Refractory Monosymptomatic Nocturnal Enuresis Treatment

Refractory Monosymptomatic zero(prenominal)turnal Enuresis TreatmentRole of Posterior Tibial Nerve Stimulation in the Treatment ofRefractory Monosymptomatic Nocturnal Enuresis A Pilot StudyAli Abdel Raheem,* Yasser Farahat, Osama El-Gamal, Maged Ragab,Mohamed Radwan, Abdel Hamid El-Bahnasy, Abdel Naser El-Gamasyand Mohamed RasheedPurpose We evaluated the betimes clinical and urodynamic results of posterior tibial eye stimulation in unhurrieds with refractory monosymptomatic nocturnal enuresis.Materials and Methods We randomly assigned 28 patients with refractorymonosymptomatic nocturnal enuresis to 2 equal pigeonholings. Group 1 received ahebdomadary session of posterior tibial nerve stimulation for 12 weeks and radical 2 wasthe placebo classify. Evaluation was performed in each group at baseline and after(prenominal)(prenominal)posterior tibial nerve stimulation to compare clinical and urodynamic findings.Another clinical assessment was done 3 months after the first followup. Results The 2 groups were similar in baseline clinical and urodynamic data.Over altogether, 13 patients (46.4%) had detrusor overactivity and 14 (50%) had change magnituded vesica capacity. After treatment 11 group 1 patients (78.6%) had a softenial or full(a) solution to posterior tibial nerve stimulation but only 2 (14.3%) in group 2 had a uncomplete chemical reaction (p 0.002). Also, the honest number of wet nights in group 1 wasimportantly lower than at baseline (p 0.002). all in all urodynamic parameters cruciallyimproved in group 1. In contrast, the number of wet nights and urodynamicparameters did not change importantly in group 2. At 3-month followup the numberof patients with a partial or full reaction in group 1 had decreased from 11 (78.6%)to 6 (42.9%). No change was evident in group 2.Conclusions Posterior tibial nerve stimulation can be a viable treatment optionin some patients with refractory monosymptomatic nocturnal enuresis. However,deterioration in some res ponders with period suggests the wish for concernprotocols.Key Words urinary vesica, nocturnal enuresis, transcutaneous electricnerve stimulation, urodynamics, treatment outcomeNOCTURNAL enuresis is usually associatedwith skanky psychological and socialdistress to children and their families.1 In recent years several treatmentmodalities emerged to treat NE, suchas behavioral therapy,2 alarm treatment,3 medical therapy with desmopressin,oxybutynin and imipramine,and combination therapy.46 However,none has been completely successful andthe relapse rate of all of them is significant.79 Therefore, there is a great needto find other treatments that could bemore effective and durable than currenttherapy.The pathogenesis of refractory NEwas discussed in many studies and attributedto decreased bladder capacityand/or PTNS was introduced with earlypromising results as neuromodulativetherapy for diseases that involve thelower urinary tract and for refractory conditions inadults and childr en.1519 These beneficial effectuate ofPTNS for controlling various bladder disorders ledus to try it in patients with refractory primary MNE.MATERIALS AND METHODSA total of 28 patients were included in this prospective,randomized, placebo controlled, single blind study fromJanuary 2010 to environ 2012 at the urology department atTanta University Hospital. The study protocol was reviewedand approved by the Tanta University institutionalreview board. Informed consent was obtained fromall participants or from parents if the patient was youngerthan 18 years.We recruited patients with severe (3 or more wet nightsper week) primary MNE at least 6 months in duration inwhom available conventional and combination therapieshad failed, including desmopressin, anticholinergics andan alarm. We excluded those with secondary NE, nonMNE,nocturnal polyuria and any neurological abnormality.All patients provided a detailed history and underwentcomplete physical examination, urinalysis, x-ray of thel umbo-sacral spine and ultrasound of the urinary system.All patients were asked to keep a nocturnal enuresis diaryfor 2 weeks, which included the time of sleep and arousal,and whether they had a dry or wet cope in the morning.Nocturnal urinary production was measured as the total urinevolume collected in the diaper after misdirecting during the furthestnight (assessed by weighing the diaper in the morning)plus the first morning urine volume. Nocturnal polyuriawas defined as nocturnal urine output 130% or greater of EBC for age.20The Arabic version of a 2-day frequency-volume chart(adapted from the Pan Arab Continence Society, www.pacs mangleice.com) was obtained from all patients to confirmthat the problem was MNE. Daytime functional bladdercapacity was considered the recorded MVV. EBC for agewas calculated by the formula, 30 _ (age in years _ 30).Children with MVV less than 65% of EBC for age wereconsidered to have a small bladder.20All patients as well as underwent urodynamic tests, as performedby the same urodynamicist using a Delphis-KTdevice (Laborie, Toronto, Ontario, Canada), including1) uroflowmetry with PVR estimation by ultrasound for atleast 2 voids and 2) cystometrogram, including 1 plectroncycle using an 8Fr double lumen urethral catheter withthe patient supine and a slow filling rate of 10 ml perminute. unhurrieds were randomly carve up into 2 equal groups bymethod. Randomization was done blindly by having anindependent nurse randomly take a card from an envelopecontaining 14 cards for group 1 and 14 for group 2. Group1 received active PTNS treatment sessions using theUrgent PC Neuromodulation System, while group 2 underwenta sham procedure.Treatment ProtocolWe applied the technique described by Stoller.21 The patientlay supine with the soles of the feet together, and theknees abducted and flexed (frog position). A 34 sensneedle was inserted percutaneously approximately 2inches (5 cm) cephalad to the medial malleolus and 1 cmfrom the poste rior margin of the tibia at an angle of 60degrees from the skin surface and the engineer wire attachedto it. The surface electrode was placed on the same legnear the arch of the foot over the calcaneus bone. Thedevice was turned on and amplitude was slowly increaseduntil the largest toe of the patient began to curl, the digitsfanned or the entire foot extended, indicating proximity tothe nerve bundle (see figure). If this answer was notachieved or pain occurred near the insertion site, thedevice was turned off and the procedure was repeated.When the needle was inserted in the correct position, thecurrent was set at a resistant level (pain threshold) andthe session continued for 30 minutes.For the sham procedure we tested only the foot solutionto the electrical impulse and then turned off theapparatus during the whole session. To avoid patientidentification of the grammatical case of procedure all participantswere informed that they may or may not feel a sensorystimulus in the l ower extremities during the treatmentsessions.Groups 1 and 2 underwent 12 weekly outpatient treatmentsessions. All participants were advised to stop allmedical treatment for NE at least 1 month sooner startingPTNS but to continue behavioral therapy, including fluidA, neuromodulation system. B, system in utilisation with flexion of left largest toe.restriction at night, complete bladder emptying beforesleep and awakening 2 hours after sleep to void.Patient appraisalThe first patient evaluation was done in the first 2 weeksafter the last session. This evaluation involved repeatingthe clinical and urodynamic assessments. The clinical partincluded a nocturnal enuresis diary for 2 weeks in whichthe number of wet nights/week was reported as well as a2-day frequency-volume chart.The clinical response to treatment was assessed asoutlined by the International Childrens Continence Society,including no responseless than a 50% decrease inthe total number of wet nights, partial response50% to8 9% decrease, response90% or greater decrease and fullresponse100% decrease.20 Urodynamic assessment includeduroflowmetry, PVR measurement and cystometry.The second evaluation was done 3 months after the lastsession. It involved clinical evaluation using nocturnaland voiding diaries only.Statistical AnalysisAll statistical analysis was performed using SPSS 17.Data are shown as the sozzled SD unless otherwise specified.The Student t and polar sample t tests were usedfor comparison between groups and in the same group,respectively. Nonparametric data were compared by theWilcoxon signed ranks or Mann-Whitney U test. Statistical importation was considered at p 0.05.RESULTSRecruited for this study were 28 patients with refractoryNE who met inclusion criteria. Initial assessmentand baseline characteristics of each groupshowed no significant remnant in clinical and urodynamicparameters (table 1). Overall, in the 2groups DO was present in 13 patients (46.4%) and14 (50%) had decreased blad der capacity.The procedure was performed easily with no uncomelyeffects in all cases. No patient discontinuedthe planned sessions.At the end of the PTNS sessions clinical assessmentrevealed significant good in the average numberof wet nights per week in group 1 (decrease from4.7 to 2.6, p 0.002, table 2). Compared to the placebogroup, the number of wet nights after treatment wassignificantly lower in group 1 (p 0.041, table 2). Atthat time 4 group 1 patients (28.6%) had a completeresponse to PTNS, 7 (50%) had a partial response and3 were nonresponders. However, in group 2 there were2 patients (14.3%) with a partial response, while theremainder did not respond. When we compared the 2groups, the difference in this response rate was statisticallysignificant (p 0.002, table 2).At first evaluation after the end of treatment, theactive group showed significant improvement in allurodynamic parameters compared to baseline, includingfirst and strong desire to void, and MCC(p 0.002, 0.01 an d 0.000, respectively, table 2). Ingroup 2 these parameters did not significantly differcompared to baseline (table 2). Also, DO disappearedin 2 of 7 group 1 patients but this improvement wasnot noted in the sham treated group (table 2). Statisticalanalysis revealed that the difference be-Table 1. Patient characteristicsActive Placebo p ValueNo. boys/girls 8/6 9/5 1Mean SD age (yrs) 13.7 2.8 14 2.8 0.8Mean SD body mint candy index(kg/m2)24.95 4.40 26.27 4.23 0.43Mean SD max urine flow(ml/sec)26.85 6.74 23.28 5.49 0.13Mean SD PVR (ml) 6.21 7.11 5.86 5.48 0.9Mean SD daytime frequency 3.9 0.67 4.29 0.64 0.07Mean SD MVV (ml) 266.57 82 288.93 106.29 0.27Mean SD No. wet nights/wk 4.7 1.3 5.1 1.4 0.42No. detrusor overactivityPresent 7 6 1Absent 7 8 Mean SD void desire (ml)1st 148.46 25.89 153.50 21.65 0.59Strong 260.43 84.18 271.79 75.43 0.71Mean SD MCC (ml) 291.21 86.82 322.21 76.04 0.32Table 2. inner and intergroup comparisons of clinical and urodynamic findings after PTNS at first eva luationActive PlaceboBaseline After Treatment p Value Baseline After Treatment p Value Posttreatment p ValueMean SD void desire (ml)1st 148.46 25.89 177.71 35.48 0.002 153.50 21.65 154.14 20.71 0.59 0.041Strong 260.43 84.18 283.64 72.03 0.01 271.79 75.43 271.6 72.8 0.94 0.67Mean SD MCC (ml) 291.21 86.82 322.5 65.89 0.000 322.21 76.04 323.57 77.44 0.57 0.97No. detrusor overactivityPresent 7 5 0.44 6 6 1 0.7Absent 7 9 8 8Mean SD MVV (ml) 266.57 82 280.14 71.81 0.022 288.93 106.29 291.07 96.84 0.73 0.6Mean SD No. wet nights/wk 4.7 1.3 2.6 2.2 0.002 5.1 1.4 4.7 2.1 0.08 0.041No. response Full 4 0 0.002Partial 7 2None 3 121516 POSTERIOR TIBIAL NERVE STIMULATION FOR REFRACTORY NOCTURNAL ENURESIStween the 2 groups in this regard was not statisticallysignificant (p 0.7, table 2). Furthermore, inthis evaluation urodynamic parameters showed thatbladder volume at first desire to void was significantlyhigher in group 1 than in group 2 (p 0.041).On the other hand, bladder volume at strong des ireto void and MCC did not significantly differ betweenthe groups (p 0.67 and 0.97, respectively, table 2).Five of the 8 group 1 patients with decreased EBCshowed improved capacity. MVV also significantlyincreased after treatment from a mean of 266.5782 to 280.14 71.81 cc (p 0.022, table 2).When we studied the relationship between the responseto PTNS and initial urodynamic findings, wenoted that all 10 group 1 patients with small bladdercapacity and/or DO showed a good response to treatment,including 4 and 6 with a full and partial response,respectively. However, when we compared the type ofresponse in those with normal vs abnormal urodynamicresults, the 4 patients with normal urodynamic findingsin this group had a poor response to the sessions, including3 with no response and 1 with only a partial response.This difference was significant (p 0.007).Clinical results at 3 months after the last sessionshowed some deterioration in early results in theactive group. In this group the numb er of patients ith a full response decreased from 4 to 2 and thenumber of those with a partial response decreasedfrom 7 to 4. No change was detected in the othergroup. However, when we compared the responserate in the 2 groups at this time, we detected nosignificant difference (p 0.13). In addition, theaverage number of wet nights per week at that timewas 2.9 in group 1 and 4.2 in group 2, which did notsignificantly differ (p 0.07).DISCUSSIONThis study demonstrates that PTNS could be of valuein some patients with primaryMNEin whom previousconventional therapies failed. To our knowledge thistreatment modality has not been tried before in suchcases but it has been successfully used for overactivebladder syndrome,22,23 lower urinary tract dysfunctionin adults and children,15,18 refractory overactive bladder,16 refractory vesical dysfunction19 and refractorynonneurogenic bladder sphincter dysfunction.17Absent daytime lower urinary tract symptoms inpatients with NE does not necessarily m ean that thebladder functions well because DO and/or decreasedbladder capacity was previously reported in suchpatients.10,11 The clinical response to desmopressintherapy is less acceptable when NE is associatedwith decreased bladder capacity and/or DO.1214 Inour study we detected DO and decreased bladdercapacity in 46.4% and 50% of patients, respectively,although patients with MNE only were included inanalysis. These values agree with previous reportsshowing bladder overactivity24 and small bladdercapacity25 in 49% and 50% of children with MNE,respectively. These findings may partly explainthe mechanism of resistance to the previous treatmenttrials in our patients.Our results and those of others reveal that PTNScan be applied easily and safely in children.18,19After the 12 PTNS sessions in our series, patientsshowed a significant increase in MVV and urodynamicparameters, including first and strong desireto void, and MCC, compared to the placebo group.These results agree with those in previous reportsdemonstrating that PTNS increased cystometric capacityfrom 197 to 252 cc26 and from 243 to 340 cc,27and increased MVV by 39 cc, which was statisticallysignificant.23However, at 3-month followup we detected somedeterioration in the response rate compared to earlyresults. The overall number of full and partial respondersdecreased from 11 (78.6%) to 6 (42.9%) ingroup 1. This deterioration during followup suggeststhat PTNS may have temporary efficacy and its effectdecreases gradually with time. This finding was alsonoted in patients with overactive bladder treated withPTNS. van der Pal reported that 7 of 11 patients withan initially good response had evidence of indispensableand objective deterioration after PTNS.28 They suggestedthe need for maintenance treatment.The early promising results of this study encouragedus to suggest that PTNS might be effectivein patients with refractory primary MNE inwhom nocturnal polyuria is not an etiological factorbut in whom the ma in underlying pathologicalcondition is decreased bladder capacity and/or DO.However, the exact mechanism that could explainthe mode of action of this treatment modality isstill unknown. PTNS may induce some inhibitoryeffects on DO. The existence of this functionalabnormality in the bladder implies that the detrusoris not completely relaxed between voids.Therefore, the capacity of the overactive bladder isusually smaller than that of the bladder with anormal detrusor. Consequently, the clinical responseusually occurs when bladder capacity increasesand DO improves after PTNS. This explanationmay be supported by the improvement inbladder capacity (functional and cystometric) andthe disappearance of DO in patients who respondedto PTNS in our study.The main limitations of this study are the smallsample size and the short 3-month followup. Inaddition, we did not repeat urodynamic tests atthe second followup at 3 months to avoid patientdiscomfort but depended only on the patient clinicalre sponse. However, this information could be important for assessing the cause of the deterioration in PTNS efficacy after treatment wasstopped.CONCLUSIONSPTNS appears to be a viable treatment option insome patients with refractory primary MNE. However,deterioration in the response rate with timeraises important questions about the long-termefficacy of this therapy and the need for furthermaintenance sessions. More studies are needed tosupport our findings and select patients whowould be good candidates for this therapy.

Different Aspects Of The Speech Presentation English Language Essay

Different Aspects Of The Speech Presentation English Language EssaySpeech analysis is an evaluation of different aspects of the language presentation. It is a critical readiness to study a language and how to deliver an effective talk. It is one of the twenty-five essential for a public verbalizer. It includes whether you attend the speech presentation, or view a video or read the speech text.Speech analysis is very important because the ability to analyze a speech willing accelerate the outgrowth of any speaker. It overly will maximise the impact of the next speech presentation of a speaker. A common thing that happens after a speech is that you will start evaluating yourself honest from the moment you leave the stage. Did everything go as planned? What did the consultation think? Frequently, you will get so caught up in presenting your speech that you lose track of how the earreach is reacting and responding. Thats why getting feedback after the speech is important, so y ou know what you did well and what you did poor. Thus, you can identify things that could make your speech even better.BodyIncorrect method of the speechOn the speech organization, first thing the speaker started with his introduction which is non organized at all, because he suddenly said, My speech is. without satisfying the listening and without revealing the event. Moreover, he didnt explain what he is going to talk about in his speech. Thus, his introduction is poor man he didnt preview his general and its points.For the luggage compartment organization, he didnt really show what is the major point of his speech. He used to explain some(prenominal) photos and using some examples with it. There is no clear idea about the way he organized his speech, he kept talking about some things which are not belong to the speech. Like changing from a topic to another without knowing where the beginning of it, he besides said whatever came on his mind. The way he organized his speech is very direct and without any introductions of his ideas that he is going to talk about.In the end of the speech, he gave his personal opinion about the topic and how to go beyond your occu slyion, there is no specific endeavor in his speech. There is no clear summary for his topic and he was desire well-favoured his personal idea only.On the language, in the first place, the speaker having trouble in saying what he wants to say. This might be the weakness of the speech muscles. For example, like the muscles of the face, tongue, and lips.The speaker also may have different speech characteristics. One of them is the speaker difficult to put sounds and syllables together in the correct order to phase book of accounts. Longer words are usually harder to say than shorter words. Besides, he also made mistakes when speaking. The speaker may try saying a word some(prenominal) times before he said it correctly. Additionally, the speaker may not be able to communicate effectively wit h speech, and may take up the help of surplus communication methods.On the speech delivery, the speaker supposes speaking extemporaneously by uses only a set of brief notes or a speaking delimit to jog the memory. However, besides using a set of brief notes, the speaker has relied on the presentation slide of the power point from the laptop to read to his audience for his speech presentation.On the other hand, on the speakers voice, although the speakers voice volume is loud enough for a small size of audience in a classroom, he gradually speak softly and not loudly when the time he read the script from the presentation slide of the power point from the laptop, the audience cannot go steady clearly. The speaker also fall into repetitions pitch patterns that are just as hypnotic as a monotone. Although overall the speaker is not speaking in like manner fast, he did mistakes again when the time he read the script from the presentation slide of the power point from the laptop. He is speaking so quickly that the audience lose track of his ideas.In addition, the speaker does too many pauses especially when every time he is forgot the script. Furthermore, when he does pause, he also pauses at the spirit of thought units. This may distract audience from his ideas. Most important, one of the major mistakes that he made is he fill the silence with vocalized pauses such as uh, er, and um. This scratchy the audience and they create negative perceptions about the speakers intelligence. Moreover, the speaker spoke extemporaneously with poor vocal variety. He did not develop a lively and communicative voice end-to-end the speech.On the speakers body, his physical actions affect much the outcome of his speech. Based on the personal appearance, the speaker wore a simple casual turn and a hat during his speech. Its not a suitable attire clothes while you give a formal speech to audience. He also pay a cap during a speech, it shows disrespect to the audience. Besides , the speaker did a big mistake in his movement. He shakes his body here and there while talking. Sometimes, his body faces back or side to the audience.Next, is the gestures mistake that he had made. He moved too much of his hand throughout the speech. Sometimes he put his ii hands inside his pocket sometimes he let them hang at the sides even sometimes he wring his finger and gently pat the table to retrieval his memory. These gestures that the speaker makes draw attention to themselves and distract from his message. The last mistake which he had made is his nerve center contact. He has almost no eye contact throughout the speech. He kept feeling up and down from the laptop then back to audience again. It is the biggest mistake and the obvious part that he had made in this overall speech. Even sometimes, he closes his eyes to recall his memory.Suggestion of the correct method to improve the speechOn the speech organization, the right organization that the speaker has to do is t o gather his ideas and gestate the ideas with the right materials to send the clear idea of his speech, and as we said before, the writer didnt announce his specific purpose he announced only the general idea of his speech.He has to work on his speech by choosing the right methods of organizing the ideas and the points to be clear to the audience. Moreover, he has to support the ideas with statistics, examples or testimony, but he only used one method with is the examples but it was not on its right place, because he kept on expectant examples about his opinion.The speaker should have organized his speech under the topical order because his general idea is about the host club so it is about a topical speech.On the language, basically there are some language techniques that the speaker can use for an effective speech. First, adjectives. Adjectives are the simple ingratiatory language. Second, repetition. It can be used for emphasis. By the way, it en surelys the audiences are list ening because repetition catches the ear. Third, asking question. Of course, the list of the speech is not complete without the question. This is an effective speech because it requires an audience response.It is also important for the speaker to remember that the language used in a presentation. Use only professional language to the audience. The speaker has to make sure that correct grammar and word choices are used through the presentation.On the speech delivery, because of the speaker supposes speaking extemporaneously, he should well-prepare and rehearse for several times for the speech which is just presented from a brief set of notes and no other materials.On the other hand, on the speakers voice, the speaker need to maintain his loudness throughout his speech and need to talk louder when the audience look puzzled, are leaning forward in their seats, or are otherwise straining to hear. The speaker also has to work on varying pitch patterns either upward or downward to fit the meaning of his words of the speech. Again the speaker has to maintain the rate he speaks throughout his speech, not too fast especially a slower tempo is needed when he is explaining complex information that is not familiar to the audience.In addition, when the speaker does pauses, he should make sure his pause at the end of thought units. Most important, to ensure the speaker do not filled with vocalizations such as uh, er, and um when every time he is forgot the script, he has to practice the speech several times using only the speaking outline as practice makes perfect. Moreover, when swelled the speech, the speaker should modulate his voice to communicate his ideas and feelings.On the speakers body, posture, facial expression, gestures, and eye contact will affect the way audience respond to him. Based on the personal appearance, he should wear an at least formal suit and formal trousers. He has to take off his cap while giving the speech as it shows disrespect to the audience . Besides, on the movement, what he has to do is to stand straight and sometimes just move a little is possible. He body should also just face front to the audience.Next, on the gestures, he should only move his hand when he emphasizes any keywords. Eventually, on the eye contact, he should direct optic contact with the eyes of audience to help gauge his truthfulness, intelligence, attitudes, and feelings. He should also prepare a speaking outline before his speech and practice or memorize some parts of the speech to avoid mistakes happened by looking on the laptop by the audience.ConclusionIn summary, weve covered three ways to give feedback from watching a video recording of a speakers speech. For the first viewing, we recommended listening to audio only for the speech organization and writing down word for word what the speaker actually said. Next, for the second viewing, we recommended listening closely to language that has been speaking by the speaker. Finally, for the third viewing, we recommended looking for speech delivery. Speech delivery includes methods of delivery, the speakers voice, and the speakers body. Particularly, we recommended looking deeply for any distractive or repetitive mannerisms to polish and refine the speakers speech delivery. When you implement these tips, you will not only look more professional, but you will feel more confident in your speech presentation as you make a greater your impact on your audience.

Looking At The Issues Surrounding Adoption Social Work Essay

Looking At The Issues Surrounding word meaning Social Work stressThis short study concerns my run intos in traffic with an adopt service user who wishes to puddle pass with her race mother. The essay takes up the case of J, a 46 year old divorced lady who finds out about her history of toleration after the death of her choose p arents. J tries to directly establish contact with her biological mother, who refuses to meet her, leaving J traumatised and emotion anyy devastated. The case scenario is provided in the appendix to this essay and is considered as read.This reflective and analytical account concerns (a) my experiences in dealing with Js problems and needs, (b) my thoughts and theoretical knowledge of social start theory and practice with escort to children who are put up for adoption at digest, (c) their various emotional and bodily challenges, and (d) the desire that is sometimes manifested by them during various stages of their lives to establish contact with their biological parents. It makes use of established social work theories like the attachment theory and the detachment anxiety theory.I besides take up the growing prevalence of the use of social networking sites by follow children to establish contact with their long marooned blood lineing parents, and the social work mechanisms available in the UK to facilitate meetings mingled with adopt children and their comport parents.The Challenges of AdoptionJ was put up for adoption at birth and was adopted by foster parents. She grew up in her foster dwelling house in the company of her siblings, who were the birth children of her adoptive parents. The fact of her adoption was notwithstanding concealed from her by her adopters. J grew up with some feelings of unease between her and her siblings and adoptive parents and suffered from low self esteem when she was young. She alike displayed some behavioural problems and lay out it difficult to establish friendships with other children.Adoption is undoubtedly an important and beneficial social process. It serves the critical needs of opposite individuals (Howe and Feast, 2000, p 34). It relieves natural parents of the onerous responsibilities of transport up children when their circumstances make it impossible for them to do so, on account of social and sparing reasons. It ascertains safety, security, physical and emotional nourishment, education and improved life chances for unwanted, deprive or abandoned children (Howe and Feast, 2000, p 34). It also fulfils the needs of childless couples, single people, and families for a child. Whilst adoption is undoubtedly an important social process, it brings along with it different types of social, economic and emotional challenges for all involved people, the child placed for adoption, the birth parents and the adopters (Howe and Feast, 2000, p 34).Adopted children, numerous studies suck in revealed, are prone to the adverse consequences of attachment dis gilds and detachment anxiety (Cassidy S containr, 1999, p 11). John Bowlby, well known for his advancement of the attachment theory, explains the critical importance for infants to develop secure attachments to their primary care givers. Bowlby states that attachment processes between infants and caregivers are biologically based, chosen by evolution to maximise survival chances, and aim to provide infants with feelings of security (Cassidy Shaver, 1999, p 11). Such security provides infants with the foundations required to explore their environments, with the exuberant knowledge that their caregivers will be able and available to provide them with protection in the face of adversity or stress (Cassidy Shaver, 1999, p 11).The insularity of children from their primary caregivers often results in feelings of separation anxiety and the development of attachment disorders if their attachment needs are not met or resolved effectively (Blum, 2004, p 538). Studies on adopted childr en show that positively formed attachments between children and caregivers improve chances of well adjusted lives, irrespective of the biological relationships of attachment figures with children (Blum, 2004, p 538). Whilst it is known that J was put up for adoption at birth, the exact age at which she was adopted is not clear. Research shows that that children adopted after 6 months of age are at greater risk for development of attachment disorders (Blum, 2004, p 538). Such attachment disorders can lead to emotional disturbance, eating disorders, bedwetting, lack of performance at school, difficulty in development of positive relationships, withdrawal from society and poor life outcomes (Blum, 2004, p 538).The adoptive parents need to take special care to hold good adjustment of their adopted children. It is important for them parents to meet the needs of infants for love and nurturing on a consistent basis (Brisch, 1999, p 79). Adoption requires an active fiber from adoptive par ents who assume the role of caregivers. As adopted infants explore their new and alien environment, adoptive parents must provide the required guidance, supervision and structure to ensure their safety (Brisch, 1999, p 79). Caregivers must also have the capacity and power to provide levels of stimulation that do not overwhelm or stifle the infants developmental level. They must be attentive to the internal creation of infants by being emotionally available to help them during periods of frustration, rejoice in their achievements and share their joy of geographic expedition (Brisch, 1999, p 79).Secure attachments create positive feelings in children that relationships can be helpful, fulfilling, and valuable and provide adequate protection in an occasionally overwhelming world (Blum, 2004, p 545). Whilst secure attachments do not secure immunity from subsequent psychopathology, childhood security is certainly related to (a) increased capacities for stress management and ability to rebound after periods of psychological disturbance, (b) capacity to manage family stressors, (c) increased self-esteem, (d) good peer relationships, and (e) good psychological adjustment (Blum, 2004, p 545).Contemporary psychiatric theory states that adopted children often need therapeutic parenting, rather than normal domestic environments. Such parenting should be based on principles like sensitivity, responsiveness, following the lead of the child, the manduction of congruent and inter-subjective experiences and the creation of an environment of safety and security (Goldsmith, et al, 2004, p 2). Parents, in order to engage in such therapeutic parenting, require to be pull to adopted children, have reflective abilities, good insightfulness and secured mental states with respect to attachment (Goldsmith, et al, 2004, p 2).With J showing evidence of emotional disturbance and behavioural problems during her childhood, it is possible that her parents, whilst providing her with a nor mal and secure domestic environment, did not place great emphasis in responding to her specific emotional needs. Their concealment of her adopted positioning is possibly an indicator of their concern for the child and their desire to protect her emotions and feelings. Contemporary psychological and social theories however recommend that children be informed of their adopted spatial relation (Hollingsworth, 1998, p 303). Such information, when provided with sensitivity and in appropriate circumstances and environmental surroundings, prevents adopted children from experiencing emotional traumatisation when they otherwise inevitably come to know of their history of adoption and helps them in adjusting to their new homes (Hollingsworth, 1998, p 303). Knowledge of birth parents is also important, both for the adoptive parents and the adopted children, in order to effectively cope with possible medical exam problems (Hollingsworth, 1998, p 303).J came to know about her adopted status b y accident when she was 42, after the death of her adoptive parents. The knowledge left her emotionally traumatised and brought stick out memories of her childhood and of feelings of strain in her relationships with her adoptive parents and their birth children. It is however only if fair to realise that Js parents very possibly had her best interests at heart and were also unaware of the future impact of not informing her of her adopted status.Reunion of Adopted Children with Birth ParentsJ, on knowing of her adopted status and the name of her birth mother, became emotionally ill because was not informed of the facts of her adoption, or about her birth parents. Adopted children, as they grow older, often run curious about their birth parents, especially so in situations of little or no contact (Adoption UK, 2010, p 1). Studies by Adoption UK, a national charity operated by adopters, reveals that all adopted children do not wish to know or contact their birth parents. Such desir es are essentially personal, with some adoptees wishing to know more and others having little interest (Adoption UK, 2010, p 1). It is however also true that people who are not interested in contacting their birth parents when they are young, change when they become older, especially after they become parents and experience desires of knowing, contacting and establishing relationships with their own birth parents (Adoption UK, 2010, p 1).The emergence of social networking sites like Facebook and My Space have made it far easier for adopted children, who wish to know more about their parents, to establish contact with their birth families (Fursland, 2010, p 1). Such accessibility has introduced significant complexities in the social relationships of adopted children with their adopted and birth parents and is creating difficult challenges for social workers when they are asked for assistance by individuals in need (Fursland, 2010, p 1).Establishment of contact between adopted childr en and birth parents is an passing sensitive issue and needs to be handled with care and sensitivity (Adoption UK, 2010, p 2). Adoption reunion can be a truly enriching and joyful experience, full of anticipation, twists and turns, joy, confusion, excitement, and fear. However reunion, like adoption, is not simple and can turn out to be a difficult, complex and sometimes saddening event (Adoption UK, 2010, p 2). Reconnecting with birth parents and children is rarely seamless and easy. It requires dedication, motivation, and a leap of faith (Adoption UK, 2010, p 2).Adoption reunions often give rise to complicated issues that have been dormant for decades and have to now be dealt with and resolved. Many birth parents may have never have shared their childs adoption with anybody else (Howe and Feast, 2000, p 57). Some birth mothers protect their secret because they are fearful of how others might or will react. For some mothers it is a matter of shame and they are instructed not to reveal their secrets to others (Howe and Feast, 2000, p 57).The National Adoption Standards for England, (Department of Health, 2001), along with the Adoption and Children Act 2002, provided birth parents in England and Wales entitlement to a support worker, apart from the childs social worker, from the point of identification of the adoption plan for the child (Goldsmith, et al, 2004, p 4). The Standards state that birth parents (a) should be able to access different types of support services, including counselling, advice and information before and after adoption, which recognise the long term implications of adoption, and (b) should be treated with transparency, fairness and regard during the adoption process (Goldsmith, et al, 2004, p 4).Most adopted children now have plans for direct or indirect post-adoption contact with birth relatives. Agencies are required to learn contact arrangements in adoption plans and consider post-adoption support requirements of all concerned (Gold smith, et al, 2004, p 4). Existing regulations like The Adoption Support Services Regulations entitle adopted children, adoptive parents, and birth relatives for need assessment regarding contact arrangements and mandate agencies to maintain services to help such contact arrangements (Adoption UK, 2010, p 2).Helping JJ contacted us for support on making contact with her birth parents. The Adoption and Children Act of 2002 has established a framework that provides adopted people, who are more than 18 years old and their birth relatives, rights to request for intermediary services if they wish to make such contacts. Such intermediaries are provided by registered adoption agencies, (either voluntary or local authority), or registered adoption support agencies and act as mediators between adopted people and their birth relatives. It is recommended that people wishing to make contact with birth relatives do so through intermediaries. J was informed about the intermediary process and serv ices that could be provided by me in mediating with her birth mother but refractory to contact her directly.When J contacted our agency and the case was assigned to me to help her with her emotional challenges and her desire to establish her birth mother, I engaged her in a long discussion in order to assess her emotional status, her views about her adopted childhood and her desire to meet her birth mother. I met her at her home on two occasions after taking prior appointments in order to ensure that she was prepared for the meeting and would be able to convey her thoughts go once morest in familiar surroundings.I took care to adopt the person centred approach and deliberately avoided all judgemental feelings about her background as a relinquished and adopted child. The adoption of a person centred approach is necessary for the true implementation of anti-oppressive and anti-discriminatory approaches and I was able to understand Js emotional and mental condition with greater pell ucidity and empathy (Mearns and Thorne, 2007, p 9). Whilst my choice of open and close ended questions did help her in opening up and in shedding her inhibitions and reservations, I found her to be disturbed about her adopted status. She appeared to be disturbed with her adoptive parents for their concealment of information about her birth, her birth parents and her adoption, and kept talking of small incidents of her childhood about her parents and siblings. She also spoke about her behavioural problems, her disturbed sleep and her difficulties in making friends at school.J was however determined to establish contact with her mother and decided to contact her as soon as she found out her contact details. I offered to act as intermediary and contact her mother in order to assess (a) her views on the relinquishment of her birth child, (b) her current emotional status and (c) her attitude towards establishing contact with J. The lady (J) was however unwilling to wait even for a few da ys and was convinced that her mother would like to meet her as much as she did. I did mildly explain to her that her mother could have different opinions on the issue and even offered to expedite the process. Whilst J did provide some indication of being ready for my help at the closure of our second meeting, she afterward changed her mind and established direct contact with her birth mother. Her birth mother, from what J told me later, was absolutely surprised at receiving the call and was taken aback by the development. She responded to Js front communication with brusqueness and asperity, informing her that she did not wish to respond to her overture or to establish contact.I do feel that J acted with great downfall and the result of the initiative could well have been very different with the use of an intermediary. I would have telephoned Js mother and asked for a personal meeting. I would have again adopted a person centred approach, refrained from being judgemental, and wou ld have engaged her in discussions about her reasons for relinquishing her birth child. I would have then gently brought up the matter of J, her adopted childhood, the concealment of information about her adopted status, and her current emotionally disturbed condition. I do feel that such an approach would have yielded a better response from her mother than Js arbitrary method of establishing contact.ConclusionsThis reflective account details my experiences of dealing with an adopted service user, who tried to unsuccessfully establish contact with her birth mother. Modern day theory on social work and psychology stresses upon the complexity of adoption and the various challenges that the process brings up for the adopted children, the adopters and the birth relatives. Adopters have particularly significant responsibilities in ensuring, possibly through the use of therapeutic parenting methods, that their adopted children do not suffer from separation anxieties and do not develop att achment disorders. It is important for social workers to understand the emotional implications of these complexities and consider the emotional needs of all involved people with empathy and understanding.It is also important, as my experience with J reveals, for adoption reunion processes between adopted individuals and their birth relatives to be handled with great care and thought. I do feel that I should have been more persuasive and possibly more forthright, without being judgemental, with J on (a) the possibly very different perceptions of her birth mother towards the meeting, (b) the compulsions that forced her to relinquish her birth child for adoption and (c) her current emotional condition and social environment.Such an action would have possibly produced better results at the end. My knowledge of social work theory and practice has been significantly enhanced by my experience with J and will help me to deal with such situations much better in future. intelligence informati on Count 2625, without citations and bibliographyBibliographyAdoption UK, 2010, Wanting to know more or not, Available at www.adoptionuk.org/information/217131/wanting_to_know_more/ (accessed January 30, 2011).Blum, H. P., 2004, breakup-Individuation Theory and Attachment Theory, Journal of the American Psychoanalytic Association,(52) 535-553.Bowlby, J., Parkes, C. M., 1970, Separation and loss within the family, In E. J. Anthony C. Koupernik (Eds.), The child in his family International Yearbook of Child Psychiatry and Allied Professions, pp. 197-216, New York Wiley.Bowlby, J., 1973, Attachment and loss, Vol. 2 Separation, New York fundamental Books.Brisch, K. H., 1999, Treating attachment disorders, New York Guilford Press.Cassidy, J., Shaver, P. R., 1999, Handbook of attachment Theory, research, and clinical applications. New York Guilford.Feast, J., Howe, D., 1997, Adopted adults who search for background information and contact with birth relatives, Adoption Fostering 21 2, pp 8-15.Fursland, E., 2010, Facebook has changed adoption forever, www.guardian.co.uk, Available at www.guardian.co.uk//19/facebook-adoption-tracing-birth-mother (accessed January 30, 2011).Goldsmith, F. D., Oppenheim, D., Wanlass, J., 2004, Separation and Reunification Using Attachment Theory and Research to Inform Decisions Affecting the Placements of Children in Foster Care, juvenile and Family Court Journal, pp. 1-12.Hollingsworth, L., 1998, Adoptee dissimilarity from the adoptive family clinical practice and research implications, Child Adolescent Social Work Journal 15, (4) pp 303-19.Howe, D., Feast, J., 2000, Adoption, Search and Reunion The long-term experience of adopted adults, London The Childrens Society.Mearns, D., Thorne, B., 2007, Person-Centred Counselling in Action, 3rd edition, London Sage Publications.Levant, F. R., Shlien, M. J., 1987, Client-Centered Therapy and the Person-Centered Approach New Directions in Theory, Research, and Practice, USA Praeger Pa perback.Appendices

Earth Faces a Sixth Mass Extinction Essay -- Exploratory Essays Resear

Earth Faces a Sixth Mass Extinction Scientists in enormous Britain have been studying the distribution of birds, butterflies and plants for the past 40 years and the results from these studies suggest that the Earth is heading towards another mass extinction, and this one may have its root in human activity. Within the four billion years that Earth has been around, it has already experienced five mass extinctions. The most recent, and most well cognize occurred 65 million years ago and caused the extinction of the dinosaurs. While that my have been caused by a meteor colliding with the earth, if scientists are correct, our actions, both past and present, are harming galore(postnominal) species of organisms and we may even be causing our own demise. The ongoing studies in Great Britain covered the biodiversity (that is the pith of species of an organism within a given area) and the amount of land the plants, birds, and butterflies each occupied. It covered 1254 species of p lants dropvass from 1954 to 1960 and again from 1987 to 1999, 201 bird species studied amid 1968 and 1971 and again from 1988 to 1989, and 58 butterfly species studied between 1970 and 1982 and again between 1995 and 1999 (Thomas et al. 2004). Before this study there was only speculation into the possible population decline of insects. Since they are so abundant it had been hard to get any kitchen stove on their actual number or the effect humans were having on them (Pennisi 2004). Over the time they were studied 3.4% of the species of butterflies went extinct compared to only .4% of the plant species. None of the species of birds that were studied went extinct during the time of the research. The extinctions that occurred were evenly spread throughout Great... ...xtinction just yet, a short period of time from a geological point of view can be hundreds of thousands of years. ReferencesAnanthaswamy, Anil. Earth faces sixth mass extinction NewScientist.com News Service. Mar ch 18, 2004 http//www.newscientist.com/news/news.jsp?id=ns99994797Pennisi, Elizabeth. 2004 Naturalists Surveys Show That British Butterflies Are Going, Going ... Science v. 303, p. 1747Recer, Paul. Humans demonic for march toward 6th mass extinction Star Ledger Online. March 19, 2004 http//www.nj.com/news/ledger/index.ssf?/base/news-14/1079682723291630.xmlRincon, Paul. UK wildlife heading into crisis BBC News Online. March 18, 2004 http//news.bbc.co.uk/2/hi/ experience/nature/3520372.stmThomas, J. A. et al., 2004 Comparative Losses of British Butterflies, Birds, and Plants and the Global Extinction Crisis Science v. 303, p. 1879

Harmful Aspects of The Automobile Essay -- Essays Papers

Harmful Aspects of The Automobile Air taint refers to the presence of foreign substances in the atmosphere. Air pollution is a problem in countries where urban and population growth have been accompanied by the use of the automobile. Smog, carbon monoxide, and stinging rain, atomic number 18 only a few of these foreign substances in the atmosphere. The negative effects these poisons have upon the environment and the human body are astronomical. Respiratory inflammation, impaired vision, learning disabilities, and death are all results that smog, carbon monoxide, and acid rain have on the human body. The deterioration of the ozone, and precious trees, as well as the destruction of many necessary rain forests are examples of pollutions negative effects on the environment. Smog, carbon monoxide, and acid rain are all main roots to the deterioration of humans, as well as the planet. For additional information, see http//cses.scbe.on.ca/air4.htm. The first poisonous gas to be discussed would be smog. Smog builds when sunlight cooks everyday emissions from automobiles. Automobiles body paint, as well as gas pedal fumes, all play a deadly role in the destructive path of smog. When these pollutants cook in the sunlight, they form ground-level ozone, which is the main component in smog. Pollutants are generated by traffic in urban areas. To view an example of a polluted see http//www-wilson.uesd.edu/education/airpollution (76k). The pollution is then blown from urban center to city in wind flows carrying toxins into the rural areas. Motor vehicles are the main source of hydrocarbons and nitrogen oxides. The emission from motor vehicles combined with sunlight create a browned haze, which we have come to recognize as smog(Deg... ...erioration of humans, as well as the planet. Works Cited - Degobert, Paul. Automobiles and Pollution. Warrendale PA Society of Automotive Engineers, 1995. - Grad, P. Frank. The Automobile and The Regulation of its Impact on The Environment. Norman University of Oklahoma Press, 1975. - Haslam, Sylvia. River Pollution An Ecological Perspective. London New York Belhaven Press, 1990. - Meisel, S. William. Monitoring Carbon Monoxide Concentrations in Urban Areas. Washington Transportation interrogation Board, National Research Council, 1979. - Schwieger, Robert G. and Elliott, Thomas C. Acid Rain Engineering solutions, regulatory Aspects. New York Hemisphere Pub. Corp. Magraw Hill, 1985. - Southwestern The Student Handbook. 4 vols. New York Harper collins Publishers, Inc, 1997. 4 vols.

Mumia Abu Jamal Essay -- essays research papers

America, the land of the free, the land of the just. It is here, where paople from all over the world can come for refuge from tyranny. Here, people are not judged by their color, but by who they are. Too bad it isnt true, for what you are about to read will contradict everything that America is supposed to be. Mumia Abu Jamal, a former Philadelphia journalist, was put finished an unfair and biased trial, then convicted of murdering a Philadelphia cop in 1982, and has been on death row since. And here is his story."My name is Mumia Abu-Jamal ... Ive been on death row since July of 1982 - in fact, Ive been on several death rows in Pennsylvania, in the United States of America. Despite my penal status Im a writer, a journalist, a columnist, and a professional revolutionary." -- Mumia Abu-Jamal (Wideman 107) natural 24 April 1954 Wesley Cook, Mumia Abu-Jamal, author, journalist and inmate of death row, is one of Americas most powerful outspoken voices against injustice. Seen b y the State as a dangerous revolutionary who essential be silenced, he has been incarcerated for the last seventeen years. (West 2)Mumia Abu-Jamal was born in Philadelphia where he grew up. The name Mumia was portrayn in High School, when he took an African name for his Swahili studies. The Arabic, Abu-Jamal, meat Father of Jamal, came later. (West 5)Mumias first introduction to politics was in his teens when he and a few friends attended a George Wallace presidential rally. They shouted slogans and raised their fists in a black power salute. To their relief they were thrown out, but their relief was short lived when they were set upon outside by a gang of white thugs. Rescue seemed at hand when the police were spotted, but their rescuers joined in the assault, kicking and beating. Mumia was kicked in the face. (West 13)Mumia became a founding member of the Black Panther Party in Philadelphia and curate of Information (fall 1968). Mumia filed reports from New York and other citi es, but was mainly based in Philadelphia. For a time he worked in Oakland, California, on the staff of the partys newspaper. The Black Panthers were to give Mumia a good grounding in radical politics and it was where he cut his teeth as a journalist. When the Panthers began to tear themselves apart, Mumia left. (West 34)Mumia Abu-Jamal "The prospe... ...p West, Cornel. Death Blossoms Reflections from a prisoner of Consience. New York Plough Pub House Publishing, 1997     "Mobilazation to Free Mumia Abu-Jamal." The Crime Scene. Website. Online. Internet. Available www http//www.freemumia.org/mumia_files/scene      "Mobilazation to Free Mumia Abu-Jamal." The Trial. Website. Online. Internet. Available www http//www.freemumia.org/mumia_files/trial      "Mobilazation to Free Mumia Abu-Jamal." The swain and Their Lies. Online. Internet. Available www http//www.freemumia.org/mumia_files/fop       "Mobilazation to Free Mumia Abu-Jamal." The Witnesses. Online. Internet. Available www http//www.freemumia.org/mumia_files/witnesses      "Mobilazation to Free Mumia Abu-Jamal." Judge Sabo. Online. Internet. Available www http//www.freemumia.org/mumia_files/sabo     "Mobilazation to Free Mumia Abu-Jamal." Support for Mumia. Online. Internet. Available www http//www.freemumia.org/mumia_files/ lose

Sociology :: Sociology Essays

Some sociologists have marked the course of the history remarkably. Others with lesser impact, have been rapidly forgotten. Karl Marx belongs to those with unforgettable memory. His works didnt perish, but are rather classified as everlasting.Karl Marx, German political philosopher and revolutionist, is one of the most influential thinkers of all times. Hes the founder of modern socialism and communism. Hes by many appraised and glorified and in the eyes of others, hes viewed as a abash to mankind. Karl Marxs achievements are numerous but the main issue of this paper is aimed to analyze his theory on capitalism. It is as an economist theorist that he commands our saki here. Its important to mention that karl Marx was, in his youth, influenced by many sociologists and it is through their influence and ideas that he had shaped his overall doctrine. To mention, Adam smith, in reference to his frugal views Ricardo, as a political economist Williams Friederick Hegel, by his dialectica l process of thesis, contradiction and antithesis even though he rejected his view about idealism. not to forget, his close friendship with Frederick Engels who had an enormous effect on his writings and who had continued many of his unfinished writings after his death. Marxs theory of capitalism for the first time emerged in The Communist Manifesto, a book written by Marx in 1847,and which was the first systematic contestation of modern socialist doctrine. It contains a statement of principles that clarifies his theory. In few words, The Communist Manifesto embodies the materialist conception of history or historical materialism. The manifestos propositions are that in every historical epoch, the habitual economic system by which the necessities of life are produced, determines the form of societal organization, and the political and intellectual history of the epoch is a history of struggles between exploiting and exploited, thats between ruling and ruled, social classes. A furt her explanation will be given latter on.Karl Marxs theory appeared again in a book written in 1867, the Das Kapital(volume 1). Its as well, a systematic and historical analysis of the economy of the capitalist system of society, in which he developed the theory that the capitalist class exploits the working class by appropriating the surplus value produced by the working class. Now, the theory of capitalism will be analyzed deeply. The history of all hitherto existing society is the history of class struggle(communist manifesto).Capitalism, for Marx, is a historical development.