Words Will Never Hurt Me Essay Example

Words Will Never Hurt Me Essay Example Words Will Never Hurt Me Paper Words Will Never Hurt Me Paper One significant advance so as to dodge any sort of battle and horrendous circumstance in class is to overlook tormenting done by certain understudies. The understudies, who get into harassing others their fundamental reason for existing is to cause disappointment, stimulate outrage and squeeze others. Be that as it may, on the off chance that they don't get any reaction they basically leave it. A few understudies discover joy in driving others mad and upsetting them. Guardians and instructors impedance is an unquestionable requirement when understudies battle or menace one another. A few understudies in the class have the propensity for harassing others, utilizing injurious language, assume responsibility for power in the class, and show themselves as very virtuoso. They attempt to putdown their colleagues, insult them, bother and counterfeit to bring out annoyance. In such circumstances different understudies must find support from their educators and guardians. Guardians and educators must meddle to get the things settle down. Sally investigates in subtleties the motivation behind why a few understudies stick on harassing others. She writes in insights regarding a few different ways that children can deal with in circumstances where they’re harassed by somebody. They would simple be able to avoid prodding and deriding done by others. Sally makes some significant focuses that a few understudies may get fanatical about their religion, race and shading. She investigates the reasons that for what reason do a few understudies have such a scornful demeanor towards others. They may be desirous at something. They may be envious of the great imprints different understudies acquire, the consideration they get from the instructor, the things they forces, and they likewise have an envy among kinships with young ladies. There could be numerous reasons. Understudies get desirous at a few focuses. Sally in her book utilizes some down to earth and fun techniques as opposed to making circumstance unpleasant, strained and requesting. It isn't essential that we ought to consistently insult, censure and show outrage on understudies for not getting work the correct way. Be that as it may, what instructors must have in them is to see every single understudy and before censuring them s/he should ask understudy for what good reason it was impractical for him/her to achieve the errand. Numerous investigations show that when we make things distressing for understudies they free enthusiasm for it. It is significant that educators must take intrigue while instructing kids. It is a by and large recognizable thing that when educators take intrigue while instructing and focus on every single understudy the outcomes are significantly more productive. Creating student’s intrigue requires talented instructing. The one that makes showing a fun and energizing for understudies, it must not be a wild or weight. When understudies get intrigued, the subject itself turns into an eye catching for understudies. Simply directing understudies hardly any significant focuses isn't sufficient as most understudies can't keep their fixation concentrated on what is being said. This is on the grounds that they free intrigue. The best way to keep them intrigued is to show them down to earth way. Instructor and understudies both must be basically associated with playing out those assignments that are being educated. Essentially each and everything can be comprehended in a vastly improved manner. While examining a point or subject it is essential to investigate it for all intents and purposes. Unless we don’t do things for all intents and purposes there are numerous things left that are not satisfactory. By doing things for all intents and purposes it is simpler to remember and get acquainted with the subject of study. What's more, making some of things fun can just lift their advantage. Sally mixes her showing involvement in brain science of understudies in the homeroom and amusingness that makes study hall circumstance lovely and fascinating spot to learn. The tips and methods she tended to are valuable for instructors and study hall as well as they can be helpful for guardians and all in all for each and every individual who participates in educating and managing kids. It is a mix of mental standards and instructing methods that improves learning a lot. Boisterous attack is regular in today’s study hall. If not endured, it can bring about genuine sort of battle between the two gatherings. Sally, in Words Cannot Hurt Me, manages passionate condition of understudies who endure in class and make them mindful of a few practices they can embrace to stay away from such harassing.

Communication In Chronic Obstructive Pulmonary Disease Palliative Care Nursing Essay

Correspondence In Chronic Obstructive Pulmonary Disease Palliative Care Nursing Essay Coming up next is an assessment of improved correspondence methods in palliative consideration for patients with constant obstructive aspiratory sickness (COPD) regarding a contextual analysis. COPD is an incapacitating terminal condition that is recognized by a dynamic wind stream hindrance, principally brought about by smoking. It is typically not completely irreversible (NICE, 2010). For a wind stream deterrent to qualify, post bronchiodilation FEV1/FVC is under 0.7 ( FEV: constrained expiratory volume in one second, FVC: constrained imperative limit). The course of COPD is featured just like an ailment portrayed by a long inexplorable sickness, punctuated with extended times of handicapping windedness, decreasing activity resilience, causing intermittent medical clinic affirmations and sudden passing (Buckley, 2008). Finding of COPD isn't altogether subject to seriousness of windedness yet in addition history, physical assessment and furthermore spirometry affirmation of aviation route block (Buckley, 2008; NICE, 2010). Due to the trouble with the forecast of COPD, it presents a test for doctors and medicinal services professionals to give satisfactory consideration to patients (Curtis, 2006; NICE, 2010). Because of the idea of side effects related COPD, (for example, dyspnoea), patients more incredible COPD or related than from it (NICE, 2010) with death rate for men consistently decreased from 1970 while womens has seen a little yet consistent ascent, despite the fact that COPD mortality is on the general ascent. Buckley (2008) revealed that there was a generally higher extent, (72%) of COPD who pass on in clinic care, contrasted and 12% at home and none in hospices. Palliative Care Palliative consideration has a few definitions however has comparative ideas as per Campbell (2009). Decent (2010) rules characterize palliative consideration as dynamic all encompassing consideration of patients with cutting edge dynamic disease. Curtis (2006) characterizes palliative consideration as the objective being to forestall and soothe enduring and bolster the most ideal dependability of life for patients and their families and their families, paying little mind to the condition of ailment or the requirement for different treatments. The general point of palliative consideration is to improve the nature of care through lightening of manifestations and advancing solace over treatment as some treatment include mechanical guides which patients may discover burdening (Curtis, 2006). This has achieved the recommendation for the need of specific focuses (Curtis, 2006) taking into account how little consideration palliative consideration quality has gotten. Curtis (2006) at that point proceeded to report that there was an exceptionally low number of patients who discussed end of life care with their doctors, which can be made much progressively troublesome with loss of enthusiastic control or dread of having small preparing (Wittenberg-Lyles et al., 2008). There is likewise a requirement for patients to show more trust in their carers (Curtis, 2006). The Gold Standards Framework GSF (2006) Prognostic Indicator Guidance (PIG) records the models that would help with making an anticipation for necessity of palliative consideration as: Seriousness of infection, for example, FEV1 being under 30% anticipated Repetitive emergency clinic affirmations Long haul oxygen treatment Brevity of breath with 4/5 evaluation on the Medical Research Council (MRC) Dyspnoea scale Signs and indications of right cardiovascular breakdown Other factor, for example, non obtrusive ventilation (NIV) The GSF (2006) PIG sums up which three stages are critical to figure out which patient needs palliative consideration. They are Recognizing understanding dependent on rules Surveying needs Arranging organization The above advances are reliant on patients fulfilling ceaseless condition measures recorded before. Correspondence Correspondence is the way toward improving contemplations or data between people through various media: spoken or composed and through non-verbal communication signals (Payne et al., 2004). Buckley (2008) states that great correspondence is the way in to the conveyance of compelling strong palliative consideration benefits as it has a relational point of view that is about wellbeing experts and patients connecting inwardly (Wittenberg-Lyles et al., 2008). Conveying terrible news isn't a simple or agreeable accomplishment. The United States EPEC (Education for Physicians on End of life) is a preparation program dependent on SPIKES model (Setting, Perception, Invitation, Knowledge, Empathy, and Strategy/Summary), that has recorded strides to follow that in the conveyance of terrible news, summed up underneath: Getting ready to meet for example area setting Survey what patient thinks about condition Decide measure of data to give quiet Conveyance of news React to any inquiries from quiet as well as family Make follow up arrangement Contextual analysis: Patient profile The subject utilized for the situation study was a multi year elderly person in a nursing home who introduced as commonly calm, with long standing interminable obstructive aspiratory infection (COPD). Assent was gotten from him to take an interest in the investigation with the potential advantages disclosed to him. The subject had history of chain smoking and was determined to have heart mumbles in 1986. Long haul smoking makes the harm the lung tissues and rehashed chest contaminations (NICE, 2010) and is a significant supporter of COPD. The subject was recommended bronchodilator salbutamol 2.5mg/2.5ml nebuliser fluid unit portion vial, regulated by cover a couple of ampoules four times each day. It was utilized as and when it was required despite the fact that he didn't as a rule surpass three portions day by day. The subject had brevity of breath with essential living undertakings and reliant on staff. The subject had a few GP visits for COPD related chest diseases over the most recent a year and must be upheld by cushions in a practically upstanding situation to rest to diminish the uneasiness brought about by the dyspnoea. The subject was picked as he fulfilled a large portion of the standards from the GSF (2006) regarding brevity of breath, dependence on the bronchiodilator, a few GP visits for chest contaminations and long history of smoking. The don't revive (DNR) structures were filled in gave to the multidisciplinary group that incorporate the Ambulance administration with the family mindful. Correspondence in Palliative consideration with COPD Diverse correspondence methods were utilized when it came to managing the subject to console him and the family aptitudes for example keeping in touch, low manner of speaking is the way in to the conveyance of successful strong palliative consideration administration (Buckley, 2008). A SPIKES model methodology was utilized with the current contextual investigation. Conversation It is fundamental for medical attendants to build up a helpful relationship with patients as they interface more with the patient, utilizing procedures, for example, sympathy, investing more energy tuning in and being progressively activity (Edwards, et al 2006). Correspondence some of the time can likewise been restricted by working environment strategies or lacking preparing (Edwards, et al 2006), which raises the requirement for legitimate preparing to better these connections (Davidson et al., 2002). The current contextual analysis had the option to defeat the challenges of speaking with the patient and family as they had been there previously offering help, and consequently during the gathering to talk about the finish of life they expressed that they were happy with the advancement as a major aspect of the proceeded with care. The subject didn't appear to be content with the nebulisation treatment from the start and he communicated dread and tensions since it was another treatment, which was not bizarre (Stevens et al., 2009). Curtis (2006) study contends that social insurance for patients with COPD was regularly started proactively dependent on a formerly evolved arrangement for dealing with their ailment. The subject was given a decision on the off chance that he needed an individual from his family to be available and if the time was suitable to which he had no complaint, being sincerely useful and ready to settle on his choices (Lemmens et al. 2008). It was likewise noticed that the subject turned out to be progressively loosened up when the nebulisation treatment was disclosed to him that it would decrease the dyspnoea, rattly chest, side effects that he recognized made his breathing troublesome and different manifestations, for example, wheezing and rest aggravation. It is essential to have a reasonable area where there would be barely any unsettling influences when breaking terrible news (Stevens et al, 2009; Wittenberg-Lyle, 2006). For the situation study, the subjects family was reached so as to mastermind a gathering to examine his analysis, the path forward with respect to his treatment and control of his manifestations and furthermore make them mindful of any progressions that would should be made as far as his consideration. This managed the subject and family to be to be consoled that the patient would be made as agreeable as conceivable to reduce the manifestations of his condition through to end of life and mourning. End Palliative consideration for COPD has not gotten a lot of consideration as of not long ago. Correspondence is a significant viewpoint for exclusive expectations of care especially in end of life care. Medical caretaker to tolerant connections are significantly increasingly significant as they assume a significant job; liaising with the family and multidisciplinary group to make the finish of life as agreeable as could be expected under the circumstances. There is still a lot to be done as far as correspondence preparing for medical caretakers and furthermore getting more doctors included. The job of a multidisciplinary group is profoundly esteemed as it smoothes out the arranging and organization of palliative consideration. The current contextual analysis found that the patient was content with the way that how his consideration was arranged.

Panera Bread Company: Still Rising Fortunes? Essay

Panera Bread is a famous café that has happened from the converging of extraordinary organizations and individuals. Be that as it may, the start was really with Au Bon Pain which was begun in Boston’s Feneuil Hall as a show bread kitchen. Louis Kane was struck by this store’s development potential and bought the business in 1978. Somewhere in the range of 1978 and 1981 the organization opened 13 stores, yet therefore shut 10 of these stores, in the Boston region and had significant obligation. Ronald Shaich, an ongoing alumni from Harvard, opened the Cookie Jar in 1980 and become a close acquaintence with Louis Kane. In 1981, the companions combined the Au Bon Pain and the Cookie Jar to shape one business known as Au Bon Pain Co. Inc. The co-CEO’s had the option to bring down obligation, grow the business, and unified offices for mixture creation. In 1985, the organization added new made sandwiches to their creation when they saw client conduct of buying a roll cut down the middle and utilizing cold slices brought from home to make sandwiches. This took into account another approach to arrive at clients with quick help, at the same time remaining nutritious. Panera opened in three business fragments: organization claimed bread shop cafã © activities, establishment tasks, and new mixture tasks. The key activities of Panera’s development was centered around developing store benefit, expanding exchange and gross benefit per exchange, utilize its capital shrewdly, and set up drivers for idea separation and upper hand. During the downturn, while different organizations were bringing down evaluating and nature of merchandise, Panera was doing the inverse. The organization rather focused on client who could stand to spend a normal of $8.50 on lunch. So during 2009, the organization raised costs twice, on bagels and soups, which empowered the organization to give more to less. This demeanor likewise permitted the organization to keep up workers and consumer loyalty. By keeping work predictable with deals and proceeding to put resources into its representatives as an approach to all the more likely serve its clients. In 2009, Panera had d eals of almost $2.8 billion and was positioned as the biggest quick easygoing chain. Panera gained from its rivals, none of those contenders presently couldn't seem to make sense of the equation for Panera’s achievement. Panera has kept on adding new and energizing items to its menu and endeavor to meet the desires for its clients, and this incorporated the new breakfast sandwiches presented in 2008. The menu was updated and its menu sheets with the desire for attracting the client eye to the most elevated edge things. These new menus additionally incorporated the calorie data for things in 2010, wellâ before some other organization did as such. The organization has had the option to envision and respond to changes in food and flexibly costs, included fuel, proteins, dairy, wheat, fish, and cream cheddar in exertion to drive net benefit per exchange. Assets: When managing assets there a not many that leap out, for example, Panera’s scholarly capital, its budgetary position, and the administrators. Every one of these assets empower the organization to develop and offer support to clients while keeping up their present norms. Panera has had the option to see their organization keep on producing benefits, keep representatives working, and develop the organization. Since the organization is so acceptable to their representatives and franchisees, these workers are anxious to look after quality, which thusly prompts increasingly faithful clients. Panera understood that the key fixing was the sort of individuals behind the counter who gives the client assistance. Since the organization is looking after quality, which incorporates newness and nourishment this permits the clients to pick this easygoing inexpensive food area for a greatly improved dinner. Since the organization is doing great monetarily, they can keep growing, which prompts more employments and potential for the regions encompassing the store. This thusly empowers the organization to keep up their budgetary position and keep on putting resources into new pursuits. Capacities: Panera offers an incredible incentive on their items. This sound alternative offers various assortments which empower clients to get anything from soup to baked goods. Since patterns are continually changing, Panera works admirably in changing their menu to keep with client requests. This regularly changing menu has contributions to fulfill changing client inclinations, improve its items, and keep up client intrigue. By keeping up the client enthusiasm for its menu things Panera must keep on doing research and grow new products. As Panera doesn’t have a test kitchen, these things are rather tried these things out legitimately in the cafã ©s. The innovative work group have twice yearly withdraws that permit these colleagues to â€Å"out do† each other with their manifestations. Panera has likewise had the option to arrange the land areas so that be really favors the organization. This is additionally evident with the requesting food items and different merchandise. The greater part of these organizations will offer limits on merchandise because of the name acknowledgment andâ stability of the organization when others are falling flat. Center Competencies: When investigating center abilities Panera has demonstrated and created huge numbers of these. The objective in the first place was to sell great food with a mid-value level. Panera has since surpassed the objective and client desires in the easygoing inexpensive food classification. The organization keeps on keeping up these desires by having new batter appropriation focuses in provincial zones. This gives the item rapidly and takes into account quicker use which saves the item fresher for clients. While Panera endeavors to keep up these measures, the organization likewise connects with the encompassing network by parting with left over bread to destitute safe houses and gathers gifts for different causes. Panera additionally puts stock in giving pastry kitchen cafã © administrators the opportunity to take an interest in the accomplishment of the area, which empower the organization to draw in and keep up experienced and exceptionally qualified work force. Discoveries of Fact: Diversifying a Key to Success: Diversifying is a key part in the development that Panera has encountered. Since a franchisee is buying the utilization of the Panera name, this implies they are likewise buying the plan of action and trademark for their area. This permits the organization to develop rapidly and the franchisee contributes the assets and abilities important to actualize the Panera ideas and systems. The establishment program started in 1996, and as of December 2009 there are 795 establishment worked bread kitchen cafã ©s open all through the US and Canada. There are likewise responsibilities to open another 240 extra areas. Panera sells areas by means of the Area Development Agreements (ADAs) and the franchisee must have the option to meet monetary prerequisites set out by Panera. The vital decision point of view, which suggests that not exclusively does the organization adjust to evolving situations, yet they likewise have the chance and capacity to reshape their own condition, implies that Panera c an draw clients who can bear to spend somewhat more. By opening establishments the nation over, the organization is going after an utilitarian system by accomplishing corporate and specialty unit objects. By executing the methodology that each franchisee must open a set measure of areas inside their improvement zone can permit the organization to extend and arrive at a greaterâ amount of clients. In 2009, 57.6% of the company’s bread shop cafã ©s were claimed by establishments contained 48 establishment gatherings. Panera doesn't encourage the development or improvement of the region where an area will be manufactured. Diversifying is an incredible path for Panera to enter new markets with almost no expense to the organization. This can be seen with how Panera moved into the Canadian market. Panera went into an acknowledge office for a Canadian franchisee and in March 2010, Panera had repurchased the areas so as to be all the more straightforwardly engaged with the new Canadian market. By executing ways for franchisees to proceed to extend and produce more deals Panera would have the option to bring down a portion of the gauges set to turn into a franchisee and this would tak e into consideration more open doors for development both inside and outside of the US and Canada. Quality and Concept Different from Competitors: Confronting rivalry from various sources in its exchange region implies that Panera brings to the table something one of a kind. This implies Panera offers something else, for example, new prepared craftsman breads, new sandwiches, soups, and servings of mixed greens without agonizing over whether it was nutritious. The extraordinary feasting experience to clients, joined with nutritious food and quick assistance keep clients returning. The inviting climate, which incorporates open to seating, warm tones, and helpful areas can offer clients a superior alternative to have the option to hang out and potentially go through more cash. Panera handles this obstruction by offering claim to fame food, easygoing eating, and brisk assistance cafã ©s. Be that as it may, serious variables incorporate area, condition, client assistance, cost, and nature of items. This implies Panera vies for the best areas, hourly representatives, and clients. The corporate culture inside Panera has consistently been an assortment of convictions, desires, and qualities learned and shared by the organization representatives. This outcomes in workers endeavoring to be as well as can be expected be when offering quality assistance and items. There are contenders who have started to test the idea of â€Å"upscale† feasting, may likewise test the wellbeing and health or manageability part that could be incorporated. By having the option to keep up their center convictions, for example, no synthetic compounds or additives, the organization can take clients back to easier occasions and give great, quality food. Since Panera is capable toâ dedicate themselves to their idea the organization has delighted in brand reliability, positive name acknowledgment, and altruism. Since Panera worked on three business sections, for example,

THEATRE CH Essay

Theater CH Essay Theater CH Essay Theater is a type of workmanship that places on-screen characters before a gathering of individuals in a demonstration of commitment and disclosure about existence Showy exhibitions have occurred for a great many years and in every world culture with hardly any exemptions. The incredible social orders of Europe, China and India previously supported performance center as a methods for assembling residents to celebrate metro achievements, caution of individual blunders, or derision society’s fools. Thus, antiquated civic establishments in the East and West made sensational workmanship and stage conventions enduring hundreds of years. Quickness and nearness have separate dramatic workmanship from different types of craftsmanship. On-screen characters present themselves to their crowd in a story including strongly close to home parts of human conduct. Theater has been characterized as a method of seeing people in real life, seeing what they do and why, and the aftereffects of their activities. It very well may be said that performance center is a quick method of encountering being human. Thornton Wilder’s, The Match Maker is a case of how theater connects with on-screen characters in an extremely human tale about genuine romance. In his play it shows the course of genuine affection neglecting to run easily on the grounds that their older folks didn't support however passed them by and saw each other at any rate. Theaters living quality-it’s promptness, aliveness, spaces and observers. Theater is not quite the same as T.V, films, and so on is the live connection of the physical nearness crowd and on-screen characters. The Lion King, The Wicked, and The Addams Family are for the most part instances of redirection from genuine occasions like common distress and unfurling wars. A dramatic occasion is limited to a fixed number of seats in a solitary structure. In New York or London playhouses seat roughly 700-2,000 individuals daily. As opposed to the intelligence of advanced media, theater connects with us in a functioning and motor physical development of conduct and importance. Theater can't be duplicated in another medium, when the exhibition closes it is gone until the end of time. What’s special and debilitating is that performance center is being lost to people in the future. Theatre’s living quality on the two sides of the â€Å"footlights† separates it from its mainstream broad communications contenders. Theater matches life-speaking to our humanness in an impersonation of human facts and real factors. Theater is â€Å"alive† as on-screen characters recount to a story in quick fellowship with its crowd. Film and theater are similarly persuading in their narrating powers, however their methods of introduction are unfathomably unique. 6 ESSENTIAL PARALLELS: On-screen characters - Humanity Reenactment - Reality Practice - Discovery Act of spontaneity - Spontaneity Stage - World Crowds - Society Consistently in theater there is doubleness. The entertainers are people speaking to the playwright’s innovative articulation of our mankind and the human condition; the stage is a stage that persuades us it’s a different universe. Theatre’s doubleness-craftsmanship reflecting life, and life reflecting workmanship is another extraordinary nature of this mind boggling craftsmanship. Doubleness mirrors a feeling of life lived in front of an audience during a dramatic encounter. The crowd encounters the entertainer both as on-screen character the living nearness of another being-and anecdotal character. The Elizabethan thought of the phase as a mirror, related for what it's worth to the demonstration of seeing, can help comprehend the elements of theater and its feel. As reflected in the mirror, our mankind has shape, shading, structure, demeanor and feeling; it is even equipped for development inside the restrictions of the mirror’s outline. It is both a phase world and a fantasy of a genuine world. Theater is life’s twofold, it is a chosen reflection sorted out into stories and fictions about occasions and individuals to reveal to us something about our mankind. Theater makes dream, as we watch, that we are imparting an encounter to others just because. In theater we both trust in what's going on before us (â€Å"suspend our disbelief,† as the writer Coleridge said) and doubt in the stage-world before us. The word

Statement of purpose Essay Example | Topics and Well Written Essays - 500 words - 11

Mission statement - Essay Example This will include onto my skill as an individual from the general public in light of the fact that the family is the fundamental unit of the general public. Clinically, my quest for this program is intended to propel my insight into wellbeing evaluation. Earlier examinations and temporary positions have underscored to me the need to have the most elevated level of skill in inspecting a patient’s clinical issue so as to single out the most reasonable mediation that tends to that issue. Moreover, I look to propel my insight into inquire about strategies in nursing since I figure that as an enlisted nurture, I have an obligation to create information, share it with different medical caretakers and add to the general development and advancement of the calling of nursing (Codina 266). I look to seek after this program with an enthusiasm of enlarging the aptitudes of recognizing and using best practices in my work as a submitted enlisted nurture. The other intrigue I have in seeking after in this program is to gain information on overseeing intense and interminable diseases. I built up this enthusiasm in the wake of seeing how problematic the impacts of such ailments are to the family. A sizeable part of rare family assets goes to the consideration of incessantly sick relatives. Other than this financial effect, guardians of the constantly who need solid protections can create melancholy. My undertaking is to utilize the information I will get from this course to devise reasonable and available intercessions that can help address the monetary, social and mental cost that intense and interminable ailments have on the two patients and their families (Codina 262). It would satisfy me to see families living joyfully without being put somewhere around the affliction of one of the individuals. My worth and high regard for the nuclear family is something that legitimize my qualification for the Family Nurse Practitioner program. The clinical hours I have taken care of in the past instructive levels and in my temporary jobs have

So Long, So Long, Front Foot Leads the Back One

So Long, So Long, Front Foot Leads the Back One When we last left off, I had narrowly dodged Hurricane Ike to fly down to the Rio Grande Valley. The saga continues McAllen, Texas September 12, 2008 September 17, 2008 I spent a nice weekend in McAllen, eating some great food and hanging out in the Valley. I had cabrito for the first time, which was fantastic. I actually met up with Louann, one of my friends from Michigan, who is down there doing a Teach for America placement at one of the local high schools. Shes starting her second year, and is already teaching AP English classes. We had a great time catching up. My hotel was right next to a Tony Romas (great ribs!) and Logans Roadhouse (tasty bread). Tony Romas had a special where you could get a 3-course dinner appetizer, ribs entree, and dessert for like $15. Mmmmm. Aside from the cabrito, I didnt really get a chance to have some authentic Mexican food (which I know many would yell at me for not doing), but when Im traveling, sometimes Im just so tired that anything more than a 2-minute drive is simply too far. Anyways, after visiting a few schools, we hosted a central meeting on Wednesday, 9/17 at a place called the Echo Hotel. There was a decent-sized crowd of about 120 students, parents, and others at the meeting. There were even a few people who drove all the way down from Laredo (about 3 hours away) to attend. I got to meet 3 really cool ECs, one of whom actually teaches math at the same school that Louann teaches English! What a small world. After the meeting ended around 10pm, some of us went to Chilis (one of the few places in the area that was still open after 10). Laredo, Texas September 18, 2008 6am. The crack of dawn. I sleepily roll out of bed, eyes drooping like Droopy the Dogs cheeks. My legs feel like cement blocks. I slump into the shower, allowing the hot water to wake me up and wash the previous day off me. Feeling refreshed, I get ready, pack everything up, and check out of the hotel. 7am. After gassing up, I start my 3-hour drive up US-83, snaking along the US-Mexico border. One thing that I noticed throughout my time in South Texas (and especially on this drive) is that people generally do not like to exceed the speed limit. In fact, they like to drive 5 miles under the speed limit. I dont know if its a culture thing or if the police are extremely strict or what, but it was VERY different from Michigan or Mass. 10am. I arrive in Laredo, check in to my hotel, and head out to my meetings for the day. I get excited that this hotel actually has FOOD NETWORK (another post on my love for TV to come), but unfortunately Ill only be here for one day. 11:30am. Ive been using a GPS unit this entire time to help me get from place to place, which has (for the most part) been extremely helpful. Its like my new best friend. I even contemplated giving it a name. But in Texas, Ive run into two main problems: 1) The highways here have service roads that run parallel to them. This poses a problem when the unit cant accurately detect whether Im actually on the highway, or the service road next to it. Particularly when Im in the right lane on the highway, and it suddenly tells me to turn left off of the overpass. 2) In fast-growing cities like Laredo, the maps on the unit were severely out of date/inaccurate. In one instance, I was on the highway, and the exit I was supposed to take no longer existed. So I figured, get off at the next exit, and either turn around and go back the other way on the highway, or find my way to my destination. So I take the next exit, and all the while problem #1 is plaguing me because Im in a spaghetti-type junction, so it starts going crazy trying to figure out which road Im actually on. At this point, I actually start yelling at the thing because the voice wont stop screaming directions at me: recalculatingrecalculatingdrive 0.3 miles, then turn ridrive 200 feet, then turnrecalculatingwhen possible, make a u-turnrecalculatingrecalculating I continue on the ramp Im on (as theres basically no other choice), and finally see a sign: BRIDGE TO MEXICO. Oops. Omgomgomg what do I do. I start to pass all the signs about border policies, firearms, etc. and am furiously looking for an exit to turn around. As I approach the tollbooths, I see out of the corner of my eye this tiny sign pointing to a dirt road that says Back to U.S. I merge over 6 lanes, get on the path, and finally make my way back towards my destination. Once I get to my destination (according to my GPS), Im basically in the middle of a field. Literally. There are no buildings around. I drive until I find a church, and manage to get directions from a friendly pastor in the parking lot. I also had a scary encounter where the GPS unit almost guided me the wrong way on a four-lane, one-way highway off-ramp. After that, I made sure to download the latest map update and updated my unit. Due up next: my trip takes me to San Antonio, Austin, Seattle, and New York City. For the solution to the last posts title, you can go here. Personally, I was referring to the Chantal Kreviazuk cover, but there are plenty of great versions of that song. Can you guess where this posts title comes from? (No Googling answers!)

Hearing Loss in Patients with Down Syndrome - Free Essay Example

There is a definite correlation between children diagnosed with Down Syndrome and diagnoses of hearing loss within the same population. This correlation is important to understand, along with the disorder itself, how it effects their lives, and what the future holds for this issue. The children are actually at a larger risk for having one of the many types of hearing losses. Down syndrome is the most prevalent chromosomal disorder in the United States, which occurs every 1 out of 691 live births. (Nightengale Daniels, 2017). Down Syndrome is a trisomy chromosome disorder, so there is an extra chromosome in the nuclei of the cells. More specifically there are three Chromosome 21s, so Down syndrome is also known as Trisomy 21. Hearing loss affects anywhere from 40-80 percent of the children diagnosed with Down syndrome (Laws Hall, 2014) along with many other health issues that they could have in addition to Trisomy 21. To accompany hearing loss, they could also have trouble with a speech or language impairment (Laws Hall, 2014), intellectual disability, growth issues, and problems with their cardiac health (Kreicher Weir, 2018). The main focus will be on the hearing loss associated with Down Syndrome. There have been many studies done on this correlation, especially since the rates are so high. Future studies are needed to find out more information reg arding hearing loss, treatments, and how hearing loss relates to language development for children with Down syndrome (Laws Hall, 2014) (Hall, 2015). There have not been very many studies done in general on this topic, and more will need to be conducted to expand knowledge of this very important issue. Down syndrome is a fairly common autosomal disorder, affecting 1 in every 691 live births in the United States each year (Nightengale Daniels, 2017) and 1 in every 1,000 live births in the United Kingdom (Laws Hall, 2014). According to these statistics, it is obvious that Down syndrome is quite a bit more common in the United States than it is in the United Kingdom. This gives a good comparison to start out with to show just how large of a population hearing loss in children with Down syndrome can affect. In fact, Down syndrome is the most frequently occurring chromosomal disorder in the United States with about 6,000 babies being born each year with this disorder (Nightengale Daniels, 2017). Down syndrome is caused by nondisjunction when the oocytes or spermatocytes are going through meiosis to produce the egg or sperm, respectively. The nondisjunction causes one of the germ cells being produced to have an extra chromosome. For Down syndrome to occur, the 21st chromosome would ha ve three copies instead of the two found in a normally developing person (Laws Hall, 2014). Because of these three copies, Down syndrome is also known as Trisomy 21, which simply shows the presence of the extra chromosome. This syndrome can cause a multitude of both physical and intellectual abnormalities in a growing human being. The physical abnormalities which affect hearing abilities will be discussed later. The intellectual abilities of a child with Down syndrome range, such as their nonverbal IQ, which can range from 30 to 70 (Laws Hall, 2014). Other issues that accompany Down syndrome are risks of developmental delays and difficulties along with the other conditions, such as growth issues and cardiac problems (Laws Hall, 2014) (Kreicher Weir, 2018). Hearing loss has a large effect on those diagnosed with Down syndrome. Anywhere from 40 to 80% of people with Down syndrome are diagnosed with a hearing loss (Laws Hall, 2014). One study using auditory brain stem response to test children produced a result right in the middle of that range with 62% of children with Down syndrome having either unilateral or bilateral hearing loss (Laws Hall, 2014). The reason this issue is so common can be attributed to commonalities in children with Down syndrome that are not found in children who develop normally. These commonalities include abnormal middle ear status along with a unusual anatomical ear structure. The ears of children with Down syndrome have narrowed ear canals, which can cause a cerumen build up, leading to hearing loss. Another issue with the anatomical build could be poor function of the eustachian tube of the ear caused by hypotonia (Nightengale Daniels, 2017) (Phelan Pal, 2016). The hearing loss could be unilateral or bilat eral, though one study shows the high majority (91.1%) of children tested had bilateral hearing loss, the rest having unilateral loss of hearing (Kreicher Weir, 2018). The majority of this hearing loss is found to be conductive, with a rate of 80% of all (children with Down syndrome) with hearing loss. This diagnosis is usually secondary to a diagnosis of otitis media with effusion (OME) (Phelan Pal, 2016). The hearing loss in most children with Down syndrome are said to be conductive hearing loss, which is usually due to ear infections and OME (Laws Hall). One study found up to 78% of children with Down syndrome diagnosed with hearing loss to be conductive (Nightengale Daniels, 2017). Although other studies have found lower percentages closer to 30% of participating children with Down syndrome and hearing loss having conductive hearing loss. Sensorineural hearing loss is also seen, but not in high numbers like conductive losses. The same study that found the prevalence of conductive hearing loss to be about 30% found about the same number of children to have sensorineural hearing loss. Usually, the sensorineural type of hearing loss is seen whe n the patient also has quite severe inner ear abnormalities (Nightengale Daniels, 2017). In general, the prevalence of sensorineural hearing loss is in the range of 4 to 20% (Phelan Pal, 2016), which is lower than the percentage found in the former study. Out of those with sensorineural loss, a very small number of the patients have severe or profound hearing loss (Phelan Pal, 2016). With hearing loss in children with Down syndrome, the severity of their issues can fluctuate over their childhood (Hall, 2015). For example, in children with Down syndrome the number of patients with OME decreased from 93% of children at age one to 68% of children by the time they reached the age of five. Also, difficulties with hearing are found to have a more severe effect on 39% of children when they are two to four years old in comparison to other ages (Laws Hall, 2014). In cases of sensorineural hearing loss, children showed a higher decline of hearing abilities over time when compared to those diagnosed with conductive hearing loss (Kreicher Weir, 2018). These three statistics go to show how the hearing loss could either get worse or better over time depending on a multitude of factors. Hearing loss and language are linked even in children who develop normally. Along with language and speech development, development of the child can also be affected in the long run (Nightengale Daniels, 2017). The risks associated with hearing loss and language development are not limited to but can include learning disabilities and short-term verbal memory deficits (Laws Hall, 2014). The effects of a hearing loss do not just end here. A mild hearing loss for normally developing children can cause a lower IQ than other normally developing children who have no symptoms of a hearing loss, which could also apply to children with Down syndrome, but has not been proven yet due to limitations on the study (Kreicher Weir, 2018). Not all children can be diagnosed with a hearing loss in an efficient manner, which can lead to further issues. These late or delayed diagnoses can have huge effects on children and how they grow and mature, especially when they are already diagnosed with Down s yndrome (Nightengale Daniels, 2017). This emphasizes the importance of diagnosing early and treating the hearing loss while there is a chance of improving the childs quality of life and chance for that child to reach their highest potential. Although there is research promoting the link between hearing loss and other issues with communication for children with Down syndrome, there are other studies that say otherwise. One study says that the link between hearing ability and speech skills is inconsistent due to studies not testing children with more severe hearing losses (Laws Hall, 2014). However, the data stated above lends itself to an understanding that the two are connected even if only a few studies have been done to test the hypothesis (Hall, 2015). If this hypothesis were proven to be true, there may be more understanding about the long-term effects of hearing loss in children with Down syndrome. However, it could still be difficult for these children to receive proper treatment for their hearing loss because of their other medical issues, which could take precedence over this particular issue (Phelan Pal, 2016). The impact of hearing loss on speech and language abilities has been proven in other children, so th is can be applied to children with Down syndrome as well, making hearing loss a very large issue which can have long-term effects for these children (Nightengale Daniels, 2017). As stated before, future studies are absolutely necessary to continue education in this area of medical issues. Many people are requesting that studies be done to help the population of children with Down syndrome with the problem of hearing loss, especially concerning treatments. This research would help medical professionals to better serve this population by finding the most effective form of treatment for their diagnoses and what the outcomes of these treatments would be (Hall, 2015) (Laws Hall, 2014). The children cannot be treated effectively if there is no evidence to support hearing treatments for their issues, whatever they may be. There are current methods to treat the children, but there could always be a more effective, modern treatment that could help them even more. A different kind of study being proposed would see how the hearing abilities would affect the development of language specifically in children with Down syndrome, which is needed to show how the hearing los s can affect other areas of the childrens lives (Laws Hall, 2014). Any future study would have a positive effect on this population and how they are medically treated because with more knowledge come better care. The correlation between hearing loss and children diagnosed with Down syndrome is important to understand, along with the disorder itself, how it effects their lives, and what the future holds for this issue. To understand the reasons for hearing loss in children with this particular disorder, there must be a background of Down syndrome first, which does not need to be extensive, but instead a simple understand of what causes this disorder and how much it could affect ones life. The disorder is chromosomal in nature and caused by disjunction, resulting in an extra 21st chromosome. Hearing loss in these children can vary from none at all to profound, but it can also fluctuate as the child ages. Sensorineural and conductive hearing loss are two of the types of hearing loss, both of which can be found in children with Down syndrome. Conductive loss is suggested to be more common in this population, but some statistics contradict this belief. The studies done on this subject are few in n umber, so the results can be inconsistent. The same is true of the studies being done with the link between hearing loss and other issues seen in children diagnosed with Down syndrome. Studies done on children who develop normally propose a link between hearing loss and speech abilities, so it can be inferred the same is true of children developing with Down syndrome. There are no specific studies that prove this, but in the future, this is possible. One similarity that is proven between normally developing children and children with Down syndrome is that late intervention or diagnosis can have negative effects on the childs development. Future studies are necessary for this field of knowledge. The issues need to be tested in order to improve this issue. Some studies that are being pushed include research on treatments and even tests to predict hearing loss in order to catch the issue early on. If researchers would conduct these studies, the experience of children with Down syndrome along with a hearing loss could be improved. References Hall, A. (2015, May 01). The impact of hearing loss in children with Down syndrome. Retrieved November 14, 2018, from https://www.entandaudiologynews.com/features/audiology-features/post/the-impact-of-hearing-loss-in-children-with-down-syndrome Kreicher, K. L., Weir, F. W., Nguyen, S. A., Meyer, T. A. (2018, February). Characteristics and Progression of Hearing Loss in Children with Down Syndrome. Retrieved November 14, 2018, from https://www.jpeds.com/article/S0022-3476(17)31307-0/pdf Laws, G., Hall, A. (2014). Early hearing loss and language abilities in children with down syndrome. International Journal of Language Communication Disorders, 49(3), 333â€Å"342. https://doi.org/10.1111/1460-6984.12077 Nightengale, E., Yoon, P., Wolter-Warmerdam, K., Daniels, D., Hickey, F. (2017). Understanding hearing and hearing loss in children with down syndrome. American Journal of Audiology, 26(3), 301â€Å"308. https://doi.org/10.1044/2017pass:[_]AJA-17-0010 Phelan, E., Pal, R., Henderson, L., Green, K. M. J., Bruce, I. A. (2016). The management of children with Down syndrome and profound hearing loss. Cochlear Implants International: An Interdisciplinary Journal, 17(1), 52â€Å"57. https://doi.org/10.1179/1754762815Y.0000000019