Broca's Aphasia Treatment - Response Elaboration Training (RET) Research Paper

Broca's Aphasia Treatment - Response Elaboration Training (RET) - Research Paper Example Damage to the Broca’s area can cause severe aphasia or difficulty in speech. An element through which Broca’s aphasia can be treated is a technique known as the Response elaboration training. This essay would further discuss the etiology of Broca’s aphasia along with its option of treatment in adult patients (Guyton & Hall 2011; Fazio et al 2009). Aphasia generally describes a condition in which an individual has impaired language skills. It can occur due to damage to the regions of the brain which are responsible for language. Broca’s area is a non fluent type of aphasia which occurs in the frontal lobe of the brain. In this type of aphasia the individuals are not able to speak whole words or they have difficulty speaking them. In this type of aphasia some motor movements of the individual are also affected because the frontal lobe is also affected. Commonly aphasia occurs due to accidents which harm the structures in the brain, a tumor in the brain, infection of the brain and dementia. It is because of these problems that the sensory pathways do not transmit the signals properly and hence aphasia occurs (Guyton & Hall 2011; LaPointe 2005). Broca’s aphasia is characterized by problems in speaking or writing language. It is also called motor aphasia, expressive aphasia or non-fluent aphasia. The individuals are not able to speak fluently and hence have difficulties in making up sentences. The individuals face difficulties when speaking up full words. The individuals are not able to make up sense with their sentences. For example individuals would just use two words such as ‘glass, table, where the individual tries to say that the glass is on the table. (Fazio, 2009). At first it was believed that Broca’s aphasia was only associated with language comprehension but recent research suggests that it also affects other portions of cognition through which individuals cannot perform and understand actions properly (Grafton et al 1996;

Organizational Behavior Essay Example for Free

Organizational Behavior Essay There are basically 2 types of organizational structures commonly found in every organization. Namely these two are the vertical organization or the horizontal organization. (Deal, Kennedy, Deal Kennedy, 2000). I myself have worked in both scenarios and personally favor the horizontal approach as the proposition for success is to work in teams, and cross functional teams. If a company follows a vertical approach then supervision of work becomes a much more difficult task and communication gaps arise which have been termed as the major component of project and process failures. In a horizontal organization hierarchal levels are divided in such a way that management of work becomes easier and people of different departments can share their expertise and knowledge when working together. An organization’s bottom line consists of 2 aspects, which are sales and costs. It is the major objective of any organization to maximize its sales and decrease its costs to the minimum in order to extract maximum revenues and hence increase profits and growth (Belker Topchik,2005). Costs can be reduced when a horizontal structure is being followed as the number of channels through which information flows till it reaches its destination is reduced but opposite is in the case of a vertical approach where any information needs to cross through many channels before it reaches its destination. his results in the altering of the original message which negatively affects business plus due to the number of channels costs also increase (Porter, 1998). In the same way cross functional teams in a horizontal approach can lead to better and efficient performance as each member of the team is representing his or her department and wants to prove his or her abilities, hence this results in more efficient business processes (Singer, 2004). On the other hand a vertical approach makes it difficult for the company to work because no department is ready to share his or her data with other departments and it is difficult to manage the circulation of information throughout the organization, which results in slow business processes and inefficiency.

Effect of Spontaneous Breathing Trial (SBT) Duration

Effect of Spontaneous Breathing Trial (SBT) Duration Effect of Spontaneous Breathing Trial (SBT) Duration on the Clinical Outcomes of Mechanically Ventilated Patients Admittted at Medical Intensive Care Units of a Tertiary Government Hospital In Davao City INTRODUCTION Background of the Study: Mechanical ventilation (MV) is primarily used to support patients whose respiratory function is compromised due to a variety of reasons. However, several studies have shown that prolonged MV among intensive care patients is associated with adverse clinical outcomes. Thus, MV should be discontinued promptly as soon as patients are capable of breathing spontaneously. Furthermore, patients who are dependent on MV stay longer in the intensive care unit, requiring dedicated care and frequent monitoring. The inadequate number of intensive care unit beds necessitates maximizing the use of limited resources in delivering essential care to critically ill patients. Discontinuing mechanical ventilation in a well-timed and safe manner should lead to desirable outcomes for both patients and clinicians. Hence, strategies that assist in early withdrawal of patients from mechanical ventilation should be investigated. The process of liberating from mechanical support is known as weaning. In most studies, it was noted that nearly half of the total duration of mechanical ventilation is spent in the weaning process. Each day, a set of weaning predictors is tested and patients who meet the criteria proceeded to a spontaneous breathing trial (SBT). Several researches set the SBT at 120 minutes. The American Thoracic Society guidelines recommend SBT for 30 minutes to no longer than 120 minutes. In our institution, current practice involves an overnight duration of SBT. The optimal duration of SBT, however, is not known. The long duration of SBT requires close monitoring of a critically ill patient, which is challenging for the limited number of intensive care unit staff. Hence, this study will investigate the hypothesis that short (30 minutes), intermediate (120 minutes) and long (overnight) duration of SBT have similar clinical outcomes. Review of Related Literature: Mechanical ventilatory support is used when spontaneous ventilation is insufficient for the sustenance of life. The word supportis emphasized in this context since mechanical ventilation is not a cure for the underlying disease, but it is at best a type of support, offering rest to the patient while the disease processes are treated. A study by Esteban et al showed that half of the intensive care units in North America had at least 40% of adult patients receiving mechanical ventilation. This data is similar to that of a prospective study involving 20 countries in 2004, where it was reported that 33% of patients required mechanical ventilation. Invasive mechanical ventilation is a risky, uncomfortable, and costly procedure that should only be utilized when indicated. Major indications for mechanical ventilation are: (1) partial pressure of oxygen in arterial blood (PaO2) cannot be maintained above 50 mm Hg despite high levels of delivered oxygen; (2) partial pressure of carbon dioxide in arterial blood rises above 50 mm Hg; (3) ventilation becomes inefficient and/or exhausted; (4) airway protection. According to Esteban et al (2002), the most common causes for mechanical ventilation were acute respiratory failure in the postoperative period (20.8%), pneumonia (13.9%), congestive heart failure (10.4%), sepsis (8.8%), trauma (7.9%), and acute respiratory distress syndrome (4.5%). The goal of mechanical ventilation is to improve ventilation, oxygenation, and lung mechanics. However, as is the case with other medical therapies, the benefit of mechanical ventilation comes at a price. An Indian study revealed that 55 of the 100 mechanically ventilated patients admitted at a university hospital developed complications as follows: nosocomial pneumonia (29%), gastrointestinal hemorrhage (11%), airway complications, (10%), cardiovascular complications (8%), equipment failure (7%), and barotrauma (2%). The most common complication is ventilator-associated pneumonia (VAP) which occurs 48 to 72 hours or thereafter following endotracheal intubation. The incidence of VAP ranges from 9 to 27%, with mortality rate of between 33 to 50 %. A local private tertiary institution reports a lower incidence of VAP at 7.6%.In this institution, a total of 621 adult patients were intubated from September to December 2014. Of these patients, 13.3% developed ventilator-associated pneumon ia. Numerous studies report that weaning from mechanical ventilation after the underlying reason of respiratory failure has been resolved, account for more than half the total duration of mechanical ventilation. In some trials, however, weaning comprise only 40% of the whole duration of mechanical ventilation. Nevertheless, the duration of weaning is an important component that needs close attention. In a study by Coplin et al higher mortality, more cases of pneumonia and longer hospital admission was reported in patients who underwent more than 48 hours delay of liberation from mechanical ventilation. Hence, physicians should be encouraged to minimize the duration of weaning. Researchers have long recognized the complications of mechanical ventilation. They have proposed multiple techniques to facilitate the transition to spontaneous ventilation. Successful weaning from MV at any time was reported to be associated with a higher survival rate. Generally, weaning has two components. The first component is a list of â€Å"readiness to wean† criteria based on clinical factors that help decide if a patient is ready to breathe spontaneously. Ely and colleagues developed a scoring system wherein all five criteria should be met to pass the screening test. The criteria are as follows: the ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) had to exceed 200; the PEEP should not exceed 5 cm H20; there had to be an adequate cough during suctioning; the ratio of the respiratory frequency to the tidal volume should be less than 105 breaths per minute per liter; and no infusions of vasopressor agents or sedatives. The second component is the spontaneous breathing trial (SBT), a period of unassisted breathing during which the patient is observed for signs of respiratory failure. Several studies have investigated the methodology for weaning. The commonly used techniques are T-piece, synchronized intermittent mandatory ventilation (SIMV), or Pressure Support Ventilation (PSV). The traditional mode of weaning is the T-piece weaning, which involves attaching the endotracheal tube to a T-piece such that one of the two remaining limbs of the T is connected to a humidifier, which supplies humidified oxygen while the third limb is left open to allow for exhalation. The primary disadvantage of this method of weaning is that apnea, low VE and airway pressure alarms are disabled, and close visual monitoring is required. However, this type of weaning provides an estimation of post-extubation breathing, resulting in rapid recognition of patients who are able to tolerate weaning. One of the potential areas of study is improving processes that shorten the spontaneous breathing trial. Three previous studies conducted in years 1999, 2002 and 2003 demonstrate the equivalence of 30 minutes and 120 minutes SBT using both T-piece and PSV protocols. Based on these trials, Macintyre (2012) recommended that an SBT should be at least 30 min but no longer than 120 min to allow proper assessment of ventilator discontinuation Similarly, White reported that the length of an SBT should be approximately 30 minutes to 120 minutes. However, an overnight duration of SBT has been in practice in this institution for many years due to limited data on the success rate of extubation using a shorter SBT duration. After the patient is able to sustain spontaneous breathing, the next step is to ascertain whether the patient can tolerate extubation. This is an important decision, as both delayed and failed extubation are associated with prolonged ventilation and mortality. Several factors may predict extubation failure after a successful SBT. The decision to extubate patients is largely based on the ability to clear secretions and protect the airway. A weak cough and moderate volume of secretions are also associated with extubation failure. Some studies suggest that a Glasgow coma score of ≠¤ 8-10 is correlated with extubation failure since increased risk of aspiration occurs in patients with reduced level of consciousness. Other characteristics recognized as risk factors for extubation failure are: older age, severity of illness on ICU admission, prolonged duration of ventilation prior to extubation, and continuous sedation

Guillain-Barre Syndrome Essay -- Medical Science Scientific Medicine E

Guillain-Barre Syndrome Guillain-Barre Syndrome, or acute inflammatory demyelinating polyneuropathy, is a self-limiting disease characterized by areflexia and acute progressive motor weakness of at least one limb. Other symptoms include motor weakness of the extremities and face, loss or reduction of deep tendon reflexes, decreased sensation throughout the body,ophthalmoplegia, and ataxia. In severe cases respiratory failure and autonomic dysfunction may occur. Respiratory failure results from the demyelination of the phrenic and intercostal nerves. Consequently, the person loses the ability to inhale and exhale. Autonomic dysfunction resulting from the demyelination of the sympathetic and vagus nerves can lead to cardiac arrhythmias, tachycardia, postural hypotension, and hypertension. Analysis of the cerebral spinal fluid (CSF) shows increased protein concentration with few cells. Other tests reveal a decreased nerve conduction velocity resulting from segmental demyelination with mononuclear cell infiltra tion. In 70% of the afflicted individuals, the symptoms of Guillain-Barre Syndrome (GBS) occur within two weeks following infection. Clinical diagnosis is based on the presence of albumino-cytological dissociation in the CSF. Following the onset, motor weakness progressively deteriorates for four weeks and may lead to respiratory failure and cardiac instability. If either respiratory failure or cardiac abnormalities occur, the patient will be placed in the intensive care unit and closely monitored. Eventually the person's condition will cease to deteriorate, and he/she will enter a plateau period of two to four weeks during which little or no change will occur. Following the plateau stage, the patient will gradually rec... ...Guillain Barre syndrome following immunisation with Haemophilusinfluenzae type b conjugate vaccine. Europ. J. Pediatrics, July 1993, 152(7): 613-614. Hartung, H. P. Immune-mediated demyelination. Ann. Neurology, June 1993, 33(6): 563-567. Hund, E. F., Borel, C. O., Cornblath, D. R., Hanley, D. F. & McKhann, G. M. Intensive management and treatment of severe Guillain-Barre syndrome. Crit. Care Medicine, March 1993,21(3): 433-446. Rostami, A. M. Pathogenesis of immune-mediated neuropathies. Pediatrics Res., January 1993, 33(1 Suppl): S90-94. Sharief, M. K., McLean, B. & Thompson, E. J. Elevated serum levels of tumor necrosis factor-alpha in Guillain-Barre syndrome. Ann. Neurology, June 1993, 33(6): 591-596. Willison, H. J. & Kennedy, P. G. Gangliosides and bacterialtoxins in Guillain-Barre syndrome. J. Neuroimmunology, July 1993, 46(1-2): 105-112.

Non Verbal Body Language

Body Language. It has been said that actions speak louder than words, but, what exactly is body language? The Merriam-Webster dictionary defines it as: â€Å"The gestures, movements, and, mannerisms by which a person or animal communicates with others. So, now knowing this definition the phrase â€Å"Actions speak louder than words † starts to make a lot more sense. Even though our body language does not reveal all our innermost thoughts and feelings, it does not mean it is to be ignored. It plays a key role in human communication.Body language simply is communication without words. Therefore it is non-verbal communication. It is the body’s natural language. Over half of our whole message is communicated through our body language. Our verbal message communicated in a conversation is nothing compared to nonverbal message. Your words may sound genuine and you may think your a good liar, but if you have poor body language your conveyor will know right away you are not bei ng genuine. Most body language messages are sent through our face and gestures.On our face, the way the corners of our mouth wrinkle up or down show whether we are happy or sad, how are forehead creases when we are angry, or how are eyes wrinkle when we laugh genuinely are all conveyors of certain messages. The face and the eyes many meanings and can be recognized or decoded easily. Facial expressions are a very important part of communication because they convey the inner workings of emotion. It is widely used by nearly everyone, when trying to strengthen a particular idea or meaning.Some people might not even know they are using it. Body language can be both intended and accidental. That being said our body laguage can contradict wat our verbal or intended message was meant to be. Messages can be passed between people, without any communication being needed. Words are not needed, as the body movements are a language itself, which tells the whole story. It is also used as a form of flirtation between couples, and also is a road people may take to get what they want.Knowing how to read body language is a useful communication skill, so is knowing how to use it. Facial expressions and body language can help give clues as to what people are thinking. We make constant movements every second of the day without realizing it. Trying to read facial expressions can be very hard, because they are so quick. Body language, on the other hand, is more easily read. We are taught some very obvious types of body language, like that someone is lying when they will not look you in the eye, but there are many ore than that.Watching people from a distance, you can usually determine how they feel about each other, whether they are friends, family, or just plain strangers. Body language is something we see everyday that helps us to communicate without words. Body language plays a huge part in many areas of the work industry. One example of this is in the Hospitality industry, especi ally in a bar, restaurant and hotel environment while serving and helping customers and patrons.Another example of body language in a workplace is the type of attitude you may display when being spoken to by a higher ranked individual in any branch of the armed services. Be it Army, Navy, Marine Corps, Air Force, Coast Gaurd. Let's take the Army for a more specific example. In the Army we have a specific set of rules written in what are known as Army Regulations, and in these regulations it is outlined that we must show our military superiors the utmost respect and follow every one of their lawful orders without question.As i said previously people may express certain non-verbal gestures without meaning to or even without knowing they did. So, for example when a soldiers mind is occupied with other tasks at hand or just not paying attention a much higher ranked individual could make an on the spot correction to the soldier and the soldier being preoccupied could accidentally shrug i t off and show disrespect without meaning to. Now, with that being said, that is by no means an excuse to disrespect a senior enlisted Non-commisioned officer.It is the soldiers duty to correct himself so that another higher ranked individual does not have to stop wat he is doing, such as getting briefed or attending an important huddle and correct the soldier on something as petty and easily avoidable as not wearing his patrol cap outdoors. which is clearly required under army regulation 670-1. Body language in the Army is a very important thing indeed. If you are not careful your accidental gestures can show a great deal of disrespect. ven theings as little as turning away from someone too early or not turning around to acknowldge someone fast enough can be taken in a disrespectful manner. Appearance is another important aspect body language. We use our bodies continuously to send messages and reinforce anything communicated earlier. The way we dress is very important in effective ly communicating. For example, if we someone at a formal event wearing jeans it can send out many mixed messages. For a punk rock star it might say ‘I do not care’ maybe in a good way but for the marketing manager of a firm it might say ‘I do not care’ in a bad way.Clothes are only one aspect of how we dress. Body piercing, excessive or minimal use of perfume, general body odor, and how we wear makeup also give out messages. So in conclusion, non-verbal communication or body laguage is a very important part of our everyday communication and human interaction. It has a huge impact on how we as people are percieved, and, without meaning to one of our habitual gestures, movements, or mannerisms can change the outcome of a conversation and greatly offend your listener. Be careful of your body language it can make or break a conversation.

External factors upon the activities of a business Essay

Introduction In this assignment, I will describe how external factors (political, legal, and social) are impacting upon the activities of a business. My chosen business is McDonalds and I will be explaining how the issues affect in both UK and India. McDonalds – is the world’s largest chain of fast food restaurants. They mainly serve hamburgers, cheeseburgers, chicken products, French fries, breakfast items, soft drinks, milkshakes and desserts. They also have options such as salads, apples, milk, and Snack Wraps on the menu. Legal Factors These are the laws and regulations affecting the business. Some of the other factors may include: freedom of information, data protection, employment law and copyright etc. UK and India’s Legal Factors Health and safety – In the UK and India, the health and safety law is very important for each individual or employees especially in the workplace, to prevent injury, death and illness. This affects some businesses especially in India because they need to have all equipment for health and safety which will cost them a lot to fill it up. Food Hygiene – In both countries, McDonalds has to be very hygienic in order for the business to stay open and successful. The impact of an unhygienic restaurant would be catastrophic for the company’s image. Recruitment and Selection Law – All workers must be treated equally. For example In UK, you cannot dismiss a worker for being pregnant. There should be proper warning before dismissing a worker otherwise it will be treated as unfair dismissal. The Government makes it mandatory to have a written contract of employment. It contains the details of the wage rate; working  hours, and other necessary details regarding working conditions. The National Minimum Wage in UK is currently  £6.31 while in India; the minimum wage is 118 rupees per day or about  £1.50 which is very low compare to UK. In contrast to the UK, India can employ individuals aged fewer than 16 and the child labour in India has a poor image as children are often left unpaid. Social Factors These are the aspects of population like for example; immigration, age of population, taste and fashion, belief, individual’s personality, attitudes and lifestyle. UK Social Factors Immigration – This has negative impact upon the social factors in UK. A long time ago, there wasn’t that many people living in the UK, however, in the 21st century, a lot of people from different part of the world started to migrate and live in UK. The major impact is on population. It has an advantage such as a lot of people are skilled to be employed in the business. However, some migrants might be illegal entrants or maybe visa over stayers. Ageing Population – The demographics in UK illustrate that the numbers of older people are increasing. McDonalds can benefit from this ageing population as they can increase the range of their hot drink products in order to target and meet the needs of older people. McDonalds can sell more healthy products such as fruits and salads. Lifestyle – Businesses are always affected by the lifestyle as people have different fashions, tastes, ethics, beliefs etc. As UK is a multi-cultural country, McDonalds needs to provide different selections of foods from different cultures such as in India McDonalds do not sell any beef products as it is prohibited in their religion. India Social Factors High population growth – In India, due to high population, people have a hard  time to find a job, as a result of this people don’t have enough funding for their daily expenses. High degree of corruption level – Corruption is a major issue that adversely affects its economy in India. The causes of corruption in India include excessive regulations, complicated taxes and licensing systems so they add extra cost to the business. Bollywood popularity – Bollywood is the nickname for the Indian film industry. It became very popular as Indians are in love with movies. Political Factors Political factors are factors that deal with the public. For example; EU membership, taxation government support for business, infrastructure (roads), skills, business ethics (corruption). UK Political Factors EU membership – McDonalds will need to act in accordance to the European regulations. One of the regulations is the working hours where workers must only work for no more than 48 hours. Taxation – McDonalds is affected by the government taxes, such as income taxes and business rates as it is a large business, meaning that a lot of tax is taken away from their profits. And McDonalds will have to pay tax. Tax has an impact on McDonalds as it will be taken off their annual profit which will result in less diligence for shareholders. India Political Factors Infrastructure – India isn’t modernized unlike UK; the technology systems are much less advanced which could affect the business ability to produce, to sell, expand, and demand. The roads are not well established. And if McDonalds in India have poor machinery, poor buildings and facilities, then  it won’t benefit the business and won’t be able to expand.