Back Pain Essays - Medicine, Clinical Medicine, Pain,

Back Pain Page 1 Case Scenario: EM is a 74 year old woman admitted into the hospital with a complaint of back pain. She states that she is unable to sit for extended periods of time. During her bouts of pain, her blood pressure rises substantially. She is a telemetry patient on the floor and is on bed rest. The patient has a history of Crohn's Disease and in 1997 underwent a sigmoid colon resection. She also has a history of diverticulitis and COPD. Her final diagnosis consists of back pain related to degenerative joint disease of the lumbrosacral spine as a result of osteoarthritis. A. Description of the Disease - Osteoarthritis Osteoarthritis, also known as degenerative arthritis can cause the breakdown of cartilage between the facet joints. The facet joints are located in the posterior spine. These facet joints consist of two opposing bony surfaces with cartilage in between them. There is a capsule of fluid that allows the joint to move without friction. When these fluids dissipate due to cartilage breakdown, joint movement becomes impaired and eventually, leads to bone against bone friction. Hence, the patient loses motion and as lose mobility, contributing to the onslaught of lower back pain. B. Symptoms of Osteoarthritis The primary clinical manifestations of OA are pain, stiffness and functional impairment of the affected joint. The pain in OA is due to an inflamed synovium, stretching of the joint capsule or ligaments, irritation of the nerve endings in the periosteum, tendinitis and muscle spasm. Stiffness is most common in the morning but generally lasts about 30 minutes or so. Functional impairment is based on pain upon movement and guarding, along with the limited motion caused by structural changes in the joints. Normally, these affected areas are palpable and non-tender to the touch unless there is notable inflammation. Page 2 C. Causes of Osteoarthritis Risk factors for OA include simple wear and tear, aging, female gender, genetic predisposition, obesity, mechanical joint stress, joint trauma, previous bone or joint disorders and a history of inflammatory, endocrine or metabolic disease. However, OA can be primary (idiopathic) or secondary though, the relationship between the two is not always apparent immediately. By the age of 75, 85% of the population will have undergone x-rays or other diagnostic tests to either rule out or confirm osteoarthritis. Out of this number, only 25% will experience symptoms. D. Medical Treatments for the client with Osteoarthritis 1. Orders: With this particular client, a complaint of back pain was the factor that brought her to the emergency room. Upon examination, it was found that the client was experiencing more pain while standing or sitting rather than lying down. The doctor ordered an x-ray which confirmed the presence of large and inflamed vertebrae in the back and the progressive loss of joint cartilage. This client also had a history of a degenerative spinal disorder. Since cartilage does not appear on x-rays, the doctor takes note of a narrowing of space between the bones, where the cartilage and fluid capsule should lie. Serum studies are not useful in this type of disorder, however, labs were drawn on this client due to evidence of infection in her system (high fever, redness and swelling over the lumbrosacral area). The client was ordered to reduce her activity level to bedrest. A K-pad was ordered to provide heat and pain relief to the area of inflammation in the back. The client was put on Flagyl and Cefz il for evidence of bone and joint infection and Demerol and Ativan for pain management. These medications will be looked at in depth in section D3 of this paper. The patient was assigned a regular diet and additional yogurt supplementation to prevent a candidas infection with relation to the extensive levels of antibiotics she is on. Page 4 2. Procedures: The patient is to get up with Physical Therapy three times a day. Other than that, her activities are strictly limited. The use of heat (K-pads) is indicated for whenever the client is in bed. The client is to be observed for skin breakdown, due to extensive amounts of time on bed rest. There is an outstanding order to collect stool specimens times 3 to rule out the presence of C-Diff. The clients vitals are to be monitored

An Overview of Territories of the World

An Overview of Territories of the World While there are fewer than two hundred independent countries in the world, there are more than sixty additional territories that are under the control of another independent country. There are several definitions of territory but for our purposes, we are concerned with the most common definition, presented above. Some countries consider certain internal divisions to be territories (such as Canadas three territories of Northwest Territories, Nunavut, and Yukon Territory or Australias Australian Capital Territory and Northern Territory). Likewise, while Washington D.C. is not a state and effectively a territory, it is not an external territory and thus not counted as such. Another definition of territory usually is found in conjunction with the word disputed or occupied. Disputed territories and occupied territories refer to places where the jurisdiction of the place (which country owns the land) is not clear. The criteria for a place being considered a territory are fairly simple, especially when compared to those of an independent country. A territory is simply a external piece of land claimed to be a subordinate location (in regards to the main country) that is not claimed by another country. If there is another claim, then the territory can be considered a disputed territory. A territory will typically rely on its mother country for defense, police protection, courts, social services, economic controls and support, migration and import/export controls, and other features of an independent country. With fourteen territories, the United States has more territories than any other country. The territories of the U.S. include: American Samoa, Baker Island, Guam, Howland Island, Jarvis Island, Johnston Atoll, Kingman Reef, Midway Islands, Navassa Island, Northern Mariana Islands, Palmyra Atoll, Puerto Rico, U.S. Virgin Islands, and Wake Island. The United Kingdom has twelve territories under its auspices. The United States Department of State provides a nice listing of more than sixty territories along with the country that controls the territory.

Ancient Africa and Andrea Primary Sources Assignment

Ancient Africa and Andrea Primary Sources - Assignment Example This shows the importance of the river and the important role which it played in the growth of the Oyo kingdom. In the land of the Seyon, the red sea and the historic ivory trade routes influenced the development of the Ethiopian kingdom. In regard to this, Andrea and Overfield (2001) record that the Ethiopian kingdom thrived as a result of its strategic location between the trade route that joined the Mediterranean world and Egypt. The adoption of Christianity in the Ethiopian kingdom during the reign of King Ezana was also a factor to the growth of the kingdom (Andrea & Overfield, 2001). The religion served to unite the people of Ethiopia. Historical markets and geographical tropical rainforests were also very influential in the development of kingdoms in the medieval Africa. Andrea and Overfield (2001) note that the Berber and Arab Merchants showed keen interest in the land of Ghana-Western Sudan kingdom because of its location between the tropical rainforests and the markets of North Africa. In addition, the cities of the Mediterranean north developed because of the gold mines, as Andrea and Overfield (2001) records. Similarly, the kingdom of the land of Zanj grew as a result of its closeness to the Indian ocean. The Indian ocean offered transport for traders and a conducive environment for the tremendous rise of the kingdom. In sum, the medieval African continental societal changes were greatly influenced by geographical features like the rivers, mountains, seas and the

E-mail spams Essay Example | Topics and Well Written Essays - 500 words

E-mail spams - Essay Example nsensus on a policy framework to tackle spam issues† (OECD., 2006, p.2) The task force on Spam was approved by the OECD and resulted in the OECD Anti-Spam Toolkit. The OECD’s drive against spam resulted in the New Zealand Department of Internal Affairs implementing the Unsolicited Electronic Messages Act 2007 (the Act), which came into effect on the 5th September 2007. The focus of this analysis is to review how far the Act has gone to implement the recommendations in Element 1 of the OECD Anti-Spam toolkit. Element 1 of the OECD toolkit on spam addressed regulatory approaches to tackle spam. Element 1 extrapolates that â€Å"the development of anti-spam legislation which tackles spam and related problems is fundamental† (OECD, 2006, p8). Moreover, Element 1 observed: â€Å"as the legal, political and cultural environments of different countries vary, there is not a global uniform approach to spam or a common definition of spam accepted at the international level. For this reason the Toolkit, rather than advocate a single approach, aims to underline decision points that need to be discussed while elaborating anti-spam legislation and examine the related policy questions† (OECD, 2006, p. 24). In order to achieve these goals, Element 1 of the toolkit proscribed that legislation should conform to four general principles, namely policy direction, regulatory simplicity, enforcement effectiveness and international linkages (OECD, 2006, p. 25). 2) Require commercial electronic messages to include accurate information about the person who authorised the sending of the message and a functional unsubscribe facility to enable the recipient to instruct the sender that no further messages are sent to the recipient; The Act further aims to encourage consistent direct marketing practices by requiring electronic messages to include an unsubscribe facility and ensure that electronic messages are only sent to customers who have consented to receiving it (New Zealand

Respiratory Muscle Training for Cervical Spinal Cord Injury Essay

Respiratory Muscle Training for Cervical Spinal Cord Injury - Essay Example Several articles would be used as a way of finding conclusive statement that would be aimed to be a solution to the several problems associated with patient with spinal cord injuries. The other methodology applied in training of patient with spinal cord injury is use of simple breathing device. The effect of these devices would ensure improved respiratory function as a result of the increased strength of the expiratory muscles. The training includes a repeated action by patients through the expiratory muscle training equipment with focuses being laid on the voluntary nature of the patients while in some instances the patients would need to endure a compulsory training session. The focus of the devices according to Roth et al(2010) the training that deploys a low resistance levels would result in improved pulmonary functions which are essential to patients with spinal cord injury. The article also indicate the effectiveness of the resistance training group as compared to the sham model of training The levels of cough according the article are an indicator of the strength of the expiratory muscle which is subject to the training and improvement for the pulmonary fu nctions. Both Silveira et al (2010) and Roth et al (2010) indicates two modes of training with both articles indicating a sitting position to be the preferred method while carrying out the training to people with spinal cord injuries. Roth et al (2010) indicate the effectiveness of the resistance training group as compared to the sham model of training. There is a relationship between trainer and the outcome to quadriplegic patients. The mode of training will involve inspirational training at low loads which would indicate the patient being subjected to conditions of about 30 percent of MIP (Silveira et al, 2010 P 317). The article indicates an improved 20% for the 8 weeks training period for sitting patient Upon attaining the required load

Separates Science From All Other Human Activities Philosophy Essay

Separates Science From All Other Human Activities Philosophy Essay Science is distinguished for its changeable nature of conclusions. It addresses the method  used to reach conclusions; the ideas of verification, falsification, and the thought that science presents its theories with a degree of probability. The conclusions in science are conditional because currently they are considered to be true, but according to the nature of the science, they are subject to change. Science is defined as knowledge gained by systematic experimentation and analysis (Munday). What distinguishes the sciences from other areas is a very different method of finding truth. The definition of truth in this case is what works in practice or is useful to us because science is heavily based on the pragmatic theory (Munday). The question is perhaps misleading since it doesnt mention which type of science is implied; natural science, human science, or ethical science Science is a provisional human activity; this can be observed when comparing areas of knowledge in terms of pr ovisional conclusions. Science is a practice where truth is supported through experimentation and observations. It is a posteriori knowledge, meaning that it is knowledge that is derived from experience or empirical evidence. People state that science is based on too many assumptions, and the rules always change, therefore, we should employ other ways of knowing such as our perception. In my view, the main reason we should appreciate this way of knowing; the conclusions of science are changeable. These regular changes show that even though we might never find out the truth, we are progressing in subjects such as biology, physics, chemistry, etc. However, by expressing it as a pragmatic way of knowing, we can see that science is about discovering the truth. This truth may not be the perfect truth such as outlined by Plato with his idea of ideal forms. This truth is more concerned with value or usefulness. Within the history of science, scientific laws and theories have been changed or have been disproved. F or example, there was a cubical atom theory that stated that all atoms had a shape of a cube (Munday). This theory was disproved by many scientists such as Bohr and Rutherford (Munday). We now have a different prediction of what the atom is due to quantum mechanics (Munday). However, if you take account of Quantum Theory, then even the conclusions about the physical world become highly provisional reality is no longer deterministic and mechanistic, and some of our conclusions about this reality end up being provisional. Scientific knowledge is derived from the use of a precise, rigorous method that involves inductive logic. For example, if I observe that water always boils at 100 °C when I am cooking (Arnhart), I assume that this will always be the case (induction). However, if I were to boil water in Denver, Colorado, a location 1.6 km above sea level, I would discover that the water now boils at 94 °C, as the pressure on the liquid is reduced (Arnhart). As we can see, the ind uctive component of the scientific method can sometimes lead to an incorrect hypothesis. Even if a scientific theory has been rigorously tested one million times there is always the possibility that an exception will be found, and hence the theory falsified. Karl Popper acknowledged this problem and suggested that a hypothetical deductive method should be used, whereby false hypotheses are discarded through trials and disproof (Arnhart). This means we cannot prove a theory is correct; we can only prove that a hypothesis is false. Thus we can never know that a scientific theory is true; the reason why scientific conclusions are provisional. For instance, a scientist is trying to find a cure for cancer, but instead finds out how a persons brain works, he still expands our knowledge of all the things around us, even though that scientist was trying to find a different answer. This usefulness always reshapes our knowledge since it brings in new ideas and models that attempt to explain t he patterns that are all around us and where conclusions are made according to the current knowledge. Our knowledge is available to adapt by being provisional. With science, we accept our limitations of todays instruments, and we analyze the situation and what we can potentially do for further knowledge or experimentation. Science doesnt stop improving our customs of experimenting even though we know we cant reach the perfect truth (Plato) making it provisional even if it may seem to be currently true. Science is so relied upon for this reason that it advances our society. One of the main differences between the Natural and Human Sciences (ethics, history) is the object of study: while the Natural Sciences observe and experiment on the world of nature, the Human Sciences focus more on human behaviour. Humans are, arguably, less predictable and stable than the natural world, so the conclusions about our behaviour should be more provisional than the conclusions reached. Although science is the answer to many of our disputes, it is based mostly on theoretical predictions, and that creates a fallacy. For example, scientists in a university have made a device to clean and purify water for the people in South Africa and they have sent it to Africa (Arnhart). Once the device was in use, it killed 45% of the people in 3 weeks. A study relived that the filter used did stop Cysts (bacteria) from going through initially but these bacteria started to grow inside the filter clogging the filter. Nothing was noticed because the bacteria were so small, and the pressur e of the water squeezed the 4.5 micron bacteria into the 1 micron holes of the filter. In theory, filter was a valid device to use to clean the water but when in application is failed. These predictions are based on theoretical assumptions. Even though our limitations can be accurate even, this accuracy is not perfect; we try to achieve the best at finding a conclusion. Yet, the uncertainty of the conclusion can still prove it false, and so the science turns provisional. Math is a very different area of knowledge. The only difference today is that math is much more complex in applications of basic principles. The definition of math is the system of quantities, forms, space and their relationships in use of numbers and symbols.   The Egyptians came up with simple functions such as addition. These functions are still useful since we substitute symbols to represent difference concepts in reality. The symbols and applications might differ, but the expressions stay the same. The ancient Greeks used symbols rather than numbers; equations, they came up with were the same. One may deduce that math is not a provisional subject. In many ways, math is the foundation of other areas of knowledge such as analysis and measurement in sciences. In some cases, wed never find out more about certain topics. For instance, the string theory can only be proven with math because physically we cant comprehend eleven dimensions. Multiplication will not change over time comp ared to a scholar learning how his brain works- he will soon have to update his knowledge because what we know in the field of science always changes. Today, scientists try to link the missing puzzle pieces; however, once a scientist connects a puzzle to the whole picture, and it is perceived to be the correct placement, then more and more questions arise. Furthermore, in math, once something is proved, it is no longer contested. For example, today nobody should argue that two multiplied by five is not ten. Math, arguably, is a human construct; it is up to us to make up symbols that would represent the patterns that we encounter. The knowledge and conclusions of math arent that provisional but its application is. Like science, art has many changing conclusions. When a person looks at a picture, he invariably interprets it and evaluates it. However, when a different individual looks at the same picture, he might interpret it in a very different way. These interpretations can vary because of many aspects. Ones age, for example; there is a painting of a cow (Arnhart). An elder might think of it as a source of meat, while a boy might see a joy ride (Arnhart). Thus each person has concluded on a different interpretation and this uncertainly on which is the true conclusion makes the art as a area of knowledge provisional. Generally, conclusions in art are based on the frames of reference of the person that is evaluating the art piece with a personal experience or posteriori knowledge. Thus, art is provisional in nature because even one painting might have different conclusions based on it. By comparing math, sciences, and art one can see that the knowledge gained from the sciences change; however, it is not the only subject that is provisional, that is shown through subjects such as art and history. Even one art piece can have many conclusions associated with it. The statement what separates science from all other human activities is its belief in the provisional nature of all conclusions (Michael Shermer, www.edge.com) is only partly true since science is provisional; however, that doesnt separate it from all other human activities. Math is an example of a static subject whereas, science is a subject open to debates and updates. We might think that sciences are not important to us since what we know now as the truth always changes; however, we must understand that a person who is confident that he knows everything will never learn. Through science we accept that our knowledge is limited, and we strive to improve what we already have. Even though some scientific knowle dge is considered be truth, it is still provisional since science is focused on disproving predictions and not on gathering enough evidence to make the conclusion valid or sound. Without science, one may argue, we would never achieve the advancements that we are fortunate to have today. Word Count: 1652

Hando :: Interview Dialogue Essays

Hando "Is it on?" "Yes, Mr....ah..." "Hando, you can just call me that." "Of course, Hando. Well, just start whenever you’re ready." "I hate being recorded, but we might as well get it over with. I am getting a check for this, right?" "Yes sir. Your story will be a great contribution to the civilization of Zyemlya and a wonderful edition to our magazine. It really is quite remarkable after all." "Yeah, well, whatever. As long as I get my check. Social Security just doesn’t cut it these days. Seems if my story was so remarkable, this ungrateful generation wouldn’t have stuck me in this home, after all I’ve done." "Most have forgotten. Maybe you’ll get the respect you deserve after your story is published." "Maybe. Just maybe." "What exactly is it you did?" "Well, I’ll get to it. You want something to eat? Nothing but hospital food, but what can you do?" "No thank you." "Suit yourself. Let’s see, where to begin. We obviously won the Conflict, since we’re here talking to each other right now. After that victory, there were lots of questions about what to do now. There were only about 4 or 5 hundred of us left. Thousands had died off, most of the population of Zyemlya. They resisted the change. Most of them still couldn’t believe what was going on, even after all that happened. They didn’t actually die; it was more that they faded out with the Being. We all lost loved ones; I lost a sister and a groundhog, but we knew it was necessary to destroy the Being. "We had never had our own world before, our own will, our own lives. The Being had made sure of that. We never really knew exactly what it was, or where it came from, or if it even was an "it." We just knew it was there, and what it was doing. "I’ll take credit for that one though. That was a long time ago, and me with my slipshod memory, I don’t know how well I can recount it all. Now you young whippersnappers come in here and want to scoop out my brains to put in your magazine. The way things work around here, this will probably turn into a half page section in some fifth grader’s textbook. "I guess I’ll start with the dreams. I hadn’t always had them; they started when I was about 16. Hando :: Interview Dialogue Essays Hando "Is it on?" "Yes, Mr....ah..." "Hando, you can just call me that." "Of course, Hando. Well, just start whenever you’re ready." "I hate being recorded, but we might as well get it over with. I am getting a check for this, right?" "Yes sir. Your story will be a great contribution to the civilization of Zyemlya and a wonderful edition to our magazine. It really is quite remarkable after all." "Yeah, well, whatever. As long as I get my check. Social Security just doesn’t cut it these days. Seems if my story was so remarkable, this ungrateful generation wouldn’t have stuck me in this home, after all I’ve done." "Most have forgotten. Maybe you’ll get the respect you deserve after your story is published." "Maybe. Just maybe." "What exactly is it you did?" "Well, I’ll get to it. You want something to eat? Nothing but hospital food, but what can you do?" "No thank you." "Suit yourself. Let’s see, where to begin. We obviously won the Conflict, since we’re here talking to each other right now. After that victory, there were lots of questions about what to do now. There were only about 4 or 5 hundred of us left. Thousands had died off, most of the population of Zyemlya. They resisted the change. Most of them still couldn’t believe what was going on, even after all that happened. They didn’t actually die; it was more that they faded out with the Being. We all lost loved ones; I lost a sister and a groundhog, but we knew it was necessary to destroy the Being. "We had never had our own world before, our own will, our own lives. The Being had made sure of that. We never really knew exactly what it was, or where it came from, or if it even was an "it." We just knew it was there, and what it was doing. "I’ll take credit for that one though. That was a long time ago, and me with my slipshod memory, I don’t know how well I can recount it all. Now you young whippersnappers come in here and want to scoop out my brains to put in your magazine. The way things work around here, this will probably turn into a half page section in some fifth grader’s textbook. "I guess I’ll start with the dreams. I hadn’t always had them; they started when I was about 16.

Financial ratios analysis Essay

NoCarb Limited Ratio Analysis will cover four ratio groups: Liquidity, Profitability, Activity and Financial structure ratios, in order to have a better understanding of company financial position. Liquidity ratios Measure the organization ability to satisfy its requirements for cash to meet its obligations based in its current assets. Cash is very important to keep company’s operations running. A failure to do that could lead the company to major problems, even a risk of bankruptcy. Nocarb current ratio has improved in 0.44 (1.48 – 1.04) from previous year (2013), this is basically due to the increase of inventory levels and the conversion of receivables to cash. Quick ratio has decrease only in 0.02 (0.37 – 0.35); not a significant variation. Quick ratio does not consider â€Å"Inventory†, which in this case is not a good idea to omit it, because we do not know how much divers are Nocarb’s products. We only certain about inventory being made up of soft  drinks. Profitability ratios To measure profitability performance, we are going to analyse profit margin and ROA ratios. Alternative Profit margin indicates the percentage of profit we get from each dollar of sales. In the case of Nocarb has increased in 0.96% (16.24 – 15.28) with respect to 2013. Soft drink industry profitability depends more from the volume of sales rather than the high profit earn from each unit. This industry is completely different from, for example High Tech industry, where volume of sales is small but with a high rentability per unit or service. There is a significant decline of 1.22% (4.61-3.22) in the ROA ratio (also known as ROI). This value indicates that Nocarb is losing efficiency at the moment to generate profit. We need to analyse activities ratios to have a better picture of Nocarb financial position. Activity (turnover) ratios From Note 2 we can see that Inventory level s have constantly increased since 2012. It is not a surprise that â€Å"days in inventory† has increased from 285 days to 760 days. This indicates that Nocarb have serious problems with the associated cost of keeping high level of inventory like insurances, obsolescence, handing and warehouse renting cost. This is also reflected in the drop of sales from 59860 in 2013 to 43014 for this year. Nocarb sales on credit. Therefore is important to analyse â€Å"days in debtor† indicator, which indicate how long it takes for Nocarb’s customers to pay their debts. We can see that it is taking longer for customers to pay their bills from 285 days in 2013 to 760 days this year. If this becomes a tendency Nocarb can be in risk of running out of cash, necessary for daily operations. This also indicate that Nocarb it is over financing its customers. Financial structure ratio After analysing Nocarb’s liquidity and activity ratios, which indicates a poor performance, we need to measure the borrowing level of Nocarb. â€Å"Debt to Equity† will help us to see how risky this company is. Debt to Equity ratio has significantly decreased from 294.53% in 2013 to 178% this year but it is still a high level. A ratio of 178% indicates that Nocarb assets are financed mostly with debt, making Nocarb more vulnerable to any fluctuation  of interest rates. Conclusion Soft drink industry is a mass production industry. We assumed Nocarb does not have a unique product as most of its counterparts. This industry relays in high levels of sales, maximum inventory turnover and minimal levels of inventory to reduce costs. Profit margin ratio is not a good indicator for Nocarb due to the low profit margin per unit; usual for mass production industries. Nocarb has serious problems with high levels of inventory and its associated additional costs. This situation is a result of the decline of sales and the increase of inventory, more probably financed by debt as â€Å"debt to equity† ratio indicate. Nocarb need to redesign its Sales and Marketing strategies. Review its supply chain and inventory strategies. Review its Credit Policies and promote Cash sales. Also needs to be very care full with its borrowing/debt level.

Custom Essay A No-Cost Sample About Pandas Created by Top Writers

Custom Essay A No-Cost Sample About Pandas Created by Top Writers Descriptive Essay Example about Pandas How could anyone not be charmed by a Giant Panda? The black-and-white bears are a national treasure of China, whose bamboo forests are their natural habitat, and universally recognized as the epitome of cute: A panda is nothing more or less than a chubby, fluffy ball of gentleness, and if we didn’t know they were a real animal from an identifiable part of the world, we would assume they came from the same place where rainbows and unicorns are made. In ancient China, warring armies even used to raise flags emblazoned with images of pandas when they wanted to stop fighting and discuss their problems peacefully. Private Writing offers professional writing assistance with any kind of writing assignments in any field of knowledge alongside with the individual approach to every customer. Our top-notch customer support is ready to help you 24/7. Place an order and enjoy the result. It seems, however, that Mother Nature may have given the Giant Panda its heartwarming appearance as a consolation prize to partly make up for all the other traits that make the panda kind of an evolutionary failure. The Giant Panda is indeed a peaceful creature, but that is because it simply does not have the energy not to be. Unlike other bears, which are omnivorous, the panda’s diet consists solely of bamboo. A single panda requires an area of about four square kilometers of bamboo to have a sufficient supply of food, and it must spend 14 to 16 hours of each day eating that food in order to survive. The panda has to spend so much of its time eating because it has a poor digestive system. The panda only uses about 30% of the nutrients from its diet; by comparison, other herbivores such as deer use about 80%. The panda’s diet does give it one dubious talent: Pooping. Because most of what it eats passes through the panda’s system undigested, an adult panda produces an astonishing amount of â€Å"number two† – as much as 62 kilograms per day. The Giant Panda’s inability to use its food efficiently also prevents it from hibernating; the panda simply cannot eat enough to build up the fat reserves necessary to allow it to slumber through the winter like a â€Å"normal† bear. The diet also is responsible, some scientists believe, for the panda’s unusual reproductive pattern. Female pandas ovulate just one a year and are only fertile for two or three days. Because pandas must individually maintain a large area of the bamboo forest for their own food needs, encounters between pandas in the wild are relatively rare, and that includes opportunities for mating. If mating is successful, gestation takes from four to eight months; the wide time range is due to the female panda’s body delaying implantation of the fertilized egg until there is enough nutrition to support it. Then once the panda cub is born, it has a fifty-fifty chance of surviving to adulthood; panda cubs are easy prey for a number of predators, but more often than not are killed by being accidentally crushed by their own mothers. While the Giant Panda has been seriously threatened by human activity such as poaching – which is treated as a heinous crime in China, punishable by a long prison sentence or even the death penalty – and destruction of its natural habitat, the panda’s characteristics that naturally seem to work against its survival have led some scientists to conclude it is a â€Å"remnant species†: One that is naturally becoming extinct on its own. In that sense, the fact that pandas are just so darned adorable may be a clever evolutionary advantage – unable to survive in the wild, the Giant Panda is equipped with a look and a personality that has proved irresistible to the one species with the ability to overcome nature for the panda’s ultimate benefit. We hope that this descriptive essay sample provided above will help you to write a brilliant descriptive essay. If you dont have time to write a descriptive essay on your own, feel free to contact our essay writers or place an order.

The prevalence of dental caries in European Children (0-18 years) and Associated Risk Factors The WritePass Journal

The prevalence of dental caries in European Children (0-18 years) and Associated Risk Factors Introduction The prevalence of dental caries in European Children (0-18 years) and Associated Risk Factors IntroductionMethods Review Questions ObjectivesSource of Information Search StrategyInclusion Criteria Exclusion criteriaQuality Assessment SystemData Extraction SystemResultsDiscussionReferencesRelated Introduction Dental caries (also known as tooth decay or a cavity) is a disease where bacteria (in the presence of food) damage the hard tooth structure (Enamel, Dentin and Cementum). Acs et al. (1992) showed that three year-olds with nursing caries (caries caused due to prolonged breast and bottle feeding) with atleast one pulpally involved tooth were likely to weigh about 1 kg less than the children without nursing caries. They also reported that, when dental rehabilitation was carried out, the children’s growth rate increased. Therefore, it appears that the poor oral conditions were compromising nutritional intake. Poor oral health can have a profound effect on general health and quality of life (Peterson et al., 2005). The decline in the prevalence of dental caries in Western European countries was documented at the ‘Second International Conference of Declining Caries‘  Ã‚   held in London in April 1994 (Naylor, 1994). In Central and Eastern Europe, the prevalence of caries is still high and there are no signs of substantial improvements. In the recent years an increasing number of papers have shown that the prevalence of dental caries was highest in the lowest socioeconomic strata with the immigrants of Europe (Bratthall et al., 2000) showing the skewed nature. Dental caries is still a common disease among children and adolescents (Nithila et al., 1998; Marthaler, 2004) and affects 46% of 4-year-old children (Stecksà ©n-Blicks et al., 2004) and 80% of 15-year-olds (Hugoson et al., 2005). Furthermore, there is a trend in many developed countries for the prevalence of dental caries to increase again, especially among young children (Haugejorden and Birkeland, 2002; Stecksà ©n-Blicks et al., 2004), after a long period of caries decline (Marthaler, 2004). The purpose of this systematic literature review is to summarize the prevalence of dental caries in European children (0-18 years) since 1995 (end of decline) till March, 2011. Methods â€Å"A systematic literature review can be defined as the rigorous search, selection, appraisal, synthesis and summary of the findings of the primary research in   order to answer a specific question† (Parahoo, 2006:134) Review Questions    What is the available evidence regarding the prevalence of dental caries in European children (0-18 years) since 1995? What are the factors associated with such prevalence? Objectives    To investigate the prevalence of dental caries among children up to the age of 18 years. To study the risk factors associated with the prevalence. To analyze the data odds ratio and confidence interval were reported. Odds ratio is the ratio of the odds of an event occurring in one group to the odds of it occurring in another group. Source of Information PubMed and Science Direct were extensively searched to retrieve articles. An additional supplementary search was also done. The initially identified papers were carefully examined which provided the further relevant articles. Other UEL-databases (Medline, EBSCO, Project Muse) were also searched. An additional advanced search was done on British Dental Journals. Search Strategy The key words included in the search strategies in PubMed and Science Direct were (dental caries, prevalence, Europe, children, risk factors) related to the research questions. One of the search strategy is described in detail below: Search Strategy PubMed: (Epidemiology[Subheading] OR Epidemiology[All Fields] OR Prevalence[MeSH Terms]) AND (Dental Caries[MeSH Terms]) AND (Europe[MeSH Terms] OR Europe[All Fields])=3484 (Epidemiology[Subheading] OR Epidemiology[All Fields] OR Prevalence[MeSH Terms]) AND (Dental Caries[MeSH Terms]) AND (Europe[MeSH Terms] OR Europe[All Fields]) AND (Risk Factors[MeSH Terms])=387 ((Epidemiology[Subheading] OR Epidemiology[All Fields] OR Prevalence[MeSH Terms]) AND (Dental Caries[MeSH Terms]) AND (Europe[MeSH Terms] OR Europe[All Fields]) AND (Risk Factors[MeSH Terms]) AND (Infant[MeSH Terms] OR Child[MeSH Terms] OR Adolescent[MeSH Terms])=302 ((Epidemiology[Subheading] OR Epidemiology[All Fields] OR Prevalence[MeSH Terms]) AND (Dental Caries[MeSH Terms]) AND (Europe[MeSH Terms] OR Europe[All Fields]) AND (Risk Factors[MeSH Terms]) AND (Humans[MeSH Terms]) AND English[lang] AND (Infant[MeSH Terms] OR Child[MeSH Terms] OR Adolescent[MeSH Terms]) AND (1995[PDAT] : 2011[PDAT]))Limits: English, Humans=179 Total 179 articles were retrieved in this single search.   The titles of 179 journals were read and inclusion- exclusion criteria were applied and 50 papers were selected. (2,4,7,8,10,12,14,20,21,23,24,26,29,31,34,35,36,39,42,44,47,49,51,55,56,60,63,64,65,67,70,73,74,75,77,82,84,88,90,98,109,110,111,112,118,122,128,129,143,147). Abstracts of 50 papers were critically read and finally six papers were included in the study. Four papers were identified and included from the reference lists, three papers were added by the manual searching of local journals (to include papers from all geographical regions of Europe) and one journal was retrieved from British Dental Journals. Sixteen papers from different countries of Europe (England, Scotland, Wales, Northern Ireland, Norway, Kosovo, Germany, Lithuania, Spain, Latvia, Sweden, Portugal, Turkey and Greece) were included in this review. Inclusion Criteria Studies conducted in Europe. Studies reporting overall prevalence of dental caries in dmft/DMFT (The number of D=decayed; M=missing due to caries; F=filled T=teeth in a case or individual, one of the most reliable dental caries index). Studies that reported risk factors. Original papers published in English. Studies including children (0-18 years). This age group was chosen because this is the root foundation stage where good habits are developed and incorporated in the daily life. Preventive measures if used give the best outcomes. Studies conducted from 1995. There was constant decline in dental caries in Central and Western Europe till 1995 but after this period, there was a tendency towards an increase in dental caries (Mathaler et al., 1996) the reason to select the studies from 1995 till 2011. Exclusion criteria Studies without the overall prevalence of dental caries. Papers not published in English. Studies not using the World Health Organisation DMFT criteria. Studies with single person opinion. Studies on age group 18years. Studies involving cases with hospital and special dental care needs. Quality Assessment System Wong et al (2008) argued that quality assessing tools like QUOROM, CONSORT, STARD and STROBE were aimed at authors for reporting, not for reviewers and proposed QATSO guidelines for observational studies. As QATSO was used, the following parameters and scoring system were considered for this review, for methodological flaws (internal validity and generalisation (external validity). : Sample size:   ≠¥1000=1,   1000=0. Response Rate: ≠¥60%=1, 60%=0. Number of recruitment sites: ≠¥5=1, 5=0. Sampling strategies: Probabilistic=1, Non-probabilistic=0. Statistical analysis: Yes=1, No=0. Table 1 Each study was coded A to C (on the basis of above criterion) to measure its quality. High Quality (A) score ≠¥4. Fair quality (B) score 2 to 3. Poor Quality (C) – score 2. Data Extraction System Data extraction system comprised of the following sections and each section included a series of questions to extract data. Bibliographic information. Authors. Date of publication (year). Journal title. Focus of the study. Main focus of the study (prevalence of dental caries). Demographic details of participants (European children). Location (Country). Methodology Sampling strategy and sample size. Data collection methods. Data extraction methods. Clinical settings in which children were diagnosed. Strengths of study. Limitations of the study. Findings Results. Conclusions. Recommendations. Results The findings reported in the reviewed studies suggested the prevalence of dental caries ranged from 25% in Scotland (mean dmft1.1) to 86.31% in Kosovo (South Eastern Europe) (dmft-5.8). All the studies used WHO criteria to record the caries index (mean dmft/DMFT) indicating the prevalence of dental caries, this facilitates comparison between the studies of various regions. Three studies (Studies 1, 9 and 16) show very high DMFT in Kosovo (mean DMFT=5.8) and Lativia (mean DMFT=5.0). Sweden, Turkey, Germany, Norway, Portugal, Lithuania and Greece were reported to have mean DMFT index ranging from 2.05 to 3.19 (Studies 3,4,10,12,13,14 and 15). A low caries index (mean DMFT2) was found in the UK (England, Wales, Scotland and Northern Ireland) (Studies 2,6,7,8 and 11). Comparing the studies 2 and 11, it was found that the mean DMFT index tends to increase with increasing age (Scotland 2007/08; mean dmft 3 year-olds =1.0, mean dmft five year-olds= 1.87). Studies that reported risk factors mostly used logistic regression to quantify different independent variables (sugar consumption, preventive measures, socioeconomic factors and so on) with dental caries as the dependent variable. Most of the studies used the above mentioned variables. Eagle et al. (2003) (study 3) reported the form in which sugars are consumed as an important predictor for dental caries; consuming sweetened tea and milk increased the risk of caries by 225 times and 15 times (reference water =1) (p0.001) which is statistically significant. The risk of developing caries increased to 1.39, 1.44, 1.46 and 1.68 times when processed sugars were consumed once, twice, three times and four times respectively as opposed to never consuming processed sugars as reference (=1) (Gac Sanit;   Study 5) Socioeconomic factors (study 2,10,11,12,13,14 and 15) were also reported to be an important predictor for causing dental caries. Living in remote areas was reported to be a protective factor with cities as reference. The risk of having caries in remote and rural areas was reported to range between 0.29 times (CI 0.13-0.63; p=0.002) to 0.52 (CI 0.39-0.69) and this is statistically significant. People living in deprived areas (including immigrants) were reported to be more vulnerable. The odds of developing caries was 2.9 times (CI2.31-3.64; p0.001) (study 2), 5.32 times (p0.01) (Study 13) and 5.94 times (p0.01) with native/caries free population as reference. The risk of developing caries was reported to be 1.68 times higher in children with mothers having secondary education as opposed to the children whose mother had done higher studies (Constantine et al. (2011); Study 15). Eagle et al. (2003) (study 3) reported that 70% of the mothers having caries free children knew about caries and its prevention but only 22.5% of mothers having children   with caries were aware of this problem (p0.001). The results were statistically significant. With daily tooth brushing as reference, the risk of having dental caries for children who brushed on alternate days was 1.48 times (CI 1.22-111.78)higher; for children who brushed with two days gap was 1.57 times(CI 0.91-2.33) higher and for those who brushed with gap of three or more days was 1.60 times(CI 1.20-2.28) higher (Study 5). Applying excessive toothpaste while brushing was reported as a risk factor for caries. Risk of caries was 1.32 times (CI 1.10-2.16) and 1.52 times (CI1.20-1.61) higher if the amount of tooth paste used was 2/3 of the tooth brush head size and whole head size respectively with 1/3 of the toothbrush head size as reference(=1) (Study 5). Constantine et al. (2011) reported sealants (material used by dentists to fill the deep pits and fissures (where caries start), of teeth in young children) as a protective factor the risk of having caries in children with sealants was 0.76 times the children without sealant use (OR=0.76; CI=0.57-1.00; p0.05) which was sta tistically significant (Study 15). Discussion Based on sixteen papers, this review demonstrates variation in the prevalence of dental caries in different regions of Europe and it ranged from 1.0 (Scotland) to 5.8 (Kosovo) (dmft).   Although, the prevalence of dental caries has decreased in Western and Central Europe, Eastern Europe is still facing a high prevalence of dental caries. This is similar to the findings of Marthaler, 2004.   In this review lower socio-economic status, sweets consumption and inadequate oral hygiene were reported as major risk factors. Studies 3 and 5 reported sugar consumption as a cause of dental caries. Similar association was reported by Cottrell, 2005. Awareness of mothers and rurality were reported as a protective factor for dental caries in studies 10,11,12 and 13. These findings were similar to Marserijian, Tavres, Hayes, Soncini and Trachtenberg (2008), who showed that caries were higher in urban children of New England than rural children. Tooth brushing was also reported as protective fac tor in study 5. Limitations of the study included, limited exploration of other factors that could be significant due to limited number of papers (+15). Journals could not be retrieved from all the European countries hence the result was generalised more widely. In most of the studies dental mirrors, dental probes, cotton rolls and natural daylight were used and these conditions were sub-optimal. Radiographs, artificial light and compressed air were not available. Finally, no attempt was done to perform a meta-analysis in the review to give a pooled prevalence. Despite, above mentioned limitations, this review can serve as a starting point for more ambitious reviews. All the studies included in this review used WHO criteria for recording the prevalence of dental caries (DMFT). The higher prevalence of dental caries in Eastern Europe is attributed to their under developed health system. Hence, there is need to strengthen the health systems in Eastern European countries. Highest caries prevalence is in lowest economic strata (Bratthall et al., 2000). Hence, there is immediate need to target lower socio-economic strata in the public health policies. References   Miller J, Vaughan-Williams S E, Furlong R, Harrison L.  Dental caries and childrens weights.  J Epidemiol Community Health  1982;  36: 49–52.  |  PubMed  |  ISI  |  ChemPort  | Acs G, Lodolini G, Kaminski S, Cisneros G J.  Effect of nursing caries on body weight in a pediatric population.  Pediatr Dent  1992;  14: 302–305.  |  PubMed  |  ChemPort  | Acs G, Shulmann R, Ng M W, Chussid S.  The effect of dental rehabilitation on the body weight of children with early childhood caries.  Pediatr Dent  1999;21: 109–113.  |  PubMed  |  ChemPort  |

Marijuana must be legal in the us Research Paper

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Globalization and Urbanization Essay Example | Topics and Well Written Essays - 1250 words

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