tracers (Malhi and Lagopoulos 2008). However, it does not offer equivalent spatial resolution to fMRI. DTI tractography images neural tract trajectories, enabling the modelling of white matter fibres localization, orientation, connectivity and integrity within the brain (Malhi and Lagopoulos 2008); (Honey et al. 2002); (Thai et al. 2009). Neuroimaging research can adopt either a whole brain or region of interest (ROI) approach (Malhi and Lagopoulos 2008) with important implications for interpretation. As ROI approaches examine fewer brain regions than whole brain univariate approaches such as VBM, they offer increased statistical power with a concomitant decrease in explanatory power (Ecker et al. 2010). In contrast, techniques such as VBM offer increased explanatory and moderate statistical power due to the necessity of multiple comparison corrections. Therefore, mass univariate approaches may be too conservative to detect subtle neuroanatomical abnormalities particularly with small samples (Ecker et al. 2010). Additionally, neuroimaging studies can be contrasted in terms of experimental design ranging from block, factorial to the most recently developed event-related designs. Event-related designs permit randomization of experimental conditions throughout scanning (Honey et al. 2002), allowing the response to a sing le event to be examined in a context-independent manner (Friston et al. 1998). This paper will evaluate the possible applications of neuroimaging research to the understanding of psychopathology in terms of its existing contribution and developments which may arise due to further technological innovations in the future. Initially, it will provide a brief introduction to a number of methodological considerations associated with neuroimaging research. Following this discussion, it will primarily focus upon neuroimagings contribution to aetiological research of psychopathology. In addition, it will evaluate the application of neuroimaging techniques to diagnosis, prognostic considerations and treatment. The paper will conclude with a review of recent technological developments within neuroimaging and evaluate the extent to which these innovations may further increase neuroimagings application to the understanding of psychopathology. Methodological and Technological considerations Critiques of neuroimaging research as The New Phrenology in its attempts to locate complex psychological phenomena in discrete brain regions have been described as the localization fallacy. The complexity of conducting research with patient groups and interpretation of associated results is emphasised when patient characteristics are considered (Honey et al. 2002). Psychiatric conditions are heterogenous in their presentation and difficult to define as discrete and homogenous entities. This increases the difficulty in obtaining a clinically homogenous sample for research purposes. Disorder and symptom heterogeneity manifesting as inconsistent neuroimaging findings may be a result of different aetiological pathways, variability in compensatory processes, chronicity of illness or the patients unique symptom profile (Honey et al. 2002). These inherent difficulties have been demonstrated by conflicting findings of hypofrontality in Schizophrenia (Keshavan et al. 2008) and led to the foll owing conclusion as long as we are not able to disentangle the heterogeneity question at the clinical level, it is not likely that heterogeneity at the aetiological and pathophysiological levels can be resolved (Peralta and Cuesta 2000). If a well matched sample is obtained, their symptomatic profile may be a manifestation of the final common pathway of disorder rather than representing a group matched for common aetiological mechanisms (Honey et al. 2002). To counteract these issues, many neuroimaging studies have adopted a symptom level approach, for example exclusively examining AVH (Honey et al. 2002). Critics have argued that symptom provocation studies may be imaging interference processes, compensation for diminished performance or other co-occuring symptoms (Honey et al. 2002). If the assumption that symptoms occur in isolation is correct, their location within discrete brain regions may over overly simplistic, it is more likely they are an element of complex, dynamic neural activity (Honey et al. 2002). The phenomenon of pure insertion asserts that a phenomenon of interest can be identified or manipulated in isolation from other mental processes (Honey et al. 2002). For example, linear increases in cognitive load (task demand) may not be associated with linear increases in neural activity. Furthermore, is it conceivable that ruminations in OCD can be isolated from other processes such as memory, attention and speech? (Honey et al. 2002). The subtraction technique is the most commonly employed method to identify brain areas that are active relative to one another; therefore, experimental task pairs should only differ in terms of one parameter. This is based on the assumption that by changing one parameter, that only one aspect of processing is altered (Nair 2005). Neuroimaging results may thus be misinterpreted as the cause of disorder or the disorder itself (Fuchs 2006). Thus, there are a number of important issues to consider when interpreting neuroimaging results such as whether differences reflect a symptom profile, a diagnostic entity and whether differences within these groups relate to state related phenomena or underlying aetiological differences at the genotype level (Honey et al. 2002). These ambiguities have led some researchers to question neuroimagings utility to aetiological research advocating a focus upon diagnostic imaging (Honey et al. 2002). Recent shifts towards a focus upon systems level, dynamic connectivity within the brain appears to be counteracting neuroimagings characterisation as the new phrenology (Zhou et al. 2009). The complexity of neuronal function has important implications for the analysis and interpretation of neuroimaging results. It is necessary to quantify both the relationship between neuronal activity and indirect measures of it via the haemodynamic responses and the associated temporal delay (Honey et al. 2002). It has been shown that BOLD signals are more responsive to increases rather than decreases in blood flow, known as the haemodynamic rectification effect (Keri and Gulyas 2003). These matters become increasingly complex when the contribution of neurotransmitter release and reuptake, receptor binding and electrical activity to rCBF, metabolic changes and behaviour are considered (Keri and Gulyas 2003). For example, low levels of neuronal activity may not be accompanied by rCBF changes, in a PET experiment, the lack of activation in this area does not exclude the area from being involved in the response under examination (Keri and Gulyas 2003). In contrast to sustained stimulati on, rapid changes in the brains functional state result in a brief uncoupling of perfusion from oxidative metabolism (Keri and Gulyas 2003). Imaging procedures must also model the effect of major blood vessels draining activated brain regions (Honey et al. 2002). Existing technology does not offer equivalent spatial resolution across the whole brain, there are also inherent difficulties differentiating between excitatory and inhibitory activation when using the proxy of the haemodynamic response (Honey et al. 2002). The complexity is further increased when the impact of experimental design is considered. fMRI images particularly those based on block designs frequently are static representations of haemodynamic activity averaged over time (Nair 2005). Furthermore, activity in some regions may only be detectable with more sophisticated event-related rather than block designs (Fusar-Poli et al. 2007). However, it has been shown that even in event-related fMRI paradigms that short inter stimulus intervals result in an overlap of haemodynamic responses to individual events (Ecker et al. 2008), thereby precluding confident analysis of condition specific activity. It has also been demonstrated that path co-efficients within SEM fMRI reflect changes in the temporal characteristics of the HFR induced by experimental design (Ecker et al. 2008) emphasising the effect of experimental design on effective connectivity studies. Recent developments In recent years there has been increased interest in furthering understanding of interactions between brain regions known as connectivity analysis (Sato et al. 2009b). Functional connectivity refers to the dynamic relationships between brain regions typically based upon correlational analyses (Thai et al. 2009). Effective connectivity studies infer causal or modulatory relationships between brain regions or networks and their directional, temporal interactions (Thai et al. 2009). SEM and DCM are the most commonly employed methods to investigate connectivity within fMRI data (Sato et al. 2009b). In SEM, the strength of an interaction is provided by a path co-efficient measuring the average influence of one ROI on another in a specified time period (Ecker et al. 2008). For example, using effective connectivity, it was demonstrated that the sACC and pACC had a strong directional influence on the right amygdale during an emotional processing task (Zhou et al. 2009). Rather than occurring as functionally distinct, feedforward sequential processing stages, it was shown that mental rotation performance includes both feedforward and feedback connections with indirect evidence of parallel processing (Ecker et al. 2008). Machine learning and pattern recognition methodologies, such as SVM are powerful techniques for the classification and prediction of mental states so called brain reading or decoding (Sato et al. 2009a); (Sato et al. 2009a). SVMs are used to identify statistical properties of imaging data which discriminate between groups of participants or brain states (Sato et al. 2009b), essentially, whether a new observation belongs to a training data set or otherwise. Not only do they offer the potential to categorize, their ability to anatomically localize discriminative information generated by the classification process presents the possibility of brain mapping (Sato et al. 2009a). Potentially, this methodology could be used to describe a healthy population, measuring the distance of subsequently tested participants from normative fMRI data (Sato et al. 2009b). For example, SVMs ability to distinguish between visual and auditory stimulation was 95.34% +/- 18.77 (Sato et al. 2009a). ANN and SV M based tools have employed in the identification and classification of pathology of patients with Alzheimers or Parkinsons disease from control participants (Bose et al. 2008). The development of imaging genetics offers the possibility of mapping the biological pathways and mechanisms whereby individual differences in brain function emerge and potentially predispose individuals to risk of psychological dysfunction (Viding et al. 2006). It enables the evaluation of the functional impact of brain relevant genetic polymorphisms with a view to understanding their impact on behaviour (Viding et al. 2006). For example, studies of healthy adult 5-HTTLPR S allele carriers found increased amygdala activation, reduced grey matter volume of the perigenual ACC and amygdale and altered functional connectivity of the pACC and amygdale relative to the LL genotype. Furthermore, 30% of variance in behavioural harm avoidance scores during this fMRI challenge paradigm was predicted by amygdala pACC functional connectivity (Viding et al. 2006). Aetiology Significant ambiguity remains surrounding the pathogenesis of schizophrenia (Keshavan et al. 2008). Although the majority of psychological disorders are thought to be multifactorial in origin (Glahn et al. 2008), genetic factors appear to exert a significant aetiological influence on the major psychoses, twin studies estimating heritability at 80% (van Os and Kapur 2009). Structural MRI studies have revealed reductions in whole brain and grey matter volume as well as increases in ventricular volume (Keshavan et al. 2008; van Os and Kapur 2009). Reductions have been observed in temporal lobe structures (in particular the hippocampus, amygdala and the superior temporal gyrus) and the prefrontal cortex, thalamus, AC and corpus callosum. There is evidence of a relationship between superior temporal gyrus volume and positive symptoms; medial temporal lobe reductions correlating with memory impairment. Qualitatively similar but less marked structural changes have been observed in the affec tive disorders. Whilst structural abnormalities may be consistently found in Schizophrenia, they are diagnostically non-specific and may be common amongst patients across diagnostic classifications. Evidence of progressive brain changes during the course of schizophrenia suggests that structural abnormalities may be a result of early and later developmental dysfunction (Karlsgodt et al. 2008). The onset of frank symptoms has been associated with progressive changes. Using longitudinal research designs, deviations from normative development can be examined (Serene et al. 2007). For example, longitudinal studies of early onset schizophrenia demonstrated progressive grey matter loss across the lateral surface of the brain, with treatment refractory patients displaying the most pronounced and rapid cortical grey matter loss. However, the explanatory power of progressive brain structural changes as the primary pathophysiological process within schizophrenia is diminished due to the prese nce of potentially confounding factors secondary to the illness such as symptom profile, severity, medication history and status and the duration of illness (Karlsgodt et al. 2008). Furthermore, structural changes are generally subtle and of relatively small effect sizes (Keshavan et al. 2008). Inconsistency has mired findings of hypofrontality in Schizophrenia, functional imaging meta-analysis have calculated moderate effect sizes for activated and resting state conditions. Conversely, once performance differences are controlled for, patients have shown increased prefrontal activation relative to controls perhaps indicative of an inefficient frontal response to task demands. There have been similarly inconsistent findings regarding other brain regions. Functional imaging research has found alterations in prefrontal and occasionally temporal lobe function (Shergill et al. 2007), with speculation regarding a specific abnormality in the reciprocal modulatory interaction of frontal areas and the hippocampus (van Os and Kapur 2009). Hyper- and hypoactive network responses have been demonstrated depending on experimental paradigm (van Os and Kapur 2009). Inconsistencies in the functional imaging literature may be a result of the diverse experimental designs employed, non-uniform standardization of resting state conditions, lack of control for performance differences, typically small sample sizes and medication confounds which curtail the interpretability of these results (Keshavan et al. 2008). MRS studies have corroborated regions implicated by structural and functional imaging results demonstrating reductions in neuronal and membrane integrity in at risk and early schizophrenic groups. However, it can be concluded that many of schizophrenias putative biomarkers are of less than robust effect sizes, non-specific and too time consuming or expensive to consider implementing as potential diagnostic biomarkers (Keshavan et al. 2008). It is proving difficult if not impossible to explain the features of this disorder and its associated functional deficits in terms of selective, focal abnormalities (Fusar-Poli et al. 2007). The disconnectivity hypothesis of the pathophysiological basis of vulnerability to psychosis implicates abnormal interaction/disconnectivity of the prefrontal cortex, temporal lobe and subcortical regions (Fusar-Poli et al. 2007). Findings of disturbed functional connectivity of the medial prefrontal, thalamic and cerebellar regions in relatives of patients with schizophrenia have provided support for this view (Fusar-Poli et al. 2007). Although evidence for disconnectivity in schizophrenia is strong, its relationship to aetiology, pathophysiology and implications for symptomatic behaviour remain unclear (Stephan et al. 2009). AVH have been found to activate a wide network of language areas in the frontal and temporal lobes and limbic areas such as the amygdale and hippocampus (Vercammen et al. 2009). The subjective intensity of AVH has been correlated with activation of the primary auditory cortex. Schizophrenic patients who experience AVH have been found to activate differential brain areas relative to healthy controls and non-hallucinating patients with schizophrenia, displaying altered activation of the anterior cingulate and superior temporal regions bilaterally (Mechelli et al. 2007; Shergill et al. 2007). DTI studies have demonstrated differences in the orientation of white matter fibres relative to patients without AVH and healthy controls. Examining the effective connectivity of AVH using DCM demonstrated a specific impairment of functional integration between the left superior temporal cortex and the dorsal part of the ACC during the evaluation of self and alien generated speech in patients with AVH (Mechelli et al. 2007). This implies a relationship between impaired functional integration and AVH experiences, Mechelli et al, speculate that a similar impairment in effective connectivity may diminish patients ability to process their own inner speech. Furthermore, a whole brain DTI study illustrated that propensity to experience AVH was associated with increased fractional anisotrophy (FA) within lateral aspects of the superior longitudinal fasciculi bilaterally, the main connection area between Wernickes and Brocas areas (Shergill et al. 2007). Similar differences in FA have been reported in at risk and first episode patients. However, it is possible that these connectivity changes may be a result of experiencing AVH rather than being causative in nature. Increased frequency of AVH may enhance connectivity in these regions. Studies conducted during the prodromal phase permit the prospective investigation of the pathophysiological processes underlying vulnerability and development of the disorder (Fusar-Poli et al. 2009; Pantelis et al. 2003).Neuroimaging studies have demonstrated qualitatively similar abnormalities to those evident in established schizophrenia and bipolar to those present in first episode psychosis and individuals without psychosis but with a strong familial risk (Pantelis et al. 2003). At risk individuals who subsequently developed psychosis had smaller grey matter volumes in the right medial temporal region, including the hippocampus and parahippocampal cortex, in a right lateral temporal region encompassing the superior temporal gyrus, a right inferior frontal region including the orbital portion of the inferior frontal gyrus and adjacent parts of the insula and basal ganglia and a cingulate region including the anterior and posterior cingulate gyrus bilaterally which mimics findings in probands of MZ twin pairs discordant for schizophrenia, first degree relatives of patients with psychosis and people with schizotypal personality disorder. Longitudinal examination of patients who transitioned to psychosis, showed a significant bilateral reduction in grey matter volume between baseline and follow up in the cingulate gyri, the left parahippocampal gyrus, left fusiform gyrus and left OFC (Pantelis et al. 2003). This study demonstrated that pathophysiological anomalies predate the onset of overt psychosis but that further grey matter volume changes are associated with the first expression of frank symptoms. It is unclear however, whether these changes represent a cause or effect of psychosis. Pantelis et al conclude that MRI may in the future prove a valuable tool in the identification of ultra high risk individuals. Neurochemical PET and SPECT studies investigating the dopamine hypothesis of schizophrenia with 18 F-dopa and 11 C-raclopride have shown that schizophrenia in its acute psychotic state is associated with an increase in dopamine synthesis, dopamine release and resting state dopamine concentration (van Os and Kapur 2009). Research has also demonstrated pre-synaptic dopamine overactivity in schizophrenic patients and first episode patients (Fusar-Poli et al. 2009) Studies of prodromal patients have demonstrated elevated Striatal 18 F-dopa uptake with levels approaching those of Schizophrenic patients (Howes et al. 2009). 18 F-dopa uptake in the ARMS was directly correlated with symptom severity and the degree of neuropsychological impairment. The most pronounced dopaminergic abnormality was found in the associative subdivision of the striatum in both schizophrenic patients and individuals with an at risk mental state (Howes et al. 2009). Thus, it has been suggested that pre-synaptic striatal dopamine function may be a worthwhile target for novel drug development and that these findings may provide a neurophysiological rationale for the introduction of anti-dopaminergic preventative intervention in high risk individuals (Howes et al. 2009). Multimodal studies of a verbal fluency task during the ARMS demonstrated an association between altered prefrontal activation and striatal hyperdopimergia (Fusar-Poli et al. 2009). Controlling for performance differences, there was increased activation of the left inferior frontal gyrus and the right middle frontal gyrus suggesting reduced efficiency or a compensatory process to achieve a similar behavioural response as controls. Improvement in prodromal symptoms has been associated with a normalization of the exaggerated inferior frontal response during a verbal fluency task. Previous findings linking the degree of elevation of striatal hyperdopimergia with symptom severity suggest that striatal hyperdopaminergia may underlie both symptoms and neurocognitive dysfunction although it is possible that another pathway is responsible. The observed correlation may represent the effect of prefrontal cortex on striatal dopamine or vice versa. Crucially, this study demonstrates that abnormal ities which were heretofore regarded as key pathophysiological features of Schizophrenia are correlates of vulnerability rather than sufficient for development of the disorder (Fusar-Poli et al. 2009). Interpretation of ARMS findings is difficult due to uncertainty regarding the degree to which they reflect trait or state factors, that is, psychosis liability or prodromal symptoms (Fusar-Poli et al. 2007). Thus, neuroimaging findings indicate changes in gray matter structure indicative of connectivity deficits at the level of synaptic connections and neuropil allied with white matter changes indicative of large scale deficits in connections between cortical regions (Karlsgodt et al. 2008). Although several biological abnormalities have been replicated (abnormally large ventricles, abnormal dopamine concentration and altered P300) they are not sensitive enough (usually only seen in 40-50% of patients) or not specific enough (seen in only 30% of first degree relatives) to be of diagnostic influence (van Os and Kapur 2009). Anxiety Disorders Neuroimaging research of anxiety disorders have implicated brain areas involved in the stress response as being associated with anxiety symptoms, including the prefrontal cortex, hippocampus and amygdala (Engel et al. 2009). However, potential brain structures implicated in the pathophysiology of anxiety disorders are extremely difficult to image due to their sizes and locations these include the amydala, brainstem nuclei and periaquaductal gray (Engel et al. 2009). Neuroimaging of PTSD highlights many of the complexities involved in conducting this research. Complexities relate to symptom presentation in terms of their variable content and emotional arousal in particular during the retrieval of traumatic memories (Peres et al. 2008). Symptomatic heterogeneity is extremely difficult to control for, additional potential confounds include nature of the traumatic experience (s) and the length of time since its occurrence. It is questionable whether it is appropriate to generalize from i maging results based on a sample of war veterans to survivors of childhood abuse (Peres et al. 2008). However, the results of neuroimaging studies appear to offer support for two broad subtypes of PTSD, one being primarily dissociative, the other characterised by intrusions and hyperarousal (Malhi and Lagopoulos 2008). Structural studies have demonstrated reduced ACC and hippocampal volumes in studies across a variety of traumatic experiences. Increased amydala activation has also been observed (Crowe and Blair 2008). Impaired hippocampal function has been speculatively linked to the memory fragmentation process observed in PTSD (Peres et al. 2008). However consistent findings of structural or functional change, they do not necessarily imply a causative relationship. Depression Research investigating the pathophysiology of depression have highlighted decreased anterior paralimbic and cortical activity in both major and bipolar depression (Malhi and Lagopoulos 2008). These decreased activation patterns are found to reverse with successful treatment. For example, in studies of major depression it has been observed that diminished activation of the dorsalateral prefrontal cortex can be increased following effective treatment. PET studies of the serotonin transporter SERT have demonstrated increased thalamic SERT in depressed patients relative to controls. Across the affective disorders, findings of hyperamydala and hypofrontality have led to speculation that these abnormalities may represent a critical pathway or potential predictive biomarker for those at risk of future development of psychopathology (Viding et al. 2006). However, it remains unclear as to whether these findings represent state or trait related function. The search for trait related biomarkers offers the potential to uncover early warning signs of impending psychological disorder as they may be present prior to symptom onset (Malhi and Lagopoulos 2008). The clarification of state related changes affords the possibility of monitoring differential responses to treatment over time (Malhi and Lagopoulos 2008). Cautious interpretation of existing neuroimaging findings is advised due to the complexity of emotional networks and lack of understanding regarding their integration with higher cognitive processes (Malhi and Lagopoulos 2008). Diagnosis As of yet there are a limited number of neuroimaging studies attempting to classify or categorize disorder (Glahn et al. 2008). Ongoing research endeavours to uncover pathophysiological biomarkers complements the development of diagnostic imaging systems. The discovery of biomarkers of schizophrenia may assist in early diagnosis and haveprognostic value (Bose et al. 2008). Initial diagnostic research efforts focused on measurement of striatal D2 receptor levels. Although it appears that striatal D2 receptor levels are elevated in schizophrenia, inconsistent and variable PET and SPECT results (possibly related to samples tested) have precluded its use as a diagnostic variable (Bose et al. 2008). Machine learning and pattern recognition techniques provide methods for analysing imaging data that may improve the sensitivity and specificity of diagnosis (Bose et al. 2008). Using ANN modelling of striatal [18F] fluro-L-DOPA influx constants, it was found that an ANN model correctly classified 84% of schizophrenic patients and 74% of controls (Bose et al. 2008). Sensitivity analysis revealed that the posterior putamen and anterior caudate nucleus were the most important areas within the ANN classification. The addition of multiple risk facto rs to the ANN classifier such as neuropsychological, genetic or structural imaging results may improve the ANN classifiers accuracy further (Bose et al. 2008). Bose et al, 2008 suggest the potential util

Sleeping Disorders Essay -- essays research papers

Sleeping Disorders I am going to start by telling you what a sleeping disorder is. A sleeping disorder is a problem that affects something to do with sleep. Not all sleeping disorders have symptoms that are obvious to a person or their family and friends, here are some common sleep disorders. - Insomnia - Sleep Apnea - Narcolepsy - Restless Leg Syndrome - Parasomnia - Bruxism - Jet Lag - Shiftwork I will be discussing the sleeping disorders listed above and what symptoms they can cause. Insomnia is a chronic sleeping disorder in which it is very difficult to start and continue sleeping. One of the other symptoms of insomnia that is most recognized is waking up repeatedly in the middle of the night. Lack of sleep leads to two other things, daytime fatigue and restlessness. These are bad on the job and at school while doing tests or other important work. The amount of sleep that each person needs to feel alert during the day varies. If you have a night of sleep which is much less than the amount of sleep you need, then you will more than likely feel quite sleepy the next day. Thirty-three percent of adults in America have a case of insomnia at least once in their life. Most cases only last one or two nights, but insomnia can continue for weeks or possibly even months. There have only been three standard types of insomnia that have been identified by doctors. They are as follows: - Transient insomnia is considered a few sleepless nights that is usually brought on by stress, excitement, or environmental changes. A person could have trouble sleeping the evening before a big meeting or shortly after a breakup or a fight with his girlfriend. - Short-term insomnia is usually two or three weeks of poor sleep caused by continual stress at work or at home, as well as medical and psychiatric illnesses. Eliminating the source of the stress usually takes care of the irregular sleep patterns - Chronic insomnia is considered poor sleep that lasts two weeks or longer. It can possibly be related to medical, behavioral, or psychiatric problems. Usually poor sleep leads to decreased feelings of well-being. Chronic insomnia can usually recur. If difficulty sleeping was the only problem with i... ...h other sleep disorders, such as obstructive sleep apnea and sleep terrors. Sleep Eating The causes of sleep-related eating are many. Most of them arise from a background of more conventional sleepwalking. In some cases, the sleep-related eating was brought on by medications prescribed for depression or insomnia. It may be a display of other sleep disorders, such as obstructive sleep apnea or periodic limb movements. The "sleep-related eating disorder" has only recently been described. Common concerns about this disorder are excessive weight gain, choking while eating, potential injury from starting fires while cooking or cutting oneself while preparing food, and sleep disruption. Approximately two- thirds of those afflicted with this disorder are women and the symptoms typically begin in the late 20s. The overwhelming majority do not suffer from a waking eating disorder. Sleeping disorders can be very weird, I did not know that until I wrote this paper. I was not aware that people could eat in their sleep, I thought that only happened in TV I have learned a great deal from this paper and I hope you did also.

The Prince Essay -- Essays Papers

The Prince The Prince by Niccolo Machiavelli provides an analysis on how to govern and maintain power in a principality. In the first five chapters, he defines the three ways a monarch can acquire his dominion: either he inherits it, whether he creates a new one, or annexes territories, and further discusses how to govern them. Machiavelli states that hereditary principalities are less problematic than the mixed ones since newly acquired dominion tend to be more rebellious. The ruler must therefore colonize them and allow citizen to keep their laws or annihilate the governmental structure. In order to illustrate his point, he analyses the success of Alexander the Great conquest in Iran. He then considers five possible ways to acquire power and become a prince (Ch. VI-XI). First, a private citizen can become a ruler due to his own qualities or virtues, like Cyrus or Romulus. A second way to become a ruler is through other’s power or favor. Hence a man like Cesare Borgia gained power due to his father support, but lost it when the latter died. For Machiavelli, getting power so quickly can be dangerous since the new monarch might lack knowledge on how to govern. In the third case, he uses the example of Agathocles of Sicily to illustrate power gained through murders. In his opinion, the conqueror must decide if his crimes will help him establish power and then commit them all at once so that he can later reestablish the confidence of his subjects. The fourth method is called civil principality, people basically choose the ruler, and this enables him to maintain power. The last possibility is to be elected pope and Machiavelli provides a brief overview of the religious order. Next, he explores (Ch. XII- XIV) which arms are best to defend a principality and states that a ruler can chose to use â€Å"his own, or mercenaries, or auxiliaries or a mixture of all three.† From Chapter XV throughout Chapter XIX, Machiavelli proposes to describe how a prince should behave and tells the truth about surviving as a monarch, rather than recommending moral ideals. He describes the virtues commonly assimilated with a prince and concludes that some "virtues" will lead to a prince's destruction, whereas some "vices" will enable him to survive. He describes the advantages of being generous or greedy, merciful or severe, deceitful or honest. Machiavelli... ...d not suffer from bad consequences on the long run. On the other hand, the Exxon-Valdez oil-spill case is an example of deceptive PR. Indeed, not much was done for the Alaskan community and the corporation ended up being perceived in a very negative way by the general public. These two crisis communication cases show that people and mechanisms of power have things in common with Machiavelli’s times, but society has become less tolerant of evil strategies. Rulers or corporations still have the means to deceive, but people are no longer subject to an authority considered divine. Therefore, the ones who govern are exposed to feedback and can hardly avoid the consequences of their acts. A counter example, of course, would be the one of President Clinton as he voluntarily lied in court about his relation with Monica Lewinsky. He put on the face of virtue to deceive his citizens and in so doing manipulated the perception they had of him. In fact, Clinton’s communication specialists probably advised him to use this strategy, which follow the Machiavellian precepts. Although power might not exactly be the same anymore, principles on human natures are constant throughout time.

The Ethics of Microsoft’s Product Pricing Structure Essay -- Microsoft

The Ethics of Microsoft’s Product Pricing Structure Introduction Microsoft, currently one of the world’s biggest and most influential software companies, was found in 1975 by William Gates and Paul Allen.[1] It quickly positioned itself as a leader in the software community and due to the strength growth of its user base for the Windows operating system and numerous other products, it became both widely popular and widely hated. Many consumers love the suite of products that Microsoft offers because they are easy to use, are widely supported, and have many applications written specifically to for them. On the other hand, there are many who dislike Microsoft, claiming that their policies lead to an uncompetitive market and that their practices are unethical. In recent years many court cases, including a major anti-trust suit have been brought against Microsoft. This paper aims to focus on the issue of Microsoft’s product pricing structure and to discuss the issues that have arisen because of it. There are two different yet similar ethical issues surrounding Microsoft’s product pricing. Within the United States there has been growing concern that because Microsoft controls such a large portion of the market that they are using this to their advantage and to drive prices up. A number of cases have been brought to court and found Microsoft guilty of price fixing, causing them to refund money to consumers in states like California and Iowa. The ethical issue clearly surrounds Microsoft’s motives. Are they driving up prices and simply trying to make more money with no thought to the impact on the community, or are they trying to run a legitimate profit-based business that strives to keep make everyone happier and ... ...p://webspeedreader.com/Articles/Microsoft.htm?Default-04-20-2001> [10] AFP, Microsoft Still in Talks with EU for Possible Compromise, 15 March 2004, [11] InfoTech, Erwin Lemuel G. Oliva, Software Makers: Pricing Standard Worldwide, 2003, 15 March 2004, 14 Santa Clara University’s Markkula Center for Applied Ethics, 2003?, 10 February 2004, [12] University of Central Florida, Barbara Moore’s Slides, Antitrust and Industrial Policy, 2003?, 15 March 2004, [13] Russel Verney, Price Fixing in Plain Sight, 2001, 15 March 2004,

Western Civilization before the Thirty Year War

Roman Emperor, Father of Europe, or the Chief Bishop Larry Ray December 15, 2013 Charlemagne was one of the greatest European rulers of medieval times. He was both part warrior and part scholar. He was also know to many as Charles the Great or Just Charles in his inner circle. He lived from 747 to 814. Charlemagne was a Frank. Franks' were German tribes who controlled the area of northwestern Europe that is now western Germany and northern France.Not much is known about Charlemagne's childhood, however her grew up to be a very religious righteous man. He boasted with Christian spirit and it is with that spirit that he wanted to rule. He believed in education and in virtuous work. Even his own children would be tasked with menial work. Charlemagne was known for his â€Å"greatness of spirit† and steadfast determination. L His autobiographer, Inward wrote many times of the fact that Charlemagne recognized and lived by traditional Roman Virtues. He single handedly battled to exte nd the area on all sides of his kingdom.Eventually he went from being King of the Franks to Emperor of the West. However, â€Å"According to this title, Charlemagne as not the Roman emperor crowned by the pope but rather God's emperor, who governed the Roman Empire along with his many other duties. † 2 By the time Charlemagne had died, his Freakish Empire was as big as the Byzantine Empire. 3 Charlemagne was a lover of the Liberal Arts. He was never satisfied with his own language so he went on to learn several others, most of all Latin. He could understand Greek but he never learned to speak it well.In the Kings spare time he studied rhetoric, astronomy, and dialectics. It wasn't until later in his life that he started to write in Journals documenting his wisdom and ideas about religion and owe the stars and the planets existed. In one of the most accomplished endeavors that Charlemagne took on, was the education of children. He was truly a visionary of his time. He himself was quite educated verbally and in reading but he never mastered the art of writing. He thought that every child should have a chance to go to school, even commoners.He felt with education that he could lead his people to eternal salvation. What better way to spread the word of God, and then teach it along side general education? In Charlemagne's conquests there were several newly conquered lands and or people hat needed saving, so he took upon himself to build school and fill them with the most educated of educators. He vowed to have the teachers teach grammar, psalms, math, and reading. Charlemagne would offer free schooling to anyone ages six years and up that would offer there children to the Church, attaching them to the monastic life permanently.He would task the nuns and monks to educate these children with little or no down time. If the child successfully completed the first series of education they would then be allowed to continue in his educational program, which would in clude subjects such as, geometry, music, astronomy, and math. 4 The end result of Charlemagne's school curriculum well surpassed anything he could have imagined. â€Å"It led too kind of literacy renaissance†. Scholars from all over Europe would come and teach different subject.These scholars from Italy, Spain, Ireland, and England influenced the regions culture not only raising questions about religion and social issues but they also influenced the way Charlemagne's own children were being raised. Charlemagne married at his mother's request the daughter of Desirous, the King of the Lombardi. However it is said she was sent away a year later because she could not have children. 6 He later took a Sabina woman as his partner and had four sons and five daughters. Charlemagne was unlike other rules with children.His autobiographer would often say that he bonded with his children, always making time for them. He would eat dinner with them, and he never would travel without them. T hey were educated Just as other children, first in the Liberal Arts, with emphasis in math and grammar and then on to the higher level, which included music and geometry. After a certain age the boys were taught how to ride horses ND carry a sword. The girls were taught how to work wool, so they would value hard work. 7 He never did marry off any of his daughters.It is speculated that he was too worried about having to give up land by the request of their suitors, so he never strove to marry them off. Each went on to have several illegitimate children. 8 One thing is for sure; Charlemagne was a visionary and a skilled warrior. He knew that education was the key and he also knew it should be available to anyone who wanted it. His successors would continue on his legacy of learning by educating their officials and by spreading the word of God throughout the lands.

LPN Scope of Practice Essay

The Nurse is defined by the University of North Carolina as â€Å"the leader in providing compassionate, quality care, focusing on the unique needs of patients and their families.† It goes on to define the Nurse as someone who â€Å"collaborates with patients families and other health team members to plan and provide Nursing care that will achieve an optimal level of health and wellness, or when this is not possible, support the experience of loss and death.† I completely agree with these statements. Deciding to take on the role of a Nurse shows the selflessness of the person. It is making the decision to put someone else before one’s self. It is the act of transforming from whatever type of person they are on the outside of the work place, and becoming someone who is non-judgmental, optimistic, positive, caring, empathetic and has the understanding ability to be able to provide care while respecting the patient’s wishes and beliefs. I feel as if certain c haracteristics of the Nurse are not taught. These are personality traits that we are born with and whether or not we utilize them, is up to us. Other Characteristics of the Nursing role, I feel are obtained by training and education. For example, inserting a Foley catheter, or any sterile procedure for this matter, training has to take place for the Nurse to properly insert the catheter. We have to be trained how to properly open the package, how to move so that sterility isn’t broken and know proper techniques to insert the catheter. The Nurse must be trained on how to do this skill but unless she is educated, then the skill is useless. The Nurse is educate on rationales to each step, i.e.: Why am I doing this?, What am I  looking for? What do I do If this happens? How will this affect the patient? Nursing is an incredibly interesting field with many doors of opportunity. It is a field that interests me greatly. There are so many different areas of nursing which makes the learning process never ending. While pursuing my Nursing license, I find it extremely comforting to know that if I ever feel â€Å"burnt out† on a specific area of the field, I can move on to different areas. I am not obligated to do the same type of Nursing for the rest of my life. My options are endless. While comparing the roles of the Licensed Practical Nurse in North Carolina versus South Carolina, I was a little surprised at some of the differences. I had a very hard time finding specific skills that an LPN in NC could perform. We are directed straight other pages which don’t necessarily directly state do’s and don’ts. Some skills with both North Carolina and South Carolina can be performed by the LPN if, and only if, the employer has documentation of proper training, continuing educations courses, verification of skill competency by at least an RN, and frequent evaluation of the Nurse’s competency of completion with the skill being performed, on file. Both states have set rules on how much continuing education is necessary or how frequent the skill competencies should be evaluated. Both States allow the Licensed Practical Nurse to assist in preforming the initial assessment but are not allowed to make nursing diagnoses. They both allow the LPN to verify blood with an RN but LPNs are not allowed to hang blood. Neither state allow the LPN’s to do any pulmonary artery pressure or pronounce death. Also, in South Carolina the Licensed Practical Nurse cannot evaluate or stage p ressure ulcers, they can only document on the observations of the ulcer once the RN have evaluated and staged it. In North Carolina, the LPN can first assess and size the wound or ulcer or even change the dressing under a specific order and a Registered Nurse will verify the LPN’s evaluation. South Carolina does not allow LPNs to do any arterial punctures, but they can manage the site; LPN’s in North Carolina can complete arterial punctures for the collection of blood. The two differences that fascinated me the most dealt with acupuncture and cosmetic procedures. In North Carolina, the LPN, or the RN, cannot practice acupuncture. It is prohibited, unless an individual has completed a 3 year postgraduate acupuncture college or training program verified by the state. In South Carolina, an LPN can practice acupuncture  under a Licensed Acupuncturist as long as he/she has been trained under the employer, it is documented, and a request to practice has been approved by the state. With cosmetic procedures, in South Carolina a Licensed Practical Nurse can only apply chemical peels with less than twenty percent acid solutions and they may also do a microdermabrasion under a dermatologist. In North Carolina, a Licensed Practical Nurse can do a broad range of skills in the cosmetology field. He/She may give a microdermabrasion, chemical peels, give Botox, collagen injections and laser hair removal. With Botox and Collagen injections affecting the appearance so greatly, it is hard to believe that this is a skill that an LPN can become properly trained on. The Charge Nurse role is defined by the North Carolina Board of Nursing as â€Å"an RN who supervises and manages patient care delivery settings or groups of clients, usually for designated time periods.† It also defines the Nurse-In-Charge role as â€Å"the assigned role and responsibility of an LPN who participates in assuming the implementation of established health care plans for a designated number of clients under RN supervision.† Basically how I interpreted this was, the LPN can be the Manager when the Manager is away. The Licensed Practical Nurse will continue to work in the appropriate scope of practice and report to the Registered Nurse. The LPN will call to report updates or for guidance in certain situations. If the task at hand is not in the scope of practice for the LPN, the RN will be called to come in to make decisions or perform the tasks. Working in a long term care facility has helped me better understand the difference between the two, although we do not use the term Nurse-In-Charge as often as we should. On weekends we have two specific Nurses who work opposite weekends of each other and are delegated the responsibility of being the Nurse-In-Charge. On Fridays, before our Charge Nurse leaves for the weekend, she will do a quick run through with the Nurse-In-Charge for the weekend. They go through and talk about the â€Å"what if’s?† for the weekend, and what to do and not to do. These Nurses also know when a phone call needs to be placed to the Charge Nurse. Throughout the weekend, they call with updates and notify the Charge Nurse of any changes that have or are occurring with any health statuses of the Residents. Depending on the situation, the RN delegates appropriate tasks in the LPN’s scope of practice over the phone or, if another RN is not in the building, she will come into work if needed. It is said that we,  ourselves, are our biggest critics. For me this is extremely true, so when it came to trying to determine my strengths, it took a while. Based on what others have told me, I’ve got an abundance of patience and I also have good communication skills. I’ve always had strong relationships with my residents and their family members. When trying to decide what my strengths were, I had to ask myself â€Å"Why do the y like me?†, â€Å"Why do they treat me as if I’m a part of their family?† â€Å"Why do they trust me?†. What came to mind was the way I talk to them. I speak to residents and families the way I would hope to be spoken to, if the roles were reversed. I believe that good communication skills, including the ability to listen, would be something positive I could bring to the role of the LPN. I hope to be an influence to other Nurses who come in with bad attitudes and forget that their patients are humans too. To remember that even though they may be a â€Å"frequent flyer†, they are still human, they still make mistakes, and more than likely are in desperate need of kind words. I hope to influence others when it comes to being open minded and influence them when they go to pass judgment. I hope to bring more compassion, optimism, acceptance and leadership to the LPN Role. My weaknesses are my confidence in my decisions and my abilities. I second guess myself a lot and I constantly double check myself. This could work both ways, good and bad. I look for reassurance from others to ensure that I am right and I know that I won’t always be in a position where I can be reassured. I want to gain the confidence without becoming â€Å"the know it all.† A good quality Nurse is one who’s always willing to learn. Another weakness I have is my inability to handle the emotions of the family members during the harder times. Times like these are very awkward for me and I would like to get stronger in my ability to be comforting and supportive. I usually try to avoid these situations as much as possible because the wall that holds my emotions in during these times, is very thin. I need to learn how to be emotionally professional while still remaining to be human. Resources NURSE–IN-CHARGE ASSIGNMENT TO LPN Position Statement for RN and LPN Practice. (1996, January 2). Retrieved November 23, 2014, from http://www.ncbon.com/myfiles/downloads/position-statements-decision-trees/nur se-in-charge.pdf LPN Scope of Practice Clarification. (2010, January 1). Retrieved November 23, 2014, from http://www.ncbon.com/myfiles/downloads/position-statements-decision- trees/lpn-position-statement.pdf Mission and Philosophy. (n.d.). Retrieved November 23, 2014, from http://nursing.unc.edu/about/philosophy-of-nursing-and-nursing-education/ Infusion Therapy/ Access Procedures. (1998, May 1). Retrieved November 23, 2014, from http://www.ncbon.com/myfiles/downloads/position-statements-decision-trees/infusion-therapy.pdf South Carolina Board of Nursing. (1989, November 1-Revised 2014, July 1). Retrieved November 23, 2014, from http://www.llr.state.sc.us/pol/nursing/index.asp?file=AdvisoryOp/advisoryop.htm