Healthcare Factors behind Cost Curve and Supply Curve Coursework

Healthcare Factors behind Cost Curve and Supply Curve - Coursework Example The recent scare globally is the threat of ebola, which needs special attention from the healthcare providers. Hospitals need to be ready for such emergencies to ensure safety of all citizens in the country. Secondly, affordability of healthcare services to most citizens remains to be a great issue that the federal government seeks to address. The cost of medical care continues to shoot day by day. The amounts allocated in the federal budget every financial year continues to rise despite various interventions to this sector. From the report that was recently issued by the government, it predicted that the entire spending of this sector will be close to 20 percent of the GDP by the year 2016. Policymakers have largely questioned this because increase costs does not reflect better, and quality services in these hospitals (Hicks, 2014). Further, the sector has vowed to eliminate both racial and ethnic disparities in their institutions. Trainings to all members of staff operating in these hospitals has been enhanced in oder to ensure performance excellence and improved healthcare services to all in the country. I totally agree with her arguments and findings. For instance, with the implementation of the Affordable Care Act, every citizen and employee in this industry is expected to have an insurance cover. However, most people who are insured are seeking medical care from these hospitals leading to strain on the available resources. Hence, this directly affects the cost curves. To some extend, people who are insured are normally charged slightly higher in these hospitals. Another issue that has been addressed in her essay is the number of taskforce operating in rural hospitals in the country. Generally, there is a shortage, and the federal government has to address this issue by employing more staff to work in these hospitals. Most of these hospitals operating in these areas experience a lot of pressure due to

'To what extent is the study of the self relevant to social care work' Essay

'To what extent is the study of the self relevant to social care work' - Essay Example These three are the core pillars that a person should always put into consideration in establishing an effective community involvement. The importance of knowing the reflexive consciousness aspect is that it covers self awareness, self knowledge and self esteem. These three creates a doorway for a person to see the outline of his personal being before engaging into inter-personal activity like social work. First self awareness and self knowledge provides a person a clear blue print of his strengths and weaknesses that as a result, provides a strong self conceptualization. The main goal here is for self enhancement which is very important to achieve self esteem whenever a person will engage in a social work. Confident to relate with other can be acquired if a person knows that he will be effective enough to handle social situations. It is a matter of getting into the public, so a person’s knowledge of his â€Å"self† creates a path or direction on how to bridge to the public. The next thing that follows in understanding self is the interpersonal and social capabilities that are achieved in effectively knowing your â€Å"self†. At this point, what is important is to how you can cater with the social world. This is dealing with other people, so self enhancement will now come from the feed back that a person could get from the people. This is a matter of presenting â€Å"self† to the society which is the core rule of social and interpersonal being. In developing social and interpersonal skill, a person will be guided by the concept of knowing what the society and culture of the society wants, thus gathering impressions from the social world. Competence in dealing with others is on the basis of the impression management which is an external factor. At the end, the most important part which establishes the relationship between self and social work is when a person will be doing his function as social care agent which requires self

Criticism on the Novel Essay Example for Free

Criticism on the Novel Essay Nature setting are explicit Page 30: When I was about fifteen years old we had retired to our house near Belrive, when we witnessed a most violent and terrible thunderstorm. It advanced from behind the mountains of Jura, and the thunder burst at once with frightful loudness from various quarters of the heavens. I remained with curiosity and delight. As I stood at the door, on a beautiful oak which stood about twenty yards from our house; and so soon as the dazzling light vanished, the oak had disappeared, and nothing remained but a blasted stump. [] It was not splintered from the shock, but entirely reduced to thin ribbons of wood. Foreshadowing?: power of electricity sparks his attention, if it can destroy something so quickly, why cant it bring dead flesh to life? Scientific descriptions lack important information Page 48: It was already one in the morning; the rain pattered dismally against the panes, and my candle was nearly burnt out, when, by the glimmer of the half-extinguished light, I saw the dull yellow eye of the creature open; it breathed hard, and a convulsive motion agitated its limbs. We see how she was a poet in this quote: she gives more descriptions of the surroundings than the scientific aspect of which many people long for. Obviously shows the lack of knowledge displayed by Mary Shelly. Countries are close together Shows once again how much knowledge Mary Shelly had regarding geography. It sparks attention when she says that it takes longer to go from Geneva to Ingolstadt (a total of 413.6 miles) than it is to go to England. Monster has superhuman abilities yet he is made from human parts Page 70: I thought of pursuing the devil, but it would have been in vain, for another flash discovered him to me hanging among the rocks of the nearly perpendicular ascent of Mont Saleve, a hill that bounds Plainpalais on the south. He soon reached the summit and disappeared. Stereotyping of the Turkish and Irish people If Frankenstein had already created a monster, why did he need help from some other scientists for the creation of another monster? Page 153: I found that I could not compose a female without again devoting several months to profound study and laborious disquisition. I had heard of some discoveries having been made by an English philosopher, he knowledge of which was material to my success [] The Monster tells Frankenstein how hes survived mobs throwing rocks and several other projectiles and such, yet Frankenstein never stops trying to think he can kill the monster. Page 206: [] the monster whom I had created, the miserable demon whom I had sent abroad into the world for my destruction. I was possessed by a maddening rage when I thought of him, and desired and ardently prayed that I might have him within my grasp to wreak a great and signal revenge on his cursed head. All quotes from Mary Shelleys Frankenstein

Research into the history of klinefelters syndrome

Research into the history of klinefelters syndrome Many chromosomal abnormalities occur early in development and involve the sex chromosomes. Klinefelters Syndrome falls directly into this category. Klinefelters Syndrome is a genetic condition affecting the male population. The following information observes who discovered Klinefelters Syndrome and when it was first diagnosed. The etiology or genetic and environmental factors of the condition are discussed as well as complete description of the disability and the clear diagnostic criteria. The affects of Klinefelters Syndrome are more recognized in adulthood, when it is typically diagnosed. Many Klinefelters patients live out their entire lives without ever knowing they have the condition. Upon conclusion, there should be an adequate amount of information that will give you, the reader, valuable knowledge into the diagnosis and treatment of Klinefelters Syndrome. History Klinefelters Syndrome was first diagnosed in 1942 at the Massachusetts General Hospital in Boston Massachusetts (Schoenstadt, 2006). Dr. Harry Klinefelter was completing his fellowship at the Massachusetts General Hospital when he was assigned to work with Dr. Fuller Albright, also known as the father of endocrinology (Bock, 1993; Klinefelter Syndrome, 2006). Dr. Klinefelter came to examine nine adult men that had a common set of symptoms during the course of his fellowship (Klinefelter Syndrome, 2006). Dr. Klinefelter organized a case study that involved these nine men and their similarities and was encouraged by Dr. Albright to lead the study (Klinefelter Synrome, 2006). The Journal of Clinical Endocrinology was published in November of 1942 with the completed case study of these nine mens similar qualities, which Dr. Klinefelter identified as Klinefelters Syndrome (Klinefelter Syndrome, 2006). The report written by Dr. Klinefelter on these men described them as having testicular dysgenesis, elevated urinary gonadotropins, eunuchoidism, azoospermia, and gynecomastia, all of which have an effect on the underdeveloped size of the testes, the lack of the amount of testosterone produced by the testes, and infertility (Schoenstadt, 2006; Visootsak Graham, 2006). These adult males also exhibit enlarged breast and sparse facial hair (Schoenstadt, 2006). Two groups found out fourteen years after Dr. Klinefelters original description of the syndrome, that the buccal mucosal cells contained an extra chromatin mass or that the cells were chromatin positive (Klinefelter, 1966). Although the patients were described as having a positive female sex chromatin, Dr. Klinefelter states that the patients are phenotypic males and should never be considered otherwise (Klinefelter, 1996). Fourteen years after Dr. Klinefelter first diagnosed Klinefelters Syndrome, another case study was performed to further understand the characteristics that define the condition (Klinefelter Syndrome, 2006). In 1956, Dr. Joe Hin Tjio and Dr. Albert Lavan took the research further to determine the factors that made those men with Klinefelters Syndrome dissimilar from normal adult males through genetic research (Klinefelter Syndrome, 2006; Schoenstadt, 2006). With the advanced experimental methodology available, Dr. Joe Hin Tjio and Dr. Albert Lavan found that humans had 23 pairs of chromosomes, confirming 46 chromosomes, which prior to this time there was thought to be 48 chromosomes (Bock, 1993; Klinefelter Syndrome, 2006). This clarification by Dr. Tjio and Dr. Lavan is the basic foundation for modern cytogenetics, the study of chromosomes and diseases originating from numerical or structural abnormalities in chromosomes (Klinefelter Syndrome, 2006). Dr. Tjio and Dr. Lavan discovered that men with symptoms of Klinefelters Syndrome had an extra sex chromosome that created the chromosomal arrangement of XXY, which is distinct to the normal male chromosomal arrangement of XY (Klinefelter Syndrome, 2006; Schoenstadt, 2006,). Klinefelter Syndrome was still believed to be an endocrine disorder of unknown etiology at this time (Visootsak Graham, 2006). In 1959, just three years after Dr. Tjio and Dr. Lavan made their historical discoveries, an English researcher by the name of Dr. Patricia Jacobs and her associate Dr. J. A. Strong published a study supplementing earlier studies (Klinefelter Syndrome, 2006; Noble, 2003). Dr. Jacobs and Dr. Strong found the link between the endocrinal disease and the extra X sex chromosome (Noble, 2003). Dr. Jacobs linked forty-seven chromosomes in Klinefelters Syndrome males and determined it to be the X chromosome, which she considered an aneuploidy defined as an unusual number of chromosomes and labeled 47, XXY (Bock, 1993; Klinefelter Syndrome, 2006; Schoenstadt, 2006). The 1970s brought forth a larger examination of males born with Klinefelters Syndrome (Bock, 1993). During this time doctors began screening newborn male babies for the extra chromosome (Bock, 1993; Visootsak Graham, 2006). The most significant of the studies done at this time was sponsored by the National Institute of Child Health and Human Development (NICHD) whom examined over forty thousand infants for this extra chromosome (Bock, 1993; Visootsak Graham, 2006). This study was important for the reason that most studies done prior to the 1970s were biased and primarily done on adult males in mental institutions and the penal system (Visootsak Graham, 2006). At this time is when the prevalence of Klinefelters Syndrome was noticed as frequently as one in five hundred to one in one thousand male newborns (Bock, 1993; Visootsak Graham, 2006). Also observed in this study was the reduction in speech and language abilities as well as decreased reading and spelling achievement (Bock, 1993; Visootsak Graham, 2006). Along with these disabilities, Klinefelters patients are characterized by an increased tendency towards fertility, endocrinal, and psychiatric disorders (Noble, 2003). This study demonstrated that most but not all of these males born with the extra chromosome will have these characteristics, and many demonstrate varying degrees of the characteristics (Bock, 1993; Visootsak Graham, 2006). Based on this research it has been found that the extra X chromosome that causes Klinefelters Syndrome is very common, however, the symptoms and characteristics that are most recognizable are quit uncommon (B ock, 1993). Most males are not diagnosed as having Klinefelters Syndrome until they reach adulthood, and many that have the syndrome are never diagnosed as having this chromosomal defect at all (Bock, 1993). One pediatrician at the University of Colorado Medical School in Denver and the director of the National Institute of Child Health and Human Development (NICHD) during the major screening research referred to these newborn males as not having Klinefelters Syndrome because of the possibility that the characteristics may not develop into a syndrome (Bock, 1993; Visootsak Graham, 2006). Etiology and Genetic Factors Every normal human cell has 46 chromosomes that are made up of 23 pairs (Stewart, 2007). Of these 23 pairs, there are 22 that are exactly the same in both males and females called autosomes (U.S. National Library of Medicine, 2010). The 23rd pair of sex chromosomes is what makes males and females different in that the male will have only one X and Y chromosome whereas the female will have two copies of the X chromosome (Stewart, 2007; U.S. National Library of Medicine, 2010). During the formation of the egg and the sperm, or gametes, the chromosomes are halved through a process called meiosis (Stewart, 2007; The Dorsey, 2009). Cells that carry a single chromosome such as the X or Y chromosome are called haploid cells (The Dorsey, 2009). When the egg and sperm join carrying 23 chromosomes each they create the fertile egg, or zygote, which has two haploid sets of chromosomes (The Dorsey, 2009). Therefore, the baby receives two copies of each chromosome, 46 total chromosomes, just like the parents (Stewart, 2007). The extra X in Klinefelter Syndrome is caused from either nondisjunction or anaphase lag. Nondisjunction occurs when the chromosome pairs do not separate as they are intended in the meiosis I or meiosis II stage (Pineyard Zipf, 2003; Stewart, 2007). When this happens there may be a chromosome pair with 24 chromosomes instead of the 23 chromosomes (Stewart, 2007). If this chromosome pair of 24 joins with an egg or sperm with 23 chromosomes then it results in a karotype with 47 chromosomes (Stewart, 2007). In this case there will be three copies of chromosomes rather than the usual two copies of chromosomes (Stewart, 2007). The sperm or egg may donate the extra X chromosome at conception causing a chromosomal abnormality (Mayo Foundation for Medical Education and Research, 2008; Stewart, 2007). This forms the XXY chromosomal formation, which is diagnosed as Klinefelters Syndrome. At least half of 47, XXY conceptions are spontaneously aborted (Pineyard Zipf, 2003). The chromosomal abnormality is random and not known to be caused by any environmental factors (Genetic Science Learning Center, 2010; Mayo Foundation for Medical Education and Research, 2008; National Institute of Health, 2007). This anomaly happens entirely by chance and is unrelated to family history prior to the male childs birth (Mayo Foundation for Medical Education and Research, 2008). This is to say that the male embryos likelihood of being born with Klinefelters Syndrome is not increased or decreased by what the parent does or does not do (Mayo Foundation for Medical Education and Research, 2008). Klinefelters Syndrome is not affected by race (Chen, 2010). This is a completely random occurrence of the sex chromosomes not successfully separating during the formation of the egg or the sperm (Genetic Science Learning Center, 2010). Once this occurs the extra chromosome is then copied into every cell of the embryo (Genetics Science Learning Center, 2008). There are extremely rare cases when there may be three or four extra X chromosomes in all copies of the cells known as 48,XXXY or 49, XXXXY (Stewart, 2007). The 49, XXXXY mosaic is also known as Fraccaros Syndrome and is the most rare form of Klinefelters Syndrome (Duenas et al., 2007). This rare chromosomal abnormality results in more exaggerated features of Klinefelters Syndrome (Stewart, 2007). There are instances where an extra X chromosome is found in only some of the cells (Stewart, 2007). This can be found as two different chromosomal patterns (Stewart, 2007). One pattern occurs when some cells have 46 chromosomes and some have 47 chromosomes (Stewart, 2007). The other pattern is called the mosaic XXY syndrome, or chromosomal mosaicism, and affects approximately six percent of these cases, with the most rare cases being the 48, XXXY or the 49, XXXXY, or other arrangements of X chromosomes (Stewart, 2007). The mosaic XXY syndrome occurs only after conception from a mistake in cell division (Stewart, 2007). Anaphase lag is a result of a gamete lacking a sex chromosome (Klinefelter, 1966). When this chromosome lags it is not incorporated into the new cell during the mitosis stage (Kinefelter, 1996). Anaphase lag is thought to be a reason for the mosaic variations of Klinefelters Syndrome (Klinefelter, 1966). Although the chromosomal abnormality of 49, XXXXY is considered to be a variant form of Klinefelters Syndrome, it appears to have a very independent, distinct phenotype (Duenas et al., 2007). Males that show the 49, XXXXY chromosomal structure have much more severe clinical features than that of a Klinefelters Syndrome male (Duenas et al., 2007). This is the most rare of the Klinefelters Syndrome variants and has been reported in over one hundred cases with the frequency being approximately 1 in 85,000 newborn males (Duenas et al., 2007). There have been reports of an even more extreme variant of Klinefelters Syndrome mosaic in newborn males (Duenas et al., 2007). This variant is a 47, XXY/48, XXXY/49, XXXXY mosaicism and has only been reported in three cases according to a researcher in Mexico (Duenas et al., 2007). This means that the male newborn would have the whole spectrum of XY variations. Another variant that affects only males is the 46, XX chromosomal variation (Bock, 1993). This condition occurs when individuals have two X chromosomes in each cell, but are male in appearance. These individuals have male external geniltalia. These individuals also have small, undescended testes possibly along with an urethra opening on the underside of the penis. A small amount of 46, XX Males have external geniltalia that dont clearly resemble either male or female genitalia. These individuals are typically raised male. Phenotypically, there are three groups of these sex-reversed individuals. The first group includes phenotypically normal XX Males, the second group includes the males with genital ambiguities, and the third group is the true hermaphrodites (Bock, 1993). Description of Characteristics or Traits Klinefelters Syndrome has only one constant physical description and that is the small testicular size (Visootsak Graham, 2003). Boys with Klinefelters Syndrome have variable phenotypic characteristics with no obvious facial dysmorphology (Visootsak Graham, 2003). The presence of gynconemastia, or enlarged breast, and other findings of eunuchoid body habits and sparse body hair vary (Visootsak Graham, 2003). Eunuchoid or eunuchoidism is defined as an abnormal condition in males, characterized by underdeveloped reproductive organs with some female characteristics, such as a higher voice or the lack of facial and body hair that results in the lack of male sex hormones (Eunuchoidism, n.d.). Gonadotropins are produced by glands, such as the pituitary, and can result in sparse body hair when not produced adequately (Gonadotropin, 2010). The medical dictionary states that eunuchoidism is marked by a deficiency of sexual development with the persistence of prepubertal characteristics, and often has the presence of characteristics that are typical of the opposite sex (Eunuchoidism, n.d.). Another likely characteristic is azoospermia (Schoenstadt, 2006; Visootsak Graham, 2006). Azoospermia is defined as having little or no sperm count (Azoospermia, 2010). Testicular dysgenesis, or gonadal dysgenesis, is another characteristic of Klinefelters Syndrome (Schoenstadt, 2006; Visootsak Graham, 2006). Testicular dysgenesis is considered a reproductive system developmental disorder that causes a progressive loss of primordial germ cells, or cells that create gametes, in the developing gonads of an embryo (Gonadal dysgenesis, 2010). This gonadal dysgenesis can lead to the extremely hypoplastic, or underdeveloped, and disfunctioning gonads mainly composed of fibrous tissues (Gonadal dysgenesis, 2010). Most infants and children with the 47, XXXY chromosomal abnormalities go through normal growth stages. It is not until puberty that the Klinefelters Syndrome characteristics or traits become more prevalent and noticeable (Visootsak Graham, 2003). There is a significant increase in height between the ages of five and eight (Visootsak Graham, 2003). Another characteristic of Klinefelters Syndrome is the elongated length of arms and legs (Klinefelter, 1966). There is a decrease in androgen production that causes the secondary sexual characteristics to not fully develop (Visootsak Graham, 2003). An androgen is any substance such as androsterone or testosterone that supports male characteristics (Androgen, n.d.). Typically Klinefelters males are infertile (Visootsak Graham, 2003). However, there have been cases of impregnation without the assistance of medical technology (Visootsak Graham, 2003). Autoimmune diseases such as juvenile arthritis can also be present in Klinefelters adolescents. Whereas boys with Klinefelters Syndrome are generally tall with long limbs and remain thin until puberty, they tend to suffer from obesity latter in life. Neurocognitive effects of Klinefelters Syndrome may be more subtle than that of the physical stigmata. Klinefelters males have been found to have relative deficits on verbal IQ subtests and have verbal IQ scores around 20 points lower than those of unaffected siblings. There are also deficits in articulation, word finding, phonemic processing, verbal memory, language comprehension, oral expression problems, as well as linguistic processing speed. It seems that the speech/language problems and some motor deficits are most common in Klinefelters males that have an extra X chromosome. Ninety-two percent of individuals with Klinefelters Syndrome confirm difficulty learning to read. Seventy percent had reading achievement discrepancies or absolute reading deficits on standardized testing. A group of boys with mental retardation and suspicion of fragile X were subject to a genetic screening and the results showed that eight of these boys had Klinefelters Syndrome. Most of the more extreme verbal, visuospatial, and motor skills, such as found in mental retardation and fragile X syndrome are typically spa red. However, some boys with Klinefelters Syndrome suffer from poor manual dexterity and are commonly found to be clumsy and below average in sports (Wodrich Tarbox, 2008). There are many different factors that may underlie linguistic and reading problems. One possibility is a dysfunction of the left hemisphere that may be related to diminished gray matter or a lack of hemispheric asymmetry, or both. It is also possible that executive and frontal deficits may be a cause (Wodrich Tarbox). There is evidence that language is a fundamental issue for Klinefelters children and this can result in further scholastic issues. This problem seems to manifest as dyslexia as defined by poor reading in the setting of normal intelligence. Klinefelters males have also been observed to have difficulties with arithmetical functions. The deficits in auditory processing and verbal memory are the two key cognitive processes that underlie these difficulties. These deficits are also true for normal chromosomal children with dyslexia. The findings are supportive of the concept that defects in frontal systems seem to be caused by a language-based, left frontal-systems problem (Geschwind Dykens, 2004). Adult Klinefelters males have reported to have difficulties with mental flexibility (Wodrich Dykens, 2004). Even with these studies, it should be noted that not all adults that have Klinefelters Syndrome show these classic patterns of verbal deficits that are observed in children (Geschwind Dykens, 2004). However, these findings are not appropriate for all Klinefelters males, many of which complete high school and move on to post-secondary education successfully (Wodrich Tarbox, 2008). Two characteristics that has been falsely associated with Klinefelters males in the past, is sociopathy and criminal behavior. There is, contrary to this belief, fewer psychiatric problems reported among these individuals. However, there are commonly traits of introversion, unassertiveness, and a paucity or lack of ambition. There are also possible traits of impulsivity and social inappropriateness (Wodrich Tarbox, 2008). A Reiss Profile of Fundamental Goals measurement was used to assess the degrees of which Klinefelters males were motivated in 15 domains (Geschwind Dykens, 2004). The Reiss Profile generates a profile that is based on the motivational sensitivities across the domains of aversive sensations, citizenship, family, curiosity, honor, independence, food, order, physical exercise, rejection, power, sex, social contact, vengeance, and social prestige. The Reiss Profile is a well-established psychometric measure that is being used more and more to assess people with and without mental retardation (Geschwind Dykes, 2004). The results suggested that the Klinefelters male group was not particularly motivated by the need for social prestige, independence, or the desire to seek vengeance. This group was also not motivated to avoid physical pain. The general motivator for all the Klinefelters males in this group was curiosity. There were no age effects to this study (Geschwind Dykes, 2004). Characteristics in Adulthood There is a persistent deficiency of androgen in adulthood that can result in the loss of libido, decreased muscle bulk and tone, decreased bone density, a propensity for thromboembolism (an obstruction in a vein or artery from a blood clot), and an increased risk of mortality from cardiovascular and diabetic complications. A common characteristic for Klinefelters adults is gynecomastia (Wattendorf Muenke, 2005). Gynecomastia involves the risk of developing breast carcinoma. There is 200 times more of a risk for Klinefelters males to develop breast carcinoma than other karyotypically normal individuals. This may be a result of the estradiol (the prominant sex hormone in females) to testosterone ratio being so much higher that karyotypically normal men. Another possibility is that it is caused by the increase of peripheral conversion of testosterone to estradiol (Visootsak Graham, 2006). There are different views as to whether Klinefelters adult males are more aggressive or have a greater chance of psychological issues depending on the resource. One study describes the differences as relative to individual testosterone levels and the age at which they received the diagnosis (Morris, Jackson, Hancock, 2009). Equally, there is an impact from the way the diagnosis is reacted to by the Klinefelters male, the family, and friends or peers. The seven major themes that emerged from this study were the diagnosis, the testosterone treatments, health care problems, appearance, self-identity, relationships, and school and education. Of the Klinefelters adults studied, 60 % reported clinical levels of anxiety and 34% had clinical levels of depression. The results of this study show that a prolonged lack of testosterone can have far reaching negative effects on the Klinefelters adult (Morris, Jackson, Hancock, 2009). The historical studies show a disturbingly increased risk for psychiatric disturbance, criminality, and mental retardation. However, these results are outdated and extremely questionable given the initial examinations were given to institutionalized populations (Chen, 2010). Differential Diagnosis Classic Klinefelters Syndrome, 47, XXY, cases make up approximately 80-90% of all Klinefelters diagnosis. There are approximately 6-10% of these cases that are mosaics, which are the cells with 46, XY/47, XXY; 46, XY/48, XXXY; and 47, XXXY/48, XXXY (Chen, 2010; Visootsak Graham, 2003; Visootsak Graham, 2006). In 5% of the cases there are two X chromosomes without a Y chromosome or 46, XX (Visootsak Graham, 2006). The other cases were karyotypes 48, XXXY, 48, XXYY, 49, XXXXY, and 49, XXXYY (Visootsak Graham, 2003). Approximately 1% of these cases are due to a structurally abnormal X with a normal X and Y chromosome described as kayotypes 47, X,i(Xq)Y and 47, X,del(X)Y (Chen, 2010). Klinefelters Syndrome variants occur much less frequently than the classic 47, XXY chromosomal abnormality (Bock, 1993; Visootsak Graham, 2006). Klinefelter variant 48, XXXY is characterized by being average or tall stature with ocular hyperterlorism, which are widely spaced or deep set eyes; flat nasal bridge; curving of the fifth finger, or clinodactyly. Other characteristics are small penis and testicles with hypergonadotropic hypogonadism, which is the absence or decrease in function of the male testes. Theses individuals intelligence quotients range from 40-60. Variant 48, XXYY is characterized by having a tall stature, an eunuchoid habitus with long legs, sparse body hair, small testicles and penis, hypergonadotropic hypogonadism and gynecomastia. These individuals intelligence quotients range from 60-80. Males with variant 49, XXXXY are severely affected. They have smaller than average head circumference also known as microcephaly, short stature with ocular hypertelorism, flat nasal bridge, and upslanting palpebral fissures. Cleft palates are present along with small geniltalia and a heart defect known as patent ductus arteriosus. These individuals intelligence quotients range from 20-60. (Visootsak and Graham, 2003). Klinefelters Syndrome 47, XXY, has no major physical signs, which explains why it may go undiagnosed or misdiagnosed throughout an individuals life. Also with no physical signs, it is truly only diagnosed when genetic testing occurs for a variety of unrelated reasons. Klinefelters Syndrome may be diagnosed prenatally or during early childhood, as an adolescent during puberty, or as an adult when there are recognized fertility problems (Bock, 1993). Klinefelters Syndrome can be diagnosed prenatally through amniocentesis or chorionic villus sampling (Bock, 1993). These tests are normally done if the pregnant woman is older than 35, if there is a family history of genetic defects, or when other medical indications exist (Bock, 1993). A pediatrician may suspect a male child as having Klinefelters Syndrome if there are delays in learning to talk or difficulties in reading and writing as well as physical abnormalities during adolescence (Bock, 1993). Treatments and Interventions All hope is not lost when it comes to the treatment and interventions of the undesirable traits and characteristics that males diagnosed with Klinefelters Syndrome may display or develop. It is recommended that Klinefelters males have a comprehensive neurodevelopmental evaluation as soon as they have been diagnosed. A multidisciplinary developmental evaluation can determine the appropriate treatments during infancy and early childhood. These treatments may include physical therapy, infant simulation programs, and speech therapy (Wattendorf, 2005). If the language difficulties are detected in childhood, then there is more of a possibility for intervention. The language barriers that Klinefelters males may have to cope with can not only affect their academics, it can obstruct their building of social relationships and learning social skills necessary for these relationships. Here is where the Klinefelters child could benefit from a social skills training program. In a social skills training program, the Klinefelters child will be able to practice talking and listening, observing childrens making friends processes, sharing of information, attitudes, and beliefs. This will also assist them in proper classroom behavior and playground behavior. Language disabilities and barriers can prevent Klinefelters males from fitting in socially, so this kind of intervention and assistance can benefit the child greatly. Hearing can be an issue if frequent ear infections occur. Hearing test and screens should be done to ensure that a hearing impairment is not a part of the language difficulties. If the Klinefelters child is not communicating effectively with single words by the ages of 18 to 24 months, then consultation with a speech and language pathologist will be very beneficial (Klinefelter Syndrome Information, 2002). Teachers should be informed of the difficulties that a Klinefelters child may be dealing with in the classroom. A teacher may consider the Klinefelters child to be lazy and daydreaming and a teacher may even forget the child is even in the room. This can result in the Klinefelters child falling behind and eventually being held back a grade. Under the Public Law 94-142, the Individuals with Disabilities Education Act, adopted by Congress in 1975, all children with disabilities have a right to a free, and appropriate public education (Klinefelter Syndrome Information, 2002). Once the Klinefelters male reaches puberty there is usually an inability to produce a normal amount of testosterone. This along with hypogonadism can result in impaired bone mineral density and skeletal muscle development. Also associated with testosterone deficiency is a decrease in libido and energy (Wattendorf Muenke, 2005). Androgen therapy or Testosterone Treatment should begin by time the Klinefelters male reaches middle school, approximately 12 to 14 years of age, based on the level of pubertal development (Klinefelter Syndrome Information, 2002; Wattendorf Muenke, 2005). Testosterone Treatment will ultimately increase the muscle size and strength, as well as, promoting the growth of body and facial hair. It must be noted that Testosterone Treatments can also bring on psychological changes. It is important to adequately inform the parent(s) and the child of these changes so that they can make the most informed decision (Klinefelter Syndrome Information, 2002). There are diff erent ways to receive Testosterone Treatment and that is through injections, transdermal (patches, gels, or creams), orally, or implantation. The kind of testosterone injection will depend mainly on the dosage used and the country in which you receive the injections. Some injectable testosterone esters are Testosterone enanthate, Testosterone cypionate, Sustanon, Testosterone propionate, Testosterone phenylpropionate, Omnadren, and Aqueous testosterone suspension. Types of transdermal patches are Androderm and Testosterone TTS. Two different kinds of testosterone gels and creams are Androgel, and Testim. A few oral supplements include Methyltestosterone and Testosterone undecanoate. The last form of Testosterone Treatment is the Subcutaneous testosterone pellet, which is delivered by implanting a pellet of pure, crystalline testosterone under the skin of the buttocks or abdomen (Testosterone Types and Delivery, n.d.). Adult males with Klinefelters Syndrome usually develop gynecomastia which predisposes men to breast cancer. Therefore, it is important that Klinefelters males do monthly breast examinations. If gynecomastia causes psychological or physical problems, then possible treatment would be cosmetic surgery to remove the breast tissue (Wattendorf Muenke, 2005). Swerdlow et. al (2005) stated that men with Klinefelter Syndrome have elevated risks of several cancers. Prostate cancer, along with breast cancer was more prevalent. Men with Klinefelter Syndrome are also at a substantially higher risk for non-Hodgkin lymphoma, and possibly lung cancer. Breast cancer risk is higher in 47, XXY mosaics. Adult males may face possible infertility issues due to the lack of testosterone production, but if diagnosed early on, this can be minimized and they will be able to reproduce without outside assistance. Summary Klinefelter Syndrome is one of the more recently discovered medical syndromes. Klinefelter Syndrome is not one that causes major dysfunctions and is usually only discovered during genetic testing for infertility or during prenatal testing due to maternal age or prior genetic issues within the family. Because Klinefelter Syndrome has not had a lot of research until the last few years, there is no federal funding set aside for this syndrome. Families with sons that are found to be affected by it have no real support system that is knowledgeable of this syndrome and have to research on their own and create resources to fit their situation as none are available in most areas.

Views of Heaven in From the Fifteenth District :: Fifteenth District

Views of Heaven in From the Fifteenth District Mavis Gallant presents us with a disconcerting view of death in the short story "From the Fifteenth District," where dying is not a salvation from the pains of life but where the dead are forced to suffer eternally. In this story, the author sets out three distinct cases of 'haunting,' except that these hauntings are reported by the dead about the living. Major E. Travella, killed during World War I, is angry that he is being exploited by the church and the public. Mrs. Ibrahim is upset that her doctor and social worker are fighting over her death. Finally, Ms. Essling is frustrated that she is unable to get on with her 'life' after death because of her husband. All three of these individuals are harboring anger and hostility after death and are unable to move on and rest in peace. Major Emery Travella feels as if the church is trying to capitalize on his death. When the Major visits the church for Communion he realizes that the congregation is not there to pay tribute to God but instead, "the congregation sits, hushed and expectant straining to hear [his] footsteps" (282) which signal his haunting of the church. The Major is upset that the church is allowing the congregation to make a mockery of the church by devoting their time to him instead of the Communion which should be the reason they are there. The church is also trying to profit by the Major's haunting by allowing cameras and tape recorders into their place of prayer. Travella feels that the church is sacred and is supposed to be seen as a place of worship, not a place to record abnormal phenomena. Major E. Travella feels that he is not being respected by the congregation, instead, he is being insulted by people only caring about him because he is a ghost, not because of who he was as a living per son. Mrs. Ibrahim is bothered that her doctor and social worker cannot settle their differences in opinion in their accounts of her death. She does not see the point of fighting over her because she is no longer living and has died of natural causes. They are both lying to save themselves from punishment, and even though no one was at fault, they were both trying to place the blame on the other.

Essay --

Kyra Joray Joray 1 Curtis English 10H 10 March 2014 The Serial Killer Mind â€Å"We never really grow up, we only learn how to act in public.† Bryan White once said. Basically White is saying, childhood is a very fragile state and as a kid you’re learning social norms by what’s around you. Kids born into or raised around strange situations can affect the type of person they grow up to be. As an adult, you learn more about the logical way to act around other people and how your mind works. Certain experiences can alter the way a mind functions, and can result in a human lacking logical consent. Some people may seek guidance to control any urge they may experience while others chose to act upon their feelings. Once any violence is pursed, a criminal is born. A criminals mind makes different choices, ignoring whatever right or wrongs a normal person would know. This unhealthy brain can make a killer, whether they are mission oriented and kill to accomplish a mission, are hedonistic and seek thrill and pleasure, or are visionaries and kill because of an illness from birth altering...

Donald J. Trump Essay

Donald John Trump is a real-estate developer who shot to international fame after his hit television series â€Å"The Apprentice†. The best-known facet of his life also happens to be the most motivating one – How he bounced back from bankruptcy to being a billionaire again, through a very innovative idea. Donald Trump was born on 14th June 1946 in New York (Allen 2007). The son of billionaire real-estate businessman Fred Trump, Donald Trump or â€Å"The Donald† as he is popularly known, was born with the proverbial silver-spoon in his mouth. After finishing his schooling from the military academy he entered the Fordham University. He went on to study Economics at the Wharton School of Finance, at the University of Pennsylvania. After finishing the college education in 1968, Donald Trump started his career at the Trump Organizations, owned by this father and started assisting him in his business (A&E Television Networks). He worked with his father for five years. During this time he made several successful business deals but was disillusioned by the low-profit margins. He shifted his base to the more affluent Manhattan in 1971, to make higher profits and also gain public recognition. He hobnobbed with many rich and influential people and built a niche market around them, by making properties having unique architectural designs. He focused on exclusivity instead of cost-saving schemes, which was the mantra for the builders at that time. His name is associated with the most influential and posh addresses like the Fifth Avenue skyscraper, Trump Tower; the luxury residential buildings, Trump Parc, Trump Palace; Trump Plaza, 610 Park Avenue, The Trump World Tower and Trump Park Avenue. He was also the owner of many hotels like Plaza Hotel, the St. Moritz Hotel, Trump International Hotel and Tower etc. (http://www. nbc. com/nbc/The_Apprentice/bios/Donald_J. _Trump. html) However, the recession times in the 1990s saw a sharp fall in the real estate market. His net worth fell from $1. 7 billion to $500 million. When he was unable to pay a $2 billion bank loan, creditors seized his assets. This left him with about $900 million in personal debt and approximately $3. 5 billion in business debt (Allen 2007). This made him declare bankruptcy. He could bail himself out only when his father died in 1999; and real-estate business was sold. He bounced back both financially and publicity-wise via the reality telly-show â€Å"The Apprentice†. Currently his financial worth is estimated as close to 2. 5 billion dollars, and his catch phrase â€Å"You are fired† is embedded firmly in the minds of the public (http://www. atouchofbusiness. com/business-topics/success-stories/business-leader-trump-0006. html) The huge popularity of the TV show and the financial success it brought enabled Trump to venture into other fields like clothing – Trump Men’s Collection, magazine – Trump Magazine, liquor – Trump Vodka, tours – online portal named GOTrump. com, and even education when he opened Trump University in 2005 which offers a degree in business . Personality Traits Donald trump sets himself apart from other people in his leagues purely due to the sheer force of his personality. While his flamboyant nature and his many associations with women have gained him a lot of notoriety, no one can deny that he possesses ‘something’ which sets him apart from other rich people. This has made him make a brand name which sells many businesses including the very successful television series and the many books he has written on his life experiences and means to gain success. One of the most obvious traits he has is intelligence. This does not merely mean possessive a superior technical or business mind, it also points to the amount of calculated risks he has taken over the years and succeeded. While seeming to always go against the flow, his decisions in retrospect always seem to be the most logical way to succeed. As Columbus once said when to his detractors â€Å"Any one would have found newer lands, I thought of it first! † Another obvious trait he possesses is confidence, which shines through all the situations he has faced. For instance, his shifting to Manhattan would have been pointless is he could not get into the inner circles of the rich and famous people in New York. Though he was almost broke when he went to Manhattan, it took him no time to charm the committee people in many exclusive clubs to give him contracts (Biography Channel 2007) Still another trait that has helped him to get past difficult situations is his immense determination to succeed. The adverse situations have merely spurred him to think of unique, away from the stream, way to bounce back. In addition to his many businesses, he also a philanthropist who believes in uplifting the society where one lives. He is associated with many charities and donates generously to social causes. He also has a very charming personality which is probably the main reason for the huge success of his television show. Skills and Strengths Donald Trump in addition to having distinctive personality traits also possesses certain skills that have helped him succeeding in his various ventures. Even in the very early days of his career Trump was known for his consummate skill in making business deals. In fact his father often said that, â€Å"some of my best deals were made by my son, Donald†¦ everything he seems to touch turns to gold. † (NetGlimse 2007) He made his first successful deal at the age of 25, when he bought property off a transportation firm which was having financial troubles and sold it to the government. His negotiating skills often allowed his firm to secure loans with little collateral (Allen 2007) He is also an opportunist and is known for spotting successful business opportunities. As an example, while the real-estate business of his father was doing fairly well Donald chose to move his focus from their traditional business of middle-class rental housing to commercial real estate development (Allen 2007). In addition, he also decided to shift the business from Brooklyn to New York which the rich and famous lived. He is known to be a very successful self-promoter, which has led him to become a very successful brand name. From the buildings he has built which bear the Trump name to constantly telling potential ‘apprentices’ that the way to succeed is to be like him, he is carved out a public image in the minds of the people as a cocky, arrogant but immensely successful personality. He has cashed on this celebrity status to sell many books which also bear his name like â€Å"Trump: The Art of the Deal†, â€Å"Trump: The Art of Survival†, â€Å"Trump: Surviving at the top†, many of which have been best sellers. (http://www. nbc. com/nbc/The_Apprentice/bios/Donald_J. _Trump. html ) Leadership in situations As Donald Trump’s television show preaches – leadership is the name of the game. The word leadership means different things in different situations. Trump’s unique leadership qualities make him a cut different than others. For instance the very essence of leadership is having the conviction and guts to take on risks and few have taken risks which Trump has taken. As mentioned earlier in the report Trump was almost broke when he decided to venture into the real estate business for the rich and famous. It was a bold decision to take on especially considering the fact that the immensely rich people do not really allow any outsider to enter their circles, let alone a person who is not of their social standing. That his business was worth billion in a few years span shows how right he was in taking the risk (Chandy 2007) Another important leadership quality is the ability to capture the attention of people positively. Needless to say the huge popularity of his show, demonstrates that he does have this quality which makes people sit-up and take notice. Successful leaders also take responsibility of their actions and have absolute control over decisions. Again as mentioned earlier in the report each of the ventures of Donald Trump unmistakably have the imprint of his persona, not to mention his name. He does not believe in passing around the blame to others when decisions do not gain expected results. Leadership Outcomes The phenomenal success of the â€Å"The Apprentice† is due to the person who has conceptualized the show i. e. Donald Trump. The way the show is run clearly points his personality. The contestants are judged on a weekly basis and there are no appeals to the finals decision. In his words – â€Å"I mean, there’s no arguing. There is no anything. There is no beating around the bush. â€Å"You’re fired† is a very strong term. † Even the contestants are usually asked to stand up for themselves, which in itself means being leaders (NetGlimse 2007) Leadership also means facing challenges head on. This is evident in Trump’s decision to sell of his family business to bounce back from bankruptcy. There are times when an unsavory decision might be the best decision to overcome a situation. Trump would have to fend off creditors indefinitely if he had not decided to sell off the business. Another leadership trait which Trump possesses is the conviction in his decisions. He has succeeded in making many complex business deals due to this trait. For instance, when Trump moved to Manhattan, he decided to try his hand into building luxury hotels. With this view, in 1974 Trump focused his attention The Commodore. This hotel was unprofitable, but was very centrally located. He managed to convince Hyatt Hotel Corporation to enter into a business deal concentrating on the fact that Hyatt did not have any manor downtown hotels. He also managed to successfully arrange financing for this venture and proceeded to completely renovate the hotel. The hotel was renamed The Grand Hyatt in 1980, and became very popular, making Trump the city’s best known and most controversial developer (A&E Television Networks). Conclusion Donald Trump is many times seen as a self-promoter whose proclamations are not credible. In fact people even question his present worth of 2. 7 billion dollars (Allen 2007). However, no one can question the success he has gained through his unique qualities as a pioneer in many types of business. His business decisions have been maverick and controversial but have been hugely successful. He believes in leading by example, which is the chief draw factor of his reality television show. Although his self-promotion comments can be termed as immodest, people modeling themselves after him would immensely profit from his no-nonsense attitude and self confidence. These are the two major qualities leaders need when they are dealing with others if they do not wish to be pushed around by other people. There are many books what preach about the qualities of the leader in a very idealistic way; however people can rarely succeed following only idealistic principles of anything. Another thing which can be learnt from Trump is his â€Å"Never say die† spirit. Every time he come up with an adversity, he just sees it as a means to demonstrate his skills to find a unique solution to the problem. In conclusion, the personality traits of Donald Trump which are mentioned here are the true reasons for his success. While these traits may not make everyone a billionaire, they will surely make people a much confident and self-assured person. References Allen S, â€Å"Donald Trump – Billionaire Real Estate Tycoon and Host of The Apprentice†, 2007, New York Times Company http://entrepreneurs. about. com/od/famousentrepreneurs/p/donaldtrump. htm A&E Television Networks, â€Å"Donald (John) Trump Biography (1946-)† 2007, http://www. biography. com/search/article. do? id=9511238&page=1 Biography Channel â€Å"Donald Trump†, 2007, http://www. thebiographychannel. co. uk/biography_story/1123:1290/1/Donald_Trump. htm Chandy A, â€Å"Donald Trump Biography†, 2007, http://www. buzzle. com/editorials/4-28-2005-69193. asp â€Å"Donald J. Trump as Executive Producer/Host†, 2007, http://www. nbc. com/nbc/The_Apprentice/bios/Donald_J. _Trump. html A Touch of Business, â€Å"Donald J. Trump – The Business Leader Who Thrives on the ‘Art of the Deal’†, 2007 http://www. atouchofbusiness. com/business-topics/success-stories/business-leader-trump-0006. html NetGlimse, â€Å"Donald Trump-Biography†, 2004, http://www. netglimse. com/celebs/pages/donald_trump/index. shtml