Grow Little Cell Grow! Investigating Neurogenesis Essay -- Biology Ess

Grow Little Cell Grow! Investigating Neurogenesis Neurogenesis, the production of new nerve cells, has been a revolutionary finding as nerve formation has always been thought to end with adulthood. It has not been until recently that such dogma has been contradicted as research findings report that neurogenesis continues in the hippocampus throughout most of the adult life of mammals and primates (1). Recent correlations have been further made between neurogenesis and depression as the latter depletes neuron cells in the brain while antidepressive drugs have demonstrated to increase neuronal growth (2). Neurons are the building blocks of the nervous system as they are responsible for the input, processing and transmission of information. Neurons are derived from stem cells as the latter differentiate into specialized cells and make progenitor cells which are responsible for the formation of neuron and glial cells. Although the majority of neurons are formed during the pre-natal and perinatal stage of development, neuron formation continues in the dentate gyrus of the hippocampus (2). The hippocampus, which lies beneath the cortex is a major factor of learning and memory formation and can indirectly influence emotion. Progenitor cells which are present in the sub ventricular zone of the hippocampus are responsible for such growth as they produce daughter neuron cells through division (2). In the 1960s, Joseph Altman from MIT reported that new neurons were being produced in the dentate gyrus of the hippocampus of adult rat brains. Although such findings were groundbreaking, they failed to create the stir that Elizabeth Gould's 1998 study caused . The Princeton University neurobiologist demonstrated that the marmoset b... ...is is a complex issue with an array of possibilities for the future. Further investigations will have to answer some of the questions and issued raised. Sources (1)The Scientist Magazine , Human neurogenesis. Group demonstrates that adult human brains grow new cells after all. http://www.the-scientist.com/ (2)American Scientist Magazine, Depression and the Birth and Death of Brain Cells. http://www.sigmaxi.org/amsci/articles/00articles/Jacobs.html (3)National Depressive and Manic Depressive Association, Antidepressants and Brain Cell Growth. http://ndma.com/web05/web9152.htm (4) Neuroscience for Kids, New Neurons in Neocortex? New Study Says NO! http://faculty.washington.edu/chudler/newneu.html (5)National Institute of Mental Health, Learning From Songbirds About Adult Brain Generation. (6) The Scientist Magazine. http://www.the-scientist.com/

Improving Communication for People with Learning Disabilitie

learning zone CONTINUING PROFESSIONAL DEVELOPMENT Page 58 Improving communication for people with learning disabilities Page 66 Learning disabilities multiple choice questionnaire Page 67 Read Annette Martyn’s practice profile on type 2 diabetes Page 68 Guidelines on how to write a practice profile Improving communication for people with learning disabilities NS336 Godsell M, Scarborough K (2006) Improving communication for people with learning disabilities. Nursing Standard. 20, 30, 58-65. Date of acceptance: February 6 2006. Summary Patients with learning disabilities have higher healthcare risks than the general population. Similar essay: Collate Information About an Individual's Communication and the Support ProvidedHealth professionals need to develop skills that enable them to communicate effectively with this patient group. Identifying barriers to communication is the first step to reducing or removing them. Suggested strategies to improve healthcare access for patients with learning disabilities include: developing individualised health action plans, simplifying communication styles and providing accessible facilities and tailored resources. learning activities you should be able to: Understand the impact of communication on interaction between healthcare providers and patients with learning disabilities.Describe the relationship between communication and the health inequalities experienced by people with learning disabilities. Identify strategies to improve communication between health providers and patients with learning disabilities. Authors Matthew Godsell and Kim Scarborough are senior lecture rs, Faculty of Health and Social Care, University of the West of England, Bristol. Email: Matthew. [email  protected] ac. uk Introduction Learning disability is not a diagnosis but a term used to describe people with a wide range of strengths and needs.Eighty per cent of children and 60 per cent of adults with learning disabilities live with their families (Gravestock and Bouras 1997), and many people with learning disabilities exceed the expectations of families and professionals in their capacity to learn new skills and develop their talents (NHS Executive 1999). The term ‘learning disability’ says little about an individual’s strengths and needs but it does incorporate three elements that appear in most definitions (Box 1). Emerson et al (2001) state that the number of people with learning disabilities in the UK has not been determined.They estimate that in the UK there could be as many as 350,000 people with severe learning disabilities (intelligence quotie nt (IQ) 50). This means that 2 per cent of patients are likely to have a learning disability (NHS Executive 1999). The ways in which people with learning disabilities are described have changed. Terminology and related facts are listed in Box 2. NURSING STANDARD Keywords Communication; Learning disabilities nursing: attitudes These keywords are based on the subject headings from the British Nursing Index. This article has been subject to double-blind review.For related articles and author guidelines visit our online archive at www. nursing-standard. co. uk and search using the keywords. Aims and intended learning outcomes The aim of this article is to explore the impact of communication on health care for people with learning disabilities. The article discusses how cognition and communication influence interactions between healthcare providers and patients. It also examines how poor communication can contribute to health inequalities that separate people with learning disabilities f rom the rest of the population.The article explores communication strategies that can overcome or reduce barriers to effective health care. After reading this article and completing the 58 april 5 :: vol 20 no 30 :: 2006 Time out 1 Based on a figure of 2 per cent of patients having learning disabilities, it is likely that 40 per 2,000 patients registered with GP services are likely to have learning disabilities. How many patients with learning disabilities are you aware of in your practice area? List some of the reasons that might prevent people with learning disabilities from accessing local health services. Health inequalitiesAlthough people with learning disabilities are living longer, the gap that separates the health status of people with learning disabilities and the general population has increased. Cohen (2001) asserted that gross inequalities in health are politically, socially and economically unacceptable. An investigation into health inequalities by the Disability Rights Commission (Nocon 2004) found that people with learning disabilities have: An increased risk of early death compared with the rest of the population; mortality rates are particularly high for those with more severe impairments.A greater variety of healthcare needs. Many needs that are not met. High rates of unrecognised or poorly managed medical conditions including: hypertension, obesity, heart disease, abdominal pain, respiratory disease, cancer, gastrointestinal disorders, diabetes, chronic urinary tract infections, oral disease, musculoskeletal conditions, osteoporosis, thyroid disease, and visual and hearing impairments.A briefing paper produced by the NHS Service Delivery and Organisation (SDO) Research and Development Programme (NHS SDO 2004) identified barriers to appropriate and timely BOX 1 Definition of a learning disability A person with learning disabilities has: Significant reduction in the ability to understand new or complex information. Reduced ability to cope inde pendently. Impairment starting in childhood that will have a lasting effect on development. (DH 2001) access to health care within and outside services.Many people with learning disabilities find that identifying their healthcare needs is a major challenge. Proactive strategies are required to encourage people to access the full range of services that are available. Some people with learning disabilities have said that negative and unhelpful attitudes from healthcare workers have prevented them from seeking medical help (Bristol and District People First 2003). Support and encouragement are required by carers, allies and friends before people with these concerns are ready to engage with services again.People are more likely to trust service providers when they are convinced that services and practitioners have responded to their needs by improving communication skills and producing information in an accessible format. People with learning disabilities have the same right to access m ainstream services as the rest of the population (Department of Health (DH) 2001). However, mainstream services have been slow to develop the capacity and skills to meet their needs.In the document Valuing People (DH 2001) it was acknowledged that the wider NHS had failed to consider the needs of people with learning disabilities and that overcoming this source of inequality was the most important issue for the NHS to address for this patient BOX 2 Terminology and facts related to learning disabilities ‘Mental handicap’ was a term used to describe people with learning disabilities. It is no longer used in the UK. ‘Mental retardation’ is a term used internationally, however, it is not an accepted term in the UK and some may find this term offensive. Learning difficulty’ is the term used in education to define individuals who have specific learning needs, for example, dyslexia. Some people who are identified as having learning difficulty by education s ervices may also be considered to have a learning disability, but this is not necessarily the case. ‘Mild’, ‘moderate’, ‘severe’ and ‘profound’ are terms to describe different degrees of disability (Figure 1). A person with mild learning disabilities might communicate effectively, learn, live and work with little support.However, a person with profound learning disabilities will require support with activities of daily living, for example, communication, dressing, feeding, washing and mobility. A diagnosis of ‘mental illness’ is not the same as having a learning disability, but people with learning disabilities may have mental health issues as well. Not everyone with learning disabilities requires a social worker or a community nurse. People with learning disabilities may have multiple diagnoses resulting in complex health needs. People with the most profound physical or sensory impairments do not always have the most profound cognitive impairments.NURSING STANDARD april 5 :: vol 20 no 30 :: 2006 59 learning zone nursing attitudes group. The briefing paper produced by the NHS SDO (2004) provided key action points for removing barriers and improving access to health care, which included: Using specialist learning disability teams to aid adaptation of mainstream services to meet the needs of patients with learning disabilities. Developing strategies for health education and health checks for people with learning disabilities that promote timely access to health care.Families and paid carers have an important role in helping people with learning disabilities to access health care. Some people will need assistance to recognise mental health problems and to identify gradual changes in health. Time out 2 Make a list of the ways that you communicate with patients about their health, for example, through appointments and telephone calls. Take three examples from your list and consider reasons why communi cation with a person with learning disabilities might be difficult.Give an example of effective communication between a practitioner and a person with learning disabilities. Policies should address the use of technology to support communication, and the development and dissemination of accessible information. Jones (2003) suggests that managers and commissioners of services should liaise with health, social care and education agencies to ensure consistency in communication policies throughout the lives of people with learning disabilities. Communication can be broadly defined as the exchange of information between a sender and a receiver (Figure 2).Where a person has learning disabilities they may be communicating with an intention to attract a communication partner and commence a two-way dialogue. However, for some people with profound learning disabilities sending a message might be a response to their body and feelings. Their level of cognition might be such that they are unaware of possible communication partners and of how to take the communication further. This is called pre-intentional communication, in which the individual says or does things without intending to affect those around them.It is important to remember that everyone communicates and that the role of communicator and communication partner swaps from one person to the other so that a conversation can develop. The challenge for health professionals is to develop skills that enable them to interpret the messages they receive and make the messages they send understandable. Communication is not only about verbal communication; it is also about nonverbal communication, for example, the use of body language, words and pictures. CommunicationRecommendations have been made to improve communication and access to health services for people with learning disabilities. Jones (2003) states that services supporting people from birth to older age should develop communication policies. FIGURE 1 Estimated pe rcentage of people with learning disabilities according to level of severity Mild Moderate 12% Severe Profound 80% 7% 1% Augmentative and alternative communication systems Systems of communication, such as sign language, symbols and eye pointing, are known as augmentative and alternative communication systems (AACs).AACs can be used to enhance or replace customary pathways, such as speech or writing. The use of photographs of everyday objects, picture boards, line drawing and real objects are good ways to enhance communication with people with learning disabilities (American Speech-Language-Hearing Association (ASHA) 2005). You do not need to attend specialist training to be able to use AACs such as these. More formal AACs, such as Makaton (a form of sign language for people who have learning disabilities that uses keywords to enhance understanding), require preparation but learning a basic vocabulary does not require extensive training.Cognition and communication (Winterhalder 1997 ) Understanding complex information People with learning disabilities have a reduced ability to NURSING STANDARD 60 april 5 :: vol 20 no 30 :: 2006 understand new or complex information (DH 2001), and those who experience difficulties when processing information may find it hard to learn new skills. Intelligence can be quantified as a figure related to an individual’s IQ. However, it might be more useful to think about intelligence in relation to cognitive processes.Smith and Mackie (2000) describe cognitive processes as: ‘†¦the way in which our memories, perceptions, thoughts, emotions and motives guide our understanding of the world and our actions. ’ Intelligence exerts a powerful influence over the ability to process information, the capacity to learn new skills and to adapt knowledge to different situations. Intelligence is an attribute that can guide our understanding of the world, but it is not fixed or static. Teaching and learning strategies can be used to stimulate cognitive processes so that people can approach information, or potentially confusing situations, with more confidence.Similarly, complicated tasks and information can be broken down into small, simple steps so that people can approach them in stages. Attempting to understand another person’s cognitive processes can help practitioners to develop a more empathetic and person-centred approach to care, and can provide an incentive to develop the teaching and learning strategies that are best suited to the individual needs of patients. Coping independently People with learning disabilities may have a reduced ability to cope independently (DH 2001). Independence is defined according to levels of social functioning.Assessment of a patient’s strengths and needs in social functioning is a fundamental stage in developing planned care that is familiar to practitioners from all branches of nursing. Making an accurate assessment of social functioning provides val uable information about the range of activities that a person can undertake on his or her own as well as those activities where a person requires support. Some people with learning disabilities may require assistance with tasks such as washing and dressing, and many need help to have their mode of communication understood.Learning disability and development Learning disability starts before adulthood, affects people of all ages and has a lasting effect on development (DH 2001). A majority of younger people with learning disabilities are living in the community with their parents or carers. Older people with learning disabilities also live in the community but they may have periods of institutional care. Some people will have frequent contact with health services and others have irregular contact. People with learning disabilities are not a homogeneous group. Their perceptions of nurses, NURSING STANDARDFIGURE 2 A model for communication Person communicating: we take turns in this ro le of sender of information. Depending on the person’s cognitive ability, this may be intentional or pre-intentional communication Communication barriers: can be present in the environment as well as being caused by the communicator and communication partner Communication partner: we take turns in this role of the person who receives the information sent, makes sense of it and responds appropriately doctors, health centres, clinics and hospitals will have been shaped by their formative experiences with staff and services.Providing encouragement for people with learning disabilities to attend health checks and to make use of healthcare services can involve changing their perceptions of health professionals. Some people with learning disabilities have not received the treatment they need because they are reluctant to engage with services where they have had bad experiences in the past. To encourage people with learning disabilities to make effective use of healthcare services t hroughout their lives, practitioners need to use their communication skills to initiate and maintain positive relationships. Time out 3Think about the last time you communicated with a person with learning disabilities, or someone who has communication difficulties. Refer to the list you made in Time out 2 about the communication systems you use in your workplace. What are the main barriers to communicating about health with a person who has learning disabilities? How do you remove or reduce barriers to communication? Which environmental factors impede communication? Identify any barriers that you had not previously considered. april 5 :: vol 20 no 30 :: 2006 61 learning zone nursing attitudes Barriers to communicationThere are barriers to communication which can be identified in relation to the person with learning disabilities, the health professional and the environment (Box 3). When barriers have been identified, health professionals can start to think about ways of reducing or removing them. Health professionals exchange information by using terminology that reflects their specialised knowledge. Patients and other people who are not involved in the day-to-day delivery of health care BOX 3 Barriers to communication The person with learning disabilities may: Have limited understanding.Have limited vocabulary or difficulty speaking. Have sensory impairments that limit ability to hear requests or instructions. Have poor understanding of health and healthy living. Be scared of people in uniforms. Be stressed because of illness. Not like new places. Have difficulty waiting and may not understand the concept of time or queuing. Have limited literacy and numeracy skills to read health advice and information, for example, instructions, letters, dosages. Expect contact with nurses to be unpleasant because of previous experiences. The nurse may: Be rushed because of heavy workload.Have biases and assumptions about people with learning disabilities. Have poor listeni ng and attending skills. Be unable to understand augmentative and alternative communication systems. Have limited knowledge of the individual. Have insufficient time to develop a good relationship with the individual or carer. Not use visual aids to support understanding. Use technical jargon and/or long words. Provide written information without thinking of the patient’s ability to read it. Provide information about the next appointment in a way the patient will not understand or remember.The environment may: Be crowded. Busy. Uncomfortable. Have strange smells and noises. Bring back bad memories. Have limited physical access, for example, no hoists. Include unhelpful people. Have poor signage, relying on literacy skills and good sensory abilities. Have no area to sit quietly with limited sensory stimulation while waiting. Be filled with machines and instruments that a person with learning disabilities may not understand. may find it difficult to comprehend the terms and ide as they encounter in healthcare settings. They can find it hard to follow advice or instructions.This could result in patients making inappropriate decisions or exposing themselves to unnecessary risks. For example, patients with learning disabilities who take their own medication may be at risk of overdosing or taking an ineffectual dose, particularly if the route and dosage of a newly prescribed medicine has not been explained clearly and/or recorded in an accessible format. Time out 4 Consider the list of potential barriers to communication and categorise them according to: Barriers that have been addressed for patients with learning disabilities using the services you work in.Barriers that can be remedied quickly. Barriers that need planning to be reduced or removed. Barriers that require financial investment to be reduced or overcome. Discuss this list with your colleagues. Identify strategies for removing barriers and improving communication. Good practice in communication In South Warwickshire, health passports have been developed for people with learning disabilities (Leamington Spa Today 2005). These provide detailed information about an individual’s health, strengths and needs so that practitioners can provide patient-centred care.They are used to improve communication across a range of healthcare providers. Having an alert system incorporated into patient notes which provides individual communication needs could be beneficial, especially where staff do not know individual patients. Health practitioners may use and be involved in developing health action plans. These are plans specific to individuals and are developed to meet their access needs. Health action plans are a way of overcoming some of the barriers to high quality health care (DH 2001).Plans are produced by a group of people including the patient. They encourage the development of a shared understanding about an individual’s health needs. Where training in health action plann ing has been provided for GP surgeries, improvements have been shown in the health of patients with learning disabilities (Smith et al 2004). There are benefits to having a lead person to deal with learning disability issues. In primary healthcare services, a lead person takes an interest in learning disability issues, collates information, NURSING STANDARD 62 april 5 :: vol 20 no 30 :: 2006 ives support and advice to health staff and develops links with specialist services for people with learning disabilities and other agencies (NHS Executive 1999). Time out 5 Does your organisation have a lead person who is involved in initiatives such as joint communication policies and the development and sharing of accessible health information? If yes, find out how he or she is supporting your team to develop skills in communicating with people who have learning disabilities. If no, how might developing this role benefit your team and improve access to health care for patients with learning d isabilities?To improve communication with people with learning disabilities, more time should be allocated to appointments so that there is more time for them to express themselves and understand any information they have received (DH 1999). This is particularly the case if AACs are being used. Reception staff are often aware of people who have difficulties using services. Supporting these key staff to develop effective communication skills and flexibility can improve access to health services (NHS Executive 1999).For example, if staff in reception are aware that someone finds it difficult to wait in a queue, they may offer that person the first appointment. Several resources have been developed by trusts to improve communication. Some examples of these include: Hambleton and Richmondshire Primary Care Trust (PCT), in partnership with Mencap, has developed an accessible ‘Choose and Book’ guide for hospital appointments that uses a combination of pictures and words to ex plain how patients can make choices about hospitals and appointments.Bristol South West PCT, as part of its ‘Expert Patient Programme’, has developed plans that help prepare people with learning disabilities for a visit to the doctor. The Health Facilitation Team at Gloucestershire Partnership NHS Trust (2004) has produced a ‘traffic light assessment’ that conveys information about individuals on admission to hospital. This ensures that important information is clearly communicated to health professionals. Camden PCT (2005) has used this work to develop an online resource. Although people may appear to have limited communication skills, they should not be ignored.These patients should be addressed directly and NURSING STANDARD the information they receive should be provided in a simple way without being patronising. Effective communication often depends on how the information is delivered. Practitioners may have to talk to carers, but they should not forget to address the person with learning disabilities. Practitioners should examine their beliefs about people with learning disabilities and avoid making assumptions about an individual’s strengths and needs. This will help to make health assessments more accurate (DH 1999).It is useful to invite a speaker with learning disabilities to talk to healthcare staff about living with a learning disability and his or her experiences of accessing health services. Time out 6 What beliefs and values do you think society holds about people with learning disabilities? Some examples of negative beliefs and values are that people with learning disabilities: Have a poor quality of life. Have higher pain thresholds. Are dangerous and promiscuous. Will not understand anything. Should not get married or have children. Cannot care for their children. Need institutional care. Cannot work.Are like children not adults. What are your feelings about these statements? How might the presence of any or al l of these beliefs influence the care given to a person with learning disabilities? People with learning disabilities can have additional physical or sensory impairments that should be considered. They are also more likely to have more mental health needs than the general population (DH 2001). Where a patient has additional impairments or health issues these need to be considered during communication. The healthcare environment should be adapted to accommodate people with physical or sensory impairments.Time out 7 In your work place: Do you have a private area to talk to a person who has a large wheelchair? Do you have rooms where glare is controlled and the environment is suitable for people with limited vision? Do you consider the needs of interpreters/ carers and ensure they fully understand information before they pass it on? april 5 :: vol 20 no 30 :: 2006 63 learning zone nursing attitudes Accessible information Accessible information comes in many forms, such as videos, CDs, DVDs and audiotapes. Pamphlets can be produced with accessible information about the services offered.Written information needs to be in plain language, with short sentences and one subject per sentence. Photographs, drawings, symbols and other visual information can be used to support written information. It is important to keep pages uncluttered on plain backgrounds so that text does not detract from graphics. Letters should be large, 16-18 point type size, and fonts that do not have serifs, such as Arial and Comic Sans, should be used. Graphic text, underlining and italics should be kept to a minimum because they can impede readability. Many trusts are now producing resources to enhance accessibility.Some of these include: The United Bristol Healthcare NHS Trust has produced a leaflet called ‘You are coming to the Bristol Royal Infirmary about your heart’, TABLE 1 Using terminology that is easy to understand Health issue Common words that are used Epilepsy Investigat ions EEG (electroencephalogram) Strategies or words that improve understanding Find out more about This word would have to be used, but a photograph of someone having an EEG may help understanding Medicine tablets to help control your epilepsy Having two or more seizures straight after each other or whatever describes status for the individual Taking your medication as we have agreed Things that might make you have a seizure Not being able to have a poo for three days Things you feel in your head and body that make you think you will have a seizure Having a fit or turn, whichever word the person uses which uses pictures and words to introduce some of the staff and explain what happens when patients are admitted to the cardiology department.The Learning Disability Partnership Board in Surrey has developed ‘The Hospital Communication Book’ that combines words, pictures, signs and symbols. Trafford North and South PCTs have produced a toolkit for people with learning disab ilities called ‘Cancer and You’ (Provan 2004). Contact your local Community Learning Disability Team or People First organisation for information about local resources. Simplifying conversation When talking to people with learning disabilities, use approaches similar to those used for written text. Plain language, the use of keywords, short sentences and one subject per sentence should be used. Give people time to process what is being said and to formulate a reply.Use openended questions to assess a person’s understanding and rephrase the question if necessary, as repeating the same question rarely improves understanding. When information is presented during a consultation it is important to check that the person with learning disabilities has understood it. If there is insufficient time during the initial consultation, it may be necessary to make a further appointment to check what the person has understood and retained. For an individual who processes informat ion slowly this might be essential to ensure an accurate assessment and the effective implementation of a treatment plan. Examples of terms that are easier to understand are presented in Table 1.Such terms are only beneficial if the person understands them so, for example, ‘constipation’ could be described as ‘not being able to have a poo’, but the health practitioner needs to know whether the person uses this term to describe defecation. Anti-epileptic drugs Status epilepticus Drug compliance Triggers Constipation Aura Time out 8 Think of four common illnesses that are likely to make a person visit your service. Write these in the first column of a table (see Table 1). Identify the language you use when discussing these illnesses and record these words or phrases in column two. These might be medical terms, health terms or long words. Now spend some time identifying words that are easier to understand and record them in the third column. NURSING STANDARD S eizure 64 april 5 :: vol 20 no 30 :: 2006 ConclusionPeople with learning disabilities may have communication difficulties that have restricted their access to health care and prevented them from receiving the information required to maintain their health. In addition to learning disability, they are more likely to have complex healthcare needs leading to multiple diagnoses. Steps towards better health for people with learning disabilities can be made by providing encouragement and support to attend regular health screening and reviews, and by developing a range of strategies to improve communication between practitioners and individuals with learning disabilities NS RECOMMENDED RESOURCES British Institute of Learning Disabilities (2001) Factsheet No. 005 Communication. www. bild. org. uk/pdf/factsheets/communication. pdf (Last accessed: March 10 2006. British Institute of Learning Disabilities (2005) Your Good Health (a set of 12 illustrated booklets). www. bild. org. uk/publication s/your_very_good_health_details. htm (Last accessed: March 10 2006. ) Communication Matters (updates 2005) What is AAC? www. communicationmatters. org. uk (Last accessed: March 10 2006. ) Communication Matters (updated 2005) How to be a good listener. www. communicationmatters. org. uk (Last accessed: March 10 2006. ) Department of Health. www. dh. gov. uk (Last accessed: March 10 2006. ) Foundation for People with Learning Disabilities (2004) Communication and people with learning disabilities. www. learningdisabilities. org. uk/page. cfm? agecode=ISSICMMT (Last accessed: March 10 2006. ) Foundation for People with Learning Disabilities (2005) Patients with learning disabilities in South Warwickshire have been given a new type of passport to help with their medical appointments. www. learningdisabilities. org. uk/profilenews. cfm? pagecode=ISSICOLN&are acode=ld_communication_news&id=7231 (Last accessed: March 10 2006. ) MENCAP (2003) You and your health: a basic guide to being heal thy. www. mencap. org. uk/download/you_and_your_health. pdf (Last accessed: March 10 2006. ) Plymouth Hospitals NHS Trust (2005) Living with cancer. www. learningdisabilitycancer. nhs. uk/ (Last accessed: March 10 2006. ) Time out 9Complete a SWOT analysis (strengths, weaknesses, opportunities and threats) of your skills and knowledge when communicating with and supporting access to health care for people with learning disabilities. Time out 10 Now that you have completed this article, you might like to consider writing a practice profile. Guidelines are on page 68. References American Speech-LanguageHearing Association (2005) Introduction to Augmentative and Alternative Communication. www. asha. org/public/ speech/disorders/acc_primer. htm (Last accessed: March 9 2006. ) Bristol and District People First (2003) We are People First. (Film) People First, Bristol. Camden PCT (2005) What You Need to Know About Me in Hospital. www. camden. gov. k/ (Last accessed: March 17 2006. ) Cohen J (2001) Countries’ health performance. The Lancet. 358, 9285, 929. Department of Health (1999) Facing the Facts: Services for People with Learning Disabilities: A Policy Impact Study of Social Care and Health Services. The Stationery Office, London. Department of Health (2001) Valuing People: A New Strategy for Learning Disability for the 21st Century. The Stationery Office, London. Emerson E, Hatton C, Felce D, Murphy G (2001) Learning Disabilities: The Fundamental Facts. Foundation for People with Learning Disabilities, London. Gloucestershire Partnership NHS Trust (2004) Traffic light assessment. Unpublished document.Gloucestershire Partnership NHS Trust, Gloucester. Gravestock S, Bouras N (1997) Emotional disorders. In Holt G, Bouras N (Eds) Mental Health in Learning Disabilities: A Training Pack for Staff Working with People who have a Dual Diagnosis of Mental Health Needs and Learning Disabilities. Second edition. Pavilion Publishing, Brighton, 17-26. Jones J (2003) Th e Communication Gap. www. learningdisabilities. org. uk /page. cfm? pagecode= FBFMCHTP04 (Last accessed: March 10 2006. ) Leamington Spa Today (2005) Patients with learning disabilities in South Warwickshire have been given a new type of passport to help with their medical appointments. Leamington Spa Today. January 19, 2005.NHS Executive (1999) Once a Day One or More People with Learning Disabilities are Likely to be in Contact with Your Primary Healthcare Team. How Can You Help Them? Department of Health, Leeds. NHS Service Delivery and Organisation (SDO) Research and Development Programme (2004) Access to Health Care for People with Learning Disabilities. Briefing paper. NHS SDO, London. Nocon A (2004) Background Evidence for the DRC’s Formal Investigation into Health Inequalities Experienced by People with Learning Disabilities or Mental Health Problems. Disability Rights Commission, Stratford upon Avon. Provan K (2004) Cancer and You: Toolkit for Working with People with Learning Disabilities. www. cancerandyou. info/docs/ FullToolkitNov04. pdf (Last accessed: March 9 2006. Smith ER, Mackie DM (2000) Social Psychology. Second edition. Psychology Press, Hove. Smith C, Giraud-Saunders A, McIntosh B (2004) Healthy Lives: Health Action Planning in a Person Centred Way; Including Health in Person Centred Planning. www. valuingpeople. gov. uk/ HealthHealthyLives. htm (Last accessed March 10 2006. ) Winterhalder R (1997) An overview of learning disabilities. In Holt G, Bouras N (Eds) Mental Health in Learning Disabilities: A Training Pack for Staff Working with People who have a Dual Diagnosis of Mental Health Needs and Learning Disabilities. Second edition. Pavilion Publishing, Brighton, 1-6. NURSING STANDARD april 5 :: vol 20 no 30 :: 2006 65

6 Quotes from Roxanne Dunbar About Female Liberation

Book Report On Kill A Mockingbird - 9802 Words

LOG ENTRIES (TO KILL A MOCKINGBIRD) Chapters 1-2 The chapters 1 and 2 of the novel To Kill a Mockingbird, the story begins at the beginning of summer, with the introduction of Scout and Jem two kids trying to enjoy to dog-days of summer in the plain and simple town of Maycomb. Their summer stays this way until they meet a boy by the name of Dill; Dill, Scout, and Jim play together by reenacting scenes from famous movies like Dracula. But when Dill hears about the legend of the Radley’s and there abandon estate, he becomes entranced with the Radley’s and wants to find out what really happened to Boo Radley. His interest in the Radley’s goes to such an extent that he dares Jem to get Boo Radley to leave his house by going on his property. After the deed was done summer winds down to an end as Dill leaves for Meridian, bored with nothing to look forward in summer Scout realizes that school is going to start. Jem starts to distance himself from Scout saying â€Å"Jem was careful to explain that during the school hour I was not to bother him†. Scouts starts to realize that school is different as she is punished for speaking out of turn and trying to explain why Walter cannot accept money from Miss Caroline. She takes this as an insult against Walter and punishes her, as it turns out school is a lot different than home. We get this lovely snippet about the life of the ever day average person that lives in Maycomb â€Å"People move slowly then. †¦There was no hurry, for there was nowhereShow MoreRelatedBook Report On Kill A Mockingbird, By Robert E Lee834 Words   |  4 PagesDrew Pauley Ms.Neeley English 10 6 May 2016 Title A reappearing subject in the classic book â€Å"To Kill a Mockingbird,† revolved around equality for African-Americans. Tom Robinson, an African American, was falsely convicted of rape. This problem is still relevant in today’s society. There have been recent cases that have raised awareness for true equality. White cops have been killing African-Americans and getting away with it. A boy named Tamir Rice was killed in a park for playing with aRead MoreBook Report On Of Kill A Mockingbird By Harper Lee1857 Words   |  8 PagesLucas Garvey Mrs. Tavares H. English 10 21 May 2016 Inequality in American Society Today The book To Kill a Mockingbird, by Harper Lee is a book based around social inequality present in Maycomb county in the 1930’s. The novel takes place in Maycomb, a small town in southern Alabama. The book is also during the 1930s depression era. Lee s novel is told from the perspective of a young girl, Jean Louise Finch, who s nickname is Scout. Scout grows up in a racist, and intricate world. 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The s Theory Of Internal Morality - 1852 Words

Intro Wishful blindness is a lot more common than pure dishonesty - it is when someone knowingly stays oblivious to dishonesty occurring Becker’s theory (SMORC) is that decisions about dishonesty are based on a cost-benefit analysis An increase of police and punishments won’t necessarily decrease dishonesty SMORC isn’t necessarily true because people have internal morality that also governs their decisions Taking little by little is much more common than someone taking a huge amount I know for a fact that I have looked the other way when something dishonest was going on just so that we could benefit, and at the time my conscience was convincing me that it wasn’t cheating. So I can understand how common wishful blindness really is. I’m certain that I don’t weigh the costs and benefits on everything that I do, so I tend to agree with Ariely’s theory of internal morality being more plausible than SMORC Something that I thought of about the stealing bit by bit part was the whole idea of pyramid schemes, where you take little by little from certain people and make huge amounts of profit while doing so. Chapter 1 Does a study on how students cheat using the matrix experiment Finds that many cheat by a little but few cheat by a lot When more money got involved the amount of cheating dropped (internal morality) When people were less likely to be caught the level of cheating remained the same The thought of getting caught doesn’t really affect when someone might cheat BehaviorShow MoreRelatedThe Doctrine Of The Divine Command Theory1237 Words   |  5 PagesThe Divine Command Theory dictates that â€Å"An act is morally required just because it is commanded by God, and immoral just because God forbids it (Shafer-Landau 65).† This view is often accepted by religious people as the basis for morality; the morality of an action is determined by whether or not it is commanded by God. However, there are multiple problems presented by this line of thinking. 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Soft determinism is a philosophical theory that opposite to Hard determinism’s conclusion that people are not accountableRead MoreDeterminism, Soft Determinism And Libertarianism982 Words   |  4 Pagesourselves since the evolutions of the human societies in thousands years, it s not correct to say that no choices are ever made by ourselves. And the key point is that most of the causal laws were found through scientific methods, but sciences has enhanced our power on predicting and even changing the progress that will result in a different end by discovering more causal laws as time passes. Soft determinism is a philosophical theory that opposite to Hard determinism’s conclusion that people are not accountableRead MoreKant And Kant s Categorical Imperative1241 Words   |  5 Pagesphilosopher, had contended that the fundamental principle of morality is the Categorical Imperative, from here will be additionally labeled as (CI) or otherwise mentioned. 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Joseph Louis-Gay Lussac free essay sample

He was the eldest son of Antoine Gay. Antoine Gay was a judge at Point-de-Norblac and had acquired the name Lussac a small family property in a nearby town. Gay Lussac received his early education in his hometown of Saint- Leonard. Since an early age, Gay-Lussac had a curious interest in science. He was very talented probably because one of his grandfathers had been an author, and a few of his relative were notable figures in France.In 1794, he was sent to Paris by his father in preparations for his further education in college. In 1797, after passing an admission examination, Gay Lussac was admitted into the University of Ecole Polytechnique. However, three years later, he was sent to Ecole des Ponts et Chaussees where he became a student and a research assistant to C. L Berthollet. Gay-Lussac was also appointed as the assistant to Antoine Francois Fourcroy in 1802. A while later, after Berthollet astonished by Lussac’s intelligence and science potential, Berthollet declared himself as the â€Å"father in science† to Gay-Lussac. We will write a custom essay sample on Joseph Louis-Gay Lussac or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page In 1809, Gay-Lussac married Genevieve-Marie-Joseph Rojot who worked in a tailor’s shop. They had five children and the eldest son, Jules, became a laboratory assistant to Justus Liebig, a close friend to Gay-Lussac. In 1807, Gay Lussac became a member of the Socite d’ Arcueil. He became a Professor of chemistry at Ecole Polytechnique in 1809. However, Gay-Lussac kept alternating from being a chemistry professor, to being a professor of physics. As a highlight of his successful career, Gay-Lussac was elected into the Haute Vienne chamber of deputies in France in 1839. Gay-Lussac was involved in numerous scientific researches and studies.His studies included capillary action, hygrometry, properties of gases, and standard measurement of alcohol content in beverages. He worked with Pierre Simon Laplace, a close French chemist, while researching the laws of capillarity. They both made publications, and also collaborated in many researches afterwards. Although Gay-Lussac is not accredited with the study of hygrometry nor the device itself, his involvement with the atmosphere prompted him to publish his ideas and observations concerning hygrometry. A formal request to Gay-Lussac to study the effects of increasing altitude on the Earth’s magnetic field took him to the skies.In 1804, together with Jean Baptiste Biot, Gay-Lussac ascended in a hydrogen balloon in order to collect data samples of air. He also had the opportunity to investigate the composition of air at various altitudes. After testing the air samples at his laboratory, he concluded that altitude was not a determining factor in the strengthening or the weakening of Earth’s magnetic field. Gay-Lussac also found out that the composition of the different gases in air to be constant at different altitudes despite the fact that he had a headache about twenty thousand feet off the ground.Gay-Lussac’s next major study was the measuring alcohol(ethanol) concentration in alcoholic beverages. He developed an alcohol by volume standard measurement by mainly using units of volume. This standard measure showed how much alcohol was contained in an alcohol beverage by dividing the amount of alcohol (ethanol) by the volume of the alcohol beverage. The result (ABV) was finally expressed as a percentage. The percent-expression proved useful globally since all kinds of capacity units (such as litres and gallons) could be used without necessary conversion.The alchol-by-volume standard measurement has been used since his times till now. Two years after his magnetic field experiment in a hydrogen balloon, Gay-Lussac discovered the relationship between the pressure and temperature of a gas while researching on the thermal expansion of gases. He noted that when the temperature of a gas was increased, the pressure increased as well. Therefore, the relationship between the two factors, temperature and pressure, was directly proportionate. For his discovered law to function properly under correct conditions, the volume of the gas had to remain the same.

The Unprincipled Family Essay Example For Students

The Unprincipled Family Essay The Unprincipled FamilyFredrickPer8Interrelated artsThe dangerous relationship of Claudius, the king, and Hamlet, the kings nephew and stepson, contain two elements that are pervasive enough to categorize it as such. Treachery and paranoia are those traits. Treachery is one of the basic unprinciples of the relationship, as is shown in the scene of the fencing match and the planning that goes around it. In a scene that relates to the planning of the match itself, the king and Laertes, a man whose family is dead because of Hamlet, have plotted the death of Hamlet through various things. All of which are to happen to Hamlet in the course of the match:King.And wager on your heads. He, being remiss,Most generous, and free from all contriving,Will not peruse the foils, so that with ease,Or with a little shuffling, you may chooseA sword unbated, and, in a pass of practice,Requite him for your father. We will write a custom essay on The Unprincipled Family specifically for you for only $16.38 $13.9/page Order now Laertes.I will dotAnd for that purpose Ill anoint my sword. I bought an unction of a mountebank,So mortal that, but dip a knife in it,Where it draws blood, no cataplasm so rare,Collected from all simples that have virtueUnder the moon, can save the thing from deathThat is but scratched withal. Ill tough my pointWith this contagion, that, if I gall him slightly,It may be death.(IV, vii, 134-148)So in fact, within this quote there are two foul plans, the use of an unbated foil, which is more than technically cheating in a fencing match, but then, adding insult, the use of a poison tipped foil. With the use of contagion and the unbated foil, Claudius and Laertes are making sure that they win. This is still not enough for them, however they move on to another backup scheme to win: a poisoned chalice:King.When in your motion you are hot and dry-As make your bouts more violent to that end-And that he calls for a drink, Ill have prepared himA chalice for the nonce, whereon but sipping,Our purpose may hold there. -(IV, vii, 157-162)Claudius introduc es a poisoned chalice, which, as the third option, or in better terms, the third method is used to kill Hamlet. After being stabbed by Hamlet, Laertes, in his final breaths pronounces the treachery of the king:Laertes.The treacherous instrument is in thy hand,Unbated and envenomed. The foul practiceHath turned itself on me. Lo, here I lie,Never to rise again. Thy mothers poisonedI can do no more. The King, the Kings to blame.(V, ii, 317-321)As Laertes states quite bluntly, the king is to blame. Claudius indirectly causes the deaths of almost everyone in the area of the match (fig.1)But that is not all. Claudius proves himself not only conniving, but also extremely paranoid. He believes (rightly) that Hamlet is out to get him. But even realizing that, he takes extreme measures. For example, in Act 3, scene 3, he dispatches Hamlet to England, with the ever-present Rosencrantz and Guildenstern. Notably, he Hamlet has done nothing to Claudius at this point; he hasnt fought, talked harsh ly, or abused him in any way. Apparently that does not matter to Mr. Guilty-Conscience , a.k.a. Claudius, who ships him off at the first sign of trouble (madness ):King.I like him not, nor stands it safe with usTo let his madness range. Therefore prepare you. I your commission will forthwith dispatch,And he to England shall along with you. The terms of our estate may not endureHazard so nears as doth hourly growOut of his brows (III, iii, 1-7)Essentially Claudius is saying, Hes nuts! Take him away (from me!) Specifically Claudius states that he does not like the madness that Hamlet expresses, and as the only logical recourse is to send Hamlet away. Even if the previous quote is too general he states it again, to this speedy voyage(III, iii, 24) another stage to his paranoia is the fact that he spies on (III, i), or has Polonius (III, iv) spy on Hamlet. The conspiracy theories finally add up until the only way he knows Hamlets out of the way is to order him killed in secret and in seclusion from Denmark (in England). This instance is best shown by the events told by Hamlet to Horatio:Hamlet.Up from my cabin,My sea gown scarfed about me, in the darkGroped I to find out them, had my desire,Fingered their packet, and in fine withdrewTo mine own room again, making so bold,My fears forgetting manners, to unsealTheir grand co mmission; where I found, Horatio-Ah, royal knavery! -an exact command,Larded with many several sorts of reasons,Importing Denmarks health, and Englands too,With, ho, such bugs and goblins in my life,That on the supervise, no leisure bated,No, not to stay the grinding of the ax,My head should be struck off. (V, ii, 12-24)Essentially, the king had Hamlet sent to England, but on arrival wanted him killed. After this quote came the fencing match. Again the excess planning was given through the paranoiac delusions of the King. .u1c7835613d3844556a54903a2a1ec573 , .u1c7835613d3844556a54903a2a1ec573 .postImageUrl , .u1c7835613d3844556a54903a2a1ec573 .centered-text-area { min-height: 80px; position: relative; } .u1c7835613d3844556a54903a2a1ec573 , .u1c7835613d3844556a54903a2a1ec573:hover , .u1c7835613d3844556a54903a2a1ec573:visited , .u1c7835613d3844556a54903a2a1ec573:active { border:0!important; } .u1c7835613d3844556a54903a2a1ec573 .clearfix:after { content: ""; display: table; clear: both; } .u1c7835613d3844556a54903a2a1ec573 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u1c7835613d3844556a54903a2a1ec573:active , .u1c7835613d3844556a54903a2a1ec573:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u1c7835613d3844556a54903a2a1ec573 .centered-text-area { width: 100%; position: relative ; } .u1c7835613d3844556a54903a2a1ec573 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u1c7835613d3844556a54903a2a1ec573 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u1c7835613d3844556a54903a2a1ec573 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u1c7835613d3844556a54903a2a1ec573:hover .ctaButton { background-color: #34495E!important; } .u1c7835613d3844556a54903a2a1ec573 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u1c7835613d3844556a54903a2a1ec573 .u1c7835613d3844556a54903a2a1ec573-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u1c7835613d3844556a54903a2a1ec573:after { content: ""; display: block; clear: both; } READ: Cheating EssayAs Hamlet and Claudius relationship progressed, the dangerous situations increased both in intensity (a progression to violence, madness) thorough confrontations, and in number. By the end of the play, their arguments become more evident as one conversation relating to the conflict happens at least once a scene. The treachery and paranoia state that danger shows the power of the most evident relationship in the play.