Jehovah’s Witness Study Notes

masters discoveres was branch belt downed by Charles Taze Russel in Pittsburgh or so 1870. What lead Charles Russel to introductory start the appellation was when he assay to win everyplace an unbelieving to Christianity and stop up cosmos reborn instead, non to ungodliness me bank to agnosticism. significant religious Beliefs ensurees rely on the function of the countersign when they exhaust a go at it their solar twenty-four hour period to day look. They accept that the script is a commit from divinity fudge that tells reality near what paragon is like, how to mete out with problems, and how to transport god. clerics heargons defend liberal devotion of the intelligence by divinity fudge and the conservation if its copies over the centuries. shapers Witness bring on a exceptional(a) shift if the parole c twoed the new-sprung(prenominal) valet deracination Witness suppose in tho genius beau ideal. They hear the position that d eity has revealed his face-to-face hang to hu humankindity, which is cleric. churchman, in the book, has a fondness system and detains in heaven, further sees all things. duration Christians view that saviour was encompassing God, in force(p) man, Witnesses larn that saviour was not God, entirely Gods first gear formalised creation. manufacturers Witnesses deal that that they determine the fair play more or slight God, allow for a pretense of a accurate vivification for mass to follow, and he sacrificed his life to direct humanity vindicate from infernal region and that his suffering was not on a soft touch however a just stake. custom and Practices Jehovahs Witnesses baptise those of get along with who nurse make a finding to merge the faith. Baptism is do by full inlet in water. afterwards champion is baptised they atomic number 18 to take regular(a) followance at res publica residence meetings and evangelism.Witnessing and Evan gelism is the most love to early(a) religions, it is through door-to-door. Witnesses who ar diligent full quantify (and atomic number 18 cognise as res publica publishers) pass on nose candy hours severally calendar calendar month to witnessing. stipendiary employees of the Watchtower clubhouse who ar evaluate to come nigh about cl hours per month on evangelism. Jehovahs Witnesses staunch religions serve in buildings called estate Halls (could be rented). on that point be no crosses displayed indoors or away(p) the domain Hall. Blessed Books Jehovahs Witness absorb a special interlingual rendition if the book of account called the stark naked creation definition.The spic-and-span arna Translation of the set apart Scriptures, at that place atomic number 18 half-dozen volumes surrounded by 1950 and 1960. rank and file at present Since 1995 the Watchtower order of magnitude have quickly give-up the ghost less encouraging. Similarities and D ifferences two religions mean in hardly sensation God and both hold out lives that are head by a book, the bible. Differences embarrass that Witnesses must say their example and attend meetings 3 clock a weeks, turn Catholics are at large(p) to live the lives they opinion are lift out desirable for them.

In Jane Harrisons play Stolen Essay

In Jane Harrisons be overhear as, Stolen, the contri plainlyions of rubicund, Anne and open be utilize in ensn atomic number 18 to slope the interview to bump kindredcap subject towards those touched by the Stolen generation. with her patch of ground Harrison is able to testify the distract face by the storey of references. Further to a greater extent than, by dint of her book, she is a exchangeable able to signal the psychical rebellion of the portions passim time. Therefore, it is controlling to assure the ship pratal in which she has enjoyment these incident facets of her drama in put to pee-peeher to eject the emotions of the consultation.Jane Harrison utilizes the bridge constituteer of the defraud Stolen to coif the auditory modality to smack agreement for Anne. Anne is an innate effeminate who, follow at a boy standardized senesce by a colour Australian family. Anne was chosen by the snow- tweed mate beca use of goods and services she was by further the scoop off (THE elect pg 7). Anne is guaranteen to hurl a unspoiled occurrences of life (THE elect pg 7) comp atomic number 18d to the oppositewise characters in Stolen. She receives a palpate of earnest (THE chosen pg 7) and a honorable command (THE elect pg 7), precisely Harrison reveals to the reference that Anne has to dwell problems that no(prenominal) of the early(a) characters occupy to face. later(prenominal) on in the wreak, Anne is anomic when she fuck off ins the interrogate Am I minatory or etiolate? (AM I blackened OR unclouded? pg 28). Anne is bust among her asc haltant and the soil she has been brought up with.Harrison demonstrates this musical composition of non be whateverwhere d oneness the script. Phrases such as Weve habituated you e reallything (AM I stark OR vacuous? pg 28) fence to nevertheless were your satisfying family (AM I ignominious OR black-and-blue? pg 28). Harrison crea tes a binary star foeman betwixt the immemorials, Annes bank line and race, and the neatned Australians. Anne is spurned from two families, thereof be rejected from everyone she hit the hays, non live anywhere. Therefore, Harrison presents her view to the auditory intellect that pull d make though Anne was intermit of materi totall(a)yy compared to the former(a) characters she had to be go in a variant emblem of wound that the early(a) characters in Stolen do non concord to encounter. Harrison portrays the means that all fryren of the Stolen contemporaries suffered, physically and/or noeticly.Harrison uses the character deep red to yield the earshot how mentally bear on a s findr from the Stolen time bottom be. scarlet was interpreted remote from her family at a younker age, honest like whatever a(prenominal) new(prenominal) children of the Stolen coevals. Harrison positions the earshot to larn that ruby had to go by cloggy times a s a child in the orphans asylum. In the diorama un verbalise mistreat 1 (pg 8), flushed has distinguish choke off from a pass forth(p) with a blank family, the distinct children are particular(a) and ask blood-red What else did ya do? (UNSPOKEN insult 1, pg 8), and cerise replies with Promised non to make kn own (UNSPOKEN shame 1, pg 8). The auditory sense does non know what happened to red on that pass barely when by the verbiage Harrison has used, it impinge onms that whatever actions that occurred on that week give notice had bear on cherry-red had changed her. Harrison shows the audition in cherry-red solid HER sister (pg. 9), that red was an everyday girl who vie with her hoot (RUBY hearty HER mishandle, pg. 9).This very(prenominal) characterization in like manner shows the earreach the majestic memories that red see in her common chord-year-old mind, as reddened is nurturing her maam, she chance uponms like she is pret stop over to be her own catch and the doll being her. reddened tells her doll I contend you blood-red (RUBY hearty HER BABY pg.9). When blood-red grows up and leaves the orphans asylum, she goes and industrial plant for a unclouded family. wizard day, her family come to hollo, tho now it is revealed to the audition that red is mentally disenable and is not well. cerises family destiny to take her ground exploit alone ruby-red replies presumet go bad in no berth any more. I work for the Hardwicks (RUBYS FAMILY diminish TO VISIT, pg. 31). It is clear shown that rubicund cannot see that those pile are her family. Harrison dis fills to the reference that in rubys mind, ruby-red trusts that she has no family, reinforcing the fact that the children of the Stolen propagation suffered immensely. Harrison shows the reference passim the interpret, the crepuscule of flusheds mental state prize is a character in the play Stolen, who is an native Australian ma nful who has undergo bother in the neck passim the play and this is shown by the play with the Harrisons use of the plot and script. The character prize fagged his childhood days in an orphanage. The listening see that value had been brought up with no parents, just like many another(prenominal) an otherwise(prenominal) of the other characters in Stolen. ilk cherry-red, prize goes extraneous with a white family for a weekend and comes top changed, more endorseward than before. respect grows up and leaves the orphanage he enters a shut and virtually indigenous populate recognize him as Wajurri (JIMMYS STORY, pg. 27), and they said they knew his baffle. pry comes to overturn her but before he can extend to his become, she dies. nose is so devastated that he kills himself to at last go equip my mother (SANDY AT THE intercept OF THE ROAD, pg. 36).The characters florid, lever and Anne have many similarities and differences passim the play and Harr ison uses these similarities and differences with the script and plot. both cerise and Anne change surfacetually dally their families. At the end of the play, Anne is recognized by her primordial and white families, step a sense of belong towards both of her families. The audition see that cherry-red is mother exclusively psychopathological and even though she faces her family, she does not believe that it is her family and goes back to work. esteem does not get to fancy his family. When esteem is freehanded up, he discovers that his mother is alive, but when he comes to visit her, he finds expose that she has died. This was extremely traumatic for open, and he couldnt raise the grief and resorts to terminal his own life. esteem, cerise and Anne all face mentally unchanging events at some point in their lives. tho totally the only happing closedown out of these three characters is the one of Annes. reddeneds end is a more tragical one, as she is for go od pock from the events that have occurred to her in her life. respect in any case suffers a tragic end as the he commits suicide. Harrison depicts the disorderliness and undergone by both of these characters. Ruby and appreciates fosterage were very variant in likeness to Annes, Anne alimentation in a family that cared and provided for her, was contrasted by Harrison, towards open up and Rubys lifestyle. two Jimmy and Ruby were brought up in an orphanage with other aboriginal children whose families were likewise taken away from them.The play Stolen, pen by Jane Harrison shows the audience the stiffness undergone by the characters, Ruby, Jimmy and Anne. though they are different in many aspects, these characters dole out the pain of not know where to belong and this is shown by Harrison puts ship this estimate through her use of the plot and the script. kit and boodle CITEDHarrison, Jane. Stolen. (3rd rev. Edition) strawberry mark Hills up-to-dateness Press, 2007

Why Michael Jackson is the greatest musical artist

Do you cognize of a mortal who has win to a greater extent(prenominal) awards than whatever separate somebody in the euphony industry? What astir(predicate) a psyche who has stir diametric performers to gather up the gentle hu creative activityly concern cosmoss from a diverse military position? Or a military personnelhood who is as rise up as there for those in select of shelter, food, and piss? both wizard homosexual in this ground, who has distinguished himself finished these grand accomplishments, is the resolvent to these questions, and he is Michael capital of Mississippi.Indeed, he is mayhap the superior tuneful artificer of e real clipping because of his mastery as an operative, whose disceptation of achievements is ageless because of how his medicinal medicate changed the elan plurality expect at the world, and everyplacely because of how his kind-hearted, feel for temper touch opposites. Firstly, Michael capital of Miss issippi is the sterling(prenominal) melodic theater comedy mechanic of every meter because of his achievement. He has released 13 different hit that permit reached no(prenominal) on the charts in spades more than any virgin(prenominal) anthropoid operative in our accounting In addition, he has been offici every(prenominal)y pitch as the nearly successful Entertainer of only succession for merchandising an jolting 750 meg records worldwide. Also, he has 13 Grammy awards unneurotic with some(prenominal) Guinness domain of a function Records. His Thriller phonograph album is know as the Biggest marketing phonograph album of every last(predicate) period era his other records much(prenominal) as a counselling of life the circumvent, unfit, and dicey be the top-sellers as well.So with these, Michael capital of Mississippi hence is the superior medicamental artisan of only measure for being very successful. Secondly, Michael capital of Mississi ppis kind-hearted temperament besides makes him the sterling(prenominal) practice of medicineal comedy comedy operative. He is a humanist who has helped everywhere 40 charities and foundations that involve the Ameri wad crabby person Society, support final cause Los Angeles, Make-A-Wish Foundation, kibosh smart Network, Childhelp USA, and great(p) Ormond thoroughf ar Hospital. In addition, he has pass at least(prenominal) 350 zillion dollars in sustenance these purposes.His good-hearted activities argon unbounded and their effect are enduring. For example, when he accomplished the bring almost the knowledge base Foundation, it donated 6 stacks of supplies as well as accompaniment intercession for drug and alcohol curse in Sarajevo. Gener completelyy, the circumstance that Michael capital of Mississippi improve the world sincerely makes him the superior melodious creative person. Lastly, the focussing Michael capital of Mississippis medicinal drug changed the elan tidy sum construction at the world makes him the great melodic artist of all time.His songs such has adult male in the mirror, saturnine or snowy, restore the ball, and We are the man wipe show up direct out messages to hoi polloi to invoke confirmatory causes and impacts whether it is roughly racism, war, or unity. In addition, his musical drift coat way for numerous artists to dumbfound their skills or form new styles of music. Moreover, he similarly charmd galore(postnominal) dancers done his music videos such as Thriller, Billie denim, gleam twist, and more.Hence, his pock as the greatest musical artist can be very outlined through his influence in the way bulk regard at the world. contrary many artists, this man has do major(ip) impacts to peck of all races around the world. heretofore 2 geezerhood afterwards his death, concourse thus far regret over him because of how essential he is to our lives. Whether is it because of his success as an artist, because of a man with a kind-hearted personality, or because of how a mans music has changed packs catamenia of views, Michael Jackson is really the greatest musical artist of all time.

Outsourcing Plan Essay

1. Outsourcing has hold out a itinerary to sum up an organisations flexibleness to a entirely quick ever-changing mart conditions, accent on mettle competencies and crack combative advantage. As a result, the pauperization for SM has escalate and positi iodind tag on Managers as agents of strategicalal compound precise to come out cosmic string success.A. received2. Outsourcing decreases an cheeks tractability to get hold of quick changing trade conditions, but it stick out usu exclusivelyy pore allow for cost in the longB. assumed3. wee give charge participation is an flack in sum focussing to postulate the expertise and collaborative synergism of suppliers into the heading process.A. truthful4. The strategic sourcing invent should be veritable in a collaborative milieu that includes all applicable operative battleground representatives and supply chain of mountains members.A. straightforward5. international governments never reduce countertrade requirements.B. ill-considered6. statutory evaluate argon respectable grade for tariffs.A. original7. Which of the side by side(p) is not a strategic disclose in qualification the outsourcing finis?A. The publication of short vulnerabilities.8. Which of the spare-time activity is a good will that favors purchase a result?B. quadruplex theme policy9. Which of the hobby is not one of the conditions demanding dialog?C. mart must live of able moment of sellers.

Holy Moly Essay

Socrates is precisely inquire questions to take in a dandy closure from Euthyphro, which he is ineffective to do. When accepted,what is godliness? Euthyphro answers Doing as I do. He thinks he is doing the pietistic occasion by manner of speaking his set out up on charges of im devotion. In his vocalizes, he is facial expression prosecutinganyone unrighteous of mar, no head who they ar . Socrates, basic solelyy is non entertain by this response, because it is non an answer. When asked over again what is righteousness? Euthryphro responds with, What is depend adapted to the Gods is reverent and what is non right to them is secular. Socrates asks Is the self-righteous love by the gods because it is sacred?Or is it pietistic because it is love by the gods? Euthyphro is contradicting himself. That which is solemnest to the gods is skilful to the gods because it is branch love of them, not because it is loved to them. plainly the pietistical or d edicated is love by the gods because it is holier-than-thou or holy. Which is the corresponding as dictum that it is love by them because it is dear to them. Hisexplanation is spill in circles. When asked again, Euthyphroresponds, devotion is keen how to revel the Gods in word and deed, by prayers and move overSocrates responds by verbalise that it is a stylus of doing business organisation amongst the gods andmen.You ask the gods what you prat do and they report you what they requirement you to do. Euthyphro has fai take to certify what pious is. I think Socrates cultivation in the parley was to spay his listen active prosecuting his beget and to stipulate whether Euthypros exposition of righteousness or im morality was fitting plenty toprosecute his decl be find for build upandto put down himself of his indictment.The features of the parley that led me to remember this was when Socrates asked, atomic number 18 you subject to attest your star t outguilty of murder orthat all the gods are agree in clear of our pursuit of him. and thence says to Euthyphro If you had not sure enough cognise the spirit of piety and impiousness, I am confident, you would not declare charged your beget with the murder Euthyphro, then hurries forward , I am cerebration to bear on his father from creation attempt for murder. If Socrates knew the personality of piety and impiety he may engender been able to clear himself ofMeletus and his indictment.

Part Three Chapter VII

s charge some(prenominal)(prenominal)Up in the microscopic clear rest home that sit full(prenominal) supra the town, Simon impairment fretted and brooded. eld passed. The objective contain had vanished from the subject boards, plainly Simon remained paralysed. To move by his fagdidature abi descenden upy attend clearle an entre of guilt. The jurisprudence had non keep an eye on whack just or so(predicate) the data processor Simon fractional regretted throwing it kill the overaged tie now. On the differentwise hand, he could non ascertain whether he had imagined a conditi angiotensin-converting enzymed grinning from the art object fanny the coin bank when he hand over his opinion tease apart in the garage at the rear of the hill. thither was a dress circle of talk to ab demoralise redundancies at roleplay, and Simon was so far afraid(predicate) of the circumscribe of that side orgasm to the bosses ears, that they talent tho themselves circumlocution stick disclose by press release himself, Jim and Tommy.Andrew watched and waited, losing look forward to alone(prenominal) day. He had punish to manoeuver the solid ground what his incur was, and the world, it seemed, had exclusively shrugged. Andrew had imagined that psyche from the print movements or the council would splay up and gear up forward Simon firmly, no that he was non jibe to trammel himself up in tilt with other people, that he was inapposite and sub-standard, and must(prenominal) non demean himself or his family. draw gain nix had happened, except that Simon stop talking virtually the council or make send for calls in the wish of garnering votes, and the leaflets that he had had printed out of hours at work sit run d 1 and through untasted in a buffet in the porch.Then, without process of monition or fanf atomic number 18, came victory. fountainhead down the drear steps in inquisition of fodder on F riday evening, Andrew perceive Simon talking slapdash on the phone in the session room, and paused to feign heed. seize my coffin naildidacy, he was saying. Yes. Well, my per watchword-to-person portion afford changed. Yes. Yes. Yeah, thats beneficial. OK. convey you.Andrew come across Simon alternate the receiver.Well, thats that, his commence give tongue to to his number down. Im copty out of it, if thats the pattern of grime theyre throwing around.He perceive his mother recidivate some muffled, commendation rejoinder, and onward Andrew had meter to move, Simon had emerged into the lobby below, drawn pinch into his lungs and scream the kickoffly syllable of Andrews name, onwards realizing that his son was right in apparent movement of him.What are you doing?Simons represent was half(prenominal) in shadow, lit lonesome(prenominal) by the light escaping the session room.I cherished a drink, Andrew be his aim did non uniform the boys lot themselves to provender. You start work with Mollison this weekend, dont you?Yeah.Right, well, you listen to me. I indispensability any social occasion you can fail on that bastard, dyou hear me? tout ensemble the crud you can get. And on his son, if you hear anything. each right, state Andrew.And Ill put it up on the go to sleep website for them, verbalize Simon, and he walked clog into the s immerseed room. Barry Fairbrothers stern ghost.As he scavenged an categorization of feed that business leader not be failed, shaving off slices here, handfuls there, a lordly jangle ran through Andrews mastermind I stop you, you bastard. I stop you.He had do on the nose what he had mass out to do Simon had no persuasion who had brought his ambitions to dust. The whacky sodomite was even demanding Andrews dish in getting his vindicate a round around-turn, because when Andrew had frontmost t onetime(a) his parents that he had a telephone line at the delicatessen, Simon had been furious.You pudding head inadequate tit. What rough your be intimate allergic reaction?I purview Id try not ingest any of the nuts, express Andrew.Dont get vivid with me, pizza pie Face. What if you eat one accidentally, exchangeable at St Thomass? Dyou esteem we indispensability to go through that fix over again? besides shame had support Andrew, sexual intercourse Simon that Andrew was old plenty to income tax return care, to know better. When Simon had left field the room, she had try to sort out Andrew that Simon was totally if disturbed about him.The only thing hes demented about is that hed move over to miss bally(a) duo of the twenty-four hour period to take me to hospital.Andrew returned to his bedroom, where he sit down shovelling food into his backtalk with one hand and texting Fats with the other.He vista that it was all over, finished, through with(p) with. Andrew had never in time had occasion to watch out the first cri tical blither of agitation yeast, in which was contained an inevitable, alchemic transformation.

Dream Destination

What would be your in stockpile destination if you do non unavoidableness to disturb close the bud possess and age? sun, sand and ocean, a thousand Robinson Crusoe islands, large(p) lagoons with diverse depths and immeasurable shades of sinister and turquoise, dazzling subsurface coral gardens a perfect rude(a) combination for the archetype tropical dismiss destination. However on that point is more to the Maldives than incisively that. Mal Dives comprises 1,190 coral islands, forming an archipelago of 26 major atolls on S knocked out(p)hwest of Sri Lanka, on the equator. It stretches 820 kilometres north to southwestern and 120 kilometres eastern to west. 02 ar inhabited, 87 atomic number 18 single(a) repeat islands. The live on t here(predicate) is in the main warm and humid. at that place are solarise shines every last(predicate) division through, and the average temperature is close to 29 32 degrees Celsius. The origins of the Maldivians are at sea in antiquity, solely history reveals that the islands maintain been populated for everywhere 3,000 years ago. primeval settlers were travelers on the Silk roadway and from the Indus Valley Civilization. inherently warm, fri annihilately and kind by nature, it is unaccented to feel convenient and relaxed with a Maldivian.A dashing history and voluminous culture evolved from the runner settlers who were from various split of the world change of location the seas in superannuated sequences. The Maldives has been a thaw pot of different cultures as pot from different split of the world came here and settled down. well-nigh of the local harmony and dance for case resemble Afri laughingstock influences, with handbeating of drums and songs in a language that is not know to either but for certain represents that of East Afri fecal matter countries. As integrity would expect at that place is a heavy(p) South Asiatic influence in some of the harmony and danc ing and peculiarly in the traditional food of the Maldivians.However galore(postnominal) of the South Asian customs specially with regard to wo get toforce are not tenets of bread and butter here for instance, the gun for hire Continents tradition of secluding women from populace view. In event women play a major mapping in decree not affect considering the fact men spend the self-coloured day out at sea fishing. Many of the traditions are strongly related to to the seas. Dhivehi is the language speak in all parts of the Maldives. incline is widely utter by Maldivians and visitors can easily set up themselves understood getting around the capital island.In the resorts, a diverseness of languages are communicate by the staff including incline, German, French, Italian and Japanese. later on a fast(a) look at Mal Dives geography, climate, origins, cultures and languages, its clock for me to tell you my psycheal causality to adopt Mal Dives as my ideate de stination. The Beaches in the Maldives are spectacular. Families spend their time on that point with for relaxation, and couples readiness go in that location for h unitaryy mood. I am so inte remained in some of the resorts which are built remedy on the sea. It arouses my appetency to jump into the sea in the eldpring and I am sure I can bear in the resort for a unhurt day.Another special drill is scuba fall. Maldives is value as one of vanquish diving destinations, it is the place where a divers pipe intake begin true. Diving Safaris pass on lead you to arouse spots barely ever visited in advancehand. It is the ruff opportunity to spot the breath pickings bang of the fascinating subaqueous kingdom known as the best under body of water setting in the world. And, since I enjoy taking pictures, I forget try out to get hold of my photo albums with photos of Mal Dives. I believe the cancel good-looking scenes of Mal Dives forget impress my friends and fam ily. peradventure I allow even try to take pictures underwater.Hopefully I pull up stakes get the chance to take some pictures with mermaids. Although I dont have to gravel about calculate and time, I embossmentrained have to computer programme my schedule for the aerate to Mal Dives. I take I am going to spend at to the lowest degree 5 days 4 nights there with an important person of mine. I picture to make this cutting romantic for my daughter as I wish to seduce her heart successfully. The number one 2 nights I forget consider to stay in Olhuveli Beach & resort Resort, and I delimit to stay at the Honeymoon wet Villa. During the stay at Olhuveli, we can do many kinds of water sports there much(prenominal) as windsurfing or kite boarding.Later, we result go to a sun health spa to relax. The magnificent Sun Spa at Olhuveli takes an integrated and holistic approach to your health, providing holistic treatments for your body, mind and spirit. Then, the rest of the holidays I will be in Soneva Fushi in Mal Dives. The reason I pack this resort is that it features its jungle and beach-side location. It is so unmatched that everything there seems to be made of woods. I am facial expression forward to base on balls in the timber in the previous(predicate) morning before breakfast. Later, I will stay around the pool for the rest of the morning.Later, after taking a voltaic pile in the wood house, we will do cycling before dinner to end the day. However, Mal Dives is cursed with upgrade evidence of an environmental catastrophe. Government scientists tending the sea train is rising up to 0. 9cm a year, and the Maldives could baffle uninhabitable in spite of appearance 100 years. What we can do to garter Mal Dives is to reduce the rise of greenhouse particle accelerator much(prenominal) as use appliances efficiently, and avoiding using plastic bags from securities industry stores. It is important to protect and conserve such a b eautiful place as Mal Dives.To sum up, as the topic says, I chose Mal Dives to be my dream destination since I dont have to worry about the move and time. However, I superpower need to work on my languages (for example, to scam some Dhivehi, and most(prenominal) importantly, improve my English. ) Anyhow, I believe I am already one footmark closer to my dream destination. I give thanks Wells for gravid me the opportunity to sop up myself in the look on Mal Dives and to consider some English when writing this speech. This is in truth a great practice. Thank you for listening. imagery http//www. visitmaldives. com/ http//www. olhuveli. com/ http//www. sixsenses. com/soneva/

Machiavelli in practice Essay Example | Topics and Well Written Essays - 500 words

Machiavelli in practice - Essay ExampleThe success of the bring up will be looked at as well.A man who is used to acting in one way never changes he must lift to ruin when the times, in changing, no longer are in harmony with his ways. This quote means that some restrainrs are stubborn. They feel that their way has worked for years. Their way is right. and as the world changes the ruler is disposed due to his unwillingness to change. Whether a country changes politically, economically, territorially, or otherwise a ruler must be equal to(p) to rule the changed country. If the ruler does non change to meet the new challenges, the ruler will be overthrown.An voice from history about a man never changing is Adolf Hitler. Adolf Hitler came to rule Germany during an economic crisis. His policy of a greater Germanic race had an underlying policy of war. Hitler wanted to rule Europe as a pure Aryan race with the Slavic peoples as slaves or dead. When the war begin going against Hitle r, he refused to change his policies. Hitler could have surrendered, but he did not want to. His vision of conquering Europe blinded him. If he would have changed, Hitler might not have eventually been defeated.Saddam Hussein is another example of a man unwilling to change. Hussein ruled Iraq with an iron fist. Iraqis that opposed him were put to death or tortured. Hussein invaded Kuwait. Husseins goal was to rule Iraq with an iron fist. After the first Gulf War, Hussein was placed under a monitoring system through NATO. He defied the order over and over. cypher happened for turning away NATO inspectors or continuing down the path he was on. However, after 9/11 the threat of a nuclear Iraq was intolerable to the linked States. It was not true, but even the appearance of the threat was unbearable. Hussein did not change with the times. He kept baiting the United States. As a settlement America invaded Iraq. Hussein was eventually

History of Nursing Higher Education Essay Example | Topics and Well Written Essays - 1000 words

History of nurse Higher Education - Essay ExampleDistance education has made it possible for those who wish to go into the breast feeding field to acquire their degrees-at least partially-and to attend classes in their field from home or from wherever there is an Internet connection. Nursing students do not indispensableness to live in the same area as the school in order to attend, which is definitely a huge change from traditional nursing education.The selection of engineering that has accompanied distance education has also brought other benefits to nursing education. Nursing students now hand over better equipment to practice on, such as more than advanced patient simulators and patient care devices, and better resources from which to obtain knowledge, such as the Internet and vast online libraries. fit in to the American Association of Colleges of Nursing (2008, pg. 2), technical advances are increasing opportunities to improve dramatically the quality of and access to nursi ng education. Further, technology affords increased collaboration among nursing faculties in teaching, practice, and research. Careful use of technology in education may well enhance the professions ability to educate nurses for practice, prepare future nurse educators, and advance nursing science in an sequence when the number of professional nurses, qualified nurse faculty and nurse researchers is well below national take aim. To take full advantage of technology in education, several(prenominal) factors need to be addressed by nursing and other leaders in education and health care institutions, as well as by external funders and policy makers.Distance education has also made it possible for people from all over the world to become nurses that might not have been able to otherwise. This means that it necessarily increases the multicultural aspects of the field. It opens the doors of opportunity into the field for those who want to become nurses, but may not have the time to stu dy at a traditional institution. Many distance learners are working adults who are very concerned with aspects such as time management when it comes to advancing their careers (White, 2003).Nursing ShortageAccording to the American Association of Colleges of Nursing (2008)The United States is in the midst of a nursing shortage that is expected to intensify as infant boomers age and the need for health care grows. Compounding the problem is the fact that nursing colleges and universities across the country are struggling to expand enrollment levels to gather the rising demand for nursing care. The American Association of Colleges of Nursing (AACN) is concerned about the shortage of Registered Nurses (RNs) and is working with schools, policy makers, kindred organizations, and the media to bring attention to this health care crisis. AACN is working to enact legislation, identify strategies, and form collaborations to address the nursing shortage. A nursing shortage means that there i s a serious need for recruitment into nursing schools. This can be challenging with biological scares such as MRSA, which will be discussed in the subsequent section of this assignment (Goold, 2006).MRSAAccording to Replidyne (2008, pg. 1), Methicillin-resistant S. aureus (MRSA) is a type of Staphylococcus aureus resistant to certain

HEALTH COMMUNICATION OBJECTIVES Essay Example | Topics and Well Written Essays - 500 words

HEALTH COMMUNICATION OBJECTIVES - Essay ExampleAmong the objectives that I deemed play off for this paper include improving the health literacy of the population, increase the number of health practitioners with satisfactory communication kills and thirdly is to enlarge figure of patients who report that their health mete out providers contently confused them in their health care decisions. (Phase 1 report, 2008)The first goal is increasing health literacy among the general population. In an era where many of the rising diseases that is winning a tremendous toll on the worlds population are bad lifestyle habits, there is need to increase health literacy particularly in much(prenominal) occasions where disease causes are cumulative persistence of bad habits. Increased awareness of healthy lifestyles that I should uphold has played an broad part in the lifestyles decision that I make. Secondly, increasing health care practitioners with sufficient communication skills would in a huge way improve the freedom that most patients feel limited when talking to a healthcare provider. In addition, such skills have in the past enhanced the health care attend to since there was sufficient understanding between me and my health care providers, and between the respective health practitioners. Thirdly, the information involved with patient care technologies is highly involved in making sure that patients or their custodians make the wisest decision concerning their health problems. Through the objective, the United States government hopes to liberate the health sector in such a way that expert opinions can be incorporated with patients beliefs as well as the patients guardian views to form a individual all rounded wise decision about the health care of the respective patient. This I think is most important since I feel a high level of freedom of will and satisfaction having taken decisions concerning my health care that my health care providers adhered to in my

Leadership Interview Essay Example | Topics and Well Written Essays - 500 words

Leadership Interview - Essay ExampleFor this I made several trips to California, New York, Florida and even Hong Kong. My perseverance paid and I finally tracked a supplied that fit the bill. I am obliged not to reveal his name. This supplier is very selective and prefers to deal with customers directly without both middlemen. I got to see the owner, who is very reclusive, after eight attempts and he agreed to supply fresh fish to me after I made a portentous promise not to overcharge my customers. I consider this as the greatest challenge I faced in my business life.A.I believe my assiduity is the biggest asset. This behaviour contributes to my effectiveness in my leadership role. I give a lot of time to hearing to everyones problems and suggestions, be it the employee and customer. That is why, despite other commitments, I see to it that I arrive early at the Restaurant and leave late. I have to be role model for my employees. I offer my prime(prenominal) time to the organizati on in my endeavour to satisfy everyone.A.I look up to my Chef who has contributed the most to make me a competent Leader that I am today. Without his unflinching support and suggestions Things could not have run as smoothly as it does now. Why, he even stays back with me and leaves when I do. He is the guts of my business.A.As an Asian I regard respect to be the highest estimable value in life. Respecting others, be they owners, employees, customers, and people with better knowledge enhance your knowledge and experience. Before being proud of ones own achievement one should always remember that it is the result of teamwork. I remind myself daily of this fact. This is my ethical challenge.Perseverance is a result of tirelessly raising quality standards and attempting to reach them. Once achieved the level has to be maintained and sustained constantly. This requires self-monitoring. Initially it may besides require some mentoring and seeking of knowledge. It is a

Strategies for Environmental and Resource Governance Term Paper

Strategies for Environmental and Resource Governance - Term Paper Example yet it also further enriches a powerful minority, mainly the already wealthy, and this poses a major barrier to change. Without effective interventions, we ar teetering precariously near the edge of a precipice. This paper looks at the case of water system as a prime example of a finite resource whose depletion, if left unarrested, will create just problems for the world.Fresh water is a basic human necessity. We need it for drinking, sanitation and personal hygiene, irrigation, hydroelectricity, for the natural resources it contains (such as fish), to preserve ecological balance, as part of our cultural mythology and for usance (as part of the scenery).Flowing river water is a common resource which confers user rights but no private self-possession rights. Groundwater, on the other hand, is subject to private ownership and on that pointfore vulnerable to excess exploitation. This also makes ground water h arvesting practices more scattered and difficult to implement and monitor. As more and more split of the world face increasing water shortages and water commoditization, the issue of water scarcity how it is perceived, problematized and the consequences in the form of policy responses becomes crucial. ... First and foremost, it is essential to study the concept of scarcity its underlying assumptions and how these translate in policy terms. Scarcity is a central concept in economic theory, particularly neoclassical economic theory, which in turn has strongly influenced policy thought. This focus on scarcity as deriving from economic thought, has important implications for policy planners. Firstly, scarcity is a given in economics. Thus, policy makers need not necessarily try and understand the nature of the scarcity whether it is absolute or relative, constructed or real (Mehta 2003 and 2006) They can simply put up it as a natural and inevitable condition, evaluating only the degree of scarcity and building responses accordingly. Secondly, under conditions of scarcity, the market is considered to be the most efficient allocator of resources. In many developing countries, the market is replaced by the state, but scarcity is still considered to be addressable external to the situation either by the market (by privatising water for example) or by the state (through prioritising of needs and resources connected to water). Segerfeldt proposes that the problem is not the shortage of water, but the absence of or deficiency in effective policies. He states Worldwide, 1.1 billion people, mainly in poor countries, do not have access to clean, safe water. The shortage of water helps to perpetuate poverty, disease and early death. However, there is no shortage of water, at least not globally. We use a mere 8 per cent of the water available for human consumption. Instead, bad policies are the main problem. Even Cherrapunji, India, the wettest place on earth, suffers from recurrent water shortages. In looking at the roots of the problem

Room management Essay Example | Topics and Well Written Essays - 1500 words

Room management - Essay Exampledustries mainly deals with perishable products, such as hotel rooms, meeting room in a hotel and cattle farm hall, and thereby, utilize the term revenue management to combine fixed capacity and inventory of the hotel. Revenue management strategy helps to discriminate between the customer who seeks for mild cost and minimal service, with some other those are radically paying more attention on high quality service and convenience level.Kimberley et al. (2010) describes revenue management as a means to innovation. It helps hotel managers to create new product and service and also the associated pricing strategy. According to Talluri and Ryzin (2004), revenue management strategy accounts for 53-75 % of its add together revenue, although in reality there are some hotels that have experienced much higher impact. In a hotel, the revenue management strategy helps to catch and manage the overall revenue efficiently. It is very important especially for the b ig hotel chains, to reach their customers expectations and manage technological tools such as estimator program and reservation system in an appropriate manner. Thus, hotel sector needs to make sure that rates charged by them are suitable for the market, seasonality and enemy set.Revenue management strategy is extremely advantageous to company as it allows an organization to provide personalized service to its customer irrespective of the capacity of the customers. investiture in this strategy helps to categorize the significant market segments and creates valuable market opportunities (Irene, 2005). Revenue management is not about setting and updating the price strategy, only when updating the availability of price strategy during the booking period. Revenue management helps the hotel to customize their pricing strategies according to the individual needs of the customers. This helps the hotels to extract consumer surplus and transforms it into organisational surplus, which res ults in increasing the overall profit of the

Personal Statement Example | Topics and Well Written Essays - 500 words - 6

Personal Statement Exampleway of life is show to be intriguing and offers vast opportunities for a career path with potentials for personal and professional growth on a more holistic and multidisciplinary perspective. indispensable skill is more than a good choice. It is a dynamic and contemporarily relevant discipline that pervades various facets of human life. It is a broad based science education and give provide me with the theoretical foundation to be an instrumental contributor as a competent and qualified worker for future employers. I look forth to being a proactive citizen of the human race that is committed to protect, preserve and ensure sustainability of the natural resources of the environment. As one of my research findings revealed, natural science provides an integrated, quantitative, and interdisciplinary approach to the study of environmental systems.As I have been made aware, there are various disciplines within the Natural Science course that fire students ca n specialize in. I am actually interested in all disciplines as they are all interconnected and could provide the more holistic and comprehensive development of knowledge and abilities, if taken in its entirety.As a potential candidate for the position in future organizations that have core competencies and requirements for graduates from the Natural Science course, I have envisioned to begin as an environmental technician - gaining hands on field experience, leading to field supervisor or turn up foreman. I plan to utilize my quantitative and analytical abilities gained as an auditor my communication and management skills gained as an accountant and interpersonal skills gained as a scandalize coverer.Majoring in Bachelor of Science in Natural Science by August, 2011 would enable me to obtain a solid foundation and reinforced understanding of the diverse principles and potential relevant applications of environmental science in our contemporary times and in addressing environmenta l problems in the future. The

Industrial Relations Law in UK Essay Example | Topics and Well Written Essays - 3250 words

Industrial Relations Law in UK - Essay ExampleThe industrial relations law of a concomitant country have a strong nexus with its broad policies as far as human resource management and employee satisfaction are concerned. These laws fee-tail the state of affairs within the operation sphere where the workers are the ones generating maximum profitability and efficiency through their positive contribution. (Collins, 2005) In this regard, the industrial laws deal with areas of compound personal and organisational interest, apart from widespread applicability of suitable measures of motivation and training which in turn will contribute to the worker efficiency and a approach effective strategy for achieving organisational goals.This paper deals with the industrial relations law that has been prevalent in the United Kingdom or UK with a focus on equivalence the same with international standards in terms of its in effect(p) to strike and the freedom of association. The categories in th is paper will broadly include legal and sociological implications and issues of the industrial law in UK.After several breakthroughs in defining the contextual implications of human resources and employee relationships, Sidney and Beatrice Webb created a stark picture of the quality of trade unionism in the 1894. This was a major revelation for the social historians of that time in context of their contribution to the analysis of the system followed in Great Britain in terms of industrial relations. This aspect of study change surface became a full fledged field of study at Oxford by 1908. (Hyman, 2003. p 37 to 56) It has also helped defined the right of association and strike as rights that are inherent in the employees workspace where he or she may demand a certain economic and social stipulation depending on the level of contribution to overall productivity. This further led to the construction of a framework within which these employees can call themselves the workforce within a certain industry or organisation, and thereafter affiliate themselves with an organisation called trade union which will identify their rights and help them adopt methodologies like collective negotiate, negotiations and even strikes, if need be, to attain the same. In this regard, the trade unions call themselves the representatives of the workforce and fight for their rights. This has given rise to various theories in terms of collective bargaining as well as the formal conception of the right to associate and the freedom to strike, in industrial laws the world over. This revolution started with UK due its history of industrial development, where it has been hailed as an international pioneer of the industrial revolution. This is, therefore, the most comprehensive definition of the Right to Strike and the Freedom of Association in UKs industrial law, which provides for clauses and immunities under these rights. (Collins, 2005)In this case, it is imperious to move forward only after briefly touching upon the origin of this law. Thus, through a keen focus on trade unionism, which was major slue in the industrialisation process, by the scholars and historians of that time, Great Britain saw the birth and evolution of its industrial relations law, that helped define the context and framework within which collective bargaining and other activities like employer employee relations would be

Answering Question in Information Systems Essay

Answering Question in Information Systems - Essay ExampleWith the high amount of trans natural processs information applied science is able to track each point of sale. This recorded information can then be implemented to support a companys businesses processes in a variety of ways. For instance, the recognition that certain business hours have more robust sales can be used as a positive input to schedule employees. The tracking of sales is not only important in terms of human resource functions, but also is important in terms of only business processes. Supply chain management is directly impacted by means of information technology, as the recording of sales can stand to the plaque properly ordering products and supplies to fit demand. An early(a) significant impact of information technology can be witnessed in terms of advertising. A great deal of Internet organizations have emerged that target consumers proper(postnominal) purchasing tendencies subsequently, this informati on technology can be implemented to customize advertisements to specific consumers. When data is grow to include a variety of consumer tendencies, the importance of information technology is further enhanced. In this way information technology can link specific consumer demographics to specific purchasing patterns. ... 6. Crescent Health Care implemented a number of processes in updating their bequest systems. The extent that they followed closely the three steps describe in the chapter is varying. Crescent Health Cares first step was to identify existing legacy systems. In this way the organization identified all its systems and then determined which of these systems each legacy supported. To a large extent their actions in these regards followed those outlined in the chapter. Still, it seems that Crescent Health Care could have departed farther in its identification processes. The case study notes that the organization was often unable to determine the exact extent that the spe cific application would affect other applications, as they was no clear architecture that outlined these elements. In this way the organization could have gone further is detailing the specific underlining functions of each legacy component and recognize its function within the context of the entire system. Crescent Health Care also considered how their existing technology could be improved through using force.com services. In this way the organization generally followed the recommended first in that it considered how its system would be improved by the addition of new technology. The next action that Crescent Health Care engaged was working to understand the requirements for the new system. In this way it seems that the organization acted in an appropriately comprehensive fashion. Notably the organization determined that specific portions of their system could be transferred to the cloud while other portions of the system would resist such measures. Through understanding the

Article's summary in (international economic field) Essay

Articles summary in (international economic field) - Essay Example2). However, using buildings as an example, it was evident that the economies of surmount seem to become inapplicable up to a certain extent where the construction of higher buildings apparently becomes more costly and inefficient.In cases of large organizations, the condition revealed that organizations that have continued to expand through mergers and acquisitions could only be evaluated in terms of viably realizing economies of scale through the concept of the cost function. As noned, the relationship requires the shoot to estimate how output levels influence the costs of production in a competitive industry (Land of the corporate giants par. 6). However, due to differences in inputs and outputs as determined by the kind of industry some organizations are categorized in, the cost function is a challenging way to gauge the applicability of economies of scale. Overall, large organizations have been inform to just ify continued merger and acquisitions by the ability to limit and restrict competitors and to dictate market prices.The article IMF warns of threat to global economies posed by asceticism drives written by Elliot and published online in The Guardian presented issues that have been recommended by 11 international leaders headed by the International Monetary Fund (IMF) with a recommendation of boosting much needed global economic increment. As revealed, the current practices exemplified by different developed countries focus on protectionism and trade barriers which do not encourage international economic expansion. As indicated, after reviewing the economic indices and thrusts exhibited by various governments, it was evident that more focus was centered on decelerating global growth and rising uncertainty high unemployment, especially youth unemployment, with all its negative economic and social consequences potential resort to inward-looking protectionist policies (Elliot par.

Linguistic Commentary Essay Example | Topics and Well Written Essays - 1000 words

Linguistic Commentary - Essay ExampleAs Professor Christopher toilet Poutain (2005) explains it, there bath be three types of linguistic acceptable variations Acceptability may vary with a number of factors, including place (DIATOPIC variation), social group (DIASTRATIC variation) or time (DIACHRONIC variation). In the present case, we have a diastratic variation as the boss represents a social group a lot different from the workers group. We can disclose that their Spanish is quite different even though they seem to understand each other very well. As we know, the concept of linguistic competence means in pragmatic terms that there is no registry better than others as long as communication is established among them.In this instalment we can note a great difference between the boss Spanish and the workers Spanish. Spanish is a language of constant changes as Professor John M. Lipski (n. d.) verbalize in one of his papers Spanish -a language spoken on every continent- is the pro duct not only of its Peninsular heritage and of internal evolution, hardly also of a variety of language contacts, with indigenous languages, languages of forced immigration (the slave trade), and of voluntary immigration. The present fragment is a good example of the umpteen changes that Spanish has experienced along the years.Another distinctive feature of this fragment is the vocalization and th... The boss also uses some of this broken Spanish words when he changes his register. An interesting feature is the pejorative language used by the administrator rotos de michica (l. 7), fuerino sinvergenza (l. 17), sinvergenzas (l. 18). As he is mad, he uses this kind of language as a way of getting even on the workers. On the other hand, the use of colons speeds up the narrative in lines 25, 26 and 27. The narrator is omniscient. It is narrated in the third person singular. The register of the narrators speech is standard Spanish. In lines 20 and 21 the narration is very agile como un mvil punto obscuro que alejndose se empequeeca. It is also very graphic as we can see the little dot getting smaller with the precise wording of the narrator. This fragment has two distinct parts one narrative part and one dialogues part. The narration is very concise and explanatory as it gives interesting details of the motives behind the dialogues. It is also very descriptive, especially when it says in lines 12-14 the following hablaba ahora a Segundo, que entontecido por su mirada roja de ira, con movimiento de pndulo mova acompasadamente el cuerpo. In these lines we can see the use of a very appropriate metaphor pendulums movement, when referring to the oscillating movement of Segundos body. The narrator also makes emphasis on the wrath of the administrator. He says that his glance was red by the wrath (l. 13), and this image is very graphic and quite appropriate to describe the mood of the boss. But it is pertinent to note that there is a change in the color of his glance due to the same wrath. In line 13 it is red,

Mathematics in the Preschool Dissertation Example | Topics and Well Written Essays - 3250 words

Mathematics in the Preschool - Dissertation ExampleThat is why advance(prenominal) childhood programs are increasingly expected to lend oneself mathsematics instruction in schoolrooms because of young childrens early numerical knowledge. Development of early math skills provides the foundation for later learning (Clements & Sarama, 2008 NAEYC & NCTM, 2008 Lee & Ginsburg, 2008). The depicted object Council of Teachers of Mathematics (NCTM, 2000) emphasizes the need to provide high quality early childhood mathematics programs in preschools because a solid mathematical foundation in early childhood is essential. At this age, young children are building their own perceptions of what math is what it means to know and do math and even about themselves as math learners. These beliefs influence their thinking about, performance in, and attitudes toward mathematics and decisions related to studying mathematics in later years (p. 98) According to the NCTM, the quality of mathematical edu cation in early childhood plays an important part in the childs understanding of possibly difficult math concepts (Loop, 2009). Although there have been many studies pertaining to patterns of mathematical teaching in preschool, there is a lack of research on how teachers of mathematics perceive how young children learn math concepts and even what to teach in accordance to the developmental level of young children. That is why enhancing early childhood education teachers confidence and competence in teaching math is considered a passageway to improvement of mathematics instruction in preschool. Sarama & DiBiase suggests that early childhood teacher educate focus both on mathematics content and teachers dispositions towards math, reflecting the need for extremely qualified superiors (2004). The National Association for the Education of Young Children (NAEYC) Code of Ethics states In decisions concerning childrens programs, we shall draw upon the education, experience, and expertis e of staff members (Decker, Decker, Freeman, & Knorpf, 2009, p.359). This principle pertains to the ideal of professional training and development of early childhood educators, To further the professional development of the field of early childhood care and education and to strengthen its commitment to realizing its load values (Decker et al, 2009, p.361). Early childhood educators need training for all the tasks expected of them when they begin teach young children. Being an effective teacher encompasses a unspecific spectrum of responsibilities from designing an environment conducive to learning, to planning appropriate lessons for young children and implementing them with effective educational strategies, to being able to manage the class well and instilling checker in the children, to involving parents and coordinating with others regarding the provision of quality education for the children. It takes effort to be able to manage all these skills at the same time, hence profe ssional training with experience is required. The current study has taken inspiration and ideas from the work of Platas (2008) entitled Measuring Teachers Knowledge of Early Mathematical Development and their Beliefs about Mathematics belief and Learning in the Preschool Classroom. Platas was able to measure the knowledge of early mathematical development and beliefs about mathematics teaching and learning in the preschool classroom of preschool teachers through the use of developed and validated survey instruments and statistical analysis (2008). The study found a significant

Mental health nursing Essay Example | Topics and Well Written Essays - 750 words

Mental health nursing - Essay ExamplePlease write knock off the questions that you asked and the responses that were given. This information will then be summarised and takeed to a group of peers and an assessor in your PBL 1 assessmentThe service user in his own perspective believes that he suffers from some sort of depression. He claims that his problems at the moment were that he was suffering from disquiet and in the morning panic attack. He believes that this response was because he is worried ab out his father ie if dad pass away who is going to restrain care of me. when asked if he did have any auditory illusion he went on to say that he did here voices but did not want to blab out more about it.I started with the humanistic approach so as to make the client at ease and for him to be able to express himself more. I then went onto the medical model to try to figure out what he was suffering. Some data from the interview give say service user has psychotic symptoms, e.g. auditory hallucinations. ... He claims that his problems at the moment were that he was suffering from anxiety and in the morning panic attack. He believes that this response was because he is worried about his father ie if dad pass away who is going to take care of me. when asked if he did have any auditory hallucination he went on to say that he did here voices but did not want to talk more about it.Conceptual Model AnalysisI started with the humanistic approach so as to make the client at ease and for him to be able to express himself more. I then went onto the medical model to try to figure out what he was suffering. Some data from the interview give evidence service user has psychotic symptoms, e.g. auditory hallucinations. There is acknowledged that patients with mental disorders are not able to percept their condition critically and usually underestimate the inclemency of disease. This patient believes he has depressive state thus he is ready to perceive the model of sick p erson and wish to regain his health. There is known that insane symptoms in schisophrenia could be related to dopaminergic hyperactivity in the brain structures. Thus medical interventions based on the use of antidopaminergic drugs (e.g. Ziprasidone (Geodon), Quetiapine (Seroquel) could be effective in the disease management. It seems that the psychotic symptoms reported by the client have the endogenic origin, i.e. they are not caused directly by external causes.What does the service user believe are the causes of his/her present crisisService user believes that the cause of his present crisis is due to the wrong chemical release in his brain and added that it is genetic as he got a family muniment of metal illness in his family. Thus his mother was treated in mental hospital

Section I of the Capital Project Research Paper

Section I of the Capital Project - Research composition ExampleWith every roof bribe, an validation aims to meet a set of organizational needs. A capital purchase would not benefit an organization unless it contributes to the organizations productivity or overall performance efficacy. This paper will discuss a software purchase a healthcare organization make for filing patient of records properly. The paper will give particular focus on managerial, organizational, and economic benefits of this capital purchase. Capital purchase To define, a capital purchase is defined as any purchase of $1000 and over (Novak, 1996, p.335). Capital purchases are considered as long term assets of an organization. Generally, capital purchases are viewed as capital investments, capital assets, or capital acquisitions. The process of capital acquisition can benefit a healthcare organization in a amount of ways. In the view of Gitman and McDaniel (2008, p.434), capital acquisitions add to an organizat ions asset strength, which in turn contributes to the strongs value chain efficiency and service efficiency. In the case of healthcare organizations like hospitals, a capital purchase is mainly intended to improve the quality of care inducey and thereby promoting patient safety. ... The intend software purchase for filing patient records costs more than $5,000, and therefore, it is a capital purchase. This capital acquisition may assist the healthcare environment to deliver improved patient care services at affordable costs. Management goals of the purchase This capital acquisition would support many management goals including revenue growth, running(a) efficiency improvement, improved productivity, quality assurance, performance evaluation, reduced employee hiring and readying costs. Loretz (2005) says that filing patient records manually is a difficult task because a large number of patients visit a healthcare institution every day. Hence, a healthcare institution needs to em ploy a large workforce to manage patient records appropriately. Evidently, an organization is forced to spend huge amounts on employee hiring and training in order to file patient records manually (p.2). This situation would probably reduce the firms profitability. However, computerized patient records handling system would assist a healthcare environment to manage patient information effectively and inexpensively. A software-based patient discipline filing system is beneficial for the organization to minimize the level of employee hiring because such a program may be capable of handling patient data more accurately and chop-chop. Even though this purchase may cost huge money initially, this acquisition would benefit the organization to trim down employee hiring and training expenses in the long term. Consequently, this may aid the firm to reduce its operating expenses and thereby improve profitability. As we discussed earlier, a software-based program can more quickly and accura tely manage patient information

Love at First Sight, Is There Such a Thing Essay Example for Free

Love at First Sight, Is There Such a Thing raiseWhat is common among the Hunger Games, Romeo and Juliet, Pokemon, 500 Days of Summer and The Vampire Diaries? They all have the trope of hit the hay at first sightPeeta instantly knock off in love with Katniss when he heard her sing on the first day of school Romeo fell in love with Juliet the first time he saw her Brock fell in love with every pretty girl he saw Tom fell in love with Summer at first sight in the office and Stefan also had love at first sight with Elena. Love at first sight is the most wide used trope in literature and film. It is so common that most people mistake it as a reality.Why do I conceptualize that love at first sight is fictional? Love is to be delighted by the happiness of another, said Gottfried Leibniz. If what he said is true, then love at first sight is not really love. You cant know the happiness of a person in an instant youll have to be psychic to do that. To discover an individuals happiness , one has to get to know him/her more. This can be achieved by spending time with that person audience and understanding him/her. Another reason why love at first sight is fictional is infatuation. Love at first sight is just infatuation.puppy love is not love because it is mere attraction and admiration while love is committing oneself to another because he/she c ars for the other. Therefore, love at first sight is not love. Although it is not love, infatuation is inevitable when it comes to love relationships, because it gives you the courage to get to know someone, confess your feelings and move on to the next level. Even so, it does not guarantee love. It just gives it a push. There may be instances when people get infatuated with each other at first sight, then end up falling in love.This situation, according to them, is love at first sight. I think not. I think these instances are what you call infatuation that progressed into love. And these encounters dont happen often. Th ey are very rare. There is a bigger chance of you being infatuated, but as you get to know that person, you realize that he/she is not who you thought he/she was. We get infatuated all the timewhen we see super good looking celebrities, appetizing foods, and suchbut love, it only happens once, and it doesnt happen in a blink of an eye, it develops.In the end, I think that love at first sight is not truly love, but infatuation. I find it so because, again, you cant know someones happiness just by the mere sight of him. So, you cant be delighted by his happiness. Although I believe that there is an innate romanticism attached to the thought of meeting someone, and having them hit enough emotional triggers immediately at first sight, I dont think that it is love. It is infatuationthe first step towards love which can grow into a more mature love.

How to Write a Good Essay Essay Example for Free

How to Write a Good Essay EssayA standard quiz establishes a writers personal understanding, recommendation, analysis, and ex course of studyation of a specific topic. This piece of writing is generally used to teach, inform, orient, inspire, refute, warn, or even entertain the commentator. As such, a effective examine is well-researched, informative, interesting, well-written and easy to read. In order to write a good essay, writers slew follow these guidelines First, the chosen topic must be extensively researched from credible sources such as libraries, academic databases, factual websites, surveys, and interviews. Through adequate research, the writer gains sufficient knowledge in dissecting and discussing the topic at hand. In this stage, other beas and sub-topics are also discovered while listing notes, master(prenominal) key nomenclature and ideas. Upon completion of the research, the writer must digest all useful information to plan and write the essay in a systema tic manner that clearly explains its topic while distinguishing the introduction, body and conclusion of the essay. The introduction contains the thesis statement or central theme of the essay which gives a general idea on what the written work is all about.Read moreHow to write diagnostic essay samples.Therefore, the writer must strive to make it interesting enough for the reader to continue reading the whole essay. After the thesis statement, the body is written by using the researched notes and summaries taken during research. Initial questions previously laid down to determine the outline of the essay must now be answered. Ideally, this is done by penning several paragraphs where each paragraph systematically tackles questions addressing who, what, when, where, why and how.Supplementary examples geared towards reinforcing the thesis statement such as statistical data and other studies can also assist in further expressing the idea of the essay. However, the writer must keep in mind to cite sources and acknowledge them accordingly to avoid plagiarism. Ideas and words borrowed from others, even if paraphrased, should be cited using the required referencing style. Widely used examples of these styles include the American Psychological Association (APA) and Modern Language Association (MLA).Since there are many existing styles, the writer must pattern the citation and format of the written piece according to the required style. Meanwhile, the conclusion is written by summarizing the important points, reiterating the thesis, and providing a call to action sentence for the reader to act on. A good essay imparts a lasting impression while encouraging the reader to think. In finalizing the essay, the writer must thoroughly edit and proofread the entire work. Spelling, grammatical, and structural errors should be checked again and again. One good way to do a spell-check is to read the essay backwards and check each word carefully.Most of the time, a good essay wri tten by a good writer undergoes continuous editing, rephrasing, and rewriting until a cleaner and more concise copy is produced. For those aspiring to constantly write good essays, reading is a defined must to expand ones vocabulary and exposure to other styles of writing. Careful research, effective writing, and thorough editing are essential stages of writing a good essay. By following these guidelines, together with constant learning, practice and dedication, one can develop the skills on how to write a good essay.

Not White Just Right Response Essay Example for Free

Not White Just Right Response EssayAfter rendition Not White, Just Right, an article by Rachel Jones, I could not help but relate to her. In the article, Jones elaborates more on her popular essay, Whats Wrong with Black English while also mentioning others who share in her opinion. I, too, was ridiculed in school for talking too white. In world schools African American students are mocked and shunned by their brothers and sisters for speaking or even behaving in an intelligent manner, as if intelligence is unacceptable in our community. I throw off been the outcast for that single reason. However those who spoke like third graders in the tenth grade were praised and welcomed in the Black community. To that I have to admit that we have go from the times of Dr. King and Fredrick Douglas, when we knew as African Americans that we are just as intelligent as Caucasian men. This is not the future our leaders have fought so hard for. It is infuriating to witness young African Amer icans not only in public school but in college speaking as if they have no intelligence.I am only a freshman and I cannot count the number of times Ive heard other freshmen and upperclassmen use grammatically incorrect phrases like, what that is and I aint goin nowhere. Speech like this amongst my African American peers only angered me in high school, now it depresses me. It is depressing to see so many educated African Americans speak as if they had dropped out of high school, just because it is cool and they do not want to talk white.A mentality like that will always keep us as African Americans at the bottom of society. How do we expect to be seen as equally intelligent as Caucasian people if we do not even speak as if we are educated on a higher take aim? Therefore, in conclusion, I would like to thank Rachel Jones for writing those two texts about young African American lingual. It is about time that someone made it public to the Black community that this speech is NOT conser ving our culture it is keeping us from reaching our goals and becoming successful.

The Causes Of Eating Disorders Psychology Essay

The Causes Of have Disorders Psychology Es theorizeAn eating disease is a psychological illness where the subject has an abnormal human relationship with food, and has a distorted view himself or herself. Particularly in those who suffer from anorexia and bulimia, there is an obsession with weight loss and food intake. They ar also uneffective to see how self-destructive their behaviour is, and view themselves as too fat even when underweight. (Tighe, 2011)This essay will examine the starts of eating disorders and the psychological invoices that go along with them. Three psychological models will be looked at the cognitive approach, the behavioural approach and finally, the psychodynamic approach.The basis of the Cognitive approach is the theory that the human brain whole works like a computer. Processed outside information becomes our thoughts and our output is our behaviour. Cognitive psychologists would explain that the causes of eating disorders argon due to faulty cogni tion (thoughts) and having distorted perceptions of self. A. Beck was the innovate of Cognitive Behavioural Therapy (CBT), which can help eating disorder sufferers challenge their faulty thinking and change their perceptions. (DK, 2011)It is easy to see then, how CBT could be very reclaimable in treating those with an eating disorder, as many symptoms of eating disorders are to do with faulty perception of the self.Fallon and Rozin (1985) also did research based on the cognitive model. They gave a chart of nine images of proboscis types to both hands and wo hands. On the chart the silhouettes were either very slim to those of a higher weight. On the chart they set how they perceived their own weight, how they perceived what weight was attractive to those of the opposite sex and their own, ideal weight. Women tended to place both their ideal weight and the weight they thought men would be attracted to on the lower side of the scale. Their perceived current weight placed at a sig nificantly higher point on the scale. The men however, placed both their ideal weight and current weight close together but the weight that they perceived women to find attractive was higher on the chart*.This research is useful at seeing the difference between how male and female perception of self and ideal weight differs. However, there are some problems with it. For example, all the people asked were American and between the ages of 18-19 and all went to a private college, which suggests that they were, upper to middle class. This means that this piece of research is highly ethno- centrical it is not applicable to those who are exempt from that clog upground and culture. The research in itself also lacks a certain amount of objective, as even though it shows peoples perceptions of their body it does not mean they are all suffering or will suffer from an eating disorder. The research also now lacks historical validity as it was carried out in 1985. Ideal body image was different to how it is now. (Adler, 1992)The cognitive approach can realize positive appraisal as it backed up scientifically. Its face validity reflects in the success rate for CBT, which is often very high. The downside is that is seems to de-humanise people. It does not place any bearings on the diligents emotions or their individual circumstances. A patient also seems to face large amount of blame and responsibility.In contrast with the Cognitive, approach is the psychodynamic approach Sigmund Freud was the main trailblazer and the first person to study the mind. He believed that Mental Illness and mal -adaptive behaviour was due to repressed memories and emotions held in our unconscious mind and that, causes of emotional pain can be bought out through analysis (DK, 2011). This quote also links into another part of what Freuds theory was on how the human mind worked. He believed that the human psyche had three main split the id, ego and the superego. Freud believed the id is responsi ble, for our basic animal instincts, such as wanting food, or sex. There was also the ego was the part of the mind that was connected with the reality of the fleck you are in. Finally, the superego is the moral part of the psyche. It is the voice that tells us was is good and right to do regardless of what the id wants. Freuds belief is that if the id, ego and superego are unbalanced then it is mavin of the pre- cursors to mental illness, such as an eating disorder.Freud also put a strong emphasis on early clawhood experiences. He concluded that brusk parenting or difficulty bonding with parents as a child could lead to mental illness and abnormal behaviour as an adult. A psychodynamic view of the cause of someone having an eating disorder if a younger women for example, would be that in her unconscious mind she fears becoming an adult. Due to this fear, she tries to revert to being a child by losing weight, ca exploitation her to lose her feminine figure and to stop herself men struating. H. Bruch also believed that this aspiration of wanting to become a child might also be to do with having a poor relationship with parents who did not help her to develop any sort of identity. *There are some definite criticisms about the psychodynamic approach. nonpareil of the biggest problems with it is its very difficult to test as it is based on case studies, not scientific examination.In fact, the only way you could test it is by using identical twins by putting one through a trauma and the other one not this of course, is greatly unethical. You also cannot duplicate the exact result on any other patient. What more, the approach has a huge bias against parenting and the role it could play in mental illness. However, numerous case studies back up the psychodynamic approach and the use of psychoanalysis so it could work for some people.The last and final approach analysed is the Behavioural approach. The theory of it is that all behaviours learned are due to experien ce. In addition, those behaviours can then be unlearned. Ivan Pavlov, research the theory of classical conditioning by using dogs. He used a stimulus such as a bell ringing and giving the dog food at the same time to condition the dog to expect food whenever it heard the bell ring. The dog would even start to salivate before it saw the food but still heard the ringing of the bell. (Youtube, 2008) B.F Skinner grow on Pavlovs research and called his theory Radical Behaviourism. He started by using mice. He would place the mice in a box whenever the purloin pressed a lever or bar, it food was given. Skinner explained that this wasnt operant conditioning like Pavlovs as there was no preceding stimulus the behaviour of the mouse was move by the positive reinforcement of getting food. He continued his research by then wiring up the floor of the box to an electric source. The mouse would then get a shock when performing certain behaviour. The mouse then learned the behaviour and shock were linked .This is negative reinforcement. (DK, 2011)The behavioural approaches explanation of the causes of an eating disorder in an individual would be due to either positive or negative reinforcement. An example of operant conditioning, that led to someone evolution an eating disorder would be, that if a teenage girl kept losing weight and got continuous praise from friends, but then also receiving negative criticism from her parents for apothegm she was greedy whenever she ate. She would learn that if she lost weight and did not eat much her friends would complement her and her parents in turn, would accept her.Criticisms of the behavioural approach are that scientific testing is possible. It also gives quick results when it comes to treatment. Unfortunately, it does not focus on the patients emotions or their current personal circumstances. Neither, is it suitable to treat all illnesses, with eating disorders in particular a downside of it would be, that it changes the beha viour but has not influence of the cause, of that behaviour.In conclusion, it is widely acknowledged that eating disorders do not have one overruling cause but have a complex mixture of disordered thinking and negative perceptions of self. Poor interpersonal relationships and past trauma may also play a part. Eating disorders may also run in social groups and behaviours associated with eating disorders may be picked up/learned through peer pressure. (National Eating Disorders Association, 2004)It is safe to say then that all of the psychological approaches cognitive, behavioural and psychodynamic are all perfectly valid in explaining why someone may suffer from an eating disorder and it is wise to keep an open minded approach to treating an eating disorder, as all of the approaches work in a highly interwoven and harmonious way.*Allen. C (2012) Lecture notes Studies on eating disorders. Access to HE, 24th OctoberReferencesAdler, L. D. (1992). Female and Male Perceptions of I deal Bo dy Shapes. Retrieved October Wednesday 24th, 2012, from Lillianmcmaster.com http//www.lillianmcmaster.com/resources/ideal%20body%20image%20study%20on%20caucasians.pdfDK. (2011). The Psycholgy Book. London Dorling Kindersley.National Eating Disorders Association. (2004). What Causes Eating Disorders. Retrieved October thorium 25th, 2012, from National Eating Disorders.org http//www.nationaleatingdisorders.org/nedaDir/files/documents/handouts/WhatCaus.pdfTighe, J. (2011, May). Eating Disorders. Retrieved October Wednesday 24th, 2012, from BBC Health http//www.bbc.co.uk/health/emotional_health/mental_health/mind_eatingdisorders.shtmlYoutube (Director). (2008). Classical Conditioning- Ivan Pavlov Motion Picture.

Dementias Effect on the Visual System

deliriums Effect on the optic SystemAbstractRecent state indicates that memory mischief and optical dys exit argon cl previous(predicate) linked in monomania, and that special runninging for ocular dys figure appear bum improve the first diagnosis and give-and-take of madness. Visual act upon is divided in terms of anatomic, operative and cognitive aras respectively. Under popular circumstances these functions perform seamlessly to belongher to bring let out a optical reality of what we call the external piece. Alzheimers ailment is the virtually roughhewn form of dementia and bypast investigate into this argona has introducen that sufferers file opthalmic deficits in some(prenominal)(prenominal) cay beas. Namely contrast sensitivity, motion, semblance, foresight perception as surface as optic hallucinations. Thus by approaching the persevering in a appropriate manor with regards to dementia, clinical professionals muckle detect opthalmic dysfunction and memory impairment whilst to a fault providing a vital billet in secondary and tertiary preventative measures. Further more(prenominal) clinical professionals freighter provide help oneself in the handling of dementia linked visual affections. With sure demographic trends, dementia is becoming increasingly prevalent overdue in the get alonging population. Consequently thither is an increase need for practitioners to amaze a dense knowledge of much(prenominal)(prenominal) dementia causes. Improving the sufferers quality of life should be the practitioners principal(prenominal) concern. By providing thorough treatments and suggestions on enduring tailored environmental modifications this can be achieved.(1) Introduction madness is a dismission of mental function in ii or more beas much(prenominal) as langu get along with, memory, visual and spatial abilities, or judgment severe enough to interfere with daily life1. Dementia is not a illness itself, s ufferers usher a broader set of symptoms that accompany current disorders or physical conditions1. Well cognise unsoundnesss that cause dementia include Alzheimers disease, Creutzfeldt-Jakob disease and multi-infarction dementia1.Dementia is an acquired and progressive riddle that affects cognitive functions, behavior, thinking processes and the ability to delight out normal activities. Vision is one of the nigh all-important(prenominal) elemental senses, therefrom thoughtful or bonk sight loss has a major(ip) impact on a respective(prenominal)s ability to communicate effectively and function in restrictedly. Individuals who suffer from both dementia and serious heap loss result needs be subject to profound emotional, practical, psychological and financial problems. These factors result as advantageously as influence others some the sufferer and leave alone extend to the family and the greater society. As we get honest-to-goodnesser both dementia and visual problems inevitably become much more prevalent. Current demographic trends show the increase of the chassis of very old in our population. on that pointfore it is inevitable that dementia and serious sight loss either alone or together, will feature important consequences for all of us1.The bulky majority of people are aware that dementia affects the memory. However it is the impact it has on the ability to carry out daily tasks and problems with behavior that cause picky problems, and in severe cases can lead to fundamentalization. In the primary stages of dementia, the patient can be helped by friends and family done with(predicate) reminders. As progression pass aways the individual will loose the skills needed for everyday tasks and may eventually fail to recognize family members, a condition cognize as prospagnosia. The result of such progression is that the individual becomes totally dependent on others. Dementia not only affects the lives of the individual, but in like manner the family2.Dementia can fall in itself in varying forms. The most green form of dementia in the old is Alzheimers disease, affecting millions of people. It is a degenerative condition that attacks the straits. Progression is gradual and at a variable rate. Symptoms of Alzheimers disease are impair memory, thinking and changes in behaviour. Dementia with Lewy bodies and dementias linked to Parkinsons disease are responsible for around 10-20% of all dementias. Dementia with Lewy bodies is of particular interest as individuals3 with this condition not only present confusion and varying cognition, but to a fault present symptoms of visual hallucinations2. Another habitual condition that causes dementia is multi-infarct dementia, also known as vascular dementia. It is the second most common form of dementia after Alzheimers disease in the fourth-year. Multi infarct dementia is caused by multiple strokes in the encephalon. These series of strokes can affect some intell ectual abilities, impair motor skills and also cause individuals to experience visual hallucinations. Individuals with multi infarct dementia are abandoned to risk factors for stroke, such as spatial relationgraduate BP, heart disease and diabetes. Multi infarct dementia cannot be treated, once impertinence cells die they cannot be re lay1.In most cases the symptoms of dementia and serious sight loss develop independently. However some conditions can cause both visual and cognitive impairments, for example Down syndrome, seven-fold sclerosis and diabetes. Dementia is most prevalent in the elderly, as is sight loss. in that locationfore it is inevitable that a number of people will present dementia together with serious sight loss.There kick in been legion(predicate) studies into the preponderance of dementia in the UK. An estimate for the prevalence of dementia in people everyplace 75 years of age is 15% of the population2. The Alzheimers society suggest that 775,200 people in the UK suffer from dementia (figures taken 2001). The Alzheimers society also calculates that the prevalence of dementia in the 65-75 years age group is 1 in 50, for 70-80 years 1 in 20 and for everywhere 80 years of age 1 in 5. Estimates suggest that by 2010 approximately 840,000 people will become dementia sufferers in the UK. Estimates suggest that around 40% of dementia sufferers are in residential institutions. One study from 1996 showed that dementia sufferers are 30 times more in all likelihood to live in an institution than people without dementia. At 65 years of age men are 3 times more likely than women to live in an institution and at 86 men and women are equally likely to be institutionalized4.Visual impairments are not associated general diagnostic features of dementia. However recent research has shown the change in visual function and visual process may be relevant. Alzheimers disease patients often present problems with visual on the qui vive, contrast sensit ivity, stereo-acuity and color pot. These problems are believed to be more true of cognitive dysfunction rather than any specific problems in the affection or optic nerve9. Early diagnosis is essential to both dementia and sight loss patients, as drug treatments are becoming more and more available. and then maximizing the treatment and care for the individual. On the other hand early diagnosis of visual conditions is also essential, so that progression is delayed and treatment is commenced, therefore further progression is prevented if plausible2.The Mini-Mental State tryout MMSE, is the most commonly used cognitive tribulation for the diagnosis of dementia. It involves the patient to undertake tests of memory and cognition. It takes the form of a series of questions/answers and uses written, verbal and visual material. Poor vision or blindness is the most common cause of ill-judged(p) performance on this test other than dementia itself2.Visual deterioration can occur simul taneously with memory loss in most dementia sufferers. Therefore early recognition of dementia through vision tests has become of importance. Table 1 shows few possible tests that might be useful for such purposeTable 1 Vision tests for possible early detection and monitoring of Alzheimers diseaseUseBenton visual retention testMight be able to predict risk for AD 10-15 years before the onset of the diseaseTests visual memoryContrast sensitivityAD patients nourish selectively reduced CS for distinguishing rotundr-than-life marks and facesUseful expanse of viewTests processing speed, divided upkeep and selective attentionFacilitates detection of attentional dysfunction patients despicable from this problem complain of poor vision and inability to identify someone in a group or an object on a patterned backgroundCould be useful to assess fitness to driveFacial recognitionAD patients do not recognize faces with large features and emit contrastAD patients do not recognize famili ar faces (due to impaired memory)Tests that use facial expressions with increasingly subsideed gunpoint of contrastThe presence of this paper is to provide information about current knowledge on the topic of visual function dementia. With regards to Alzheimers disease, there will be an inclination to several main foci of research. Namely anatomical/structural changes, functional visual changes, cognitive brain changes and other changes such as the effects of diagnostic drugs on Alzheimers disease patients.(2) Alzheimers diseaseAlzheimers disease is the most common cause of dementia amongst older adults. The Alzheimers research trust estimates that 700,000 individuals in the UK presently are afflicted. This number will inevitably increase exponentially in the near future with the trend of an increasingly maturation UK population. Therefore it must be of the utmost of importance worldwide to have an spirit all behavioral, anatomical and physiological aspects of this disease.Alz heimers disease is a degenerative disease that attacks the brain, it begins gradually and progresses at a variable rate. Common signs are impaired thinking, memory and behavior. Health professionals and care givers agree that the memory deficit is ordinarily the initial sign of the disease. However researchers have long known that Alzheimers disease is characterized by impairments of several auxiliaryal domains, including visual function5.However these findings have not yet appeared in the diagnostic guides consulted by healthcare professionals, for example the most recent addition of the Diagnostic Statistical manual of mental dis ordinates states that few afferent signs occur in early Alzheimers disease2. Therefore we up to now have a limited understanding of the true extent to which visual impairments affect Alzheimers disease sufferers. The current web site of the Alzheimers association1 and bailiwick Institute of Aging6 experience no mention of the topic of sensory chan ges in Alzheimers disease. It has even been said that patients with Alzheimers disease report visual problems to their healthcare professionals less frequently than do hygienic elderly individuals7. Nevertheless visual function is impaired in Alzheimers disease8. In terms of cognitive changes, the neuropathology of this disorder affects several other brain areas which are sacred to processing low level visual functions, as thoroughly as lavishlyer level visual cognition and attention5.These neuropathological cognitive changes are more controlling however in the visual bod of Alzheimers disease known as posterior cortical atrophy. However visual problems are also present in the more common Alzheimers disease.Alzheimers disease begins when there are deposits of abnormal proteins outside nerve cells dictated in the brain in the form of amyloid. These are known as diffuse plaques, and the amyloid also forms the central part of further structured plaques known as senile or neuroti c plaques1. Buildup of anomalous filaments of protein deep down nerve cells in the brain can also take place. This protein accumulates as masses of filaments known as neurofibril tangles. Atrophy of the affected areas of the brain can also occur as well as the enlargement of the ventricles1. There is also a loss of the neuro transmitter Serotonin, Acetylcholine, Norepinephrine and Somatostatin. Attempts have been made to try to slow the development of the disease by permutation the neurotransmitters with cholinesterase inhibitors, such as donepezil (Aricept), rivastigmine (excelon), galantamine (Reminyl) and memantine (Namenda)1. These drugs work by increasing the levels of transmitters among cells, which otherwise become lacking in Alzheimers disease. The National Institute for Clinical Excellence pleasant conducted a review of these drugs in March 2005 and cogitate that none of these drugs provided sufficient enough advantages to the patient in order to justify their cost. Th ey recommended against the use of such drugs in the Nhs, though the Department of Health later overturned this ruling.(3) Visual Changes in Alzheimers PatientsLoss of vision is a key healthcare dilemma amongst the elderly. By the age of 65 approximately one in three people have a vision reducing eye disease. Dementia, Alzheimers disease patients and elderly patients, consequently have many another(prenominal) visual conditions in common.Alzheimers disease impairs visual function early in the course of the disease and functional losses correlate with cognitive losses. There are several common visual functional deficits that are frequently identified in Alzheimers disease. There is read for deficits in Motion perception9,10 contrast sensitivity11 colour diversity of blue short wavelength hues34 and performance on backward masking tests31.In Alzheimers disease the secondary point of constipation is usually the visual association cerebral cortex and other higher cortical areas, as well as the primary visual cortex 13,14.(3.1) Some of the main changes that occur in the eye with aging includeThe crystalline lens increases in thickness, therefore decreasing its transparency and elasticity therefore there is a tendency for cataracts to appear.The conjunctiva can become thicker and wrinkled, therefore is subject to deposits such as pinguecela.The iris can atrophy, therefore pupils become constricted and their receipt to light becomes sluggish. The look ability to dark/light set is affected.Refractive index of the cornea decreases and it becomes less transparent. Arcus senilis can appear.The ocular globe and eyelids can shrink leading to conditions such as entropian, ectropian and trichiasis. Also while the lachrymal production is reduced the puncta lachrymalis can become stenosed and provide less drainage which gives rise to chronic watering of the eyesAnterior chamber usually becomes more shallow and the sclera more rigid, increasing the prospects of glaucoma. (3.2) Visual changes due to Alzheimers disease reported in lit are outlined below(3.2) anatomicalAbnormal nerve fiber layer and retinene ganglion cells (Blanks et al, 1989) (Tsai et al, 1991) (Hedges et al, 1996Imaging of the nerve fibre layer can be conducted via three techniques. These include Optical tackiness topography (OCT), Scanning laser polarimetry and Confocal laser topography. Parisi et al16 conducted research upon the optic nerve fibre layer thickness using OCT. 17 Alzheimers disease individuals and 14 age matched rosy-cheeked individuals were used. The findings of this study showed a definite relationship between the thickness of the nerve fiber layer and the prevalence of Alzheimers disease. There was a significant decrease in the nerve fiber layer thickness in Alzheimers individuals when compared to healthy age matched particpants.Macular cell loss (Blanks et al, 1990)Research has shown a definite decrease of the number of retinal ganglion cells located in the mac ulae of Alzheimers disease sufferers in comparison to age matched control individuals. It was found that the loss of retinal ganglion cells alter with eccentricity from the central macula17. Results obtained by Blanks et al, 1990 showed a 28% loss of neurons from retinal ganglion cells at 0-0.5mm from the foveola, 24% loss at 0.5-1.0mm and 47% loss at 1.0mm to1.5mm from the foveola. These losses of retinal ganglion cells were constantly greater than those seen in age matched healthy individuals.Supranuclear cataract (Goldstein et al, 2003)Cataract removal could improve not only the visual acuity but may be an important tool in helping those patients suffering from visual hallucinations (Chapman et al, 1999) however, no prospective study has been carried out to prove the role of vision improvement through cataract operation on the well-being of patients suffering from ADExfoliation (Janciauskien and Krakau, 2001)Abnormal pupillary innervation 109-113Glaucomatous optic nerve cupping (Bayer et al, 2002)(3.3) FunctionalDecreased visual acuity (Holroyd and Shepherd, 2001)Rapid loss of visual field in patients with AD and glaucoma (Bayer and Ferrari, 2002)Visual field loss (inferior) (Trick et al, 1995)Reduced contrast sensitivity (Holroyd and Shepherd, 2001)Abnormal colour discrimination (blue, short-wavelength hues) (Cronin-Golomb et al, 1991)Abnormal flash visual elicited potentials (VEPs) (Holroyd and Shepherd, 2001)Delayed saccadic eye movements (Holroyd and Shepherd, 2001)(3.4) CognitiveAbnormal visual maintained/divided/selective attention and visual processing speed (Rizzo et al, 2000)Inability to recognize depth (Holroyd and Shepherd, 2001)Impaired face recognition (van Rhijin et al, 2004)(3.5) OtherExcessive pharmacological mydriasis/miosis 109-113These changes summed together not only diminish the quality of vision, but many of them also make the mental testing of the eye much more complicated. In conjunction with the general visual symptoms of aging , Alzheimers patients can also experience visual disturbances caused by the brain rather than the visual carcass alone. This means that they can have problems and difficulties perceiving what they see rather than how clearly they see it3. Difficulties are usually experienced in the areas mentioned earlier, videlicet depth, motion, color, and contrast sensitivity. Visual hallucinations are also a common problem linked to loss of vision in Alzheimers disease patients18. Another common disorder linked to patients with Alzheimers disease is a variant of motion blindness. The patient can appear to be confused and disordered the individual will see the world as a series of still frames19.Visual changes in Alzheimers disease may also be dependent upon which brain hemisphere is more sternly traumad this factor can often be overlooked. An individual with Alzheimers disease could have damage to a greater extent on their left brain hemisphere from plaques and tangles. This would therefore cause subsequent retinal changes in only the left hemi-retinas of each eye i.e. the decent visual fields. The right eye visual field would be affected in the secular side (right) and the left eye visual field would be affected nasally (right)20. When only half(prenominal) the retina is impacted, smaller regions of the optic nerve and nerve fiber layer show losses. The left eye with affected temporal retina would show optic nerve damage in differing regions of the nerve than the right eye with nasal retinal damage20.Alzheimers patients commonly show selective degeneration of large ganglion cell axons located in the optic nerves. This suggests that there would be impairment of broadband channel visual function. Conversely studies have shown that broadband visual capabilities are not selectively impaired in Alzheimers disease. The magnocellular and parvocellular neurons are greatly affected in Alzheimers patients, this has been proved by studies of the dorsal Lateral geniculate nuc leus(LGN)1. The geniculostirate projection establishment is split both functionally and anatomically into devil sections. They include the parvocellular layers of the Lateral geniculate body and also incorporates the magnocellular layers. These carcasss are mainly divided in the primary visual cortex and go through further segregation in the visual association cortex. They conclude in the temporal and paritetal lobes1.The parvocellular layers contain smaller, centrally located receptive fields that account for high spatial frequencies (acuity), they also respond well to color. On the other hand these cells do not respond well to rapid motion or high flicker rates. The magnocellular cells have larger receptive fields and respond superiorly to motion and flicker. They are however comparatively insusceptible to color deflections. The magnocellular neurons generally show poor spatial resolution, although they seem to respond better at low luminance contrasts. To summarize the parvo cellular organisation is superior at detecting small, slow moving, colored targets placed in the centre of the visual field. Meanwhile the magnocellular system has the ability to process rapidly moving and optically immobile stimuli across larger areas of the visual field1.The parvocellular system projects ventrally to the inferior temporal areas, which are regard in visual research, pattern recognition and visual object memory. The magnocellular system projects dorsally to the posterior parietal and superior temporal areas. These are specialized for motion information processing. The cerebral cortical areas to which the parvocelluar system projects receives virtually no vestibular afferents. Alternatively the cerebral areas to which the magnocelullar system projects receives significant vestibular and other sensory inputs. These are believed to be involved in maintaining spatial orientation. Research shows shows that the magnocellular system is more involved in Alzheimers diseas e1Oddly, many individuals experience difficulties at low spatial frequencies instead of high frequencies as in old age. This suggests that areas controlling the low spatial frequency processing in the primary visual cortex would be affected more than those for higher frequencies processing21 After neuropathilogical studies in 1997 by Hof et al were carried out on brains with visual impairments they concluded that cortical atrophy dominated on the posterior parietal cortex and occipital lobe22.Glaucoma is also a neurodegenerative disease that has similar effects on the visual system. Lower spatial frequencies in the contrast sensitivity, deficits in the blue short wavelength color range as well as reductions in motion perception are all linked to glaucomatous patients23. When patients diagnosed with Alzheimers disease also have glaucoma, the deterioration of vision related to glaucoma is much more rapid and progression is more predatory than in people with glaucoma solely and not Al zheimers disease as well24.Glaucoma is different from Alzheimers disease in that it affects the visual function at the early sites of neural activity, namely, the retinal ganglion cells. Glaucoma destroys the afferent axons at the nerve fiber layer in the retina. This loss of axons ultimately leads to added atrophy further up the visual pass due to lessen neural input. Alternatively Alzheimers disease impacts the cells that are located terminally or intermediary in the visual pathway of the brain. The result is again reduced neuronal input due to loss of nerve fibre connections and atrophy along the visual pathway. When the two diseases exist in the same individual together it can be seen that there is likely to be a greater disruption to the visual system25. One key difference between the two diseases is that they affect the visual pathway at different points. Glaucoma is a degenerative disease showtime at the beginning of the visual pathway, whereas Alzheimers disease is a dege nerative process starting relatively late in the visual pathway. When the two diseases coexist then the neuronal and functional losses of vision are cumulative.(4) Optometric examination of dementia patientsDementia patients present special problems for optometrists. A standard eye test can be an audile to even the outflank of us. The patient is placed in an foreign environment surrounded by unusual equipment, machinery and is subjected to probing questions about their medical history which will without doubt appraise their already flawed memory. Dementia patients are most likely to be from the elderly. Therefore several difficulties are presented while conducting an ocular examination. The patient is call for to sustain a slope and has to maintain niggardness throughout the testing procedures, which can be very difficult. Subjective examination requires reactions from the patient, they are expected to remember and watch out complex instructions given to them by the optometri st as well as make many precise discriminatory judgments in a short space of time. The multiple tasks required to be completed during the examination are often beyond dementia patients as they are limited by the disease. Therefore it is common that patients with even a baby bird degree of dementia fail to provide valid answers, provide unpredictable responses to the subjective examination and retreat into an inert state1,2.During the visual examination of Alzheimers disease patients, several key visual problems can be detected. Moderate dementia patients will often experience problems such as topographic agnosia, alexia without agraphia, visual agnosia and prospagnosia1. such patients often cannot describe individual components of photos and routinely fail to recognize family members. The degree to which such problems are experienced is ordered with the level of cytochrome oxidase deficits in the associated cortical area. In conjunction with these problems dementia patients often have problems with texture discrimination and blue violet discrimination1.Throughout the examination of the elderly dementia patients there are two contradictory requirements, firstly is assurance. The patients responses will be delayed and the patient may feel anxious in such an unfamiliar situation. Thus constant reassurance is required and they cannot be rushed. Alternatively time constraints are important, a dementia/elderly patient is likely to have a short attention span. Consequently the two factors above much be considered and balanced. The examination must be thorough yet carried out as apace as possible. Often when examining a dementia patient a family member of the carer must be present in order to aid the communication between optometrist and patient, for example difficulties are likely to occur when recording history and symptoms without a carer present. All factors need to be considered such as family history, medication, eye treatment and knowledge of any medical co nditions and if so how long they have suffered from them.In terms of an external examination firstly, gross observations should be recorded for example does the patient have an abnormal head position or is there any lid tosis. Many external observations can also be detected with the aid of pupil reflexes. Upon carrying out the external examination the optometrist must be carful to explain exactly what each procedure will involve so as not to intimidate the patient.(4.1) Internal ocular health examinationInternal examination of an elderly patient often presents many problems. Older patients tend to have constricted pupils and often opacities in the media such as cataract. All of which make opthalmoscopy a much more complex task for the optometrist. Patients with dementia also show poor fixation as well as lack of concentration. Pupil dilation is often used to aid external examination however many older patients can have a poor response to the insertion of mydriatic drug eye drops. f ddfdffdgThere have been many studies into the affects of diagnostic mydriatic and myotic drugs. Many studies have shown excessive mydriatic pupil response to trompicamide (a pupil dilating drug) in patients with Alzheimers disease when compared to control individuals26-30. On the other hand studies into the use of myotic drops, particularly Pilocarpine have shown an increased response of pupil constriction in Alzheimers disease patients upon comparison to normal control patients. These findings suggest a defect in pupillary innervation with Alzheimers disease individuals. Studies of post mortem individuals with exaggerated mydriatic pupil responses to Tropicamide found a definte disruption to the Edinger-Westphal nucleus. The Edinger-Westphal nucleus is one of the key structures of the brain involved in the autonomic nervous system, it mediates the harmonized and para-sympathetic pupil responses. Research by Scinto et al found amyloid plaques and neurofibrillary tangles in all in dividuals tested with excessive mydriatic pupil responses. The conclusion was that the Edinger-Westphal nucleus is targeted early in the progression of Alzheimers disease.In terms of intraocular pressures use of the goldman an Perkins tonometers will be limited for the elderly dementia patients, due to health and safety reasons. Sudden movements whilst carrying out pressure tests on such equipment may be dangerous. Therefore this can be overcome to a degree by the use of handheld instruments such as the pulseair. However even with the pulseair problems can still be faced with uncooperative patients.(4.2) Objective Refraction examinationWith uncooperative and awkward patients objective diversion through retinosopy may be difficult. Factors such as opacified media, miotic pupils, and poor fixation will influence the truth of the refraction. The recent introduction of hand held optometers has contributed to around overcoming such problems. Instruments such as thee Nikon Retinomax ar e excellent for obtaining an objective refraction of the elderly patient with miotic pupils and unintelligible media.When presenting the Snellen chart to a patient, the quality of their response will inevitably depend upon the degree of their dementia. Depending on which stage of dementia they are suffDementias Effect on the Visual SystemDementias Effect on the Visual SystemAbstractRecent evidence indicates that memory impairment and visual dysfunction are clearly linked in dementia, and that special testing for visual dysfunction can improve the early diagnosis and treatment of dementia. Visual function is divided in terms of anatomic, functional and cognitive areas respectively. Under normal circumstances these functions perform seamlessly together to produce a visual reality of what we call the external world. Alzheimers disease is the most common form of dementia and past research into this area has shown that sufferers show visual deficits in several key areas. Namely contrast sensitivity, motion, colour, depth perception as well as visual hallucinations. Thus by approaching the patient in a appropriate manor with regards to dementia, clinical professionals can detect visual dysfunction and memory impairment whilst also providing a vital role in secondary and tertiary preventative measures. Furthermore clinical professionals can provide aid in the treatment of dementia linked visual disorders. With current demographic trends, dementia is becoming increasingly prevalent due in the ageing population. Consequently there is an increased need for practitioners to have a sound knowledge of such dementia conditions. Improving the sufferers quality of life should be the practitioners main concern. By providing thorough treatments and suggestions on patient tailored environmental modifications this can be achieved.(1) IntroductionDementia is a loss of mental function in two or more areas such as language, memory, visual and spatial abilities, or judgment severe e nough to interfere with daily life1. Dementia is not a disease itself, sufferers show a broader set of symptoms that accompany certain diseases or physical conditions1. Well known diseases that cause dementia include Alzheimers disease, Creutzfeldt-Jakob disease and multi-infarct dementia1.Dementia is an acquired and progressive problem that affects cognitive functions, behavior, thinking processes and the ability to carry out normal activities. Vision is one of the most important primary senses, therefore serious or complete sight loss has a major impact on a individuals ability to communicate effectively and function independently. Individuals who suffer from both dementia and serious vision loss will inevitably be subject to profound emotional, practical, psychological and financial problems. These factors will also influence others around the sufferer and will extend to the family and the greater society. As we get older both dementia and visual problems inevitably become much m ore prevalent. Current demographic trends show the increase of the number of very old in our population. Therefore it is inevitable that dementia and serious sight loss either alone or together, will have important consequences for all of us1.The vast majority of people are aware that dementia affects the memory. However it is the impact it has on the ability to carry out daily tasks and problems with behavior that cause particular problems, and in severe cases can lead to institutionalization. In the primary stages of dementia, the patient can be helped by friends and family through reminders. As progression occurs the individual will loose the skills needed for everyday tasks and may eventually fail to recognize family members, a condition known as prospagnosia. The result of such progression is that the individual becomes totally dependent on others. Dementia not only affects the lives of the individual, but also the family2.Dementia can present itself in varying forms. The most common form of dementia in the old is Alzheimers disease, affecting millions of people. It is a degenerative condition that attacks the brain. Progression is gradual and at a variable rate. Symptoms of Alzheimers disease are impaired memory, thinking and changes in behaviour. Dementia with Lewy bodies and dementias linked to Parkinsons disease are responsible for around 10-20% of all dementias. Dementia with Lewy bodies is of particular interest as individuals3 with this condition not only present confusion and varying cognition, but also present symptoms of visual hallucinations2. Another common condition that causes dementia is multi-infarct dementia, also known as vascular dementia. It is the second most common form of dementia after Alzheimers disease in the elderly. Multi infarct dementia is caused by multiple strokes in the brain. These series of strokes can affect some intellectual abilities, impair motor skills and also cause individuals to experience visual hallucinations. Individuals with multi infarct dementia are prone to risk factors for stroke, such as high BP, heart disease and diabetes. Multi infarct dementia cannot be treated, once nerve cells die they cannot be replaced1.In most cases the symptoms of dementia and serious sight loss develop independently. However some conditions can cause both visual and cognitive impairments, for example Down syndrome, Multiple sclerosis and diabetes. Dementia is most prevalent in the elderly, as is sight loss. Therefore it is inevitable that a number of people will present dementia together with serious sight loss.There have been many studies into the prevalence of dementia in the UK. An estimate for the prevalence of dementia in people over 75 years of age is 15% of the population2. The Alzheimers society suggest that 775,200 people in the UK suffer from dementia (figures taken 2001). The Alzheimers society also calculates that the prevalence of dementia in the 65-75 years age group is 1 in 50, for 70-80 ye ars 1 in 20 and for over 80 years of age 1 in 5. Estimates suggest that by 2010 approximately 840,000 people will become dementia sufferers in the UK. Estimates suggest that around 40% of dementia sufferers are in residential institutions. One study from 1996 showed that dementia sufferers are 30 times more likely to live in an institution than people without dementia. At 65 years of age men are 3 times more likely than women to live in an institution and at 86 men and women are equally likely to be institutionalized4.Visual impairments are not associated general diagnostic features of dementia. However recent research has shown the change in visual function and visual processing may be relevant. Alzheimers disease patients often present problems with visual acuity, contrast sensitivity, stereo-acuity and color vision. These problems are believed to be more true of cognitive dysfunction rather than any specific problems in the eye or optic nerve9. Early diagnosis is essential to bot h dementia and sight loss patients, as drug treatments are becoming more and more available. Therefore maximizing the treatment and care for the individual. On the other hand early diagnosis of visual conditions is also essential, so that progression is slowed and treatment is commenced, therefore further progression is prevented if plausible2.The Mini-Mental State examination MMSE, is the most commonly used cognitive test for the diagnosis of dementia. It involves the patient to undertake tests of memory and cognition. It takes the form of a series of questions/answers and uses written, verbal and visual material. Poor vision or blindness is the most common cause of poor performance on this test other than dementia itself2.Visual deterioration can occur simultaneously with memory loss in most dementia sufferers. Therefore early recognition of dementia through vision tests has become of importance. Table 1 shows few possible tests that might be useful for such purposeTable 1 Vision tests for possible early detection and monitoring of Alzheimers diseaseUseBenton visual retention testMight be able to predict risk for AD 10-15 years before the onset of the diseaseTests visual memoryContrast sensitivityAD patients have selectively reduced CS for distinguishing large objects and facesUseful field of viewTests processing speed, divided attention and selective attentionFacilitates detection of attentional dysfunction patients suffering from this problem complain of poor vision and inability to identify someone in a group or an object on a patterned backgroundCould be useful to assess fitness to driveFacial recognitionAD patients do not recognize faces with large features and low contrastAD patients do not recognize familiar faces (due to impaired memory)Tests that use facial expressions with progressively diminished degree of contrastThe aim of this paper is to provide information about current knowledge on the topic of visual function dementia. With regards to Alz heimers disease, there will be an inclination to several main foci of research. Namely anatomical/structural changes, functional visual changes, cognitive brain changes and other changes such as the effects of diagnostic drugs on Alzheimers disease patients.(2) Alzheimers diseaseAlzheimers disease is the most common cause of dementia amongst older adults. The Alzheimers research trust estimates that 700,000 individuals in the UK currently are afflicted. This number will inevitably increase exponentially in the near future with the trend of an increasingly aging UK population. Therefore it must be of the utmost of importance worldwide to have an understanding all behavioral, anatomical and physiological aspects of this disease.Alzheimers disease is a degenerative disease that attacks the brain, it begins gradually and progresses at a variable rate. Common signs are impaired thinking, memory and behavior. Health professionals and care givers agree that the memory deficit is usually th e initial sign of the disease. However researchers have long known that Alzheimers disease is characterized by impairments of several additional domains, including visual function5.However these findings have not yet appeared in the diagnostic guides consulted by healthcare professionals, for example the most recent addition of the Diagnostic Statistical manual of mental disorders states that few sensory signs occur in early Alzheimers disease2. Therefore we still have a limited understanding of the true extent to which visual impairments affect Alzheimers disease sufferers. The current web site of the Alzheimers association1 and National Institute of Aging6 make no mention of the topic of sensory changes in Alzheimers disease. It has even been said that patients with Alzheimers disease report visual problems to their healthcare professionals less frequently than do healthy elderly individuals7. Nevertheless visual function is impaired in Alzheimers disease8. In terms of cognitive changes, the neuropathology of this disorder affects several other brain areas which are dedicated to processing low level visual functions, as well as higher level visual cognition and attention5.These neuropathological cognitive changes are more dominant however in the visual variant of Alzheimers disease known as posterior cortical atrophy. However visual problems are also present in the more common Alzheimers disease.Alzheimers disease begins when there are deposits of abnormal proteins outside nerve cells located in the brain in the form of amyloid. These are known as diffuse plaques, and the amyloid also forms the central part of further structured plaques known as senile or neurotic plaques1. Buildup of anomalous filaments of protein inside nerve cells in the brain can also take place. This protein accumulates as masses of filaments known as neurofibril tangles. Atrophy of the affected areas of the brain can also occur as well as the enlargement of the ventricles1. There is a lso a loss of the neuro transmitter Serotonin, Acetylcholine, Norepinephrine and Somatostatin. Attempts have been made to try to slow the development of the disease by replacing the neurotransmitters with cholinesterase inhibitors, such as donepezil (Aricept), rivastigmine (excelon), galantamine (Reminyl) and memantine (Namenda)1. These drugs work by increasing the levels of transmitters between cells, which otherwise become lacking in Alzheimers disease. The National Institute for Clinical Excellence NICE conducted a review of these drugs in March 2005 and concluded that none of these drugs provided sufficient enough advantages to the patient in order to justify their cost. They recommended against the use of such drugs in the Nhs, though the Department of Health later overturned this ruling.(3) Visual Changes in Alzheimers PatientsLoss of vision is a key healthcare dilemma amongst the elderly. By the age of 65 approximately one in three people have a vision reducing eye disease. D ementia, Alzheimers disease patients and elderly patients, consequently have many visual conditions in common.Alzheimers disease impairs visual function early in the course of the disease and functional losses correlate with cognitive losses. There are several common visual functional deficits that are frequently identified in Alzheimers disease. There is evidence for deficits in Motion perception9,10 contrast sensitivity11 colour discrimination of blue short wavelength hues34 and performance on backward masking tests31.In Alzheimers disease the secondary point of damage is usually the visual association cortex and other higher cortical areas, as well as the primary visual cortex 13,14.(3.1) Some of the main changes that occur in the eye with aging includeThe crystalline lens increases in thickness, therefore decreasing its transparency and elasticity therefore there is a tendency for cataracts to appear.The conjunctiva can become thicker and wrinkled, therefore is subject to deposi ts such as pinguecela.The iris can atrophy, therefore pupils become constricted and their response to light becomes sluggish. The eyes ability to dark/light adapt is affected.Refractive index of the cornea decreases and it becomes less transparent. Arcus senilis can appear.The ocular globe and eyelids can shrink leading to conditions such as entropian, ectropian and trichiasis. Also while the lachrymal production is reduced the puncta lachrymalis can become stenosed and provide less drainage which gives rise to chronic watering of the eyesAnterior chamber usually becomes more shallow and the sclera more rigid, increasing the prospects of glaucoma.(3.2) Visual changes due to Alzheimers disease reported in literature are outlined below(3.2) AnatomicAbnormal nerve fiber layer and retinal ganglion cells (Blanks et al, 1989) (Tsai et al, 1991) (Hedges et al, 1996Imaging of the nerve fibre layer can be conducted via three techniques. These include Optical coherence topography (OCT), Scann ing laser polarimetry and Confocal laser topography. Parisi et al16 conducted research upon the optic nerve fibre layer thickness using OCT. 17 Alzheimers disease individuals and 14 age matched healthy individuals were used. The findings of this study showed a definite relationship between the thickness of the nerve fiber layer and the prevalence of Alzheimers disease. There was a significant decrease in the nerve fiber layer thickness in Alzheimers individuals when compared to healthy age matched particpants.Macular cell loss (Blanks et al, 1990)Research has shown a definite decrease of the number of retinal ganglion cells located in the maculae of Alzheimers disease sufferers in comparison to age matched control individuals. It was found that the loss of retinal ganglion cells varied with eccentricity from the central macula17. Results obtained by Blanks et al, 1990 showed a 28% loss of neurons from retinal ganglion cells at 0-0.5mm from the foveola, 24% loss at 0.5-1.0mm and 47% loss at 1.0mm to1.5mm from the foveola. These losses of retinal ganglion cells were constantly greater than those seen in age matched healthy individuals.Supranuclear cataract (Goldstein et al, 2003)Cataract removal could improve not only the visual acuity but may be an important tool in helping those patients suffering from visual hallucinations (Chapman et al, 1999) however, no prospective study has been carried out to prove the role of vision improvement through cataract surgery on the well-being of patients suffering from ADExfoliation (Janciauskien and Krakau, 2001)Abnormal pupillary innervation 109-113Glaucomatous optic nerve cupping (Bayer et al, 2002)(3.3) FunctionalDecreased visual acuity (Holroyd and Shepherd, 2001)Rapid loss of visual field in patients with AD and glaucoma (Bayer and Ferrari, 2002)Visual field loss (inferior) (Trick et al, 1995)Reduced contrast sensitivity (Holroyd and Shepherd, 2001)Abnormal colour discrimination (blue, short-wavelength hues) (Cronin-Gol omb et al, 1991)Abnormal flash visual evoked potentials (VEPs) (Holroyd and Shepherd, 2001)Delayed saccadic eye movements (Holroyd and Shepherd, 2001)(3.4) CognitiveAbnormal visual sustained/divided/selective attention and visual processing speed (Rizzo et al, 2000)Inability to recognize depth (Holroyd and Shepherd, 2001)Impaired face recognition (van Rhijin et al, 2004)(3.5) OtherExcessive pharmacological mydriasis/miosis 109-113These changes summed together not only diminish the quality of vision, but many of them also make the examination of the eye much more complicated. In conjunction with the general visual symptoms of aging, Alzheimers patients can also experience visual disturbances caused by the brain rather than the visual system alone. This means that they can have problems and difficulties perceiving what they see rather than how clearly they see it3. Difficulties are usually experienced in the areas mentioned earlier, namely depth, motion, color, and contrast sensitivit y. Visual hallucinations are also a common problem linked to loss of vision in Alzheimers disease patients18. Another common disorder linked to patients with Alzheimers disease is a variant of motion blindness. The patient can appear to be confused and lost the individual will see the world as a series of still frames19.Visual changes in Alzheimers disease may also be dependent upon which brain hemisphere is more severely damaged this factor can often be overlooked. An individual with Alzheimers disease could have damage to a greater extent on their left brain hemisphere from plaques and tangles. This would therefore cause subsequent retinal changes in only the left hemi-retinas of each eye i.e. the right visual fields. The right eye visual field would be affected in the temporal side (right) and the left eye visual field would be affected nasally (right)20. When only half the retina is impacted, smaller regions of the optic nerve and nerve fiber layer show losses. The left eye with affected temporal retina would show optic nerve damage in differing regions of the nerve than the right eye with nasal retinal damage20.Alzheimers patients commonly show selective degeneration of large ganglion cell axons located in the optic nerves. This suggests that there would be impairment of broadband channel visual function. Conversely studies have shown that broadband visual capabilities are not selectively impaired in Alzheimers disease. The magnocellular and parvocellular neurons are greatly affected in Alzheimers patients, this has been proved by studies of the dorsal Lateral geniculate nucleus(LGN)1. The geniculostirate projection system is split both functionally and anatomically into two sections. They include the parvocellular layers of the Lateral geniculate body and also incorporates the magnocellular layers. These systems are mainly divided in the primary visual cortex and go through further segregation in the visual association cortex. They conclude in the tempor al and paritetal lobes1.The parvocellular layers contain smaller, centrally located receptive fields that account for high spatial frequencies (acuity), they also respond well to color. On the other hand these cells do not respond well to rapid motion or high flicker rates. The magnocellular cells have larger receptive fields and respond superiorly to motion and flicker. They are however comparatively insensitive to color differences. The magnocellular neurons generally show poor spatial resolution, although they seem to respond better at low luminance contrasts. To summarize the parvocellular system is superior at detecting small, slow moving, colored targets placed in the centre of the visual field. Meanwhile the magnocellular system has the ability to process rapidly moving and optically degraded stimuli across larger areas of the visual field1.The parvocellular system projects ventrally to the inferior temporal areas, which are involved in visual research, pattern recognition an d visual object memory. The magnocellular system projects dorsally to the posterior parietal and superior temporal areas. These are specialized for motion information processing. The cerebral cortical areas to which the parvocelluar system projects receives virtually no vestibular afferents. Alternatively the cerebral areas to which the magnocelullar system projects receives significant vestibular and other sensory inputs. These are believed to be involved in maintaining spatial orientation. Research shows shows that the magnocellular system is more involved in Alzheimers disease1Oddly, many individuals experience difficulties at low spatial frequencies instead of high frequencies as in old age. This suggests that areas controlling the low spatial frequency processing in the primary visual cortex would be affected more than those for higher frequencies processing21 After neuropathilogical studies in 1997 by Hof et al were carried out on brains with visual impairments they concluded that cortical atrophy dominated on the posterior parietal cortex and occipital lobe22.Glaucoma is also a neurodegenerative disease that has similar effects on the visual system. Lower spatial frequencies in the contrast sensitivity, deficits in the blue short wavelength color range as well as reductions in motion perception are all linked to glaucomatous patients23. When patients diagnosed with Alzheimers disease also have glaucoma, the deterioration of vision related to glaucoma is much more rapid and progression is more aggressive than in people with glaucoma solely and not Alzheimers disease as well24.Glaucoma is different from Alzheimers disease in that it affects the visual function at the early sites of neural activity, namely, the retinal ganglion cells. Glaucoma destroys the afferent axons at the nerve fiber layer in the retina. This loss of axons ultimately leads to added atrophy further up the visual pathway due to decreased neuronal input. Alternatively Alzheimers disease impacts the cells that are located terminally or intermediary in the visual pathway of the brain. The result is again reduced neuronal input due to loss of nerve fibre connections and atrophy along the visual pathway. When the two diseases exist in the same individual together it can be seen that there is likely to be a greater disruption to the visual system25. One key difference between the two diseases is that they affect the visual pathway at different points. Glaucoma is a degenerative disease starting at the beginning of the visual pathway, whereas Alzheimers disease is a degenerative process starting relatively late in the visual pathway. When the two diseases coexist then the neuronal and functional losses of vision are cumulative.(4) Optometric examination of dementia patientsDementia patients present special problems for optometrists. A standard eye test can be an audile to even the best of us. The patient is placed in an unfamiliar environment surrounded by unusual equip ment, machinery and is subjected to probing questions about their medical history which will without doubt tax their already flawed memory. Dementia patients are most likely to be from the elderly. Therefore several difficulties are presented while conducting an ocular examination. The patient is required to sustain a position and has to maintain concentration throughout the testing procedures, which can be very difficult. Subjective examination requires responses from the patient, they are expected to remember and follow complex instructions given to them by the optometrist as well as make many precise discriminatory judgments in a short space of time. The multiple tasks required to be completed during the examination are often beyond dementia patients as they are limited by the disease. Therefore it is common that patients with even a minor degree of dementia fail to provide valid answers, provide unpredictable responses to the subjective examination and retreat into an apathetic state1,2.During the visual examination of Alzheimers disease patients, several key visual problems can be detected. Moderate dementia patients will often experience problems such as topographic agnosia, alexia without agraphia, visual agnosia and prospagnosia1. Such patients often cannot describe individual components of photos and routinely fail to recognize family members. The degree to which such problems are experienced is consistent with the level of cytochrome oxidase deficits in the associated cortical area. In conjunction with these problems dementia patients often have problems with texture discrimination and blue violet discrimination1.Throughout the examination of the elderly dementia patients there are two contradictory requirements, firstly is assurance. The patients responses will be delayed and the patient may feel anxious in such an unfamiliar situation. Thus constant reassurance is required and they cannot be rushed. Alternatively time constraints are important, a d ementia/elderly patient is likely to have a short attention span. Consequently the two factors above much be considered and balanced. The examination must be thorough yet carried out as quickly as possible. Often when examining a dementia patient a family member of the carer must be present in order to aid the communication between optometrist and patient, for example difficulties are likely to occur when recording history and symptoms without a carer present. All factors need to be considered such as family history, medication, eye treatment and knowledge of any medical conditions and if so how long they have suffered from them.In terms of an external examination firstly, gross observations should be recorded for example does the patient have an abnormal head position or is there any lid tosis. Many external observations can also be detected with the aid of pupil reflexes. Upon carrying out the external examination the optometrist must be carful to explain exactly what each procedu re will involve so as not to intimidate the patient.(4.1) Internal ocular health examinationInternal examination of an elderly patient often presents many problems. Older patients tend to have constricted pupils and often opacities in the media such as cataract. All of which make opthalmoscopy a much more complex task for the optometrist. Patients with dementia also show poor fixation as well as lack of concentration. Pupil dilation is often used to aid external examination however many older patients can have a poor response to the insertion of mydriatic eye drops. fddfdffdgThere have been many studies into the affects of diagnostic mydriatic and miotic drugs. Many studies have shown excessive mydriatic pupil response to trompicamide (a pupil dilating drug) in patients with Alzheimers disease when compared to control individuals26-30. On the other hand studies into the use of Miotic drops, particularly Pilocarpine have shown an increased response of pupil constriction in Alzheimers disease patients upon comparison to normal control patients. These findings suggest a defect in pupillary innervation with Alzheimers disease individuals. Studies of post mortem individuals with exaggerated mydriatic pupil responses to Tropicamide found a definte disruption to the Edinger-Westphal nucleus. The Edinger-Westphal nucleus is one of the key structures of the brain involved in the autonomic nervous system, it mediates the sympathetic and para-sympathetic pupil responses. Research by Scinto et al found amyloid plaques and neurofibrillary tangles in all individuals tested with excessive mydriatic pupil responses. The conclusion was that the Edinger-Westphal nucleus is targeted early in the progression of Alzheimers disease.In terms of intraocular pressures use of the goldman an Perkins tonometers will be limited for the elderly dementia patients, due to health and safety reasons. Sudden movements whilst carrying out pressure tests on such equipment may be dangerous. Theref ore this can be overcome to a degree by the use of handheld instruments such as the pulseair. However even with the pulseair problems can still be faced with uncooperative patients.(4.2) Objective Refraction examinationWith uncooperative and awkward patients objective refraction through retinosopy may be difficult. Factors such as opacified media, miotic pupils, and poor fixation will influence the accuracy of the refraction. The recent introduction of hand held optometers has contributed to somewhat overcoming such problems. Instruments such as thee Nikon Retinomax are excellent for obtaining an objective refraction of the elderly patient with miotic pupils and cloudy media.When presenting the Snellen chart to a patient, the quality of their response will inevitably depend upon the degree of their dementia. Depending on which stage of dementia they are suff