Alzheimer’s Disease

Alzheimer's Disease does not kill instantly; it destroys the individual bit by bit, tearing away at their person-hood and self-identity. Most victims suffer for 9 to 15 years after onset of the illness. It is the most common type of dementia in the United States and Canada and after age 40, the risk of developing it doubles with aging every 5.1 years during adults' life. A form of dementia, the DSM-IV-R's (Diagnostic and Statistical Manual) criteria for diagnosing dementia include: impairment in short- and long-term memory, at least one of the following: impairment in abstract thinking, impaired judgement, other disturbances of higher cortical functioning, personality change, significant interference with work, social activities, or relationships, in addition, symptoms do not occur exclusively during the course of delirium; and specific etiologic organic factor is evidenced or can be presumed. For an individual with this terrible disease, living with memory loss and its associated disabilities are very frightening. Alzheimer's includes behavioral characteristics that extend beyond its cognitive explanations. These behaviors require study because of the influence on both the patient and caregiver. Treatment often looks to drugs for relief of symptoms and to slow the course of progressive decline, rather than on assisting the individual with coping mechanisms. It has been termed a â€Å"family disease†, not only because of possible genetic relation between victims, but because family members provide 80 percent or more of the care giving. Chronic and progressive mental and physical deterioration decrease the victim's capacity for independence and increase the need for support from family members caring for the victim at home. The victim attempts to make sense of a seemingly new and hostile world, and this leads to dubious and uncharacteristic changes in behavior, personality, decision-making, function, and mood. Certain symptoms that are often associated with depression may be observed in patients who are cognitively impaired but not depressed. Professionals must be aware of all the symptoms the patient is experiencing, and reports from family members must also be taken into account. The patient usually reports fewer negative feelings or mood problems than are identified by caregivers. Patients often attempt to cover up their disease by modifying the behaviors of others, rather than identifying their own inevitable retrogression. Fears of the unknown, fears of abandonment, lowered frustration tolerance, and loss of impulse control may result in problematic behavior. Also, appropriate behavior may simply be forgotten, and faces of family members and friends unfamiliar. However, the victim of Alzheimer's often denies these symptoms. More obvious, even to themselves are the expression of emotions such as panic and deprivation. Experiences such as early retirement and anticipated changes in the responsibilities of daily life are never realized. The inability to drive a car is especially painful and frustrating for some. Self-esteem and sense of worth plummet. Individuals with Alzheimer's lose their capability to plan, postpone, wait, or predict the outcomes of their actions. Family members very often fail to attribute losses similar to those previously mentioned to a d isease. They tend to deny the existence of the disease. Family members may go through a period of denial in which they make excuses for the patient, attributing the problems they encounter to normal aging, stress, etc. Alzheimer's disease creates new demands on the family, who have to adopt numerous roles. The parent, once the primary caregiver to their children, is now like a child receiving care. Each family member defines the situation differently, but display common management behaviors that will be discussed further. Within these similar stages of management, reflection of individual attitudes is obvious due to unique interpretations of the stages. The spouse is usually the primary caregiver of the patient, but when unable to provide the care necessary, an adult child is the most likely candidate. These adult children fear that the disease terrorizing their family and destroying a loved one will be hereditary. Negative behavior changes that are undergone by the victim have major effects on the caregiver. Mental health and life satisfaction of the caregiver seem to decrease rapidly, but according to Lisa Gwyther (1994), the key to minimizing these effects is to strategically change responses by the human and physical environment. Changing the responses of the outside world, rather than attempting to change the responses of the individual with the disease helps to organize difficult changes. Experienced spouses and wise families learn to distract the patient rather than confront them on their shortcomings. They should learn to enrich the victims' pleasure in each moment, spurring preserved memories and skills to maintain the victims' positive feelings of competence, belonging, productivity, and self-esteem. Consistent reassurance and unconditional love are vital to peace and harmony within the family. The patient experiences degeneration of short-term memory, which often results in misplacement of objects and forgetting the names of familiar people. They have irrational or imaginary fears that make them suspicious of those closest to them, and they may accuse others of theft and/or infidelity. This is a source of increased frustration, confusion, distress, and irritability on the part of both the patient and the family. As a result, those involved may rely on alcohol and drugs to alleviate the stresses of coming to terms with the disease. Many families of victims either fail to seek, or do not receive a correct medical diagnosis. They tend to become over-involved and angry, stages necessary in the process of adjustment. The family members attempt to counterweigh the losses experienced by the patient, because the deterioration is beginning to become obvious. Their anger, not necessarily with the patient, stems from the burden, embarrassment, and frustrations caused by the patient's behavior. Burden is reported to be highest in this phase of mild dementia. When the spouse is the primary caregiver (in comparison with adult children or others), care is more complete, and less stress, conflict, and ambivalence are observed. Spouses tend to look for activities, or ways of interpreting the patients behavior, that allow for a continuing adult relationship, rather than a parent- child one, which may belittle the patient. Psychological stress results from conflict between resentment, anger, ambivalence, and guilt, self-blame, and the pain of watching a loved one deteriorate. Caregivers also report physical fatigue from providing care to their regressing loved one. Of all of these, the most difficult is performing the basic daily activities for the patient, and coping with upsetting behavior. Proactive approaches towards treatment of the disease involve the conscious decision that success is possible, both for the patient and family- unfortunately this is something that most afflicted individuals realize too late. In addition, the victims of Alzheimer's may or may not respond to certain types of intervention. A patient may react to one type of treatment one minute and not the next. Immediate, observable changes in patient and family behavior, function, and mood were noted when caregivers learned to separate the resolution of the problem from the intention of the patient. For example, rather than confronting a patient or assigning blame when an object is lost, the caregiver replaces the item the patient claimed â€Å"stolen†. In this way, unnecessary stress and tension are eliminated for both patient and caregiver. Each family member experiences a similar process of coming to terms with the changes. This process includes three stages: describing how the victim is the same, and/or different, prior to disease onset, rewriting the individuality of the victim, and redefining the relationship with the victim. During the first stage, family members look for behaviors that still represent the victims' â€Å"true† self, and those that the person with Alzheimer's no longer has. In the second stage, the disease and individual with the disease must be seen as two in one. Part of the struggle in this stage is to maintain the adult identity of the victim while managing their child-like needs. Still, in the third stage of the adapting process, major problems continue to present themselves. These may include: family and social disruptions, increased marital conflicts, and employment-related difficulties. Family members are usually not aware of one-another's viewpoints; they do not understand that they are not all seeing the victim the same way. Due to the fact that they are not all having the same type of relationship with the victim, paths towards the common goal of attaining highest level of function for the victim may be divided. As a result, the more effort individual family members put into achieving this goal, the more conflict is created. However, it individuals voice their different perspectives and encourage discussion, this may allow the family to function as a complete whole. Understanding between family members can be coupled with social support groups' ideas about the disease. A social network may be effective in protecting individuals with terminal diseases from some of the negative effects. An active organization, The Alzheimer's Disease and Related Disorders Association (ADRDA) established a network of individuals and families affected with dementia. The speed at which this network is growing is clear evidence of the need for more groups like it. Information sharing, encouragement, and provision of social support are among the top objectives of such groups. A committee at the St. Louis Chapter of the Alzheimer's Association developed Project Esteem to provide emotional intervention for people with Alzheimer's in the Forgetful phase. Its purpose is to provide opportunities to share thoughts and feelings with peers and professionals, and to have some fun. It came about as two separate groups, one being individuals with Alzheimer's and the other, caregivers. Reported feelings related to dementia from both groups include: anger, anxiety, stress, acceptance, and frustration. The number of individuals who report negative feelings greatly outweigh those of acceptance. At initial meetings, bonding is established through the sharing of early memory experiences. Gradually, comfort comes from knowing that the victims are not alone; there are others with the same limitations. The realization that the victims are ordinary people with a chronic illness, rather than an uncontrollable mental illness, is comforting. Overall, the most effective coping occurs when the individual recognizes their own mental change, realizes the diagnosis, and deals with the unexpected attitudes of others. Benefits of group support in this early stage of Alzheimer's are considerable. Individuals sharing similar situations gain insight and encouragement through verbal exchange; when real world suggestions were needed, and non- verbally; when words were simply not accessible. However, as word comprehension and creation becomes increasingly difficult, the individual enters a new stage of disease development. Short-term memory, orientation, and concentration are now severely impaired. Throughout this stage, remote memory, intellectual functioning, comprehension, and judgement decline steadily. Ability to care for one's self also declines, and sleep patterns are altered; this is a severe blow to the patient's independence and self-esteem. The patient then becomes suspicious and paranoid, even of those closest to them. Likelihood of involvement in accidents at home and abuse of medication increase. Behaviors may include night wandering, night shouting, and nocturnal micturition (night- time urination). Obviously, traditional family behaviors and interactive patterns realize drastic alteration. Family members begin to feel guilty for their impatience and intolerance of the patient, even though many of the demands of the patient are unrealistic and illogical. A major problem for those closest to the patient is readjusting expectations of the patient and themselves. Changes and problematic behavior become a source of stress during this phase, but overall limitation and conflict is reported to decrease, which may simply be the result of institutionalization of the victim. Use of drugs is found to be twice as high in care-givers as in community subjects, and care-givers often let their own health deteriorate. Particularly for the spouse's caregivers, social isolation becomes an issue of psychological well being. Lack of time, energy, and interest in social activities becomes prominent as the deterioration of the patient increases. In one study, spouses of patients exhibited higher levels of stress, in comparison to adult children caregivers; but husbands, in comparison to wives, report fewer burdens, and are more willing to admit the difficulty of the tasks at hand and seek out professional help. Adult male children are as likely as women are to assist their parents, but the men appeared to have the ability to distance themselves from the aging parent. This physical and emotional separation seemed to lower the amount of guilt felt by the men. Possibly because of these differing abilities to deal with the disease, there is often conflict between family members as to how to care for the victim. Two broad coping techniques of family members of Alzheimer victims are: (1) Distancing techniques and (2) Enmeshing techniques. Distancing techniques (as discussed earlier) involve establishing distance between the patient and caregiver both emotionally and physically. Enmeshing techniques involve the intensification of the relationship, and often the exclusion of others. This option is usually observed in cases where the spouse is the primary caregiver. Apparently, it is very difficult for spouses who use the Enmeshing technique to become involved in social support groups. Social support is a proven mediator and alleviator of family stress and patient dejection. Adult day care programs provide respite for family members, and allow the patient to interact with individuals with similar conditions. Generally, the patients see the support group as being most helpful in the areas of information sharing and peer support. This information and assistance may help determine the strength of the individual in last stages of the disease. This phase is the final stage of Alzheimer's disease. Mental deterioration is complete; many patients are completely unaware of, or unable to respond to their surroundings. The patients are totally dependent on others for all aspects of daily living. The patient will, most likely, not identify family and friends, and may not communicate at all. Paranoia, agitation, and combativeness increase significantly, if the patient is able to display these emotions at all. He/she eventually becomes extremely weak, incontinent, non-ambulatory and bedridden. It has been hypothesized that at least some of the premorbid changes in strength and weakness may be predicted from changes observed in the earlier stages. Descriptions by caregivers of premorbid personality traits of the victim are similar to symptoms of depression, hallucinations, and delusions. It is during this stage that most victims are admitted to an institution for professional care. Several behavioral problems such as aggression and wandering appear to increase as individuals are moved from the community to nursing homes. Acceptance of this disturbing disease comes very slowly to the family members. The disease's sly onset and the original appearance by the victim of retention of regular physical vigor make acceptance increasingly difficult. As the disease progresses further and further, the changes that occur for the victim become increasingly obvious and family members tend to define the situation more similarly than in previous, seemingly inconspicuous stages. The grieving process is lengthy, because the death of the person is long before the death of the physical body. Although the loved one is long gone, their shell lives on. At some point during this stage, the spouse must undergo the final challenge of marital evaluation. Because the patient does not recognize anyone, the spouse is totally alone, but not single. Obtaining a divorce often creates many difficult legal issues. Many caregivers need assistance coping with the guilt of â€Å"abandoning† their spouse when placing them in a nursing home. Thus, financial problems come into the picture. Paying for nursing home services is difficult, as all effort in previous years has been put into caring for the patient. Relatives of deceased victims can be compared to those whose family member is still living. Wives and husbands display similar feelings of burden, but the husbands report more social limitations. On the contrary, sons and daughters are different in their descriptions of burden. Sons report less social limitations than daughters do, and less affective limitation when the demented parents had died. The sons of the deceased elderly also report less conflict with others than the daughters do. The need for individual support for the caregiver and family of the deceased is important, especially at this stage of sorrow. There may also be a sense of relief and release, as the extensive suffering of a loved one has finally ended. The empty body, which once contained a loved one, can finally be put to rest. Help and support from the staff at institutions with dealing with the grief of the final loss of a loved one is valuable and most definitely appreciated. Alzheimer's Disease is a ceaseless debilitating disease without known cause or cure. Deterioration of mental and physical processes is inevitable, but varies between individuals- the cause for this variance has only been looked at hypothetically. It is a terrifying disease for the victim, who is constantly aware of the losses that are occurring, but can do nothing to prevent the disease from proceeding on its deadly course. Family members respond to the disease within certain guidelines, but the attitude towards the different stages differs for all involved. Social support systems have proven extremely effective for both the victim and caregiver in the Forgetful phase of the illness. From that point on, influence on patients decreases significantly, but personal gain for caregivers continues. There is an evident need for publicly funded support for Alzheimer's disease victims and their families. The obvious lack of information concerning the symptoms and results of the disease show the necessity for incorporation of education and support into intervention strategies for caregivers. Evaluation of a patient with possible dementia requires a complete medical history, neurologic evaluation, and physical examination. At the present time, no diagnostic tests for Alzheimer's are available in laboratories. It is simply a diagnosis based on elimination of other diseases. There is great need for a biological marker that would confirm the diagnosis of Alzheimer's in a living patient. Rapid progress has been made in identifying a potential genetic marker that could be used to diagnose the disease without autopsy, biopsy, or extended evaluations. Potential disadvantages of this approach would be the reluctance of both patients and physicians to have lumbar punctures done, and the potential overlap of normal patients and Alzheimer sufferers. These potential markers are a glimpse of light at the end of a dark tunnel. Metaphorically, Alzheimer's can be seen as a house that is constantly being eaten by termites, from the inside out. Although the house may look the same on the outside, the very foundation of the house, the part that makes it a home, deteriorates. Attempts to stop the decay are futile and, at best, temporary. Eventually, one will not feel comfortable at home, and will most likely leave the home- possibly for someone else to deal with. This relief is also temporary. The eating away of the house continues, until it eventually topples into an unrecognizable heap of what used to be a home. This feeling was best described by one individual in the middle stages of the disease: â€Å"†¦(J)ust a wild lost world. I'm here but I don't know where I am†. Alzheimer’s disease Alzheimer's disease is one of most prevalent medical conditions that affect the older sector of society. More and more people continue to suffer from this disease, but at present, there is still no cure available. So what causes Alzheimer's disease? What are its effects, and are there any possible solutions for this condition? This essay would delve into the aforementioned details of Alzheimer's disease. Before the nature of Alzheimer's disease can be discussed, it is important to first define what dementia is.This is because Alzheimer's disease is identified as the most general cause behind the dementia not only in America but also throughout the world. Dementia refers to a syndrome which generally damages a person's daily functioning. This is because the memory is impaired, as well as other thinking capabilities, such as reasoning and thought organization. Even the capacity for language and sight is also affected. Due to the memory decline, simple activities become difficult and pa tients need assistance from others since they cannot take care of themselves anymore.Consequently, Alzheimer's disease is a medical condition which affects the brain; it is a disease that slowly develops, damaging one's memory and other mental processes. These include â€Å"reasoning, planning, language, and perception. † It is believed that the disease is caused by the overproduction or amassment of the protein called beta-amyloid; this protein is believed to result in the demise of nerve cells. The condition worsens as time goes by and can lead to death.The possibility of acquiring Alzheimer's disease increases as one ages, especially when one reaches the age of 70. Those who are beyond 85 years of age are most likely to be affected. However, it is important to point out that though memory loss is a normal part of aging, something as severe as Alzheimer's disease is not part of it. Alzheimer's disease was first discovered in 1906 by a German doctor named Alois Alzheimer; in 1910, the disease was officially named after him. Five years prior, Dr.Alzheimer had 51-year-old patient named Frau Auguste D. ; the symptoms of her condition include problems of speech, memory and understanding. She even began doubting her husband's loyalty for no reason at all. Her condition became worse and eventually, she died. When Dr. Alzheimer performed an autopsy, he found that the size of the brain had decreased. The most notable finding was that the cortex had significantly shrunk; the cortex is responsible for memory and speech, among other vital mental functions.When her brain was viewed in the microscope, Dr. Alzheimer discovered brain cells which are either dead or in the process of dying. There were also fat and other deposits found in the blood vessels and brain cells. The brain is composed of neurons, which are nerve cells. These neurons produce signals which are chemical and electrical in nature. The signals are transferred from one neuron to another, enabling the person to think and recall. The transmission between neurons is made possible by neurotransmitters.Those who suffer from Alzheimer's disease experience the demise of neurons; eventually, neurotransmitters are also affected, and the brain functions are completely interrupted. The autopsy that Dr. Alzheimer performed on Auguste D. revealed that the brain tissues were characterized by â€Å"clumps† and â€Å"knots† of brain cells. At present, the former is recognized as plaques, while the latter is now identified as tangles. Both are acknowledged markers of Alzheimer's disease. These two are also possible contributors in causing the brain disorder.On one hand, plaques are composed of the aforementioned beta-amyloid protein. There is still no determined reason for the death of neurons, but the said protein is believed to be responsible for it. There are three genetic mutations that are recognized as responsible for a small percentage of the early-onset type of the disease . These three are as follows: â€Å"amyloid precursor protein, presenilin 1 protein (PS1) and presenilin 2 (PS2). † The said mutations create plaques of amyloid. All three mutations are known to cause at least ten percent of all cases of Alzheimer's disease. Alzheimer’s Disease Alzheimer's Disease does not kill instantly; it destroys the individual bit by bit, tearing away at their person-hood and self-identity. Most victims suffer for 9 to 15 years after onset of the illness. It is the most common type of dementia in the United States and Canada and after age 40, the risk of developing it doubles with aging every 5.1 years during adults' life. A form of dementia, the DSM-IV-R's (Diagnostic and Statistical Manual) criteria for diagnosing dementia include: impairment in short- and long-term memory, at least one of the following: impairment in abstract thinking, impaired judgement, other disturbances of higher cortical functioning, personality change, significant interference with work, social activities, or relationships, in addition, symptoms do not occur exclusively during the course of delirium; and specific etiologic organic factor is evidenced or can be presumed. For an individual with this terrible disease, living with memory loss and its associated disabilities are very frightening. Alzheimer's includes behavioral characteristics that extend beyond its cognitive explanations. These behaviors require study because of the influence on both the patient and caregiver. Treatment often looks to drugs for relief of symptoms and to slow the course of progressive decline, rather than on assisting the individual with coping mechanisms. It has been termed a â€Å"family disease†, not only because of possible genetic relation between victims, but because family members provide 80 percent or more of the care giving. Chronic and progressive mental and physical deterioration decrease the victim's capacity for independence and increase the need for support from family members caring for the victim at home. The victim attempts to make sense of a seemingly new and hostile world, and this leads to dubious and uncharacteristic changes in behavior, personality, decision-making, function, and mood. Certain symptoms that are often associated with depression may be observed in patients who are cognitively impaired but not depressed. Professionals must be aware of all the symptoms the patient is experiencing, and reports from family members must also be taken into account. The patient usually reports fewer negative feelings or mood problems than are identified by caregivers. Patients often attempt to cover up their disease by modifying the behaviors of others, rather than identifying their own inevitable retrogression. Fears of the unknown, fears of abandonment, lowered frustration tolerance, and loss of impulse control may result in problematic behavior. Also, appropriate behavior may simply be forgotten, and faces of family members and friends unfamiliar. However, the victim of Alzheimer's often denies these symptoms. More obvious, even to themselves are the expression of emotions such as panic and deprivation. Experiences such as early retirement and anticipated changes in the responsibilities of daily life are never realized. The inability to drive a car is especially painful and frustrating for some. Self-esteem and sense of worth plummet. Individuals with Alzheimer's lose their capability to plan, postpone, wait, or predict the outcomes of their actions. Family members very often fail to attribute losses similar to those previously mentioned to a d isease. They tend to deny the existence of the disease. Family members may go through a period of denial in which they make excuses for the patient, attributing the problems they encounter to normal aging, stress, etc. Alzheimer's disease creates new demands on the family, who have to adopt numerous roles. The parent, once the primary caregiver to their children, is now like a child receiving care. Each family member defines the situation differently, but display common management behaviors that will be discussed further. Within these similar stages of management, reflection of individual attitudes is obvious due to unique interpretations of the stages. The spouse is usually the primary caregiver of the patient, but when unable to provide the care necessary, an adult child is the most likely candidate. These adult children fear that the disease terrorizing their family and destroying a loved one will be hereditary. Negative behavior changes that are undergone by the victim have major effects on the caregiver. Mental health and life satisfaction of the caregiver seem to decrease rapidly, but according to Lisa Gwyther (1994), the key to minimizing these effects is to strategically change responses by the human and physical environment. Changing the responses of the outside world, rather than attempting to change the responses of the individual with the disease helps to organize difficult changes. Experienced spouses and wise families learn to distract the patient rather than confront them on their shortcomings. They should learn to enrich the victims' pleasure in each moment, spurring preserved memories and skills to maintain the victims' positive feelings of competence, belonging, productivity, and self-esteem. Consistent reassurance and unconditional love are vital to peace and harmony within the family. The patient experiences degeneration of short-term memory, which often results in misplacement of objects and forgetting the names of familiar people. They have irrational or imaginary fears that make them suspicious of those closest to them, and they may accuse others of theft and/or infidelity. This is a source of increased frustration, confusion, distress, and irritability on the part of both the patient and the family. As a result, those involved may rely on alcohol and drugs to alleviate the stresses of coming to terms with the disease. Many families of victims either fail to seek, or do not receive a correct medical diagnosis. They tend to become over-involved and angry, stages necessary in the process of adjustment. The family members attempt to counterweigh the losses experienced by the patient, because the deterioration is beginning to become obvious. Their anger, not necessarily with the patient, stems from the burden, embarrassment, and frustrations caused by the patient's behavior. Burden is reported to be highest in this phase of mild dementia. When the spouse is the primary caregiver (in comparison with adult children or others), care is more complete, and less stress, conflict, and ambivalence are observed. Spouses tend to look for activities, or ways of interpreting the patients behavior, that allow for a continuing adult relationship, rather than a parent- child one, which may belittle the patient. Psychological stress results from conflict between resentment, anger, ambivalence, and guilt, self-blame, and the pain of watching a loved one deteriorate. Caregivers also report physical fatigue from providing care to their regressing loved one. Of all of these, the most difficult is performing the basic daily activities for the patient, and coping with upsetting behavior. Proactive approaches towards treatment of the disease involve the conscious decision that success is possible, both for the patient and family- unfortunately this is something that most afflicted individuals realize too late. In addition, the victims of Alzheimer's may or may not respond to certain types of intervention. A patient may react to one type of treatment one minute and not the next. Immediate, observable changes in patient and family behavior, function, and mood were noted when caregivers learned to separate the resolution of the problem from the intention of the patient. For example, rather than confronting a patient or assigning blame when an object is lost, the caregiver replaces the item the patient claimed â€Å"stolen†. In this way, unnecessary stress and tension are eliminated for both patient and caregiver. Each family member experiences a similar process of coming to terms with the changes. This process includes three stages: describing how the victim is the same, and/or different, prior to disease onset, rewriting the individuality of the victim, and redefining the relationship with the victim. During the first stage, family members look for behaviors that still represent the victims' â€Å"true† self, and those that the person with Alzheimer's no longer has. In the second stage, the disease and individual with the disease must be seen as two in one. Part of the struggle in this stage is to maintain the adult identity of the victim while managing their child-like needs. Still, in the third stage of the adapting process, major problems continue to present themselves. These may include: family and social disruptions, increased marital conflicts, and employment-related difficulties. Family members are usually not aware of one-another's viewpoints; they do not understand that they are not all seeing the victim the same way. Due to the fact that they are not all having the same type of relationship with the victim, paths towards the common goal of attaining highest level of function for the victim may be divided. As a result, the more effort individual family members put into achieving this goal, the more conflict is created. However, it individuals voice their different perspectives and encourage discussion, this may allow the family to function as a complete whole. Understanding between family members can be coupled with social support groups' ideas about the disease. A social network may be effective in protecting individuals with terminal diseases from some of the negative effects. An active organization, The Alzheimer's Disease and Related Disorders Association (ADRDA) established a network of individuals and families affected with dementia. The speed at which this network is growing is clear evidence of the need for more groups like it. Information sharing, encouragement, and provision of social support are among the top objectives of such groups. A committee at the St. Louis Chapter of the Alzheimer's Association developed Project Esteem to provide emotional intervention for people with Alzheimer's in the Forgetful phase. Its purpose is to provide opportunities to share thoughts and feelings with peers and professionals, and to have some fun. It came about as two separate groups, one being individuals with Alzheimer's and the other, caregivers. Reported feelings related to dementia from both groups include: anger, anxiety, stress, acceptance, and frustration. The number of individuals who report negative feelings greatly outweigh those of acceptance. At initial meetings, bonding is established through the sharing of early memory experiences. Gradually, comfort comes from knowing that the victims are not alone; there are others with the same limitations. The realization that the victims are ordinary people with a chronic illness, rather than an uncontrollable mental illness, is comforting. Overall, the most effective coping occurs when the individual recognizes their own mental change, realizes the diagnosis, and deals with the unexpected attitudes of others. Benefits of group support in this early stage of Alzheimer's are considerable. Individuals sharing similar situations gain insight and encouragement through verbal exchange; when real world suggestions were needed, and non- verbally; when words were simply not accessible. However, as word comprehension and creation becomes increasingly difficult, the individual enters a new stage of disease development. Short-term memory, orientation, and concentration are now severely impaired. Throughout this stage, remote memory, intellectual functioning, comprehension, and judgement decline steadily. Ability to care for one's self also declines, and sleep patterns are altered; this is a severe blow to the patient's independence and self-esteem. The patient then becomes suspicious and paranoid, even of those closest to them. Likelihood of involvement in accidents at home and abuse of medication increase. Behaviors may include night wandering, night shouting, and nocturnal micturition (night- time urination). Obviously, traditional family behaviors and interactive patterns realize drastic alteration. Family members begin to feel guilty for their impatience and intolerance of the patient, even though many of the demands of the patient are unrealistic and illogical. A major problem for those closest to the patient is readjusting expectations of the patient and themselves. Changes and problematic behavior become a source of stress during this phase, but overall limitation and conflict is reported to decrease, which may simply be the result of institutionalization of the victim. Use of drugs is found to be twice as high in care-givers as in community subjects, and care-givers often let their own health deteriorate. Particularly for the spouse's caregivers, social isolation becomes an issue of psychological well being. Lack of time, energy, and interest in social activities becomes prominent as the deterioration of the patient increases. In one study, spouses of patients exhibited higher levels of stress, in comparison to adult children caregivers; but husbands, in comparison to wives, report fewer burdens, and are more willing to admit the difficulty of the tasks at hand and seek out professional help. Adult male children are as likely as women are to assist their parents, but the men appeared to have the ability to distance themselves from the aging parent. This physical and emotional separation seemed to lower the amount of guilt felt by the men. Possibly because of these differing abilities to deal with the disease, there is often conflict between family members as to how to care for the victim. Two broad coping techniques of family members of Alzheimer victims are: (1) Distancing techniques and (2) Enmeshing techniques. Distancing techniques (as discussed earlier) involve establishing distance between the patient and caregiver both emotionally and physically. Enmeshing techniques involve the intensification of the relationship, and often the exclusion of others. This option is usually observed in cases where the spouse is the primary caregiver. Apparently, it is very difficult for spouses who use the Enmeshing technique to become involved in social support groups. Social support is a proven mediator and alleviator of family stress and patient dejection. Adult day care programs provide respite for family members, and allow the patient to interact with individuals with similar conditions. Generally, the patients see the support group as being most helpful in the areas of information sharing and peer support. This information and assistance may help determine the strength of the individual in last stages of the disease. This phase is the final stage of Alzheimer's disease. Mental deterioration is complete; many patients are completely unaware of, or unable to respond to their surroundings. The patients are totally dependent on others for all aspects of daily living. The patient will, most likely, not identify family and friends, and may not communicate at all. Paranoia, agitation, and combativeness increase significantly, if the patient is able to display these emotions at all. He/she eventually becomes extremely weak, incontinent, non-ambulatory and bedridden. It has been hypothesized that at least some of the premorbid changes in strength and weakness may be predicted from changes observed in the earlier stages. Descriptions by caregivers of premorbid personality traits of the victim are similar to symptoms of depression, hallucinations, and delusions. It is during this stage that most victims are admitted to an institution for professional care. Several behavioral problems such as aggression and wandering appear to increase as individuals are moved from the community to nursing homes. Acceptance of this disturbing disease comes very slowly to the family members. The disease's sly onset and the original appearance by the victim of retention of regular physical vigor make acceptance increasingly difficult. As the disease progresses further and further, the changes that occur for the victim become increasingly obvious and family members tend to define the situation more similarly than in previous, seemingly inconspicuous stages. The grieving process is lengthy, because the death of the person is long before the death of the physical body. Although the loved one is long gone, their shell lives on. At some point during this stage, the spouse must undergo the final challenge of marital evaluation. Because the patient does not recognize anyone, the spouse is totally alone, but not single. Obtaining a divorce often creates many difficult legal issues. Many caregivers need assistance coping with the guilt of â€Å"abandoning† their spouse when placing them in a nursing home. Thus, financial problems come into the picture. Paying for nursing home services is difficult, as all effort in previous years has been put into caring for the patient. Relatives of deceased victims can be compared to those whose family member is still living. Wives and husbands display similar feelings of burden, but the husbands report more social limitations. On the contrary, sons and daughters are different in their descriptions of burden. Sons report less social limitations than daughters do, and less affective limitation when the demented parents had died. The sons of the deceased elderly also report less conflict with others than the daughters do. The need for individual support for the caregiver and family of the deceased is important, especially at this stage of sorrow. There may also be a sense of relief and release, as the extensive suffering of a loved one has finally ended. The empty body, which once contained a loved one, can finally be put to rest. Help and support from the staff at institutions with dealing with the grief of the final loss of a loved one is valuable and most definitely appreciated. Alzheimer's Disease is a ceaseless debilitating disease without known cause or cure. Deterioration of mental and physical processes is inevitable, but varies between individuals- the cause for this variance has only been looked at hypothetically. It is a terrifying disease for the victim, who is constantly aware of the losses that are occurring, but can do nothing to prevent the disease from proceeding on its deadly course. Family members respond to the disease within certain guidelines, but the attitude towards the different stages differs for all involved. Social support systems have proven extremely effective for both the victim and caregiver in the Forgetful phase of the illness. From that point on, influence on patients decreases significantly, but personal gain for caregivers continues. There is an evident need for publicly funded support for Alzheimer's disease victims and their families. The obvious lack of information concerning the symptoms and results of the disease show the necessity for incorporation of education and support into intervention strategies for caregivers. Evaluation of a patient with possible dementia requires a complete medical history, neurologic evaluation, and physical examination. At the present time, no diagnostic tests for Alzheimer's are available in laboratories. It is simply a diagnosis based on elimination of other diseases. There is great need for a biological marker that would confirm the diagnosis of Alzheimer's in a living patient. Rapid progress has been made in identifying a potential genetic marker that could be used to diagnose the disease without autopsy, biopsy, or extended evaluations. Potential disadvantages of this approach would be the reluctance of both patients and physicians to have lumbar punctures done, and the potential overlap of normal patients and Alzheimer sufferers. These potential markers are a glimpse of light at the end of a dark tunnel. Metaphorically, Alzheimer's can be seen as a house that is constantly being eaten by termites, from the inside out. Although the house may look the same on the outside, the very foundation of the house, the part that makes it a home, deteriorates. Attempts to stop the decay are futile and, at best, temporary. Eventually, one will not feel comfortable at home, and will most likely leave the home- possibly for someone else to deal with. This relief is also temporary. The eating away of the house continues, until it eventually topples into an unrecognizable heap of what used to be a home. This feeling was best described by one individual in the middle stages of the disease: â€Å"†¦(J)ust a wild lost world. I'm here but I don't know where I am†.

Importance of Prayer

Importance of Prayer What is Prayer Prayer is the utterance from your spirit to God. In simple terms, talking to God is called prayer. It's the simple opening of one's heart to our Father in Heaven. It's coming to Him and telling Him everything in your heart. Then, why do we find praying so complicated? Those of us who say, ‘I don't pray because I don't know how to pray, haven't understood that prayer is just being yourself and talking to God with honesty and sincerity. When I was growing up, I found prayer very boring. It's because it just seemed like an endless stream of meaningless words to me.However, when I truly understood what prayer meant (that it's speaking to God with complete honesty, without any kind of masks or worrying about how and what you talk), my whole perspective about prayer changed. Prayer today is not a burdensome task that I have to complete everyday, but a joyful time I spend with my Lord. It's such a privilege to be able to talk to the King of Kings; t o share my innermost thoughts, my deepest desires! However, this privilege came at a price. Jesus Christ died on the cross for me, for my sins, just so that I could enter the throne of God's grace with confidence. So is it for you!What is the Importance of Prayer Drawing Nearer to God†¦ If you do not pray, if you do not talk to God, you can never learn more about who He is. To understand the Father heart of God, we need to pray. To lead a life of intimacy with God, we need to pray. In John 15:15, Jesus says He no longer calls us his servants, but calls us His friends. Moreover, in 1 Corinthians 3:9, God calls us His fellow workers. But, how can we be His fellow workers if we refuse to talk to Him? Tool to Bind Powers of Darkness†¦ Prayer is powerful and you need to remember, the words uttered in prayer have wonder-working power.Do not underestimate the power of prayer. The Devil is constantly trying to discourage us, demoralize us and weaken our faith in God. When tempted to fall into sin, pray. Prayer gives us the power to overcome. Pray gives us the strength and the faith to finish the race marked before us in this life. Prayer Changes You†¦ Why are parents so worried about the company their children are in? It's because they know the company you are in, can influence you. The influence may be positive or negative, but there sure is an influence.The more time you spend with God, the more your face will shine with the radiance of God. The more your nature will resemble the loving nature of God. Our habits and lifestyles change. We no longer live selfish lives, but love others with a pure and sincere heart. Prayer changes us from the inside, which soon gets reflected on the outside. Prayer Protects†¦ It is important to pray for God's protection on your family everyday. Pray for your parents, spouse, children every single day. Parents have the responsibility to make their kids understand the importance of prayer.Children are extremely vulner able and the choices they make during their growing up years will shape their future. Pray for God's protection upon their young lives. Prayer Heals†¦ Jesus healed the sick while He was on Earth. He also gave authority to His disciples to heal. Jesus Christ has also given each one of us who believes in Him, the authority to heal. Pray for emotional, spiritual and physical healing for yourself and for those around you. Walk towards Him and you will be healed. Prayer Brings Developments†¦ There's no point in getting frustrated. One must fast and pray.There is power in fasting and praying. Fasting and prayer is powerful. Fast and pray on a regular basis (weekly or more frequently if possible). Select a time when you have the house to yourself, so you will be free to sing and pray aloud. Start by singing a few choruses, then begin reading the Bible. After that pour your heart out to God and share your burdens openly. Then read some more from the Bible. Don't stop fasting and p raying even if you feel the breakthrough is taking too long. Continue fasting and praying. You will receive the answers to your prayers.

Wgu Kot 2

Medicare, the Uninsured, and International Healthcare Review Western Governors University Medicare, the Uninsured, and International Healthcare Review Healthcare and healthcare reform are hot topics of debate in today's society. As the population grows and life expectancy increases, the nation faces many challenges in providing healthcare benefits to the people. â€Å"According to the report, titled Income, Poverty and Health Insurance Coverage in the United States: 2010, 49. 9 million Americans or 16. 3 percent of the total US population had no health insurance in 2010.That percentage represents a slight increase on 2009’s figures, when 49 million citizens or 16. 1 percent of the population was uninsured† (Gamser, 2011). Unless there is a turnaround in their economic downfall, unemployment rate, and healthcare reform these numbers will most likely continue to increase. This paper will discuss some of these issues and how they impact two different families. The paper wi ll look at Mrs. Zwick, a 77-year-old female who was hospitalized for five days following a minor stroke and is then transferred to the skilled nursing facility for rehabilitation.Her rehabilitation is delayed 10 days into her stay due to a hospital acquired urinary tract infection. Discussion will include coverage for her medical care using Medicare Part A, Part B and Part D. Discussion will also include how the hospital acquired infection is not reimbursed by Medicare. Finally the paper will discuss how Mr. Davis, a gentleman with chronic sickle cell anemia and loses his job position due to his illness, will have the option to continue insurance coverage by way of the Consolidated Omnibus Budget Reconciliation Act (COBRA).Discussion will include two challenges that state or local government face when providing care for the uninsured with long-term or chronic illnesses. Elaboration on one of the challenges will be further described. Due to his frustrations with loss of his employmen t, healthcare coverage, and his chronic sickle cell anemia, Mr. Davis verbalizes he wish he lived in another country. Through investigation of healthcare in Great Britain, Japan, Germany, and Switzerland this paper will discuss which of these countries would best benefit Mr. Davis if you ere to become a citizen there. Mrs. Zwick was hospitalized for five days following a mild stroke, and then transferred to a skilled nursing facility for rehabilitation with projected discharge in 21 days. However it is discovered that she developed a hospital acquired urinary tract infection 10 days into her rehabilitation requires IV antibiotics to treat. The infection leads per week and unable to continue her rehabilitation until the urinary tract infection is cleared. As a result, instead of 21 days in rehabilitation she has to stay 40 days.When discharged she was giving a prescription for several medications and a walker. Her daughter inquires about the bills from other is insured with Medicare Part A, Part B and Part D and asks the nurse if she can explain the benefits to her. Medicare Part A, which is also known as hospital insurance, is usually provided free since Medicare taxes are paid into the program while working. â€Å"Part A is hospital insurance that helps cover inpatient care in hospitals, skilled nursing facility, hospice, and home health care† (Medicare. gov, n. d. ). Cherry and Jacob (2011, p. 28) states that Medicare is a federal health insurance plan for Americans 65 and older and certain disabled people. The client must be eligible for Social Security or Railroad retirement. The nurse would explain that Medicare Part A will cover the cost of the hospital stay as well as the skilled nursing and rehabilitation stay. Medicare Part B she explains is considered to be the medical insurance. This will cover services such as physician services, services and supplies that are needed to diagnose and treat her medical condition and would also cover certain pr eventative services such as flu vaccines (Medicare. ov, n. d. ). This would cover the rehabilitation services that her mother has received while in the rehabilitation center as well as the walker that was prescribed by the physician at the time of discharge. Medicare Part D is the prescription drug plan. There are various options under this portion of Medicare and depending on the one that your mother has chosen would base the amount of coverage that she would receive for prescription medications. This does not necessarily cover the full cost of the prescription medications; there are deductibles and copayments that must be met. The hospital acquired rinary tract infection that Mrs. Zwick developed during her hospital stay is not covered by Medicare. Research of an article in Medical News Today states: â€Å"Starting in 2009, Medicare, the US government's health insurance program for elderly and disabled Americans, will not cover the costs of â€Å"preventable† conditions, m istakes and infections resulting from a hospital stay. So for instance, if you are on Medicare and you pick up a hospital acquired infection while you are being treated for something that is covered by Medicare, the extra cost of treating the hospital acquired infection will no longer be paid for by Medicare.Instead, the bill will be picked up by the hospital itself since the rules don't allow the hospital to charge it to you† (Paddock, 2007). Healthcare acquired infections (HAI) not only contribute to exorbitant amounts of financial burden on the healthcare system but also attribute to staggering numbers of patient deaths. â€Å"Healthcare acquired infections (HAIs) are infections that patients contract while receiving treatment for medical and surgical conditions. The U. S. Centers for Disease Control and Prevention (CDC) estimates that HAIs contracted in U. S. ospitals account for approximately two million infections, 99,000 deaths, and an estimated $4. 5 billion in excess costs annually† (Centers for Disease Control and Prevention, 2009) More recent results show a very minuscule decline in these types of infections. It is but a mere scratch at the surface of the deeply rooted problem within our healthcare systems. There are ethical implications as well in treating Mrs. Zwick’s healthcare acquired infection. As healthcare providers, there is a duty to do no harm. Ethically we must do the right thing as an advocate for patient safety.To attain these standards the healthcare provider must diligently be cognizant of infection control measures and ways to improve current practice. Examples include strict hand hygiene, aseptic technique, and current best practice as defined by evidenced based medicine. The continuous monitoring and surveillance of all healthcare acquired infections looking for trends. Perhaps it is a specific hospital unit or employee. These identifiers will assist through education and competency in the correction and preven tion of future occurrences.Healthcare as a whole also has an ethical obligation to make known to the patient, patient families and the community these HAI’s when discovered. This paper will now focus on Mr. Davis who was terminated by his employer for extended absences due to hospitalizations from chronic sickle cell anemia. Even though Mr. Davis is unemployed his employer must offer him the opportunity to continue his healthcare benefit under the Consolidated Omnibus Budget Reconciliation Act (COBRA).COBRA requires employers with more than 20 employees to provide the employee and his family the opportunity to continue medical benefits for up to 18 months. This includes voluntary or involuntary job loss, decreased work hours, changing jobs, and various life changing events. The employee may be responsible for paying the entire premium to continue this healthcare coverage. COBRA can also impose fines of up to $110 per day to employers that fail to offer continued healthcare be nefits to the separated employee. (U. S. Department of Labor, n. d. ) Should Mr.Davis remain unemployed beyond the 18 month limit imposed by COBRA, state and local government are usually called upon to provide assistance. There are options available but often times these require months or even years to get assistance and quite frequently require the assistance of an attorney to receive benefits. Medicaid is probably the most widely known and the recommended source of state medical assistance. The Medicaid program is a federal and state grant program that used primarily for the disabled, low income families with dependent children, and people who are confined in nursing homes with low income levels.The state is responsible for setting the guidelines of eligibility for this program. Once Medicaid is approved for an individual, the coverage can be retroactive for up to three months from the time it was approved. Indigent and underinsured medical care must be funded by state and local g overnment. This challenge is usually met through taxation. Each municipality and sometimes healthcare district must budget to provide care for its citizens through state and local tax. Depending on the economic region this can present a huge challenge.For example, areas of Florida where migrant farmers are present may have to budget more for healthcare than a wealthier district such as West Palm Beach. So in reality, all working citizens pay for the indigent healthcare in their particular municipality. In Texas such budgeting and care is known as the Indigent Health Care and Treatment Act passed in 1985. This act spells out what basic services must be allowed for the indigent in each county. If more care is provided then it is the local governments’ responsibility to pay for it.Other state and local programs may include State Children's Health Insurance Program (SCHIP) which is also a state and national government run program designed for families that don't meet the minimum requirements for Medicaid due to income even though the income is still modestly below poverty level. Local and state governments may also provide other benefits such as free clinics, public health, Meals on Wheels, subsidized housing, discounted transportation services, food stamps, and free or discounted childcare for working parents.Local consumers have even pitched in by providing either free or drastically reduced prescription medications that are commonly prescribed to provide assistance during these tough economic times. Mr. Davis had mentioned in his frustration that at times he wished he lived in another country. His hope would be that healthcare would be more accessible to him. This paper will look at the healthcare system of four different countries Great Britain, Japan, Germany, and Switzerland. After a brief review of the healthcare systems in these countries this paper will focus on one country's health care system that would benefit Mr.Davis the most. Discussion of th is country's healthcare system will examine areas such as medication coverage, pre-existing conditions coverage, requirements if necessary for healthcare specialist evaluation and the access for retired people, children, and the unemployed. The healthcare system in Great Britain is considered to be socialized medicine. Basically what this means is that the citizens of Great Britain pay taxes for health care and in return the government-run National Health Service (NHS) provides and pays those funds to healthcare providers.There are no fees when a patient sees a physician since most physicians and nurses are government employees. In order to see a specialist patients must first visit there general practitioner for a referral. Physician visits are free; however there are fees for prescription medications. â€Å"Young people and the elderly are exempt from all drug co-pays† (Public Broadcast System, n. d. ). A major problem with this healthcare system according to Tanner (2008 p . 4) is the extremely long waits for healthcare and depending upon the patient's severity of illness, a procedure such as an open heart surgery for someone deemed too ill or too old by the government may be denied treatment. Switzerland has long been considered to have one of the best healthcare systems in the world. However it is not without its drawbacks. The overall cost for healthcare and Switzerland is second only to the United States. Even still is far less than what the United States spends on healthcare. All residents residing in Switzerland are required to purchase basic healthcare insurance with them three months of residency.Swiss law requires all citizens to purchase a basic package of health insurance, an individual mandate. The term basic benefits package is somewhat misleading since the required benefits are quite extensive, including inpatient and outpatient care, care for the elderly and the physically and mentally handicapped, long-term nursing home care, diagnosti c tests, prescription drugs, and complementary and alternative therapies. (Tanner, 2008 p. 25) The Swiss government does provide assistance for those that are low income and can't afford to pay the healthcare premiums.It is expected that citizens pay no more than 10% of their income on healthcare premiums. Referrals to specialists are not required by the primary care physician. There are no exclusions for pre-existing conditions. Private rooms in the hospital and dental insurance require a supplemental policy and are not covered in the basic plan. Healthcare in Germany is based primarily on two types of insurances, public and private insurance. Anyone earning a salary in Germany must have public health insurance. This public health insurance covers not only the employee of German citizenship but all nonworking dependents as well.There is no added cost for pre-existing conditions. Pregnant women are provided public health insurance for free. The premium for the insurance is around 5% of the person’s total income. Referrals are not required to see a specialist but higher co-pay may be charged. If a person opts out of the public health insurance for private insurance he cannot go back later to the public health insurance, even if income drops below the level required for private insurance (Underwood, 2009). The unemployed people are covered through a social fund which pays the physicians fee.This paper will now discuss the healthcare system in Japan. The Japan healthcare system would probably be the most beneficial for Mr. Davis of the four countries that we have researched. There are two types of healthcare insurance in Japan, National Health Insurance and Employees’ Health Insurance. Anyone who cannot afford healthcare insurance is provided with public assistance. The premium for the Employees’ Health Insurance is usually split between the employer and the employee; although there are some companies that will pay more. â€Å"Everyone in Ja pan is covered by insurance for medical and dental care and drugs.Insurers do not compete, and they all cover the same services and drugs for the same price† (Arnquist, 2009). The government decides on the fee schedule. Insurance premiums are not held or inflated for pre-existing conditions. Premiums are based on taxable income for the National Health Insurance. This insurance is for the self-employed, retirees and students. â€Å"The financial resources for unemployment benefits are covered by insurance premiums paid by employees and employers (they equally bear the amount equivalent to 0. 8% of workers' wages) and by the National Treasury† (The Ministry of Foreign Affairs of Japan, 2011).Healthcare is free for all children under the age of six. So as a result Mr. Davis would be well covered under Japan's healthcare system. Mr. Davis will have coverage for his medications, he would be able to see any specialist of his choice although a premium might be added without ha ving a referral, and there is no denial or rate increase for pre-existing conditions and the healthcare system provides for children, the unemployed and retired persons. In summation, this paper has discussed Medicaid Part A, B, and D. There is discussion on how COBRA would help Mr. Davis continue his insurance while he's out of work.There has been discussion of at least two challenges that both local and state government would face in providing care for Mr. Davis. And then finally there is some discussion of healthcare in Great Britain, Germany, Switzerland, and of course Japan which is the system that was chosen for Mr. Davis. While researching this paper it is discovered that healthcare reform is needed not only in the United States of America but throughout the entire world as well. The hope is that one day everyone will be afforded some type of healthcare coverage. References Arnquist, S. (2009, August 25). Health care abroad: Japan.Retrieved from http://www. prescriptions. blo gs. nytimes. com/2009/08/25/health-care-abroad-japan/ Centers for Disease Control and Prevention (2009, December 31). Healthcare acquired infection and prevention plan. Retrieved from http://www. cdc. gov/HAI/pdfs/stateplans/or. pdf Cherry, B. , & Jacob, S. R. (2011). Contemporary Nursing issues, trends, & management (5th ed. ). St. Louis, MO: Elsevier Mosby. Gamser, M. (2011, September 16). US Census Shows Little Change in Number of Uninsured Americans. Retrieved from http://www. globalsurance. com/blog/us-census-shows-little-change-in-number-of-uninsured-americans-420520. tml Medicare. gov (n. d. ). Medicare Benefits. Retrieved from http://www. medicare. gov/navagation/medicare-basics/medicare-benefits/part-a. aspx? AspxAutoDetectCookieSupport=1 Paddock, C. (2007, August 20). Medicare will not pay for hospital mistakes and infections, new rules. Retrieved from http://www. medicalnewstoday. com/articles/80074. php Public Broadcast System (n. d. ). Sick around the world. Retrieved f rom http://www. pbs. org/wgbh/pages/frontline/sickaroundtheworld/countries/ Tanner, M. (2008, March 18). The grass is not always greener: a look at national health care systems around the world.Retrieved from http://www. scribd. com/doc/13673626/–the–grass–is–not-always–greener–a–look–at–national–health–care-systems–around–the–world–Cato–policy–analysis–no–613– The Ministry of Foreign Affairs of Japan (2011). Second periodic report by the government of Japan under articles 16 and 17 of the international covenant on economic, social and cultural rights. Retrieved from http://www. mofa. go. jp/policy/human/econo_rep2/article9. html U. S. Department of Labor (n. d. ). Health plans & benefits, continuation of health coverage-COBRA. Retrieved from http://www. dol. gov/dol/topic/health-plans/cobra. htm Underwood, A. (2009,

The Gravity Model

Literature review Many researches and theories have been written according to the trade flows between two different zones (EU and BRICS countries). A researcher Cheney in 2008 reported that â€Å"The gravity model† is a very tangible method for empirical trade analysis that explains bilateral trade is described in trade flows in terms of the size of the trading partners (by GDPs), the distance among these countries (long distance creates additional cost on trade) and several other geographical specifications or policy aspects of any bilateral trade relationship. As these factors affect the value of trade between countries, they also affect the duration of these trade flows Prusa in 2006. Thus, we include the GDP of the destination country, the distance (in km) between Brussel, Berlin and the importer country's capital city, and various variables indicating contiguity (i.e. controlling for potential border effects), the existence of bilateral and multilateral trade agreements, EU membership of the destination market and a common language between Belgium, Germany and its trading partner (Brazil, Russian Federation, India, China and South Africa). We also control for the initial value of the export relationship in a destination to account for the initial level of confidence the trading partners originally had in the sustainability of this relationship Brenton in 2010 and to check the presented findings by Besede in 2008 that trade relations starting large last longer. The measurement of trade policy is not often changed even when the definition of trade policy is restricted to traditional tariff and non-tariff barriers to international trade.The TRAINS database of the United Nations' or the WITS database of the World Bank's are systematically exist from 1989. In totally, we can observe that measures of tariffs aremore available than measures of non-tariff barriers. (Anderson and Wincoop 2004). In some situations, there are different types of trade policy measurements: As price – we can show ad-valorem tariffs which are easy to calculate and most comparable across industries and time because they create barrier in international trade and it influences directly to the product's price. Furthermore, trade instruments such of that specific tariffs which are applied as a per-unit on imported goods. By analyzing the trade policy measurement across countries, industries and time that can effect inference about the effect of trade policies in cross-country and multi-industry researches (Harrigan and Barrow in 2009). A recent study by scholars from the  University of Kentucky College of Agriculture, Food and Environment, UK (2017) started to analyze the price of different type of chocolates in terms of consumers wants to purchase them. The research showed that online traders do not put higher cost for mixed chocolate than plain chocolate. Moreover, consumers agree to pay a premium for ordinary chocolate bars which are full of proteins and they will prefer to pay a premium for chocolate in comparison to milk chocolate according to dark chocolate's important benefits. Another interesting fact is that to produce a chocolate labeled in developing countries is less cost under the fair trade as opposed to other types of chocolate. Another author, Tracey Massey, president of Mars Chocolate (2016) stressed that for increasing our profit we have to apply newer innovation in chocolate products because of consumers' preferences. Thus, consumers love to taste new mixed products. In another tangible point, we refer to another scholar, Mr. Nielson (2016) corresponding to pricing and sales Nielson presented that chocolate as main product still covers most industry sales (88%) in the market. Hence, people buy chocolate much more during special ceremonies and holidays. In a light of another study of Mayer, which was presented in 2014, he noted that we have evaluate the level of international competition Belgian and German chocolate exporters face on each market. Firstly, we appreciate this observed level by taking into account the amount of chocolate imports from other countries (with the exception of Belgium and Germany). International competition can influence to the prolongation of the chocolate export in two levels. On the first level, countries importing a vast amount of chocolate may also import more chocolate from Belgium and Germany because of a strong preference for chocolate. On the second level, if international competition is tougher, Belgian and German exporters may see it more difficult to compete with other exporters in the market. Another important study came in 2011 by Lulia Monica from the Romanian Academy, Institute of World Economy. According to this paper, it can be seen that the relations between BRICS countries and these two developed countries is the key for the modernization on trade partnership. Thus, in recent decade the chocolate trade between both two areas have increased significantly, emphasizing the great evolution of Chinese and Russian shares on the market of Europe. In 2009, China became the third main exporter for the European market, and the main import country for Europe. After China, Russia came on the fourth place as exporting country, India the 8th and Brazil the twelfth. When it comes to the imports: China is the first import destination for Europe, Russia is the 3rd , Brazil the 9th and India the10th. As a result, this paper indicates that Belgium and Germany as EU countries is the most important trade partner for BRICS countries, both in the sector of exports and imports. Therefore, the points of this enquiry directed to analyze chocolate market share of the given countries above, the situation trade among these countries, to touch some parameters that directly affect the development of the chocolate market and to take into account trade factors in the different countries, how tariffs applied influence the level of export to BRICS countries.

Equity Theory of Motivation Essay

As the cliche goes, no man is an island. Everything man does is influenced by other men and his environment. Be it in school or at work, the reason why people persevere lies on the desire to achieve a certain goal. Hence, motivation is essential to keep the drive of doing things passionately and effectively. However, the enthusiasm to sustain the dream and keep the motivation alive can be tampered by life’s uncertainties. Given the unique characteristics that each student possess, the amount of effort exerted by an average student does not always equal the amount of effort exerted by an outlier in class, yet the results are the same or sometimes exceeded by the outlier. Perhaps there are instances when studying overnight and not studying at all yielded the same result. These situations affect the level of motivation a student harness when studying. The feeling of unfairness affects how he/she will prepare for the next exam. In the workplace setting, motivation is likewise an i mportant factor to increase productivity. For example, an employee who worked overtime to get the job well done vis-a-vis an employee who slacked off and produced a mediocre output both received the same salary and the same praises from their boss. The hardworking employee might feel wronged upon seeing how his extra effort was overlooked. To give justice to the unfairness he feels, he opts to mimic the other employee, thus also producing a mediocre output. The equity theory of motivation, developed by workplace and behavioral psychologist John Stacey Adams in 1963, is grounded on the concept that employees tend to seek equity or balance in the amount of input they give to their job or relationship with their bosses, and the output they receive. The inputs referred in this theory include college degree, hard work, effort, committment, ability, adaptability, determination, flexibility, skill, loyalty, tolerance, enthusiasm, trust in superiors, support from colleages, personal sacrifi ce and the like. On the other hand, outputs come in the form of financial benefits like salary, bonuses, and perks, and also intangible benefits such as recognition from superiors, praises, responsibility, job security, good reputation, sense of achievement, personal growth and the like. When an employee’s inputs outweigh his or her outputs, he or she becomes demotivated and unhappy. To achieve equity, the behavioral response is to balance out the input-output equation by asking for an increase in the output side, or  simply diminishing his or her input. The state of equity lie on the perception of an employee in relation to another employee’s input and output ratio, which shows that employee motivation is subjective nature. However, an employer or manager’s role of keeping employees motivated should not be deterred by this notion. Instead, understanding the sources of employee dissatisfaction and demotivation can help managers address the issues surrounding t he workplace to allow for a more productive and work-conducive environment. The equity theory is more commonly known as the social comparison theory or the inequity theory since an employee compares his input-output ratio with another employee’s input-output ratio to determine equity, and an employee who feels inequity or unfairness reduces this through his behavior and attitude towards work. The â€Å"exchange relationship† between work and compensation in comparison with a colleage draws forth discernment of what is fair and unfair. To grasp the intuition behind the theory, four objects must be present which include the person, whose aim is to reduce whatever inequity feeling he or she has; the comparison to other, which pertains to the benchmark person from whom equity and inequity is determined; the inputs and the outputs. According to the theory, a person first compares inputs and outputs with a comparison other, then determines if there is inequity or unequal input/output ratio between himself/herself and comparison other. Basically, the theory assumes that an individual addresses his/her inequity feeling after comparison to others, and remains at the level where equity is achieved. Several ways a person does in reaching equity include altering his/her inputs, altering his/her outputs, distorting his inputs and outputs cognitively, finding a new job, or changing the person of comparison. (Gogia, 2010) In line with this, Huseman, Hattfield and Miles (1987) dissected the equity theory into four basic ideas. First, the notion of fairness is conceived through comparing an individual’s input and outcomes ratio with others. The other does not necessarily require a colleage, because it can also be his/her old self. Comparing the amount of effort exerted and the amount of salary received to a colleage’s or an old job facilitates the judgment of what is fair to an individual. Second, if the compared ratios are not equal, then there is inequity. The two kinds of  inequity are underpayment inequity and overpayment inequity. Underpayment inequity happens when an individual deems that his/her ratio is smaller than others, or in other words, his great effort mismatches with the benefit received as compared to another employee. On the contrary, overpayment inequity occurs when a big compensation is received from the little effort exerted, as compared to other coworkers. Third, the greater the difference in inequity, the greater tension and distress the individual feels. The different attitudes people have toward life’s unfairness in general brought about the three kinds of equity-sensitive people namely the benevolents, the equity sensitives and the entitleds, with the benevolents being the most tolerant of underrewards, and the entitleds having the most preference of over-rewards. The equity sensitives just want their ratio to be the same with others, but the entitleds believe that the world owes them, so it is just rig htful for them to receive more. Forth, the more intense feeling of tension brought about by inequity, the harder an individual will work to restore equity. This is just like how a more oppressed victim is more thirsty he is to seek justice, if not revenge. The ways in achieving equity varies from person to person. Upon experiencing the feeling of unfairness, the assumption of this theory is that employees will find ways to reduce inequity. The two most typical ways are through behavioral options and cognitive options, where the latter is used more often used since it is both less riskier and easier to do than the former. For behavioral options, the employees change their input to match outcomes like slacking off or leaving work early, changing outcomes to match input by asking for an increase, or perpetrating a crime like theft or fraud, persuading others to change inputs by complaining to superiors, and withdrawal through tardiness, absenteeism or quitting the job. As for the cogni tive options, the employee distorts his own inputs or outcomes by underestimating his own performance so that the inputs will match the output; distort the inputs or outcomes of others by thinking that others earn more because they probably deserve it; change the comparison others by choosing a different benchmark for them to feel better. (â€Å"Motivation theories†, 2009) Applying this theory in the government office place gives a clearer understanding as to why in general, government employeees are unmotivated and unhappy with their jobs. Perhaps they have once tried to work dilligently, but only end up with having the same  across-the-board incentive as fellow workers who do not work as hard as them. Hence, the Aquino administration came up with the performance-based incentive system to allow a fair compensation to those who deserve to be rewarded. By altering the outcome through a performance-based bonus, government employees try to match their performance to the amount of bonus they wish to receive. Motivation Theories. (2009, April 26). Why Do Employees Take More Initiatives to Improve Their Performance After Co-developing Performance Measures? A Field Study (Groen, Wouters & Wilderom, 2012)  Usually, people work more conscientiously when their performances are being monitored, be it in school, at work, or even in playing games. Knowing how grades, scores or output are obtained help an individual’s goal setting and invoke the determination and commitment to achieve the said goal. What more if the employees themselves determine how they are to be rated? Having an opinion and first hand experience in developing performance measure criteria make employees not only feel valued, but also feel a sense of fairness because they know that the criteria they set are attainable and reasonable. Groen, Wouters and Wilderom (2012) conducted a field study to investigate why employees perform better when they are involved in developing peformance measures. The study used the theory of planned behavior, which states that beliefs predict how individuals behave or plan to behave. Gathering data from meetings, interviews, company information data, quantitative questionnaire and first-hand experience in the field in a beverage manufacturing company, bottling line employees were found to be more motivated, have more initiative, and more positively affected by social pressure when they were involved in developing performance measures. The  variables examined in the study included attitude towards the job, social pressure from coworkers, capability from personal skills. All these variables were found to positively and significantly influence an employee’s intiative towards his job, thus increasing his productivity. The study showed that productivity and initative of the employ ees who were aware and had a say on performance measurement criteria improved the departments’ overall performance. 7. Models of Performance-Measurement Use in Local Governments: Understanding Budgeting, Communication, and Lasting Effects (Melkers & Willoghby, 2005) Since performance measurement has been emphasized in various literatures, the importance of having them adopted and implemented is no longer debatable. Performance measurement schemes help in understanding the strengths and weaknesses of the organization, and it also serves as an objective basis of planning the budget to be used to fund government projects. The study of Melkers and Willoghby (2005) paid close attention to the usefulness of performance-based information on the operations of the local government in the US, communication, and budgetary decisions. The pervasiveness of performance measurement implementation in the US was also studied through the results obtained from a national survey of city and count y administrators and budgeters of nearly 300 governments. Multiple regression analysis was implemented to find out whether dependent variables budget effects, communication effects and lasting effects index were individually affected by independent variables community characteristics, respondent characteristics, organizational culturea and performance measurement characteristics. The results showed that although the use of performance indicators was pervasive, the respondents were apathetic with regards to the effectiveness of these performance measurements for budgetary concerns and operational processes within the government unit. Promoting the Utilization of Performance Measures in Public Organizations: An Empirical Study of Factors Affecting Adoption and Implementation (Julnes & Holzner, 2001) It is true that performance measurements are vital for making informed decisions. Both public and private firms need to be guided on a set of parameters that help them determine where they have done well and what areas need improvement. If the government departments are serious  in improving their service to the public, then coming up with a set of criteria and implementing these evaluation criteria would be essential in determining where to start the change. Despite recognizing the importance of having performance measures, there are several issues that impede the development and usage of a performance measurement scheme. The empirical study by Julnes and Holzner (2001) examined the factors that hamper the utilization of performance measurement in public organizations in the US. A sample of state and local governmen t employees were drawn from the Government Financial Officers Association, International City/County Management Association of College and University Business Officers obtained from GASB. A total of 934 questionnaires were sent to state and local government employees across the nation in 1997. The variables used in the survey included adoption and implementation for the dependent variable, and external requirements, internal requirements, internal interest groups, external interest groups, attitudes, risk taking, information, resources, goal orientation, percent unionized, government type and position. Using ordinary least square mulitple-regression analyses, the results of the study revealed that output measures were developed for various programs, but efficiency measures and outcome measures were less developed. Looking at the performance measure usage, the researchers found out that efficiency and outcome measures were less used for strategic planning, resource allocation, progra m management, monitoring and evaluation, reporting to internal management, electec officials, citizens or media. Aside from these, the researchers’ findings showed that internal requirements, external requirements, goal orientation and access to information positively and significantly affect the adoption of performance measures, while external interest groups and internal requirements positively affect implementation of performance measures, but unionization negatively affect implementation. Overall, the policy of using performance measures would more likely be adopted if it were an internal requirement wherein top management commits to the effort of evaluating government programs. On the contrary, external requirement would not automatically merit the implementation of performance measures since factors such as organizations’ ability, politician’s support, sufficient resources and commitment to the purpose were lacking if not missing. The study suggests that p ublic administrators be aware that  performance measure is a two-step process namely adoption and implementation, wherein factors affecting adoption include mostly rational and technocratic theory, while actual implementation are determined by political and cultural factors. (Julnes & Holzner, 2001) The Use of Performance Measurement Systems in the Public Sector: Effects on Performance (Spekle & Verbeeten, 2013) Performance measurement information are collected and used in various ways such as strategic planning, budgeting, and employee bonus planning. The immense benefits of measuring performance outweighs the costs of collecting such data, which is why most government agencies have already instilled in their system a peformance measurement mechanism for reference. In the study of Spekle and Verbeeten (2013), the researchers explored whether the pefromance measurement system actually improves or deters organizational performance. They also introduced the concept of contractibility, which means clear goals, undistorted pefromance metrics, managers’ knowledge and control of the transformation process. Public sector organizations that have high contractibility were expected to be better than those organizations with low contractibilty in terms of performance. The test was d one through a survey of 101 public sector organizations in the US. The results showed that contractibility influences the way incentive-oriented use of the performance measurement system and performance. More interestingly, the researchers concluded that usign the performance measurement system for incentive purposes negatively influences organizational performance, unless contractibility is high. Disregarding contractibility, performance measurement system tends to enhance performance. Hence, the effect of the performance measurement system in public sector organizations are greatly affected by the level of contractibility and managers’ usage of the system. Determinants of Incentive Intensity in Group-Based Rewards (Zenger & Marshall, 2000) Key Performance Indicators (KPIs) in the Public Sector: A Study in Malaysia. Economic Incentives and the Choice of State Government Accounting Practices (Ingram, 1984)

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Public International Law as a Branch of Ethics Assignment

Public International Law as a Branch of Ethics - Assignment Example The vital question that needs to be answered in the given context is as to whether public international law is simply a branch of ethics or the concept has a distinct legal character? The fact that must be understood here is that there exists very little divergence between the ethics and the law is it in a local or international context. In such a scenario, public international law is an institution that has strong ethical moorings and an effective and pragmatic legal character. Devoid of ethics, the public international law will be a tool serving the more powerful. Sans a legal character, public international law will be some sort of international diplomatic luxury. Hence, to be effective, the public international needs to rest on the twin pillars of ethical sanctity and legal force. Law stands to be a rule or general principle that has significance and acceptance in a specific domain and is enforceable by an authority. Ethics pertain to the general aspects of morals and the particular moral choices to be made by an individual, community or a nation, which are not enforceable by any authority. Going by these definitions, there certainly exists a relation between ethics and the law. The power of law rests on an agreement between the individuals, institutions, and nations that they will abide by an acceptable and just code of conduct in their association and relationship with each other. Hence, law constitutes the fundamental foundation of any viable community, be it local or international. It can only sustain itself as a pragmatic institution if the involved parties abide by it and agree to respect its outcome and sanctity and respect the institutions and organizations divested with the power to enforce the law. The notion that encourages the individuals, organiza tions and nations to abide by and respect law is their acceptance and understanding of the fact that the institutions designed by them to enforce and administer law will do so in a just and upright manner, without resorting to any impropriety, that is in an ethical manner.

How can Artificial Intelligence enhance life in the 21st century. Are Essay

How can Artificial Intelligence enhance life in the 21st century. Are there any drawbacks If so, what are they, and how can they be overcome - Essay Example AI can be widely applied at privet homes for personal assistance. The more work is done by machines the less work is required by humans. As the result, the number of injuries and work-related stress are reduced. The debate over the need to apply AI in everyday life will persist for many years; however, the advantages offered by AI exceed all possible drawbacks. Only twenty years ago scientists did not dare to imagine computers understanding the human speech, while today the speech recognition programs are widely used. People are able to work with computers and mobile phones by talking to technology. AI made technology usable by people with disabilities, for example. The vision programs made it possible to develop robots that can see and talk. Such robots are already used for exploration purposes. AT is applied to teaching programs; impersonal software is able to adapt to its users. The capabilities of machines are infinite and the future of it is positive and optimistic. The strongest argument against AI is that machines are dead and, therefore, cannot possess intelligence. However, AI is no longer a myth and humans have already created numerous intelligent machines to help in everyday life. The "honorable" mission of AI is not supported globally. "Within a few decades, computers and robots will be cleverer than us and we won't date to unplug them, while the new biotechnologies could transform our species" (Tudge, 2000, p. 23). Humans will not give up the science because they are in need of high tech for day-to-day survival. Undoubtedly, the human brain differs from computers in complexity and quality. Half a century ago, it did not matter whether computers would be conscious or intelligent. Nevertheless, today computers already have calculating power, endless patience, and bottomless memory. With the added consciousness and emotions, computers might become formidable. The main problem with the Artificial Intelligence is the fear that it may turn against the humans. AI has enormous learning capability and can accomplish many complex tasks that humans cannot. "By 2010, computers are expected to match computational capabilities of the human brain, an estimated 3,200,000 instructions per second" (Molitor, 2003, p. 65). Computers, ranging from massive supercomputers to PCs, offer wide range of services that make human life more interesting: cable TV, teleconferencing, electronic fund transfer systems, shopping without leaving the house, magazines on video, automatic home security services, special services for the people with disabilities, etc. This list has no end. The supercomputer developed by IBM beat the chess-player master Garry Kasparov in 1995 and laid the foundation for concerns on reasoning powers and learning potentials of machines. Problems that required teams of people working many years to solve can be solved by AI in a couple of seconds. Voice recognition, in particular, has achieved a 10,000 word-capacity with 98% accuracy (Molitor, 2003, p