Asthma in Pediatric Patients - Free Essay Example

Abstract Asthma is a leading chronic condition in the pediatric population within the United States. The prevalence of asthma has increased in modern times likely due to an increase in air pollutants in the environment. Asthma also has an economic burden associated with an increased number of missed school days per year and high emergency department admission rates. Genetic and lifestyle factors have been shown to predispose people to the development of asthma. A tertiary prevention program that involves the comprehensive use of the Asthma Action Plan, developed by the American Lung Association, can help gain better control of a patients asthma and reduce the number of asthma related emergency department visits. This plan requires the cooperation of school nurses, physicians and parents in order reach its maximum potential. This program can also help patients and their families gain more control of their health at a relatively low personal and economic cost. Epidemiology of Asthma in the Pediatric Population Asthma is the most common chronic disease in childhood in resource-rich countries, including the United States (Sawicki, Haver, 2018). It is estimated that 14 million days of school are missed due to asthma in the United States each year (Sawicki, Haver, 2018). The prevalence of asthma can be contributed to a genetic component in addition to several environmental factors. These environmental factors include: diet, air quality, smoking, antibiotic use, and allergies (Patel, Henderson, Jeffreys, Davey, Smith, Galobardes, 2012). If asthma is left uncontrolled, this disease can become costly due to the potential for life-threatening symptoms that may require admission to an emergency department or hospital. By implementing a structured program with coordination from the patients, parents, school and provider, these costs can be minimized. Epidemiologic Parameters and Significance of Disease (Shafer) Asthma has been an increasing problem in the United States over the last two decades, particularly in children under 18 years old. According to the Center of Disease Control and Prevention, asthma rates of the total population increased by 12.3% from 2001-2009, making the prevalence of asthma in the United States 8.2% (2011, p. 547). The prevalence of asthma in children jumped and then plateaued (Sawicki Haver, 2018). Data collected by the Center of Disease Control and Prevention between 2001-2009 showed that the prevalence of asthma in children was at 9.6%, which was increase from previous years (2011, p. 547). With increased awareness and intervention, the prevalence of asthma in children did show a decrease to 8.3% from 2013-2016, especially in children under the age of 5 (Sawicki Haver, 2018). Asthma is a serious, chronic disease that comes with a lifetime need for medical treatment. Poor asthma management can result in hospitalization and sometimes death. According to the American Lung Association, asthma is the third leading cause of hospitalization among children under the age of 15 years (2018, para. 7). Although asthma-related death is rare in children, there were 169 children who died in 2016 due to complications of asthma (Asthma and Children Fact Sheet, 2018). The American Lung Association also reported that in 2010 there were approximately 640,000 emergency room visits due to asthma in those under 15 years of age (2018, para. 8). Asthma continues to be a prevalent chronic disease in the United States, particularly in the pediatric population. Due to its multifactorial development, additional research must be conducted to better understand the pathophysiology of the disease. Genetic Markers of Asthma (Hubacek) Asthma is a common disease that is known to develop due to genetic and environmental factors. Many studies have been completed and further research is still being done to determine which genes are responsible for genetic inheritance of asthma. Asthma does not follow a typical Mendelian path of inheritance, instead the asthma phenotype is expressed non-linearly and is highly variable so it is more difficult to make predictions of the rate at which it is passed down to offspring (Thomsen, 2015, para. 2). Important factors for determining the inheritance of asthma include: degree of genetic relation to the relatives with asthma and the severity of the asthma and the age at which the relative developed asthma (Thomsen, 2015). The recurrence risk of asthma in children with one affected parent is around 25%, whereas the risk if both parents are affected is around 50% (Thomsen, 2015, para. 3). Ober Yao found that asthma has significant genetic contributions, with heritability estimates varying between 35% and 95% (2011, p. 10). Thomsen brings to light that twin studies have shown there is an increased chance of developing asthma if someone who has very similar genetic composition has the condition (2015). For example, the risk of asthma in both identical twins is much higher than that of fraternal twins (Thomsen, 2015). At this point in time, there are several genes that have been found to correlate to the inheritance of asthma. In 2010, the largest study regarding the genetics of asthma was conducted genotyping 26,475 participants, over half of which had asthma (Thomsen, 2015). This study revealed 9 genes that are responsible for the asthma phenotype. The genetic markers involved in the inheritance of asthma include: the gene for nonmuscle isoform of myosin light chain kinase (nmMLCK), ADAM33 on chromosome 20p13, ILIRL1 and IL18R1 on chromosome 2, HLA-DQ on chromosome 6, IL33 on chromosome 9, SMAD3 on chromosome 15, ORMDL3 and GSDMB on chromosome 17, and IL2RB on chromosome 22 (Ober Yao, 2011; Zhou, Wang, Garcia, 201 5; Thomsen, 2015). The study conducted by Zhou, Wang, Garcia demonstrated nmMYLK dependent gene expression differentiates the severity of asthma in patients (2015). The ADAM33 gene has been specifically linked to the bronchial hyperresponsiveness in asthma in addition to airway remodeling (Thomsen, 2015). The ORMDL3 gene, in particular, was associated with childhood onset, whereas the HLA-DQ gene was related to later-onset asthma. Further, the results showed that 38% of all cases of childhood-onset asthma were attributable to a combination of the identified genes (Thomsen, 2015, para. 11). The extent of research completed thus far does indicate that genes are responsible for the development of asthma. However, additional research still needs to be done in order to better predict the inheritance pattern of asthma. Family Genogram of Asthma (Hubacek) This genogram illustrates there is an increased probability of developing asthma if a close family member has asthma. This is seen as b oth twins inherited asthma from their mother, likely due to their similar genetic makeup. In addition, this genogram demonstrates with Aimee and Jeromes children that there is a 25% recurrence rate of asthma when one parent is affected. Environmental and Lifestyle Factors (Shafer) Asthma is a multifactorial disease that is affected by genetics, environmental factors and lifestyle choices. There are a multitude of environmental factors that are said to exacerbate asthma, including diet, air quality and pollution, smoking, antibiotic use and exposure to different allergens (Patel, Henderson, Jeffreys, Davey Smith, Galobardes, 2012). According to Kravitz-Wirtz et al., there is evidence showing that exposure to air pollutants in utero and in the postnatal years can have an effect on the development of asthma later in life (2018). The fetal lungs begin to develop in the later trimesters of pregnancy and continue to mature until 3 years of age (Kravitz-Wirtz et al., 2018). The lungs are highly susceptible to environmental toxins due to the permeability of cells lining the respiratory tract (Kravitz-Wirtz et al., 2018). The absorption of toxins via the respiratory tract endothelium seems to contribute to the development of asthma later in life (Kravitz-Wirtz et al., 2018). There is also a correlation of the development of asthma in children with lower socioeconomic status (Kravitz-Wirtz et al., 2018). According to Kravitz-Wirtz et al., children in under-resourced neighborhoods lack access to proper health care, therefore increasing their stress levels, contributing to poorer nutrition status and exposing them to more air pollutants (2018, para. 6). The combination of these lifestyle and environmental factors seem to have an increased risk of asthma in children across the United States (Kravitz-Wirtz et al., 2018). Another significant risk factor for developing asthma is obesity (Asthma Risk Factors, 2018, para. 7). Reasons for this correlation are still unknown, but inflammation is suspected to play a key role (Asthma Risk Factors, 2018, para. 7). According to the American Lung Association, obese patients often use more medications, suffer worse symptoms and are less able to control their asthma than patients in a healthy weight range (2018, para. 7). The growing obesity rates in the United States, especially in pediatric patients, put more children at risk for developing asthma. Tertiary Prevention Program for Asthma At this point in time, asthma is a well-known diagnosis among the pediatric community. However, many pediatric patients suffer from uncontrolled asthma. Uncontrolled asthma increases the number of emergency department visits and hospital admissions, costing families thousands of dollars yearly. We would like to implement a tertiary prevention program to ensure better control of asthma in pediatric patients. This would reduce the number of asthma related emergency department visits and hospital admissions. The American Lung Association has created an Asthma Action Plan to be used for all patients with an asthma diagnosis. This plan includes three zones (green, yellow, red) to guide patients with their home asthma care when their symptoms are controlled, moderately uncontrolled, and severely uncontrolled, respectively (American Lung Association, 2018). In order for this plan to be effective, patients must receive education on how to use a peak flow meter, what the results mean, and how often they should test their lung function using this device at home. Upon diagnosis, providers should review this information with the patient and parents and have them demonstrate before the end of the appointment. Providers should also review when patients should return for a follow up appointment. The current form recommends following up within 24 hours of reaching the yellow zone (American Lung Association, 2018). This tool is not being widely used among pediatric patients with asthma. We would like to fully implement the use of the Asthma Action Plan form, Figure 2, within pediatrician offices and schools. This requires full cooperation of school nurses, patients, parents and the provider. Patients with asthma who attend public school will be required to have a follow up visit regarding their asthma treatment before the school year starts. The school will require the Asthma Action Plan to be completed and signed by the parent and provider. Spirometry should also be completed at this follow up visit to monitor lung function and determine whether or not the current treatment plan is effective for the patient to use during the school year. Two peak flow meters will be given to the patient to keep one at home and one at school along with duplicate controller and rescue medications. If the patients asthma is not well controlled, they should follow up monthly and update their Asthma Action Plan until their symptoms consistently stay within the green zone. When a patient remains in the green zone, they should plan to follow up every 6 months. Ethical and Cost-Benefit Considerations (Hubacek) Monitoring asthma in previously diagnosed patients is fairly cost effective and non-invasive. There are not any ethical conflicts in our proposed tertiary prevention program for asthma due to its necessary and non-invasive nature. Asthma is most commonly tracked with the use of lung function tests such as peak flow and spirometry in order to determine the patients baseline lung function and reevaluate the effectiveness of their prescribed treatments. According to Alliance Tech Medical, the typical cost of a peak flow meter for CPT code A4614 is $21.95 (2018). The cost may amount to even less depending on insurance coverage. Once a patient pays for a peak flow meter, they are able to reuse this device to evaluate their lung function at home and school. The use of this device outside of the medical office can help the patient determine whether or not their asthma is well controlled and help the patient decide if they need to make additional appointments to follow up. Spirometry is also another non-invasive procedure that has the ability to diagnose asthma and determine the effectiveness of asthma medications, particularly inhaled corticosteroids, with repeat tests. Alliance Tech Medical also suggests that this is an affordable test with a cost of $35 for CPT code 94010 and $65 for CPT code 94060 (2018). Compared to the cost of most tests in health care, these tests are fairly affordable and essential for managing asthma treatment. The Asthma Action Plan forms from the American Lung Association can be downloaded for free to be filled out by a healthcare provider. Most common diagnostic methods and repeat follow ups are covered by insurance due to the high prevalence of this disease. The cost of purchasing a peak flow meter, asthma medications, and follow up appointments can add up, but they are necessary to prevent life threatening asthma attacks. Overall, the benefits of appropriately maintaining control of the patients condition outweigh the cost of the associated medical fees. Conclusion Asthma is a serious and life-threatening disease that affects the population on a global scale. In 2016, the prevalence of asthma in children under 18 years old was 8.3% (Sawicki Haver, 2018). Asthma is prevalent in highly developed countries and accounts for hundreds of emergency department visits, hospital admissions and missed school days (Sawicki Haver, 2018). Parents diagnosed with asthma have a high chance of producing children with asthma, suggesting a genetic correlation (Thomsen, 2015). Some of the known genetic markers include ADAM33, ORMDL3, and HLA-DQ (Thomsen, 2015). Environmental factors and lifestyle choices also play a role in the development of asthma. Air pollutants, smoking, diet, antibiotic use and exposure to allergens have been shown exacerbate or trigger the development of asthma (Patel et al., 2012). Early life exposure to environmental toxins, low socioeconomic status, and childhood obesity put children at greater risk for becoming asthmatic (Kravitz-Wirtz et al., 2018; Asthma Risk Factors 2018). We chose to implement a tertiary prevention program using the Asthma Action Plan, an existing screening tool developed by the American Lung Association (2018). The Asthma Action Plan includes three zones (green, yellow, red) that correlate with the level to which the patients asthma is currently controlled (American Lung Association, 2018). Our goal is to increase education and use of the Asthma Action Plan in primary care clinics. We also would require all public-school children diagnosed with asthma to have a clinic visit before the start of the school year, where they can fill out their Asthma Action Plan and receive extra medications and supplies. Our goal is to prevent severe asthma attacks and the costs associated with them. We identified that there are several major benefits of implementing this tertiary prevention program, including reduction of emergency department visits and hospital admissions, reduction of missed school days and earlier detection of asthma exacerbations. We did not identify any ethical dilemmas associated with this intervention. Asthma continues to be an ongoing problem in our country. It is imperative to control asthma at an early age to prevent complications. Implementation of the Asthma Action Plan could be extremely beneficial to help patients and parents manage asthma at home. Proper asthma management will reduce hospital admissions, emergency department visits, and the nationwide cost associated with asthma.

An Overview of Anatomy Essay - 997 Words

An Overview of Anatomy Exercise 1: Anatomical Position QUESTION: A. Explain why it is important to have a universally accepted anatomical position when studying the structure of humans. Having a universally accepted anatomical positional is important to avoid confusion. It creates a reference point so that no matter language or background of different people, they can still communicate efficiently. Exercise 2: Surface Anatomy A. Review Figure 3. Complete the table by placing each letter from the figure next to its corresponding body landmark. Body Landmark|Letter| Sural|K| Popliteal|| D Tarsal|E| Calcaneal|L| Brachial|F| Cranial|A| Acromial|H| Buccal|| B Axillary|C| Olecrenal|I| Occipital|G|†¦show more content†¦Removes undigested waste from the body.| 6. Urinary|Urinary bladder, kidney, ureter, urethra|Eliminates nitrogenous wastes from the body. Regulates water, electrolyte and acid-based balance of the blood.| 7. Skeletal |Bones, cartilages, tendons, ligaments and joints|Protects and supports body organs, and provides a framework the muscles use to cause movement. Blood cells are formed within bones.| 8. Cardiovascular|Heart, blood vessels|Transports oxygen and nutrients to the cells and removes carbon dioxide and waste from the cells through blood.| 9. Nervous|Brain, spinal cord, nerves|As the fast acting control system of the body, it responds to internal and external changes by activating appropriate muscles and glands.| 10. Integumentary |Epidermal and dermal regions and contains cutaneous sense organs|Forms the external body covering, and protects deeper tissues from injury. Synthesizes vitamin D and houses cutaneous receptors and sweat and oil glands.| 11. Muscular |Skeletal muscles|Contracts and shortens to provide movement. Generates heat for the body| QUESTION: B. Describe how cells, tissues, organs, and organ systems are related to each other. Cells are the building blocks of life. 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Descriptive Essay About Vacation - 842 Words

Max Mudger Mrs. Oncu DE 11 30 October 2017 Narrative Essay The air was filled with salt and warm sunlight. The waves were crashing against the Hawaiian sand causing a beautiful and relaxing sound. With flapping wings and squawking noises, seagulls were stalking tourists in the search of food. The soft, hot sand was soothing to the touch. The palm trees danced in the swaying wind and the aroma of distant barbecues and sunscreen wafted in the air. As a native Floridian, the thought of a Hawaiian vacation was appealing. Hours of waiting began to accumulate when I was informed that my flight to Hawaii had been rescheduled. My frustration built as I sat and anticipated the start to my vacation. After the airplane trip to the islands, I†¦show more content†¦Crowds of people began to funnel in to this one location on the beach. I imagined that an animal had washed up on the shore and could not get back into the water. My curiosity grew, and I left my chair to follow the path of everyone else down the shoreline. Upon reaching the scene, I became aware of what happened. I stared down at a little girl who was lying face up and was unresponsive to family members calling her name. It was evident that she had drowned and was on the edge of death. Life guards began to pound on her chest and start chest compulsions. She continued to stay motionless. Quickly, lifeguards began the operations of CPR. These long and tiring procedures made the lifeguards physically tired. The rest of the family bickered back and forth on whose fault this was. Why couldn’t you just watch her and do what you were told? I heard behind me. The father screamed, It was not my responsibility to do that, it was yours! The clear frustration began to build and caused more confusion. The lifeguards circling around the little girl seemed frightened. 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Some Aspects of Your Learning free essay sample

This essay aims to address a number of aspects of counselling that I have found particularly interesting since starting the introductory course in Counselling in October 2012. This will include a brief history of counselling; what it means to help in a â€Å"counselling way† from both a client and counsellor’s perspective and what the course has taught me as an individual. Reflecting on the history of counselling and considering today’s society and culture, I believe there is now a greater need to help others in a counselling way than there has been before. A variety of factors such as the media, social networking, advanced technologies and an increasing focus on individualism have arguably resulted in us being less able to recognise our inner identity at a deeper subconscious level, thereby leaving us feeling less attached to who we really are and to others we might have relationships with. Many of us have had some experience of helping others in a counselling way, although we may not perceive that help to be any more than genuinely listening to someone’s problems and providing them with the space, time and encouragement to resolve them. We will write a custom essay sample on Some Aspects of Your Learning or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page In fact, the role of a helper, in a psychological context can be performed by anyone, not just a trained and qualified counsellor or therapist. Nelson-Jones, R (2004 p. 3-10) suggests there are seven main categories of people who either use or can use counselling skills in a helping way. Some of these key categories are: †¢ Professional counsellors and psychotherapists who are suitably trained, accredited and paid for their therapeutic services †¢ Paraprofessional counsellors those trained in counselling skills but do not hold an accredited counselling qualification e. g. Social Workers †¢ Helpers using counselling skills as part of their jobs where the main focus of the job may be nursing; teaching; supervising or providing services †¢ Informal elpers such as friends; parents; colleagues Counselling skills are often used to help individuals deal with particular personal or emotional problems that can’t be resolved independently. The process of counselling aims to provide individuals with a deeper awareness of who they are, an inner strength to create their own happiness and ultimately the courage and knowledge to be able to help themselves (www. sagepub. com, Chapter 1). This was not something that personally resonated with me eighteen mon ths ago as I failed to recognise the value of counselling and the impact it could have on an individual’s outlook in life. What the Introduction to Counselling course has taught (and is still teaching) me is the importance of self-awareness and the feeling of being comfortable in one’s own skin. As a helper, in order to be effective in understanding an individual’s issues, I need to first understand myself. As a result, I decided to start Psychodynamic counselling in January 2013. I believed it was important to experience what it felt like to be in the role of a client and understand how a relationship is formed with a counsellor. As well as being able to seek a deeper connection with my subconscious, I find myself using my counselling sessions to validate some of the discussions we have in class and put what I am learning into practice. When helping in a counselling way, it is essential to understand what this really means and to recognise the key elements that are associated with this type of helping process. One of the most important aspects of any counselling relationship is active listening. A successful relationship can only be built where there is trust, acknowledgement and understanding. When a helper is actively listening to an individual, they are â€Å"experiencing something with the other† (Kennedy, E Charles, S, 1990, 46), they are not just being physically and intellectually present, but they are being emotionally present. Mearnes and Thorne (1999) in Nelson-Jones (2006, p107) who have extended Carl Roger’s person-centred theory state that counselling is based upon three key elements: trust; intimacy and mutuality. â€Å"Developing trust is important not only at the start of therapy relationships, but as they continue†. Another key aspect of any counseling relationship is that a helper be self-aware and non-judgemental when using counselling skills. It is imperative that one’s own views on race, class, gender, age, religion, sexual orientation and so forth are put aside and not translated into prejudices. This can be quite a challenge given some of these views can be deeply-rooted. Saunders (2011, 36-38) argues the importance of acknowledging differences between people, which gives them their identity. Understanding an individual’s identity and behaviour, which is ultimately a manifestation of values, beliefs and attitudes, can help counsellors to develop strategies in how they can best support them (Aldridge, S. , Rigby, S. 2011, 63-82). When some counsellors offer their clients a couch to lie down on during their therapy sessions, it can often provide an extreme way of behaving in a non-judgmental way: the client does not have a view of the counsellor’s face and therefore cannot interpret changes to the counsellor’s facial expression as any kind of judgement. Providing a safe and secure environment for an individual to be themselves in is essential for helping in a counselling way. This may not only be manifested by the material environment that surrounds an individual, but also the boundaries that are created by the helper. Within my managerial position at work, it is important that I set the appropriate boundaries with those who I am helping, however, I have come to recognise that I have not done this as effectively in all situations. An extract from my personal journal dated 19th October 2012 recounts my efforts to help a work colleague who was suffering from severe depression. I would set up an hour with my colleague each week and actively listen to what he wanted to share with me. I recall making a conscious effort to not be judgemental and to be more empathetic to his situation. Unlike a professionally qualified counsellor, I offered to meet with his parents who were significantly worried about his personal welfare. We interacted on a couple of occasions and although it proved to be a fruitful approach for this situation, I am well aware that this type of set-up would not be appropriate in a professional counselling environment that adheres to boundaries. A number of core elements required for counselling also coincide with Abraham Maslow’s original hierarchy of needs (1954) – a concept taken from his 1943 paper A Theory of Human Motivation, which describes the stages of growth in humans. His original five stage model can be divided into basic needs (physiological, safety, love, and esteem) and growth needs (cognitive, aesthetics and self-actualization). In order to build the right foundation, an individual must satisfy lower level basic needs before progressing on to meet higher level growth needs. When helping in a counselling way, a helper is often equired to provide a set of â€Å"basic needs† to the individual they are striving to support. This helps to set the right foundation for an effective therapeutic relationship. In providing an individual with the feeling of safety, trust, security, stability, honesty and warmth through a counselling relationship, an individual has the opportunity for personal growth, independence and self-fulfillment. Maslow’s hierarchy of needs stems from the Humanistic school of counselling and therapy. This school of thought focuses on an individual’s innate ability to progress towards self-development and personal growth. Carl Rogers (1902-1987) was the founder of the person-centred approach which centred around six core conditions that were necessary for therapeutic change â€Å"namely empathy, congruence and non-judgemental warmth† (Sanders, 2011, 34-39). The model assumes the client can be empowered to help themselves towards self-fulfilment and the role of the helper is to be more of a â€Å"cooperative companion rather than expert† (Sanders, 2011, 36). Interestingly, it also assumes that â€Å"helping can be done by anyone who provides the core conditions, regardless of age, status or professional qualification† (Sanders, 2011, 38). Conversely, the Psychodynamic school (derived from the work of Freud (1856-1939)), focuses on the past and emphasises the importance of unconscious influences on how people function. The theory also explores the impact of childhood experiences on an adult’s personality. This model assumes the helper (specifically a qualified counsellor), is the expert in this relationship and their aim is to increase an individual’s ability to exercise greater conscious control over their lives. This is mainly achieved through understanding historical behavioural patterns, exploring hidden meaning and the interpretation of dreams. The model assumes the counsellor acts in an educative capacity, rather than a therapeutic one. Notwithstanding the differences between all three schools of counselling, the underlying connection between them all is that the foundation of their theories are built around the core elements of helping in a counselling way: for example, being an active listener; providing empathy; being non-judgemental and so forth. However, it should not be assumed that helping in a counselling way will always result in a positive outcome – particularly if a helper is not effective in adopting the required skills. For example if they are not actively listening to the person seeking help, this could have an adverse effect on that person’s feelings or behaviour. Some helpers could get too emotionally involved in trying to address an individual’s issue and in doing so, fail to provide a non-judgemental, warm stance. Nor should it be assumed that all individuals can seek to resolve their issues if they are being helped in a counselling way. Some individuals may need professional and medical support in order to truly diagnose and understand their problem. An extract taken from my personal journal on 22nd February 2013 describes my experience of helping a fellow student after class. At times we would meet for more than two hours to talk through her experience of severe OCD. Meeting her on a number of occasions made me realise my intrinsic need to help others and my selflessness in giving them my personal time. Although my classmate regularly seeks specialist support to manage her condition, in trying to counsel her, I felt a sense of gratification in that I may have been able to positively impact her life. However it must be noted that there are significant differences between a professional counsellor and someone who uses counselling skills to help others, such as a friend. Friends tend to be more subjective and less self-aware and whereas friends might give advice and solutions, counsellors empower their clients to seek the resolution themselves. Friends tend to get emotionally involved, sharing statements such as â€Å"oh, you’re always like this† etc, counsellors remain neutral and identify patterns of behaviour. Friends follow up with friends to see how they might be feeling. Counsellors keep to regular, structured timeslots purposely set up with their clients to listen to their issues. Studying this introductory course has certainly reinforced my capacity to be more empathetic towards others. An extract from my personal journal dated 25th February 2013 shares an example of this. A friend and I were going to a concert together and I had texted her to say I wasn’t sure if I could make it as I needed to take care of my mother who had just had an eye operation. I didn’t receive an empathetic response in return and felt as though my comment regarding my mother and her wellbeing was totally disregarded. I chose not to feel upset or hurt by that, although it would have felt natural to have done so. I believed there must have been a reason for her behaviour and her lack of empathy. I later found out that my friend has a very tumultuous relationship with her own mother and has never been able to feel attached to her and thus has no affection towards her. This made everything clearer. If she did not feel a sense of connection between her and her mother, how could she be expected to feel the connection I had with mine? What all of this has shown and taught me, is that anyone can use counselling skills to help an individual. It’s a universal technique that has no limitations around an individual’s gender, age, religion, sexuality or social class. From a professional counsellor’s perspective, helping others to understand themselves better is a satisfying role to play. It provides a feeling of fulfilment, a sense of recognition and a notion that it’s possible to make â€Å"a profound difference to the life of another human being† (McLeod, J. 2009). From a client’s perspective, the process of having their personal stories genuinely heard, in a non-judgemental and compassionate manner, can have a positive impact on their life.

Night Essays (433 words) - Satmar, Borsod-Abaj-Zempln County

Night In the book Night by Elie Wiesel, it talks about the holocaust and what it was like being in it. The Germans were trying to make the German race the supreme race. To do this they were going to kill off everyone that wasn't a German. If you were Jewish or something other than German, you would have been sent to a concentration camp and segregated by men and women. If you weren't strong enough you were sent to the crematory to be cremated. If you were strong enough you were sent to work at a labor camp. With all the warnings the Jewish people had numerous chances to run from the Germans, but most ignored the warnings. The numerous chances the people of Sighet had to leave was significant that if they would have just left, none of this would have happened to them. One of the first warnings they had was when Moshe the Beadle came back from escaping the train. He was telling his story to everyone that would listen. The story was about how they made "the Jews get of the train and climb into lorries." (page 4) He also talked about how they murdered people for no reason at all. But most of the people in Sighet just ignored Moshe and thought he was making everything up. The second warning was that the people of Sighet ignored was on the radio. The first radio announcement said "the Fascist party had come into power. Horthy had been forced to ask one of the leaders of the Nyilae party to form a new government." (Page 6) The next day there was another radio announcement that said "German troops had entered Hungarian territory." (Page 7) this made everyone a little bit scared for a few days but not for long. Optimism was soon revived. The people were saying that the Germans wouldn't get to there city. When the Germans arrived in Sighet the people didn't realize what was going to happen, they just thought that they were in Sighet for something else. They thought of the Germans as nice people that wouldn't hurt them. Later after the Germans had been there for a while, the Germans sent all the Jews to ghettos. The ghettos were surrounded by barbed wire but the people did not fear anything. As you can see these warnings were pretty big. It is a wonder as to why no one believed any of this was going to happen to them. Through all of this the Jews were sent to concentration camps, many were killed, few survived.

Horny Toad Lizard Facts (Phrynosoma)

Horny Toad Lizard Facts (Phrynosoma) The horny toad is actually a lizard (a reptile) and not a toad (an amphibian). The genus name Phrynosoma means toad bodied and refers to the animals flattened, round body. There are 22 species of horned lizard and several subspecies. Fast Facts: Horny Toad Lizard Scientific Name: PhrynosomaCommon Names: Horny toad, horned lizard, short-horned lizard, horntoadBasic Animal Group: ReptileSize: 2.5-8.0 inchesLifespan: 5-8 yearsDiet: CarnivoreHabitat: Deserts and semi-arid parts of North AmericaPopulation: Decreasing to stableConservation Status: Least Concern to Near Threatened Description The horny toad has a squat, flattened body and a blunt nose like a toad, but its life cycle and physiology are that of a lizard. Each species is distinguished by the number, size, and arrangement of the crown of horns on its head. The lizard has spines on its back and tail that are modified reptile scales, while the horns on its head are true bony horns. Horny toads come in shades of red, brown, yellow, and gray and can change their color to a certain extent to camouflage themselves against their surroundings. Most horny toads are less than 5 inches long, but some species reach 8 inches in length. Habitat and Distribution Horny toads live in arid to semi-arid regions of North America, from southwestern Canada through Mexico. In the United States, they occur from Arkansas west to California. They live in deserts, mountains, forests, and grasslands. Diet The lizards are insectivores that prey primarily on ants. They also eat other slow-moving ground-dwelling insects (sow bugs, caterpillars, beetles, grasshoppers) and arachnids (ticks and spiders). The toad either slowly forages or else waits for prey and then catches it with its sticky, long tongue. Horny toads use their sticky tongues to catch prey. Â  ebettini / Getty Images Behavior Horny toads feed early in the day. When ground temperature becomes too hot, they seek shade or dig themselves into the ground to rest (aestivation). In the winter and when temperatures drop in the evening, the lizards brumate by digging into the ground and entering a period of torpor. They may cover themselves completely or leave only their nostrils and eyes exposed. Horny toads have interesting and distinctive methods of self-defense. In addition to camouflage, they use their spines to make their shadows blurry and to deter predators. When threatened, they puff up their bodies so their large size and spines make them harder to swallow. At least eight species can squirt a directed stream of blood from the corners of their eyes up to 5 feet. The blood contains compounds, presumably from the ants in the lizards diet, that are distasteful to canines and felines. Reproduction and Offspring Mating occurs in late spring. Some species bury eggs in the sand, which incubate for several weeks before hatching. In other species, eggs are retained in the females body and the young hatch shortly before, during, or after egg-laying. The number of eggs varies by species. Between 10 and 30 eggs may be laid, with an average clutch size of 15. The eggs are about a half inch in diameter, white, and flexible. Hatchlings are 7/8 to 1-1/8 inches long. They have horns like their parents, but their spines develop later. The hatchlings receive no parental care. Horny toads reach sexual maturity when they are two years old and live between 5 and 8 years. Juvenile horny toads resemble their parents, but are smaller in size. Â  Design Pics / Getty Images Conservation Status Most horny toad species are classified as least concern by the IUCN. Phrynosoma mcallii has a conservation status of near threatened. There is insufficient data to evaluate Phrynosoma ditmarsi or the Sonoran horned lizard, Phrynosoma goodei. Some species populations are stable, but many are decreasing. Threats Humans pose the greatest threat to horny toad survival. The lizards are collected for the pet trade. In areas near human habitation, pest control threatens the lizards food supply. Horny toads are also affected by fire ant invasions, as they are selective about the ant species they eat. Other threats include habitat loss and degradation, disease, and pollution. Sources Degenhardt, W.G., Painter, C.W.; Price, A.H. Amphibians and Reptiles of New Mexico. University of New Mexico Press, Albuquerque, New Mexico, 1996.Hammerson, G.A. Phrynosoma hernandesi. The IUCN Red List of Threatened Species 2007: e.T64076A12741970. doi:10.2305/IUCN.UK.2007.RLTS.T64076A12741970.enHammerson, G.A., Frost, D.R.; Gadsden, H. Phrynosoma mcallii. The IUCN Red List of Threatened Species 2007: e.T64077A12733969. doi:10.2305/IUCN.UK.2007.RLTS.T64077A12733969.enMiddendorf III, G.A.; Sherbrooke, W.C.; Braun, E.J. Comparison of Blood Squirted from the Circumorbital Sinus and Systemic Blood in a Horned Lizard, Phrynosoma cornutum. The Southwestern Naturalist. 46 (3): 384–387, 2001. doi:10.2307/3672440Stebbins, R.C. A Field Guide to Western Reptiles and Amphibians (3rd ed.). Houghton Mifflin Company, Boston, Massachusetts, 2003.

A research proposal for a research project in the area of management Essay

A research proposal for a research project in the area of management - Essay Example In the current competitive business world, leaders or managers are looking for making employees productive in order to improve organizational performance. Effective leadership and management styles have become the significant tools for improving the internal operations, responding rapidly to external opportunities, streamlining the product development or management, achieving technological breakthroughs and managing challenges in the business environment. There has been an extensive body of research exploring the issue of effective leadership and management styles employed in the current business environment to improve organizational performance (Armstrong 2009; Yukl, 2012). Researchers have realized the significant of successful business operations through employing effective leadership management style in the current competitive business environment (Darling and Heller, 2012). Therefore, this research proposal seeks to offer an analysis on the way organizations can create change th rough employing effective leadership and management styles; thus achieving effective business performance. ... Research Questions 1. To what extent do effective leadership and management styles affect workers task performance? 2. How do effective leadership and management styles influence organizational change? 3. What is the relationship between effective leadership and management styles and employee job satisfaction? 4. How effective leadership and management styles do contribute to increased organizational performance level? Hypotheses Effective leadership and management styles employed in a particular organisation contributes to job satisfaction, increased productivity and influences wok performance as opposed to lack of effective leadership management styles in another organization. Literature Review Varied literatures have attempted to examine the way effective leadership and management styles have contributed to significant organizational performance in an organization. The Relationship between Effective Leadership and Management Styles and Employees Job Satisfaction Effective leadersh ip and management styles have been linked with workers contentment. Schoemaker, Krupp and Howland (2013, p. 132) argue that employing effective leadership management roles contributes to employee satisfaction. This is crucial because satisfied employees can work together as a team toward increasing organizational productivity. The connection between organizational management styles and labor contentment cannot be overstated. This is because effective match between management styles and organizational operation realities can substantially lead to high level of performance. Raes, Heijltjes, Glunk and Roe (2011, p. 103) add that management is considered as one of the significant