City road

Drawing on what you have learned from the Making Social Lives DVD and Learning Companion 1, describe some inequalities on City Road. Contemporary Brutal over the last fifty years has come to welcome a wide and diverse community made up of nationalities, races and religions, none more so, as seen on City Road in Cardiff.This particular street is featured in the Making Social Lives DVD and Learning Companion 1 (LLC), from which it is evident that there are noticeable differences and inequalities within the community. These being; monopolizing of high street shops, secondly local businesses effected by community arrives and thirdly, a sense of security within the community. What follows will attempt to briefly describe and provide possible rationale for such inequalities to exist. Established themselves firmly along this road which happen to be In close proximity to smaller Independent supermarkets, consequently the monopoly which these shops hold mean they can afford to attract large n umbers of the community by using their buying power to host special deals, reduced items and stocks range of products all under one roof, this convenience for the individual can save the need to ravel to many of the smaller independent shops, such as the newsagent owned by Colon Butler, a family run business since the sass's.Colon Butler was interviewed by poet and artist Lloyd Robinson regarding how his business may have been effected by the larger shops to which he admitted â€Å"†¦ But that didn't affect me but it did knock out the newsagent next to him. † (the Street' 2009 Scene 1). Customers visiting Colon Butler are directly affected by this inequality, existing due to inflamed prices. However, It Is often that regular customers to such a local shop feel a sense of immunity split despite probably paying a premium.Furthermore, Colon Butler and his family business may be adversely affected due to the local council's plans to implement a bus lane along City Road. Whil st this aims to create a fast and efficient service for it's community, an inequality emerges for the local shops opposite the bus lane, as road markings will inhibit potential customers from parking and collecting goods too heavy to be carried on the bus. This is highlighted by a local business man, Jose Ramose Square stating â€Å"†¦ We are a small cuisines people, we earning our living here and we don't want to lose our customers because they, it's bad enough now people cannot park. (Making Social Lives DVD, 2009, Scene 5) It would appear according to the DVD, that some motorists may park outside their shop of choice. However, once said bus lane Is fully functional, no parking will be permitted by customers at any time Including the elderly or Injured who may view this as an Inequality. Educational establishments to name but a few. Some of these occur in daytime whilst others such as eating out would often happen after dark. The cover of which can to some residents seem uns ettling and unsafe.This sense of lack of security/safety is of course purely subjective, yet made ever more real by groups of younger people hanging around the bus shelter along the road, for instance a local police-officer, Pc Bob Keenan, argues that City Road â€Å"†¦ Is not a bad area†¦ If you apply common sense†¦ † (Making Social Lives DVD, 2009, Scene 6) conversely, a young female was interviewed at a pool hall along City Road expressing her frank feelings regarding the atmosphere in this local community at night time. Although this woman cannot recall any personal negative experiences, she talks of how this â€Å"†¦ Dead rough†¦ † (Making Social Lives DVD, 2009, Scene 8) area reminds her of Nottingham where she used to live. Coupling the female's view of City Road being an unsafe and dangerous place to be, are the sentiments of one male user of the Municipal Club, when asked â€Å"Is it safer these days? † He replied â€Å"No it's not safer, you walk top of City Road at night you're afraid to walk up there. † (Making Social Lives DVD, 2009, Scene 5) Why should these wow individuals and possibly more suffer the injustice of this particular inequality, being a sense of lack of safety?City Road, Cardiff describes to it's local community a myriad of inequalities some having been discussed. To some members of the local community certain inequalities will always exist whilst to others they may not seem so apparent. Should the local authorities fail to make parts of this neighborhood ‘feel' safer, the next result cold mean a reduction in socializing at clubs thus forcing a closure. Could such inequalities lead to a tear in the fabric of this local community? City Road When I began this course I always took for granted that inequalities were obvious things, but the more I learned on the subject and the further through the material I got I discovered inequalities can come in all shapes and sizes , obvious or inconspicuous and can affect all people differently. Through this paper I will first look at similar inequalities between ‘City Road’ and a street I know well, the street which I will use is Ballygall Road east Finglas Dublin 11, I will then look at some inequalities that seem unique to my street and why they are unique. The two main shared inequalities between Ballygall Road and City Road are private clubs and homelessness. In the very first film ‘the street’ we are shown a tennis club that because of its high walls and closed off areas gives people the assumption that it is a private club and would be unable to use its facilities . Although that is just an assumption in Ballygall Road there is a members only gym and membership can only be obtained if you are a resident of a particular apartment complex. This causes near constant tension between the other locals and the residents of the complex. In all of the films on the DVD there is a scene that is shown again and again it is the image of the homeless man sitting outside the shop. Homelessness is the most obvious inequality and there is no area that is free of it , in Ballygall Road there is two homeless people they are both originally from the area ,they are well known to all the locals and are treated with disgust and are avoided completely if possible . The two inequalities that are unique to Ballygall Road are council estates and a methadone clinic. Although council estates are not uncommon all over Ireland in Ballygall Road the council estate is seen as a thing to be ashamed of and that anyone who lives in one is lower class or ‘rough’ which is simply not true. There is one council estate in Ballygall Road and directly beside it is a private estate there is obvious distaste towards the people living in the council estate by other locals as a lot of the residents are un-employed and this is seen as socially unacceptable. A methadone clinic is a clinic for people for are trying to get themselves off heroin, there is one clinic is Ballygall Road and is possibly the biggest inequality as anyone seen entering or leaving this building is immediately labeled as a drug addict even though it may not be the case . A drug addict in Ballygall Road is on the lowest rung of the social ladder and are treated as such, there for the methadone clinic is used as a tool to label people in the area. In closing I would just like to state one observation that has been born from studying this module I believe there are two types of inequalities there are the obvious inequalities such as homelessness and being in a methadone clinic and there are inconspicuous inequalities such as private clubs or living in a certain estate. Although the obvious inequalities can affect and hurt people the inconspicuous ones can hurt just as much if not more so. These are the inequalities I noted in City Road and the inequalities in my street.

Determine the refractive index of glass

Hypothesis: The incident ray, the normal and the refracted ray all lie in the same plane. Also, according to Snell's law, for 2 particular media, the ratio of the sine of the angle of incidence to the sine of the angle of refraction should be a constant: Sin i Sin r Apparatus: 1. A rectangular prism 2. Four 1 inch pins 3. A protractor 4. A ruler 5. An A4 size cardboard 6. An A4 size sheet of plain paper 7. 4 bits of blue tack 8. A pencil Method 1. A table is drawn at the top left side of the A4 size paper with column titles: â€Å"Angle of Incidence† and â€Å"Angle of Refraction†. The table should contain 8 rows excluding the column titles. 2. The rectangular prism is placed at the middle of the top of the page and its perimeter is traced with the help of the ruler and pencil. The normal is soon after marked out in the approximate centre of the perimeter using the protractor at the 90 degrees point. The operation is then repeated at the middle of the bottom of the page and finally to the back of the page. 3. 4 perimeters with a normal on each should already be drawn at that stage. Next, an angle should be measured and traced from the point where the normal touches the perimeter line from any of the 4 sketch. The angle is noted at the table as an angle of incidence. This step is repeated five more times with different angles each time. 4. The page is placed on the piece of cardboard and stabilised using the blue tack bits. 5. 2 pins are stuck on any incident lines and the rectangular prism in placed fitting the perimeter marked previously. 6. The pins should be observed at a parallel and opposite side of the rectangular prism and the cardboard should be moved so that 1pin covers the other totally and 2 more pins should be stuck. 7. The pins are removed together with the page and a line is drawn from the 2 recent holes caused by the pins. 8. A new normal is outlined out of the new line and the angle is measured and noted as the emergent ray. 9. A line is drawn from the emergent ray to the incident ray and the angle from the normal is measured using the protractor. 10. Steps 4 to 8 are repeated 7 more times varying on the 4 perimeters. 11. The page should resemble the following: Results Conclusion The results seem satisfying enough to support the hypothesis, hence supporting the idea of the law of refraction. Evaluation and precautions * Blue tack was used so as to keep the paper stable while working to prevent errors. * A double check with another protractor was performed to ensure its accuracy. * Mistakes such as not perfectly vertical pins stuck or not exactly parallel positioning of the eye could have been performed relying on the results. * Parallax errors or other mistakes such as too bumpy cardboard may have lead to not accurate enough results. * Another method of performing the experiment yet roughly the same precision would be to use light beams which would be more accurate than our eyes' positioning therefore reducing parallax error.

Computer Testing

1. Answer the Following Questionsa. How is vsftpd more secure than other FTP server? vsftpd is more secure than other FTP servers because it does not run root privileges making it more difficult to compromise the system directly.b. What is the difference between passive and active FTP? The difference between a passive and an active FTP connection is the that in passive mode, the client initiates the connection to the server (on port 20 by default). In active mode, the server initiates the connection, having no default port.c. Why is ASCII transfer sometimes necessary? ASCII transfer is sometimes necessary in order to performs conversion between different code sets.d. If you want vsftpd to run in standalone mode, what do you need to set in vsftpd.conf? Set the listen parameter to YES in the vsftpd.conf filee. A user tries to log in, provides a user name, and gets denied. What settings would cause this and how? Setting /etc/vsftpd/ftpusers lists users that are not allowed to log in on the FTP serverf. What is a directive that has an opened and closed tag instead of being a single word called? Directive that has an opened and closed tag instead of being a single word is a containerg. What is the ability to respond to multiple IPs or names as if the server were multiple servers called? Virtual Hosting2. You can create virtual hosts by host names or IP addresses. Explain the basics of how each type works. IP-based virtual hosts use the address of the connection to decide the correct virtual host to connect to. In order for name-based virtual hosting to work, the server depends on the client to deliver the hostname as part of the HTTP headers. Many different hosts can  share the same IP address using this method.

A Study Of Uncommon Food Allergy Dissertation Example | Topics and Well Written Essays - 3750 words

A Study Of Uncommon Food Allergy - Dissertation Example 1.0. Introduction A true food allergy, according to Duyff (2003), is also referred to as food hypersensitivity, where the immune system to react to harmless substances present in food even though a person is not technically sick. These substances are generally termed as allergens, are usually proteins from some food which sets off the body’s immune system to react by the production of immunoglobulin E (IgE) antibodies. The IgE antibodies activate the release of natural body histamines to counter the allergic reaction. An individual experiences these internal bodily processes as the uncomfortable symptoms associated with allergy, such as itching, running nose, nausea, palpitation, and in worst cases anaphylaxis (Duyff, 2006) Statistics gathered by Duyff (2006) revealed that one in every three adults are allergic to milk, whereas the National Health Institute estimated that only four out of 100 or about 11 million Americans have food allergies. Approximately 60% of the food alle rgies are seafood allergies, and about 30% are peanut and tree nut allergies. The remaining percentage are allergies caused by uncommon food allergens. ... , et al., 2009), mustard (Figueroa, et al., 2005); lupine flour (De Jong, et al., 2010), pomegranate, in the case of this researcher, and many others. Duyff (2006) maintained that food allergies are frequently self-diagnosed, and declared on the basis of popular literature or common symptoms. 1.1. Research Problem A preliminary survey of existing literature demonstrated that studies on allergy and uncommon allergy focused on one or a related group of allergies, or in some studies symptoms experienced and how the uncommon food allergy is managed. Specifically, the following research problems will be addressed: 1.1.1. What are the uncommon food allergies of the respondents? 1.1.2. What symptoms are experienced by respondents who have uncommon food allergies? 1.1.3. What is the level of severity of the symptoms? 1.1.4. How are the allergy and the symptoms managed? 1.1.5. Are there significant differences in the severity of the symptoms experienced and the application of medical interven tions? 1.2. Research Hypothesis The null hypothesis that â€Å"there are no significant differences in the severity of the symptoms experienced and the application of medical interventions† will be tested using a 0.05 level of significance and a two-tailed analysis. 1.3. Terms of Reference The study is being conducted to collate evidence about uncommon food allergy, the symptoms and how the condition is managed. A summary of the findings of existing studies have also been presented. As earlier mentioned, none of the existing studies so far ventured to collate and group uncommon allergy study data. Hence, this library research is important because this is the first study so far which attempted efforts to synthesize existing knowledge on uncommon food allergy in a form which can readily

Journalism, Mass Media and Communication Essay Example | Topics and Well Written Essays - 750 words - 1

Journalism, Mass Media and Communication - Essay Example Public diplomacy makes use of several techniques or channels, one of them being mass media, international broadcasting, in particular. The techniques of mass media are used to directly affect the mass public, while the others especially cultural channels have an orientation towards elite audiences. Public diplomacy has got several geopolitical implementations. For instance, the EU member states are advanced in public diplomacy implementation about their strategies of foreign policy and these days the EU has got a Public Diplomacy Unit and Election Observation in the Action Service of the European External (Gilboa, 1998). Public diplomacy has got a great impact on the power-relation globally. Usually, the nation that advocates for public diplomacy tends to attract more foreigners. When more foreigners move in, the various nations gain because of the investments and taxes the nations subject them to. By the end of the day, the nations that advocate public diplomacy gain (Gilboa, 1998). The hybridity of culture involves the changing of culture as it adapts to various changes. Deterritorialization reinforces the change whereas sets of power relationships that are an unequal condition the change. Cultural industry hybridization represents the global forms and local culture interaction to produce cultural commodities that are dynamically localized. Censorship and adaptation in Malaysia, for instance, are significant hybridization ways monitored and enforced by several non-governmental and governmental bodies (Guan, 2010).

Management of queues Essay Example | Topics and Well Written Essays - 750 words

Management of queues - Essay Example Thus, this type of model is time efficient because the service rate, which is the number of customers attended within a given time interval, increases. A good example is of customers waiting in queues to get their checks cashed in front of multiple counters in a bank. No Customer Frustration Multiple queues put an end to customers’ frustration which they have to face in case of single queues. The frustration that single queues offer has an impact on the customer satisfaction and good will and thus costs the company a lot in the long run. Thus, with multiple queues this problem can be eliminated since customers are quickly attended to within least possible time. For example, when there are multiple check outs in a grocery store, a consumer feels good when he does not have to wait in long single queue with grocery on the trolley which he has to guard too. Multiple queuing model is a blessing at grocery stores. Fitzsimmons and Fitzsimmons gave the example of McDonalds which †Å"feared that customers would balk on seeing a long line† (454) and therefore implemented multiple queues. Switching of Queues Customers can always switch onto the queue which seems to be shorter and in which he feels that he will be attended much sooner. For example, when a new movie is going to be released, there are multiple queues in front of the ticketing counters. Some queues are long and some are short. A customer from long queue can come out and join a shorter one to save time and energy. This way, the queues also get managed themselves and the load on each counter is distributed among all the counters. Enjoyment One benefit that multiple queues have on single queues is that when customers make multiple queues, they are free to chat with each other and have fun while they are waiting for their turns. This makes them comfortable with the situation they are in and they pass their waiting time happily. Example is of people queued up for tickets in front of the cinema hall and chatting about the new movie. Disadvantages Cost Multiple queues with multiple services facilities sometimes adds too much to the set up cost because it may happen that the customers are being attended too efficiently and thus some servers remain idle for some time which also results in some employees being idle resulting in low morale. Multiple queues require a lot of service capacity in order to be efficient. No First-come first-served In case of multiple queues, since it is the customer’s choice which queue to join and since he can always switch onto the queue which seems shorter, the rule of first-come, first-served or first-in, first-out cannot be applied. A good example is that of traffic jam, where a driver can leave his line and enter one which seems shorter and running faster. This way, even if he came later than other drivers, he has chances of getting out of the traffic sooner. Also, when a queue is switched, the previous queue always seems to have become fast er and shorter. This is an out of logic stigma attached to multiple queues which cannot be explained. Alertness Although the customers in multiple queues can have an extra fun of chatting and gossiping with each other, yet they have to remain extra alert so that they can hear their number. They can be careless about their turn or number more than if they were in a single queue. Example is of fast food centers as McDonalds where people engage in socializing and may become forgetful of their numbers. Psychological

50 Cent-The Controversial Rapper Research Paper

50 Cent-The Controversial Rapper - Research Paper Example This paper discusses the theory that 50 Cent is more famous because of controversies rather than his music. Further, this paper will point out how harsh, negative lyrics of his songs have been the reason for him being criticized in the music circle but becoming famous among the people. The overall goal is to show that rather than being a talented artist 50 Cent is a clever artist who survives through all the controversies he’s involved in. 50 Cent has been known as the one straight out of streets. His biography and all the details about him are splashed with details about his difficult past and the way he had grown up in a family where his mother was a hustler. His mother died when he was young and soon his father died. He was left to be taken care of by his grandmother according to whom he’s a sweet child, much against the views of others. Having such a difficult past and having faced all the difficulties that do explain partly the way he is and the way he behaves. The refore, I think reading a person’s biography before reading other articles about him is essential in understanding the kind of person. In her article, Zonda Hughes (2003) describes the life of 50 Cent, a.k.a Curtis Jackson, explaining that his life can be summarized as being a compilation of 9 lives. Even though the article does not criticize the rapper artist as such but does provide a brief overview of the life of the artist. Right from being the son of the notorious drug trafficker to entering the same profession as his mother and being jailed to shooting to stardom with his hard hitting lyrics. Hughes mentions it all. 50 Cent has created an image of his that shows him as being the tough guy who has seen it all and it is this image that is the reason for his popularity. It is difficult to deny that his popularity is not based on his hard image as he himself has always proclaimed himself to be the one who has seen the toughest things and has gone through some of the most di fficult situations, surviving being shot 9 times is certainly a difficult situation. Whether making controversial statements like not being ashamed of being a drug trafficker or whether his own destiny that leads him to controversial situations, he definitely seems like controversies’ favourite child. He has been accused of starting the trend of gangsta rap again and is hated because he might have started the trend of gangster fights in the industry again that saw the death of many famous rappers. He has brought the era back when hip-hop industry saw hatred amongst each other. However, he does not seem perturbed about those accusations and instead glorifies his gangster image. Even though the rapper claims that his life was not his choice but he definitely loves being the bad boy and earning the popularity for being a bad boy. As both he and Hughes (2003) acknowledges, bad boys are famous with both women and men, with women because they seem more attractive and with men becau se they establish a sense of style. He is referred to as hip-hop entrepreneur in his biography and it is true that he is a clever entrepreneur who knows how to stay in the business by making shocking statements. Even though his hard work can not be ignored but his urge to become famous and rich means that he chooses to do so no matter what the means. He has been described in his biography as one having a viciously funny personality who will get rich or die trying. Adam Bernanrd (2003) notes how full

Wireless network implementation (Enterprise Network Design (Aston)) Case Study

Wireless network implementation (Enterprise Network Design (Aston)) - Case Study Example There will be a mesh topology setup in the core and distribution layers. Along with the redundant paths there will be redundant hardware in those layers. This will allow for more throughput and fault tolerance. QoS will also be implemented in all layers of the network to improve performance. The current reliability problems are half hardware failure and half over utilization of circuits. With the addition of QoS and redundancy, we can assure that mission critical applications will never fail. Aston is a leading firm in the private sector legal support business. These accounts are served worldwide by their franchise network. As you can tell, Aston is on a mission to keep trucks rolling by creating and delivering the best products and services for customers. The current network design analysis showed us that there are strong areas of the network and many weak areas. The current networks strongest point is in the campus backbone. Currently there is a full mesh between all routers. Because of this setup the backbone is the strongest part of the network. However, the backbone is currently running on 100 Mbps copper which is causing bottlenecks during peak usage. The existing network has far more weak areas then strong ones. We found one of the weakest areas of the network to be in the server farm. ... Also, all connections were made with copper to the campus backbone which limits the speed. Another area of concern is with the building distribution layer. This layer also has no layer 3 capabilities and has no redundant paths. There are multiple switches in the building distribution but in the event of a failure the core will have to reroute all traffic due to lack of appropriate redundancy. Another area that lacks redundancy is the edge distribution module. Currently if the edge distribution router were to fail, all internet and internal communications with other branches would be lost. Along with lack of redundancy, there were many security concerns. Currently there is only one firewall and it is placed between the internet service provider and the edge distribution router. This is a good start to securing the network but there is a lack of intrusion detection which is a concern. Also, the current e-commerce connection is in front of the firewall which provides absolutely no protection to the e-commerce server from the outside world. Finally, the other area of concern is the lack of outside accessibility. Currently there is only one remote access server which accepts incoming modem connections. The current system is not capable of support the very large mobile work force of Aston and it does not support current technology. In order for a remote worker to gain access to the network they have to have a dial up modem and a telephone line. Once the connection is made the speed is slow and the functionality is limited. Along with the lack of speed and functionality, the network is limited on its ability to upgrade to VPN technology. Currently there is only one internet service provider that only provides 3 Mbps which is barely enough

Analysis of Business Planning Research Paper Example | Topics and Well Written Essays - 2000 words

Analysis of Business Planning - Research Paper Example Business plans have both weak and strong components that are unique to respective plans and businesses.     The plan focuses on a beauty and hair salon called Trend Setters Hair Studio. It begins by presenting an executive summary of the salon business. The mission and motto of the salon are equally mentioned (B Plan, 2012). After the introduction, the plan provides essential keys to the successes of the salon business. A summary of the company that includes a summary of how the company began operations is present in the summary. The business plan on Trend Setters Hair Studio later reveals the products and services within the business. These include hair (weaves, and relaxers), nails (manicured and sculptures) and skin care (waxing and massages). The plan also offers a summary of the strategy and implementation of diverse strategies of the company. This aspect of the plan mentions the approaches that management should take to address the problems that may arise from competitors. The management of the salon equally presents figures for their projected sales in the next three years (Becherer & Helms, 2009). The business plan presents milestones of the salon business that includes details of salon activities.      For example, necessary finances in the running of the salon business are mentioned. The projected cash flow in the salon business is equally presented in the plan. Finally, the plan has an appendix that explains most of the figures in the business plan (Bangs, 2002). Brian's Book Barn Business Plan This plan focuses on a book barn business that dates from May 1998. The plan begins by describing the business in a clear manner. It states that the business is a store that deals with books and magazines (Canada / British Columbia Business Services Society, ND). It is located in Ladbrokes and aims to promote the culture of reading to members of this community. The plan also suggests that the community where such an organization is situated lacks such a business. This means that the business is likely to flourish because of minimal competition. The plan reveals the ownership and management of the book business. The owners are a couple, Brian Paige and Novella Reid. According to the plan, B rian has relevant experience because he previously worked with bookselling organizations. His wife has a certificate in retail management with 30 years of experience (Canada / British Columbia Business Services Society, ND). The initiatives and objectives of the business are also evident in the plan.  Ã‚  

Case Sharp Printing Essay Example for Free

Case Sharp Printing Essay Three years ago the Sharp Printing (SP) strategic management group set a goal of having a color laser printer available for the consumer and small business market for less than $200. A few months later the senior management met off-site to discuss the new product. The results of this meeting were a set of general technical specifications along with major deliverables, a product launch date, and a cost estimate based on prior experience. Shortly afterward, a meeting was arranged for middle management explaining the project goals, major responsibilities, the project start date, and importance of meeting the product launch date within the cost estimate. Members of all departments involved attended the meeting. Excitement was high. Although everyone saw the risks as high, the promised rewards for the company and the personnel were emblazoned in their minds. A few participants questioned the legitimacy of the project duration and cost estimates. A couple of RD people were worried about the technology required to produce the high-quality product for less than $200. But given the excitement of the moment, everyone agreed the project was worth doing and doable. The color laser printer project was to have the highest project priority in the company. Lauren was selected to be the project manager. She had 15 years of experience in printer design and manufacture, which included successful management of several projects related to printers for commercial markets. Since she was one of those uncomfortable with the project cost and time estimates, she felt getting good bottom-up time and cost estimates for the deliverables was her first concern. She quickly had a meeting with the significant stakeholders to create a WBS identifying the work packages and organizational unit responsible for implementing the work packages. Lauren stressed she wanted time and cost estimates from those who would do the work or were the most knowledgeable, if possible. Getting estimates from more than one source was encouraged. Estimates were due in two weeks. The compiled estimates were placed in the WBS/OBS. The corresponding cost estimate seemed to be in error. The cost estimate was $1,250,000 over the senior management estimate; this represents about a 20 percent overrun! The time estimate from the developed project network was only four months over the top management time estimate. Another meeting was scheduled with the significant stakeholders to check the estimates and to brainstorm for alternative solutions; the cost and time estimates appeared to be reasonable. Some of the suggestions for the brainstorming session are listed below.

Impact of Leonardo Da Vincis Inventions

Impact of Leonardo Da Vincis Inventions Engineering Drawings To be a proficient engineer, it requires a person to develop and possess various skill sets. The understanding of the various concepts and knowledge presented to them is crucial as well as it would allow them to apply it to their work as a practicing engineer. Some engineers may consider their best tools to be a piece of paper and a pencil. Possessing the ability to graphically communicate their ideas by sketching or drawing them, allows some of these ideas to come to life. Best known for his paintings of the Last Supper and Mona Lisa, Leonardo Da Vinci was more than just an artist, he was also an inventor and to some he is considered to be the worlds most famous engineer. His fascination for knowledge and his ability to bring his ideas to life shows that he is the epitome of an engineer. Only at the age of fifteen is when Leonardo was progressing in advancing his artistic skills under his teacher, Andrea Del Verrocchio. By 1482, Leonardo had chosen to move to Milan, Italy from Flore nce (which at the time was considered to be a more militaristic city than Florence), to work for Duke Ludovico Sforza as a military engineer. From there, Leonardo was able to innovate the war machines used by the military at the time. He essentially paved the way for some of the common weapons used in the modern day military. One of his war machine inventions was called the 33-Barreled Organ. Leonardo got the idea for this weapon when he saw that a cannons shot may not be as accurate and took quite some time to reload in battle. He figured that if a soldier could reload the weapon and fire at the same time, it would prove to be much more effective in the battlefield. The guns design consisted of a wheelbarrow like structure with big wheels and attached to it in the middle were the thirty-three guns split into three rows, which meant eleven shots were possible with just one row. It also had a rotating wheel to allow one row to fire while the other was being prepared for the next round. Leonardos idea for this barreled gun was it is now seen as the machine gun in modern day military. Another military innovation from Leonardo was the Armored Car, also known as the military tank in modern times. Leonardo thought to himself that if the soldiers could get closer to the enemy frontlines as well as their artillery that meant no soldier could stop their attack and would be forced to scatter. The armored car featured multiple cannons around the vehicle, thus giving the soldiers inside a firing range of three-hundred and sixty degrees. The shape of the vehicle consisted of a cone with a view port for a soldier to direct the vehicles motion. However, it was discovered there was an issue within the vehicle that would not allow it to move in a forward motion. Some suggested that da Vinci might have sabotaged his own design to discourage the war machine from ever being built. (Leonardo da Vincis Armoured car invention, 2008). As Leonardo was developing other war machines, he had decided to take an existing idea and improve on it for use on the battlefield. He took the soldiers average crossbow and decided to create a giant version out of it. Leonardo had claimed that this weapon was the best way to terrify the enemy. The Giant Crossbow was measured to stretch as far as 27 yards across the field. It consisted of six wheels, three on each side, to ensure mobility during the battle. It also had to be made of thin wood to allow the crossbow to have some flexibility. But the issue was, where Leonardo would create large enough arrows for use in battle. Instead, the crossbow launched large pieces of stone and at times, flaming bombs. To launch the object, it required the soldier to wind back the bow and then use a mallet to push the pin out of place for the weapon to fire. Leonardo had also improved another commonly used weapon during the war. In his observations, he found that the cannons shot may not be accurate and was too slow to reload after each shot. This meant that if the shot missed, the soldiers would be lacking in damage. He also found that the cannon lacked sufficient mobility in the battle. He designed instead a faster and more lightweight version of the cannon. But it did not just consist of one cannon, it included three cannons. Due to how lightweight it was, it made mobility on the battlefield much easier for the soldier. This also meant that the soldier could fire multiple shots at once as well and at a much faster rate compared to its predecessor. Seventeen years later, Leonardos time as a military engineer under the rule of Ludovico Sforza had come to an end once the French had invaded Milan. This left Leonardo to pursue other projects and come up with new inventions while travelling to other cities. Leonardo ended up designing an invention known as the ornithopter or known as the flying machine. His inspiration for this machine came from birds and kites. He had hoped one day the average man could fly as high as them in the sky. He specifically studied how the birds would use their wings to fly and would apply the concept into his design. However, it would become quite more apparent that the design of the wings, resemble the wings of a bat. The wingspan of the ornithopter was beyond thirty three feet. The material he used in the design of the wings consisted of pine and raw silk. This allowed the wings to be light and allow it to be easily carried by the wind. He would then have the pilot sit in the center between the wings a nd push a pedal in an alternating fashion while the machine flapped its wings. But Leonardos interest in flying did not stop there, he had come up with another invention. This time, Leonardo came up with the Parachute, not specifically the one seen in modern day, but the early sketch of a parachute. His idea of the parachute would come from a tent made of linen, sewn together to make sure all its openings were not letting air through and it would have a wooden frame which allowed the person to attach some rope to it to be able hold on. He believed at the time, that this device would allow a person to be able to jump from nearly any height without injury. But, at the time there were not any extremely high up places that were viable enough to be used for testing. It was not until the year 2000, when a known daredevil by the name of Adrian Nicholas decided to try Leonardos design of the parachute. Critics doubted his design would work and would put Adrians life at risk. But after jumping from 3000 feet above ground, Adrian proved that Leonardos design was successf ul. He also discovered that the ride to be smoother than the ripcord parachute found in modern times. But, the weight of the parachute was a concern since it could potentially injure the user as they land. Near the end of the fifteenth century, Leonardo had come up with another invention that was seen once again as ahead of his time. Using gears, pulleys, and cables, he was able to create a robot knight. By taking a knights suit and fitting it with the gears, pulleys, and cables, he was able to give the suit the ability to move various parts such as the arms and legs using different pulley systems within the suit. It could also perform human like actions such as sitting down and standing up, moving its head, and opening its mouth piece. But since then, Leonardos full drawings could not be found together, but rather, scattered designs in his notebooks. However, in 2002 a NASA roboticist by the name of Mark Rosheim took Leonardos design and was able to create a prototype out of it. As he was building the prototype, he discovered how Leonardo designed the robot to be easily built. This truly showed how Leonardo was a man ahead of his time. This allowed people in modern times now to take i nspiration from Leonardos Robotic Knight and to apply similar concepts to what is created today. It would be quite challenging to imagine life without some of the designs that Leonardo Da Vinci had created which helped pave the way for some of the modern day inventions. One may question what the world would be like in terms of technological and architectural advances had people neglected his work or he chose to not share his ideas. One can come to the conclusion that Leonardo Da Vinci was more than just an artist, but he was also an innovator that was way ahead of his time. References ENGINEERING.COM. (2006, October 12). Leonardo da Vinci > ENGINEERING.Com. Retrieved from http://www.engineering.com/Library/ArticlesPage/tabid/85/ArticleID/34/Leonardo-da-Vinci.aspx Leonardo da Vincis Armoured car invention. (2008). Retrieved from http://www.da-vinci-inventions.com/armoured-car.aspx Wight, C. (2009, March 4). Leonardo da Vinci from inspiration to innovation. Retrieved from http://www.bl.uk/onlinegallery/features/leonardo/leonardo.html Universal Leonardo: Leonardo da Vinci online à ¢Ã¢â€š ¬Ã‚ º welcome to universal Leonardo. Retrieved from http://www.universalleonardo.org/ What is Leonardos robotic knight invention? Retrieved from InnovateUs, http://www.innovateus.net/innopedia/what-leonardos-robotic-knight-invention

Child With Failure To Thrive Health And Social Care Essay

Child With Failure To Thrive Health And Social Care Essay In this review article, the definition, aetiology, evaluation, differential diagnoses, management, prevention and prognosis of failure to thrive are discussed. Failure to thrive (FTT) is a common problem in paediatric practice, affecting 5-10% of under-fives in developed countries with a higher incidence in developing countries. Majority of cases of FTT are due to a combination of nutritional and environmental deprivation secondary to parental poverty and/or ignorance. Many infants with FTT are not identified. The key to diagnosing FTT is finding the time in busy clinical practice to accurately measure and plot a childs weight, height and head circumference, and then assess the trend. In the evaluation of the child who has failed to thrive, three initial steps required to develop an economical treatment-centred approach are: (i) A thorough history including itemized psychosocial review, (ii) Careful physical examination and (iii) Direct observation of the childs behaviour and of parent-child interaction. Laboratory evaluation should be guided by history and physical examination findings only. Once FTT is identified in a particular child, th e management should begin with a careful search for its aetiology. Two principles that hold true irrespective of aetiology are that all children with FTT need a high-calorie diet for catch-up growth (typically 150 percent of their caloric requirement for their expected, not actual weight) and all children with FTT need a careful follow up. Social issues of the family must also be addressed. A multidisplinary approach is recommended when FTT persists despite intervention or when it is severe. Overall, only a third of children with FTT are ultimately judged to be normal. Keywords: Failure to thrive, growth deficiency, undernutrition. INTRODUCTION Although the term failure to thrive (FTT) has been in use in the medical parlance for quite some time now, its precise definition has remained debatable1. consequently, other terms such as undernutrition1 and growth deficiency2 have been proposed as preferable. FTT is a descriptive term applied to young children physical growth is less than that of his or her peers.3 The growth failure may begin either in the neonatal period or after a period of normal physical development.4 The term FTT is not, in itself, a disease but a symptom or sign common to a wide variety of disorders which may have little in common except for their negative effect on growth.5 In this regard, a cause must always be sought. Often, the evaluation of children who fail to thrive pose a difficult diagnostic problem. Some of the difficulties result from the numerous differential diagnoses, the definition used or misdirected tendency to search aggressively for underlying organic diseases while neglecting aetiologies based on environmental deprivation.6 In addition, early accusations and alienation of the childs parents by the health-care provider will make the evaluation and management of the child who has failed to thrive more difficult.7 In general, factors that influence a childs growth include: (i) A childs nutritional status; (ii) A childs health; (iii) Family issues; and (iv) The parent-child interactions.3,8,9 All these factors must be considered in evaluation and management of child who has failed to thrive. This paper presents a simplified but detailed approach to the evaluation and management of the child with FTT. DEFINITION The best definition for FTT is the one that refers to it as inadequate physical growth diagnosed by observation of growth over time using a standard growth chart, such as the National Center for Health Statistics (NCHS) growth chart.10 All authorities agree that only by comparing height and weight on a growth chart over time can FTT be assessed accurately.11 So far, no consensus has been reached concerning the specific anthropometric criteria to define FTT.11 Consequently, where serial anthropometric records is not available, FTT has been variously defined statistically. For instance, some authors defined FTT as weight below the third percentile for age on the growth chart or more than two standard deviations below the mean for children of the same age and sex1-3 or a weight-for-age (weight-for-hieght) Z-score less than minus two.1 Others cite a downward change in growth that has crossed two major growth percentiles in a short time.3 Still others, for diagnostic purposes, defined FTT as a disproportionate failure to gain weight in comparison to height without an apparent aetiology.6 Brayden et al.,2 suggested that FTT should be considered if a child less than 6 months old has not grown for two consecutive months or a child older than 6 months has not grown for three consecutive months. Recent research has validated that the weight-for-age approach is the simplest and most reasonable marker of FTT.12 Pitfalls of these definitions: One limitation of using the third percentile for defining FTT is that some children whose weight fall below this arbitrary statistical standard of normal are not failing to thrive but represent the three percent of normal population whose weight is less than the third percentile.5,6 In the first 2 years of life, the childs weight changes to follow the genetic predisposition of the parents height and weight.13,14 During this time of transition, children with familial short stature may cross percentiles downward and still be considered normal.14 Most children in this category find their true curve by the age of 3 years.6,14 When the percentile drop is great, it is helpful to compare the childs weight percentile to height and head circumference percentiles. These should be consistent with the position of height and head circumference percentiles of the patient.5 Another limitation of the third percentile as a criterion to define FTT is that infants can be failing to thrive with marked d eceleration of weight gain, but they remain undiagnosed and therefore, untreated until they have fallen below the arbitrary third percentile.6 These normal small children do not demonstrate the disproportionate failure to gain weight that children with FTT do.6 This approach attempts not only to prevent normal small children from being incorrectly labeled as failing to thrive, but also excludes children with pathologic proportionate short stature.14 Having excluded these easily distinguishable disorders from the differential diagnosis of FTT, simplifies the approach to evaluation of the child who has failed to thrive.6 A more encompassing definition of FTT includes any child whose weight has fallen more than two standard deviations from a previous growth curve.3,15,16 Normal shifts in growth curves in the first 2 years of life will result in less severe decline (i.e, less than 2 SD).13 Some authors have even limited the definition of FTT to only children less than 3 years old17,18 A precise age limitation is arbitrary. However, most children with FTT are under 3 years of age.6,8 EPIDEMIOLOGY In young children, FTT which does not reach the severe classical syndrome of marasmus is common in all societies.19 However, the true incidence of FTT is not known as many infants with FTT are not identified, even in developed countries.20-22 It is estimated to affect 5 10% of young children and approximately 3 5% of children admitted into teaching hospitals.3,5,23 Mitchell et al,24 using multiple criteria found that nearly 10% of under-fives attending primary health care centre in the United States showed FTT. About 5% of paediatric admissions in United Kingdom are for FTT.4 The prevalence is even higher in developing countries with wide-spread poverty and high rates of malnutrition and/or HIV infections.3,19 Children born to single teenage mothers and working mothers who work for long hours are at increased risk.22 The same is true of children in institutions such as orphanage homes and homes for the mentally retarded5,22 with an estimated incidence of 15% as a group.5 Under-feed ing is the single commonest cause of FTT and results from parental poverty and/or ignorance.19,22,24 Ninety five percent of cases of FTT are due to not enough food being offered or taken.25 The peak incidence of FTT occurs in children between the age of 9 24 months with no significant sex difference.22 Majority of children who fail to thrive are less than 18 months old.3 The syndrome of FTT is uncommon after the age of 5 years.3,22 AETIOLOGY Traditionally, causes of FTT have been classified as non-organic and organic. However, some authors have stated that this terminology is misleading.27 They based their opinion on the fact that all cases of FTT are produced by inadequate food or undernutrition and in that context, is organically determined. In addition, the distinction based on organic and non-organic causes is no longer favoured because many cases of FTT are of mixed aetiologies.3 Based on pathophysiology (the preferred classification), FTT may be classified into those due to: (i) Inadequate caloric intake; (ii) Inadequate absorption; (iii) Increased caloric requirement; and (iv) Defective utilization of calories. This classification leads to a logical organization of the many conditions that cause or contribute to FTT.10 Non organic (psychosocial) failure to thrive In non-organic failure to thrive (NFTT), there is no known medical condition causing the poor growth. It is due to poverty, psychosocial problems in the family, maternal deprivation, lack of knowledge and skill in infant nutrition among the care-givers5,11. Other risk factors include substance abuse by parents, single parenthood, general immaturity of one or both parents, economic stress and strain, temporary stresses such as family tragedies (accidents, illnesses, deaths) and marital disharmony.6,8,22 Weston et al,28 reported that 66% of mothers whose infants failed to thrive has a positive history of having been abused as children themselves, compared to 26% of controls from similar socioeconomic background. NFTT accounts for over 70% of cases of FTT.6 Of this number, approximately one-third is due to care-givers ignorance such as incorrect feeding technique, improper preparation of formula or misconception of the infants nutritional needs,29 all of which are easily corrected. A cl ose look at these risk factors for NFTT suggest that infants with growth failure may represent a flag for serious social and psychological problems in the family. For example, a depressed mother may not feed her infant adequately. The infant may, in turn, become withdrawn in response to mothers depression and feed less well.10 Extreme parental attention, either neglect or hypervigilance, can lead to FTT.10 Organic failure to thrive It occurs when there is a known underlying medical cause. Organic disorders causing FTT are most commonly infections (e.g HIV infection, tuberculosis, intestinal parasitosis), gastrointestinal (e.g., chronic diarrhoea, gastroesophageal reflux, pyloric stenosis) or neurologic (e.g., cerebral palsy, mental retardation) disorders.6,19,22 Others include genitourinary disorders (e.g., posterior urethral valve, renal tubular acidosis, chronic renal failure, UTI), congenital heart disease, and chromosomal anomalies.6,7 Together neurologic and gastrointestinal disorders account for 60 80% of all organic causes of under nutrition in developed countries.30 An important medical risk factor for under nutrition in childhood is premature birth.1 Among preterm infants, those who are small for gestational age are particularly vulnerable since prenatal factors have already exerted deleterious effect on somatic growth.1 In societies where lead poisoning is common, it is a recognized risk factor for p oor growth.5,31 Organic FTT virtually never presents with isolated growth failure, other signs and symptoms are generally evident with a detailed history and physical examination.32 Organic disorders accounts for less than 20% of cases of FTT.6 Mixed failure to thrive In mixed FTT, organic and non organic causes coexist. Those with organic disorders may also suffer from environmental deprivation. Likewise, those with severe undernutrition from non-organic FTT can develop organic medical problems. FTT with no specific aetiology Review of the literature on FTT indicate that in 12 32% of cases of children who have failed to thrive, no specific aetiology could be established.23,33-34 Causes of failure to thrive A. Prenatal cases: (i) Prematurity with its complication (ii) Toxic exposure in utero such as alcohol, smoking, medications, infections (eg rubella, CMV) (iii) Intrauterine growth restriction from any cause (iv) Chromosomal abnormalities (eg Down syndrome, Turner syndrome) (v) Dysmorphogenic syndromes. B. Postnatal causes based on pathophysiology: A. Inadequate caloric intake which may result from: i. Under feeding Incorrect preparation of formula (e.g. too dilute, too concentrated). Behaviour problems affecting eating (e.g., childs temperament). Unsuitable feeding habits (e.g., uncooperative child) Poverty leading to food shortages. Child abuse and neglect. Mechanical feeding difficulties e.g., congenital anomalies (cleft lip/palate), oromotor dysfunction. Prolonged dyspnoea of any cause B. Inadequate absorption which may be associated with: Malabsorption syndromes e.g. Celiac disease, cystic fibrosis, cows milk protein allergy, giardiasis, food sensitivity/intolerance Vitamins and mineral deficiencies e.g., zinc, vitamins A and C deficiencies. Hepatobiliary diseases e.g., biliary atresia. Necrotizing enterocolitis Short gut syndrome. C. Increased Caloric requirement due to Hyperthyroidism Chronic/recurrent infections e.g., UTI, respiratory tract infection, tuberculosis, HIV infection Chronic anaemias D. Defective Utilization of Calories Inborn errors of metabolism e.g., galactosaemia, aminoacidopathies, organic acidurias and storage diseases. Diabetes inspidus/mellitus Renal tubular acidosis Chronic hypoxaemia Clinical manifestations of FTT3,22 Commonly the parents/care-givers may complain that the child is not growing well or losing weight or not feeding well or not doing well or not like his other siblings/age mates. Usually FTT is discovered and diagnosed by the infants physician using the birthweight and health clinic anthropometric records of the child. The infant looks small for age. The child may exhibit loss of subcutaneous fat, reduced muscle mass, thin extremities, a narrow face, prominent ribs, and wasted buttocks, Evidence of neglected hygiene such as diaper rash, unwashed skin, overgrown and dirty fingernails or unwashed clothing. Other findings may include avoidance of eye contact, lack of facial expression, absence of cuddling response, hypotonia and assumption of infantile posture with clenched fists. There may be marked preoccupation with thumb sucking. EVALUATION A. Initial evaluation It has been proposed that only three initial investigations are required to develop an economical, treatment-centred approach to the child who presents with FTT and this include:35 (i) A thorough history including an itemized psychosocial review; (ii) Careful physical examination including determination of the auxological parameters; and (iii) Direct observation of the childs behaviour and of parent-child interactions. The Psychosocial Review: The psychosocial history should be as thorough and systematic as a classic physical examination Goldbloom35 suggested that the interviewers should ask themselves three questions about every family: (i) How do they look; (ii) What do they say; and (iii) What do they do? a. HISTORY (1) Nutritional history Nutritional history should include: Details of breast feeding to get an idea of number of feeds, time for each feeding, whether both breasts are given or one breast, whether the feeding is continued at night or not and how is the childs behaviour before, after and in between the feeds. It would give an idea of the adequacy or inadequacy of mothers milk. If the infant is on formula feeding: Is the formula prepared correctly? Dilute milk feed will be poor in calorie with excess water. Too concentrated milk feed may be unpalatable leading to refusal to drink. It is also essential to know the total quantity of the formula consumed. Is it given by bottle or cup and spoon? Also assess the feeling of the mother e.g., ask how do you feel when the baby does not feed well? Time of introduction of complementary feeds and any difficulty should be noted. Vitamin and mineral supplement; when started, type, amount, duration. Solid food; when started, types, how taken. Appetite; whether the appetite is temporarily or persistently impaired (if necessary calculate the caloric intake). For older children enquire about food likes and dislikes, allergies or idiosyncracies. Is the child fed forcibly? It is desirable to know the feeding routine from the time the child wakes up in the morning till he sleeps at night, so that one can get an idea of the total caloric intake and the calories supplied from protein, fat and carbohydrate as well as adequacy of vitamins and minerals intake. (2) Past and current medical history The history of prenatal care, maternal illness during pregnancy, identified fetal growth problems, prematurity and birth weight. Indicators of medical diseases such as vomiting, diarrhoea, fever, respiratory symptoms and fatigue should be noted. Past hospitalization, injuries, accidents to evaluate for child abuse and neglect. Stool pattern, frequency, consistency, presence of blood or mucus to exclude malabsorption syndromes, infection and allergy. (3) Family and social history Family and social history should include the number, ages and sex of siblings. Ascertain age of parents (Down syndrome and Klinerfelter syndrome in children of elderly mothers) and the childs place in the family (pyloric stenosis). Family history should include growth parameters of siblings. Are there other siblings with FTT (e.g., genetic causes of FTT), family members with short stature (e.g. familial short stature). Social history should determine occupation of parents, income of the family, identify those caring for the child. Child factors (e.g., temperament, development), parental factors (e.g., depression, domestic violence, social isolation, mental retardation, substance abuse) and environmental and societal factors (e.g., poverty, unemployment, illiteracy) all may contribute to growth failure.5 Historical evaluation of the child with FTT is summarized in Table 1. (b) PHYSICAL EXAMINATION The four main goals of physical examination include (i) identification of dysmorphic features suggestive of a genetic disorder impeding growth; (ii) detection of under lying disease that may impair growth; (iii) assessment for signs of possible child abuse; and (iv) assessment of the severity and possible effects of malnutrition.36,37 The basic growth parameters such as weight, height / length, head circumference and mid-upper-arm circumference must be measured carefully. Recumbent length is measured in children below 2 years of age because standing measurements can be as much as 2cm shorter.36,37 Other anthropometric data such as upper-segment-to-lower-segment ratio, sitting height and arm span should also be noted. The anthropometric index used for FTT should be weight-for-length or height. Mid-parental height (MPH) should be determined using the formula.40 For boys, the formula is: MPH = [FH + (MH 13)] 2 For girls, the formula is: MPH = [(FH 13) + MH] 2 In both equations, FH is fathers height in centimetres and MH is mothers height in centimetres. The target range is calculated as the MPH Â ± 8.5cm, representing the two standard deviation (2SD) confidence limits.14 Assessment of degree FTT The degree of FTT is usually measured by calculating each growth parameter (weight, height and weight/height ratio) as a percentage of the median value for age based on appropriate growth charts3 (See Table 3) Table 3: Assessment of degree of failure to thrive (FTT) Growth parameter Degree of Failure to Thrive Mild Moderate Severe Weight 75-90% 60 -74% Height 90 -95% 85 89% Weight/height ratio 81-90% 70 -80% Adapted from Baucher H.3 It should be noted that appropriate growth charts are often not available for children with specific medical problems, therefore serial measurements are especially important for these children.3 For premature infants, correction must be made for the extent of prematurity. Corrected age, rather than chronologic age, should be used in calculations of their growth percentiles until 1-2 years of corrected age.3 Table 2: Physical examination of infants and children with growth failure. Abnormality Diagnostic Consideration Vital signs Hypotension Hypertension Tachypnoea/Tachycardia Adrenal or thyroid insufficiency Renal diseases Increased metabolic demand Skin Pallor Poor hygiene Ecchymoses Candidiasis Eczema Erythema nodosum Anaema Neglect Abuse Immunodeficiency, HIV infection Allergic disease Ulcerative colitis, vasculitis HEENT Hair loss Chronic otitis media Cataracts Aphthous stomatitis Thyroid enlargement Stress Immunodeficiency, structural oro- facial defect Congenital rubella syndrome, galactosaemia Crohns disease Hypothyroidism Chest Wheezes Cystic fibrosis, asthma Cardiovascular Murmur Congenital heart disease(CHD) Abdomen Distension hyperactive Bowel sound Hepatosplenomegaly Malabsorption Liver disease, glycogen storage disease Genitourinary Diaper rashes Diarrhoea, neglect Rectum Empty ampulla Hirschsprungs disease Extremities Oedema Loss of muscle mass Clubbing Hypoalbuminaemia Chronic malnutrition Chronic lung disease, Cyanotic CHD Nervous system Abnormal deep tendon Reflexes Developmental delay Cranial nerve palsy Cerebral palsy Altered caloric intake or requirements Dysphagia Behaviour and temperament Uncooperative Difficult to feed. Adapted from Collins et al 41 Growth charts should be evaluated for pattern of FTT. If weight, height and head circumference are all less than what is expected for age, this may suggest an insult during intrauterine life or genetic/chromosomal factors.2 If weight and height are delayed with a normal head circumference, endocrinopathies or constitutional growth should be suspected.2 When only weight gain is delayed, this usually reflects recent energy (caloric) deprivation.2 Physical examination in infants and children with FTT is summarized in Table 2. Failure to thrive due to environmental deprivation Children with environmental deprivation primarily demonstrate signs of failure to gain weight: loss of fat, prominence of ribs and muscles wasting, especially in large muscle groups such as the gluteals.6 Developmental assessment It is important to determine the childs developmental status at the time of diagnosis because children with FTT have a higher incidence of developmental delays than the general population.36 With environmental deprivation, all milestones are usually delayed once the infant reaches 4 months of age.42 Areas dependent on environmental interactions such as language development and social adaptation are often disproportionately delayed. Specific behavioural evaluations (e.g., recording responses to approach and withdrawal), have been developed to help differentiate underlying environmental deprivation from organic disease.43 Assess the infants developmental status with a full Denver Developmental Standardized test.44 Parent-child interaction: Evaluate interaction of the parents and the child during the examination. In environmental deprivation, the parent often readily walks away from the examination table, appearing to easily abandon the child to the nurse or physician.6 There is little eye contact between child and parent and the infant is held distantly with little moulding to the parents body.6 Often the infant will not reach out for the parent and little affectionate touching is noted.6 There is little parental display of pleasure towards the infant.6 Observation of feeding is an integral part of the examination, but it is ideally done when the parents are least aware that they are being observed. Breast-fed infants should be weighed before and after several feedings over a 24-hour period since volume of milk consumed may vary with each meal. In environmental deprivation, the parents often miss the infants cues and may distract him during feeding; the infant may also turn away from food and appear distressed.6 Unnecessary force may be used during feeding. Developing a portrait of the child-parent relationship is a key to guiding intervention.11 LABORATORY EVALUATION The role of laboratory studies in the evaluation of FTT is to investigate for possible organic diagnoses suggested by the history and physical examination.33,34 If an organic aetiology is suggested, appropriate studies should be undertaken. If history and physical examination do not suggest an organic aetiology, extensive laboratory test is not indicated.6 However, on admission full blood count, ESR, urinalysis, urine culture, urea and electrolyte (including calcium and phosphorus) levels should be carried out. Screen for infections such as HIV infection, tuberculosis and intestinal parasitosis. Skeletal survey is indicated if physical abuse is strongly suspected. In addition to being unproductive, blind laboratory fishing expeditions should be avoided for the following reason:5,6 (i) they are expensive; (ii) they impair the childs ability to gain weight in a new environment both by frightening him/her with venepuncture, barium studies and other stressful procedures and the no oral f eeds associated with some investigations prevent him/her from getting enough calories; (iii) they can be misleading since a number of laboratory abnormalities are associated with psychosocial deprivation (e.g., increased serum transaminases , transient abnormalities of glucose tolerance, decreased growth hormone and iron deficiency);21 and (iv) they divert attention and resources from the more productive search for evidence of psychosocial deprivation. In one study, a total of 2,607 laboratory studies were performed, with an average of 14 tests per patient. With all tests considered, only 10(0.4%) served to establish a diagnosis and an additional 1% were able to support a diagnosis.34 Further Evaluation (1) Hospitalization: Although some authors state that most children with failure to thrive can be treated as outpatients,4,5,11,45 I think it is best to hospitalize the infant with FTT for 10 14 days. Hospitalization has both diagnostic and therapeutic benefits. Diagnostic benefits of admission may include observation for feeding, parental-child interaction, and consultation of sub-specialists. Therapeutic benefits include administration of intravenous fluids for dehydration, systemic antibiotic for infection, blood transfusion for anaemia and possibly, parenteral nutrition, all of which are often in-hospital procedures. In addition, if an organic aetiology is discovered for the FTT, specific therapy can be initiated during hospitalization. In psychosocial FTT, hospitalization provides opportunity to educate parents about appropriate foods and feeding styles for infants. Hospitalization is necessary when the safety of the child is a concern. In most situations in our set up, there i s no viable alternative to hospitalization. (2) Quantitative assessment of intake: A prospective 3-day diet record should be a standard part of the evaluation. This is useful in assessing under nutrition even when organic disease is present. A 24-hour food recall is also desirable. Having parents write down the types of food and amounts a child eats over a three-day is one way of quantifying caloric intake. In some instances, it can make parents aware of how much the child is or is not eating.11 Table 4: Summary of risk factors for the development of failure to thrive Infant characteristics Any chronic medical condition resulting in: Inadequate intake (e.g, swallowing dysfunction, central nervous system depression, or any condition resulting in anorexia) Increased metabolic rate (e.g, bronchopulmonary dysplasia, congenital heart disease, fevers) Maldigestion or malabsorption (e.g, AIDS, cystic fibrosis, short gut, inflammatory bowel disease, celiac disease). Infections (e.g., HIV, TB, Giardiasis) Premature birth (especially with intrauterine growth restriction) Developmental delay Congenital anomalies Intrauterine toxin exposure (e.g. alcohol) Plumbism and/or anaemia Family characteristics Poverty Unusual health and nutrition beliefs Social isolation Disordered feeding techniques Substance abuse or other psychopathology (include Muschausen syndrome by proxy) Violence or abuse Adapted from Kleinman RE.1 Table 1: Summary of historical evaluation of infants and children with growth failure Prenatal General obstetrical history Recurrent miscarriages Was the pregnancy planned? Use of medications, drugs, or cigarettes Labour, delivery, and neonatal events Neonatal asphyxia or Apgar scores Prematurity Small for gestational age Birth weight and length Congenital malformations or infections Maternal bonding at birth Length of hospitalization Breastfeeding support Feeding difficulties during neonatal period Medical history of child Regular physician Immunizations Development Medical or surgical illnesses Frequent infections Growth history Plot previous points Nutrition history Feeding behavior and environment Perceived sensitivities or allergies to foods Quantitative assessment of intake (3-day diet record, 24-hour food recall) Social history Age and occupation of parents Who feeds the child? Life stresses (loss of job, divorce, death in family) Availability of social and economic support (Special Supplemental Nutrition Program for Women, Infants and Children; Aid for Families with Dependent Chi

What Is the Ozone Hype Anyway? :: Free Essay Writer

What Is the Ozone Hype Anyway? â€Å"The ozone is a pale bluish form of oxygen gas with an odor like chlorine, formed by an electrical discharge in the air† (Webster 185). The first time that I thought about this research narrative was the first time that I read the syllabus for class. My immediate reaction was that I could not believe that we were actually going to write a ten-page narrative. I was never expected to write a paper of this length before and I was unsure if I were going to be able to do so. However, it turned out that it was not that bad, although I did go through many frustrations along the way. First, I had to come up with a topic. I think that this was the hardest part. In our class, we used one of our textbooks to help with this part of the process for our papers. In exercise 1.1, Ballenger suggests that you make a list under a number of different topics (23). Therefore, I made a list of at least twenty things under each topic that I thought might be a possible topic for my paper. My list ranged from pets all the way to relationships and back to health problems. However, after talking to my professor and my friends, and taking Ballenger’s advice on how to eliminate topics, I decided to go with the ozone layer (25). I had a few different reasons for making this choice. One of them was that this was something that I did not know very much about. In addition, the topic was something that I did want to know more about. Consequently, due to the fact that I did not know much, I would not do my research with a bias and more importantly, I would do the research w ell because I wanted to know more. Next, I had to come up with a question that I wanted to know the answer to. Again, Ballenger came with help. In exercise 2.1, Ballenger suggests that you make a list of questions and then have peers add questions also. During this process, I went through so many questions. Why was the ozone layer depleting? What could we do to help? How long has this been going on?

Essay --

Many students believe that a historian’s job is only to understand the past; likewise they believe that a human scientist’s job is solely to change the future. However, as a â€Å"knower†, I now comprehend that there is much more to these jobs than meets the eyes. I believe that these job â€Å"definitions† only describe the mere superficial part of the job, that there is a lot more to being a historian or a human scientist then just one simple task. However with these job â€Å"definitions†, that society has given, are many complex questions on how we accumulate knowledge on certain issues, these questions are known as knowledge issues. Some of the knowledge issues included in the job â€Å"definitions† are: Could history be seen as a cycle? To what extent can a historian â€Å"understand† the past? Do human scientists invent new ideas and theories or do they reinforce past paradigms? In what ways do the human sciences contribute to the future? In order to answer these questions I have decided to examine historians and human scientists in terms of how they engage the past and the future. There are many people who claim they have the â€Å"true† history; these types of people are known as historians. In this case my definition of historian is: an expert in the study of history, especially in that of a particular period, region, or social phenomenon. There are many different kinds of historians ranging from economics to environmental, and even to, urban. However in history, which we want to focus on, we have orthodox, revisionist, post-revisionist and many more. One may ask himself why there are so many different historians if there was but only ONE true accurate history. This is because history is full of â€Å"gaps† which the historians TRY to fill with their ow... ...ut does not give an explanation. On the other hand I define law as a concept that shows the direction of movement of a variable and gives a reliable explanation for the movement. Additionally human scientist may confuse a correlation with a casual connection. The transcendentalist poet Wystan Hugh Auden once said, â€Å"There is more than meets the eye.† These idea of concepts being more complex then they seem surround the jobs of historians and human scientists. The historian doesn’t simply understand the past for knowledge but also for the benefit that comes from it, such as to better understand the present and supply guidance for the future: â€Å"In history lie all the secrets of statecraft†. Likewise, human scientist attempt to explain and understand trends of human behavior; however, this is only achieved by examining the past the gain a comprehension on the subject.