Courtroom Workgroups Essay

In The United States criminal justice system the informal arrangement between a criminal prosecutor, criminal defense attorney, and the judicial officeris called a courtroom work group. The courtroom workgroup was proposed by Eisenstein and Jacob in 1977 to explain their observations of the ways courts, especially lower level courts, actually come to decisions. This foundational concept in the academic discipline of criminal justice identifies the seemingly opposing courtroom participants as collaborators in â€Å"doing justice.† Efficient courtroom workgroups seek to process cases rather than dispense justice. Because the courtroom workgroup deviates from the public idea of how justice works, it has developed a irregular set of virtues to continue its work and ease daily life for its participants. The academic theory of the courtroom workgroup has four cornerstone concepts that recognize this fact: Speed, Pragmatic Cynicism, Collegiality, and Secrecy. This has been proved to greater and lesser extents in different courts. Defendants are assumed to be guilty. The procedural merits of the case are the true determinative factors of an outcome. Prosecutors and defense attorneys engage in a comparison of charges against possible procedural flaws and possible defenses to determine at the going rate for a crime. These factors are used to figure out how much punishment the plea bargain will offer. For example, group relationships and the desire to â€Å"keep† a healthy working relationship are important to gr oup members. The workings of the courtroom group and the â€Å"going rate† for given crimes are not matters for public disclosure. Estimates can be given to clients, but usually uttered in terms of the prosecution’s willingness to negotiate. (Summarized by O’Connor, T.R., 2005) The courtroom workgroup is a tool for prosecutorial discretion. Many different techniques are used to convince the defendant that the evidence against him or her is overwhelming. The defendant may be persuaded to plead guilty to a few of the charges in return for not being prosecuted for the remaining charges. To convince the defendant that the risk of not pleading guilty is intolerable, â€Å"charge stacking† is a process by which police and prosecutors create a case with numerous charges or numerous instances of the  same charge to convince the defendant that the risk of not pleading guilty is intolerable. Many indirect pressures come together to boost participation in the courtroom workgroup. Defense attorneys in public defender offices often do not have enough time to prepare a case in detail for all of their clients. Further, they often do not have the budget to fully investigate the facts of a case through either staff or private investigators. They often must rely solely on police reports for such information. In some jurisdictions, clients do not meet their attorneys until they are in court. Typically, public defenders will meet briefly with clients in holding facilities or jails. The defense attorney defends his or her client by seeking less punishment. The courtroom workgroup is, in some sense, a response to a lack of resources for public defenders. Huemann (1977) indicates that many defense attorneys feel pressured to keep up with their caseloads. This pressure can be revealed in the courtroom through disapproval by the judge for delays. Many indirect pressures come together to boost participation in the courtroom workgroup. While many of the higher level prosecutions still follow the model, there is evidence that lower-level proceedings follow the courtroom workgroup model. The thought of a courtroom workgroup is associated with plea bargaining. The courtroom workgroup shows significant analytical power in overburdened courts dealing with large caseloads. The courtroom workgroup model is best suited to explain jurisdictions where defense attorneys are more or less permanently assigned, but even occasionally appointed lawyers can participate in these practices. Boland, Brady, Tyson, & Bassler (1983) indicate that approximately 90 percent of criminal cases are settled by plea bargain. This figure appears to be stable over the last twenty years (Rainville & Reaves, 2003). Some collaborative efforts on the part of the courtroom workgroup simply must be present to facilitate this high percentage of pleas. Sources Boland, B., Brady, E., Tyson, H., & Bassler, J. (1983). The prosecution of felony arrests. Washington, D.C.: Bureau of Justice Statistics. Eisenstein, J. & Jacob, H. (1977). Felony Justice: An organizational analysis of  criminal courts. Boston : Little & Brown. Huemann, M. (1977). Plea bargaining: The experiences of prosecutors, judges, and defense attorneys. The University of Chicago Press: Chicago, Il. O’Connor, T.R. (2005). Court organizational issues: The courtroom workgroup. http://faculty.ncwc.edu/TOConnor/417/417lect12.htm Rainville, G. & Reaves, B.A. (2003). Felony defendants in large urban counties. Washington D.C.: Bureau of Justice Statistics.

Problem Of Failure To Thrive Health And Social Care Essay

Although the term failure to boom ( FTT ) has been in usage in the medical idiom for rather some clip now, its precise definition has remained debatable1. accordingly, other footings such as â€Å" undernutrition † 1 and â€Å" growing lack † 2 have been proposed as preferred. FTT is a descriptive term applied to immature kids physical growing is less than that of his or her peers.3 The growing failure may get down either in the neonatal period or after a period of normal physical development.4 The term FTT is non, in itself, a disease but a symptom or mark common to a broad assortment of upsets which may hold small in common except for their negative consequence on growth.5 In this respect, a cause must ever be sought. Frequently, the rating of kids who fail to boom present a hard diagnostic job. Some of the troubles result from the legion differential diagnosings, the definition used or misdirected inclination to seek sharply for underlying organic diseases while pretermiting aetiologies based on environmental deprivation.6 In add-on, early accusals and disaffection of the kid ‘s parents by the health-care supplier will do the rating and direction of the kid who has failed to boom more difficult.7 In general, factors that influence a kid ‘s growing include: ( I ) A kid ‘s nutritionary position ; ( two ) A kid ‘s wellness ; ( three ) Family issues ; and ( four ) The parent-child interactions.3,8,9 All these factors must be considered in rating and direction of kid who has failed to boom. This paper presents a simplified but elaborate attack to the rating and direction of the kid with FTT.DefinitionThe best definition for FTT is the 1 that refers to it as unequal physical growing diagnosed by observation of growing over clip utilizing a standard growing chart, such as the National Center for Health Statistics ( NCHS ) growing chart.10 All governments agree that merely by comparing tallness and weight on a growing chart over clip can FTT be assessed accurately.11 So far, no consensus has been reached refering the specific anthropometric standards to specify FTT.11 Consequently, where consecutive anthropometric records is non available, FTT has been diversely def ined statistically. For case, some writers defined FTT as weight below the 3rd percentile for age on the growing chart or more than two standard divergences below the mean for kids of the same age and sex1-3 or a weight-for-age ( weight-for-hieght ) Z-score less than subtractions two.1 Others cite a downward alteration in growing that has crossed two major growing percentiles in a short time.3 Still others, for diagnostic intents, defined FTT as a disproportional failure to derive weight in comparing to height without an evident aetiology.6 Brayden et al.,2 suggested that FTT should be considered if a kid less than 6 months old has non grown for two back-to-back months or a kid older than 6 months has non grown for three back-to-back months. Recent research has validated that the weight-for-age attack is the simplest and most sensible marker of FTT.12Pitfalls of these definitions:One restriction of utilizing the 3rd percentile for specifying FTT is that some kids whose weight autumn below this arbitrary statistical criterion of normal are non neglecting to boom but stand for the three per centum of normal population whose weight is less than the 3rd percentile.5,6 In the first 2 old ages of life, the kid ‘s weight alterations to follow the familial sensitivity of the parent ‘s tallness and weight.13,14 During this clip of passage, kids with familial short stature may traverse percentiles downward and still be considered normal.14 Most kids in this class happen their true curve by the age of 3 years.6,14 When the percentile bead is great, it is helpful to compare the kid ‘s weight percentile to tallness and caput perimeter percentiles. These should be consistent with the place of tallness and caput perimeter percentiles of the patient.5 Another restriction of the 3rd percentile as a standard to specify FTT is that babies can be neglecting to boom with pronounced slowing of weight addition, but they remain undiagnosed and hence, untreated until they have fallen below the arbitrary 3rd percentile.6 These normal little kids do non show the disproportional failure to derive weight that kids with FTT do.6 This attack attempts non merely to forestall normal little kids from being falsely labeled as neglecting to boom, but besides excludes kids with diseased proportionate short stature.14 Having excluded these easy distinguishable upsets from the differential diagnosing of FTT, simplifies the attack to rating of the kid who has failed to thrive.6 A more across-the-board definition of FTT includes any kid whose weight has fallen more than two standard divergences from a old growing curve.3,15,16 Normal displacements in growing curves in the first 2 old ages of life will ensue in less terrible diminution ( i.e, less than 2 SD ) .13 Some writers have even limited the definition of FTT to merely kids less than 3 old ages old17,18 A precise age restriction is arbitrary. However, most kids with FTT are under 3 old ages of age.6,8EpidemiologyIn immature kids, FTT which does non make the terrible classical syndrome of marasmus is common in all societies.19 However, the true incidence of FTT is non known as many babies with FTT are non identified, even in developed countries.20-22 It is estimated to impact 5 – 10 % of immature kids and about 3 – 5 % of kids admitted into learning hospitals.3,5,23 Mitchell et al,24 utilizing multiple standards found that about 10 % of under-fives go toing primary wellness attention Centre in the United States showed FTT. About 5 % of pediatric admittances in United Kingdom are for FTT.4 The prevalence is even higher in developing states with wide-spread poorness and high rates of malnutrition and/or HIV infections.3,19 Children Born to individual teenage female parents an d working female parents who work for long hours are at increased risk.22 The same is true of kids in establishments such as orphanhood places and places for the mentally retarded5,22 with an estimated incidence of 15 % as a group.5 Under-feeding is the individual commonest cause of FTT and consequences from parental poorness and/or ignorance.19,22,24 Ninety five per centum of instances of FTT are due to non plenty nutrient being offered or taken.25 The peak incidence of FTT occurs in kids between the age of 9 – 24 months with no important sex difference.22 Majority of kids who fail to boom are less than 18 months old.3 The syndrome of FTT is uncommon after the age of 5 years.3,22EtiologyTraditionally, causes of FTT have been classified as non-organic and organic. However, some writers have stated that this nomenclature is misleading.27 They based their sentiment on the fact that all instances of FTT are produced by unequal nutrient or undernutrition and in that context, is o rganically determined. In add-on, the differentiation based on organic and non-organic causes is no longer favoured because many instances of FTT are of assorted aetiologies.3 Based on pathophysiology ( the preferred categorization ) , FTT may be classified into those due to: ( I ) Inadequate thermal consumption ; ( two ) Inadequate soaking up ; ( three ) Increased thermal demand ; and ( four ) Defective use of Calories. This categorization leads to a logical organisation of the many conditions that cause or contribute to FTT.10Non – organic ( psychosocial ) failure to boomIn non-organic failure to boom ( NFTT ) , there is no known medical status doing the hapless growing. It is due to poverty, psychosocial jobs in the household, maternal want, deficiency of cognition and accomplishment in infant nutrition among the care-givers5,11. Other hazard factors include substance maltreatment by parents, individual parentage, general immatureness of one or both parents, economic emphasis and strain, impermanent emphasiss such as household calamities ( accidents, unwellnesss, deceases ) and matrimonial disharmony.6,8,22 Weston et al,28 reported that 66 % of f emale parents whose babies failed to boom has a positive history of holding been abused as kids themselves, compared to 26 % of controls from similar socioeconomic background. NFTT histories for over 70 % of instances of FTT.6 Of this figure, about one-third is due to care-giver ‘s ignorance such as wrong eating technique, improper readying of expression or misconception of the baby ‘s nutritionary needs,29 all of which are easy corrected. A close expression at these hazard factors for NFTT suggest that babies with growing failure may stand for a flag for serious societal and psychological jobs in the household. For illustration, a down female parent may non feed her baby adequately. The baby may, in bend, go withdrawn in response to female parent ‘s depression and provender less well.10 Extreme parental attending, either disregard or hypervigilance, can take to FTT.10Organic failure to boomIt occurs when there is a known implicit in medical cause. Organic upsets d oing FTT are most commonly infections ( e.g HIV infection, TB, enteric parasitosis ) , GI ( e.g. , chronic diarrhea, gastroesophageal reflux, pyloric stricture ) or neurologic ( e.g. , intellectual paralysis, mental deceleration ) disorders.6,19,22 Others include GU upsets ( e.g. , posterior urethral valve, nephritic cannular acidosis, chronic nephritic failure, UTI ) , inborn bosom disease, and chromosomal anomalies.6,7 Together neurologic and GI upsets account for 60 – 80 % of all organic causes of under nutrition in developed countries.30 An of import medical hazard factor for under nutrition in childhood is premature birth.1 Among preterm babies, those who are little for gestational age are peculiarly vulnerable since antenatal factors have already exerted hurtful consequence on bodily growth.1 In societies where lead toxic condition is common, it is a recognized hazard factor for hapless growth.5,31 Organic FTT virtually ne'er presents with stray growing failure, other m arks and symptoms are by and large apparent with a elaborate history and physical examination.32 Organic upsets histories for less than 20 % of instances of FTT.6Assorted failure to boomIn assorted FTT, organic and non organic causes coexist. Those with organic upsets may besides endure from environmental want. Likewise, those with terrible undernutrition from non-organic FTT can develop organic medical jobs.FTT with no specific aetiologyReappraisal of the literature on FTT indicate that in 12 – 32 % of instances of kids who have failed to boom, no specific aetiology could be established.23,33-34Causes of failure to boomA. Prenatal instances: ( I ) Prematureness with its complication ( two ) Toxic exposure in utero such as intoxicant, smoke, medicines, infections ( eg German measles, CMV ) ( three ) Intrauterine growing limitation from any cause ( four ) Chromosomal abnormalcies ( eg Down syndrome, Turner syndrome ) ( V ) Dysmorphogenic syndromes.B. Postnatal causes based on pathophysiology:A. Inadequate thermal consumption which may ensue from:I. Under feeding Incorrect readying of expression ( e.g. excessively dilute, excessively concentrated ) . Behaviour jobs impacting eating ( e.g. , kid ‘s disposition ) . Unsuitable feeding wonts ( e.g. , uncooperative kid ) Poverty taking to nutrient deficits. Child maltreatment and disregard. Mechanical eating troubles e.g. , inborn anomalousnesss ( dissected lip/palate ) , oromotor disfunction. Prolonged dyspnea of any causeB. Inadequate soaking up which may be associated with:Malabsorption syndromes e.g. Celiac disease, cystic fibrosis, cow ‘s milk protein allergic reaction, giardiasis, nutrient sensitivity/intolerance Vitamins and mineral lacks e.g. , Zn, vitamins A and C lacks. Hepatobiliary diseases e.g. , bilious atresia. Necrotizing enterocolitis Short intestine syndrome.C. Increased Caloric demand due toHyperthyroidism Chronic/recurrent infections e.g. , UTI, respiratory tract infection, TB, HIV infection Chronic anemiaD. Defective Utilization of Kilogram caloriesCongenital mistakes of metamorphosis e.g. , galactosaemia, aminoacidopathies, organic acidurias and storage diseases. Diabetess inspidus/mellitus Nephritic cannular acidosis Chronic hypoxaemiaClinical manifestations of FTT3,22Normally the parents/care-givers may kick that the kid is â€Å" non turning good † or â€Å" losing weight † or â€Å" non feeding good † or â€Å" non making good † or â€Å" non like his other siblings/age couples † . Usually FTT is discovered and diagnosed by the baby ‘s physician utilizing the birthweight and wellness clinic anthropometric records of the kid. The infant looks little for age. The kid may exhibit loss of hypodermic fat, reduced musculus mass, thin appendages, a narrow face, outstanding ribs, and wasted natess, Evidence of ignored hygiene such as nappy roseola, common tegument, overgrown and soiled fingernails or common vesture. Other findings may include turning away of oculus contact, deficiency of facial look, absence of snuggling response, hypotonus and premise of childish position with clinched fists. There may be marked preoccupation with thumb suction.EvaluationA. Initial ratingIt has been proposed that merely three initial probes are required to develop an economical, treatment-centred attack to the kid who presents with FTT and this include:35 ( I ) A thorough history including an itemized psychosocial reappraisal ; ( two ) Careful physical scrutiny including finding of the auxological parametric quantities ; and ( three ) Direct observation of the kid ‘s behavior and of parent-child interactions. The Psychosocial Review: The psychosocial history should be as thorough and systematic as a authoritative physical scrutiny Goldbloom35 suggested that the interviewers should inquire themselves three inquiries about every household: ( I ) How do they look ; ( two ) What do they say ; and ( three ) What do they make? a. History ( 1 ) Nutritional history Nutritional history should include: Detailss of chest eating to acquire an thought of figure of provenders, clip for each eating, whether both chests are given or one chest, whether the eating is continued at dark or non and how is the kid ‘s behavior before, after and in between the provenders. It would give an thought of the adequateness or insufficiency of female parents milk. If the baby is on expression eating: Is the expression prepared right? Dilute milk provender will be hapless in Calorie with extra H2O. Too concentrated milk provender may be unpalatable taking to refusal to imbibe. It is besides indispensable to cognize the entire measure of the expression consumed. Is it given by bottle or cup and spoon? Besides assess the feeling of the female parent e.g. , inquire â€Å" how make you experience when the babe does non feed good? † Time of debut of complementary provenders and any trouble should be noted. Vitamin and mineral addendum ; when started, type, sum, continuance. Solid nutrient ; when started, types, how taken. Appetite ; whether the appetency is temporarily or persistently impaired ( if necessary calculate the thermal consumption ) . For older kids enquire about nutrient likes and disfavors, allergic reactions or idiosyncracies. Is the kid Federal forcibly? It is desirable to cognize the feeding modus operandi from the clip the kid wakes up in the forenoon boulder clay he sleeps at dark, so that one can acquire an thought of the entire thermal consumption and the Calories supplied from protein, fat and saccharide every bit good as adequateness of vitamins and minerals intake. ( 2 ) Past and current medical history The history of antenatal attention, maternal unwellness during gestation, identified foetal growing jobs, prematureness and birth weight. Indexs of medical diseases such as emesis, diarrhea, febrility, respiratory symptoms and weariness should be noted. Past hospitalization, hurts, accidents to measure for kid maltreatment and disregard. Stool form, frequence, consistence, presence of blood or mucous secretion to except malabsorption syndromes, infection and allergic reaction. ( 3 ) Family and societal history Family and societal history should include the figure, ages and sex of siblings. Ascertain age of parents ( Down syndrome and Klinerfelter syndrome in kids of aged female parents ) and the kid ‘s topographic point in the household ( pyloric stricture ) . Family history should include growing parametric quantities of siblings. Are at that place other siblings with FTT ( e.g. , familial causes of FTT ) , household members with short stature ( e.g. familial short stature ) . Social history should find business of parents, income of the household, place those caring for the kid. Child factors ( e.g. , disposition, development ) , parental factors ( e.g. , depression, domestic force, societal isolation, mental deceleration, substance maltreatment ) and environmental and social factors ( e.g. , poorness, unemployment, illiteracy ) all may lend to growing failure.5 Historical rating of the kid with FTT is summarized in Table 1. ( B ) PHYSICAL EXAMINATION The four chief ends of physical scrutiny include ( one ) designation of dysmorphic characteristics suggestive of a familial upset hindering growing ; ( two ) sensing of under lying disease that may impair growing ; ( three ) appraisal for marks of possible kid maltreatment ; and ( four ) appraisal of the badness and possible effects of malnutrition.36,37 The basic growing parametric quantities such as weight, height / length, caput perimeter and mid-upper-arm perimeter must be measured carefully. Accumbent length is measured in kids below 2 old ages of age because standing measurings can be every bit much as 2cm shorter.36,37 Other anthropometric informations such as upper-segment-to-lower-segment ratio, sitting tallness and arm span should besides be noted. The anthropometric index used for FTT should be weight-for-length or height. Mid-parental tallness ( MPH ) should be determined utilizing the formula.40 For male childs, the expression is: MPH = [ FH + ( MH – 13 ) ] 2 For misss, the expression is: MPH = [ ( FH – 13 ) + MH ] 2 In both equations, FH is father ‘s tallness in centimeters and MH is mother ‘s tallness in centimeters. The mark scope is calculated as the MPH A ± 8.5cm, stand foring the two standard divergence ( 2SD ) assurance limits.14Appraisal of grade FTTThe grade of FTT is normally measured by ciphering each growing parametric quantity ( weight, tallness and weight/height ratio ) as a per centum of the average value for age based on appropriate growing charts3 ( See Table 3 )Table 3: Appraisal of grade of failure to boom ( FTT )Growth parametric quantityDegree of Failure to BoomMild Moderate Severe Weight 75-90 % 60 -74 % & lt ; 60 % Height 90 -95 % 85 – 89 % & lt ; 85 % Weight/height ratio 81-90 % 70 -80 % & lt ; 70 % Adapted from Baucher H.3 It should be noted that appropriate growing charts are frequently non available for kids with specific medical jobs, hence consecutive measurings are particularly of import for these children.3 For premature babies, rectification must be made for the extent of prematureness. Corrected age, instead than chronologic age, should be used in computations of their growing percentiles until 1-2 old ages of corrected age.3Table 2: Physical scrutiny of babies and kids with growing failure.AbnormalityDiagnostic ConsiderationCritical marks Hypotension High blood pressure Tachypnoea/Tachycardia Adrenal or thyroid inadequacy Nephritic diseases Increased metabolic demand Skin Lividness Poor hygiene Ecchymosiss Candidiasis Eczema Erythema nodosum Anaema Disregard Maltreatment Immunodeficiency, HIV infection Allergic disease Ulcerative inflammatory bowel disease, vasculitis HEENT Hair loss Chronic otitis media Cataracts Aphthous stomatitis Thyroid expansion Stress Immunodeficiency, structural oro- facial defect Congenital German measles syndrome, galactosaemia Crohn ‘s disease Hypothyroidism Chest Wheezes Cystic fibrosis, asthma Cardiovascular Mutter Congenital bosom disease ( CHD ) Abdomens Distension overactive Bowel sound Hepatosplenomegaly Malabsorption Liver disease, animal starch storage disease Genitourinary Diaper roseolas Diarrhoea, disregard Rectum Empty ampulla Hirschsprung ‘s disease Extremities Oedema Loss of musculus mass Clubing Hypoalbuminaemia Chronic malnutrition Chronic lung disease, Cyanotic CHD Nervous system Abnormal deep sinew Reflexes Developmental hold Cranial nervus paralysis Cerebral paralysis Altered thermal consumption or demands Dysphagia Behaviour and disposition Uncooperative Difficult to feed. Adapted from Collins et al 41 Growth charts should be evaluated for form of FTT. If weight, tallness and caput perimeter are all less than what is expected for age, this may propose an abuse during intrauterine life or genetic/chromosomal factors.2 If weight and tallness are delayed with a normal caput perimeter, endocrinopathies or constitutional growing should be suspected.2 When merely weight addition is delayed, this normally reflects recent energy ( thermal ) deprivation.2 Physical scrutiny in babies and kids with FTT is summarized in Table 2.Failure to boom due to environmental wantChild with environmental want chiefly demonstrate marks of failure to derive weight: loss of fat, prominence of ribs and musculuss blowing, particularly in big musculus groups such as the gluteals.6Developmental appraisalIt is of import to find the kid ‘s developmental position at the clip of diagnosing because kids with FTT have a higher incidence of developmental holds than the general population.36 With environmental wan t, all mileposts are normally delayed once the baby reaches 4 months of age.42 Areas dependant on environmental interactions such as linguistic communication development and societal version are frequently disproportionately delayed. Specific behavioral ratings ( e.g. , entering responses to near and backdown ) , have been developed to assist distinguish implicit in environmental want from organic disease.43 Assess the baby ‘s developmental position with a full Denver Developmental Standardized test.44Parent-child interaction:Evaluate interaction of the parents and the kid during the scrutiny. In environmental want, the parent frequently readily walks off from the scrutiny tabular array, looking to easy abandon the kid to the nurse or physician.6 There is small oculus contact between kid and parent and the baby is held distantly with small modeling to the parent ‘s body.6 Often the baby will non make out for the parent and small fond touching is noted.6 There is small pa rental show of pleasance towards the infant.6 Observation of eating is an built-in portion of the scrutiny, but it is ideally done when the parents are least cognizant that they are being observed. Breast-fed babies should be weighed before and after several eatings over a 24-hour period since volume of milk consumed may change with each repast. In environmental want, the parents frequently miss the babies cues and may deflect him during eating ; the baby may besides turn away from nutrient and look distressed.6 Unnecessary force may be used during feeding. Developing a portrayal of the child-parent relationship is a cardinal to steering intervention.11LABORATORY EVALUATIONThe function of research lab surveies in the rating of FTT is to look into for possible organic diagnosings suggested by the history and physical examination.33,34 If an organic aetiology is suggested, appropriate surveies should be undertaken. If history and physical scrutiny do non propose an organic aetiology, extended research lab trial is non indicated.6 However, on admittance full blood count, ESR, uranalysis, urine civilization, urea and electrolyte ( including Ca and P ) degrees should be carried out. Screen for infections such as HIV infection, TB and enteric parasitosis. Skeletal study is indicated if physical maltreatment is strongly suspected. In add-on to being unproductive, unsighted research lab fishing expeditions should be avoided for the undermentioned reason:5,6 ( I ) they are expensive ; ( two ) they impair the kid ‘s ability to derive weight in a new environment both by scaring him/her with venepuncture, Ba surveies and other nerve-racking processs and the no unwritten provenders associated with some probes prevent him/her from acquiring adequate Calories ; ( three ) they can be misdirecting since a figure of laboratory abnormalcies are associated with psychosocial want ( e.g. , increased serum aminotransferases, transeunt abnormalcies of glucose tolerance, decreased growing endocrine and Fe lack ) ; 21 and ( f our ) they divert attending and resources from the more productive hunt for grounds of psychosocial want. In one survey, a sum of 2,607 research lab surveies were performed, with an norm of 14 trials per patient. With all trials considered, merely 10 ( 0.4 % ) served to set up a diagnosing and an extra 1 % were able to back up a diagnosis.34Further Evaluation( 1 ) Hospitalization: Although some writers province that most kids with failure to boom can be treated as outpatients,4,5,11,45 I think it is best to hospitalise the baby with FTT for 10 – 14 yearss. Hospitalization has both diagnostic and curative benefits. Diagnostic benefits of admittance may include observation for eating, parental-child interaction, and audience of sub-specialists. Curative benefits include disposal of endovenous fluids for desiccation, systemic antibiotic for infection, blood transfusion for anemia and perchance, parenteral nutrition, all of which are frequently in-hospital processs. In add-on, if an organic aetiology is discovered for the FTT, specific therapy can be initiated during hospitalization. In psychosocial FTT, hospitalization provides chance to educate parents about appropriate nutrients and feeding manners for babies. Hospitalization is necessary when the safety of the kid is a concern. In most state of affairss in our set up, there is no feasible option to hospitalization. ( 2 ) Quantitative appraisal of consumption: A prospective 3-day diet record should be a standard portion of the rating. This is utile in measuring under nutrition even when organic disease is present. A 24-hour nutrient callback is besides desirable. Having parents compose down the types of nutrient and amounts a kid eats over a three-day is one manner of quantifying thermal consumption. In some cases, it can do parents aware of how much the kid is or is non eating.11Table 4: Summary of hazard factors for the development of failure to boomBaby featuresAny chronic medical status ensuing in: – Inadequate consumption ( e.g, get downing disfunction, cardinal nervous system depression, or any status ensuing in anorexia ) – Increased metabolic rate ( e.g, bronchopulmonary dysplasia, inborn bosom disease, febrilities ) – Maldigestion or malabsorption ( e.g, AIDS, cystic fibrosis, short intestine, inflammatory intestine disease, celiac disease ) . – Infections ( e.g. , HIV, TB, Giardiasis ) Premature birth ( particularly with intrauterine growing limitation ) Developmental hold Congenital anomalousnesss Intrauterine toxin exposure ( e.g. intoxicant ) Plumbism and/or anemiaFamily featuresPoverty Unusual wellness and nutrition beliefs Social isolation Disordered eating techniques Substance maltreatment or other abnormal psychology ( include Muschausen syndrome by placeholder ) Violence or maltreatment Adapted from Kleinman RE.1Table 1: Summary of historical rating of babies and kids with growing failurePrenatalGeneral obstetrical history Recurrent abortions Was the gestation planned? Use of medicines, drugs, or coffin nailsLabour, bringing, and neonatal eventsNeonatal asphyxia or Apgar tonss Prematureness Small for gestational age Birth weight and length Congenital deformities or infections Maternal bonding at birth Length of hospitalization Breastfeeding support Feeding troubles during neonatal periodMedical history of kidRegular doctor Immunizations Development Medical or surgical unwellnesss Frequent infectionsGrowth historyPlot old pointsNutrition historyFeeding behaviour and environment Perceived sensitivenesss or allergic reactions to nutrients Quantitative appraisal of consumption ( 3-day diet record, 24-hour nutrient callback )Social historyAge and business of parents Who feeds the kid? Life emphasiss ( loss of occupation, divorce, decease in household ) Handiness of societal and economic support ( Particular Supplemental Nutrition Program for Womans, Babies and Children ; Aid for Families with Dependent Children ) Percept of growing failure as a job History of force or maltreatment by or of care-giverReview of systems/clues to organic diseaseAnorexia Change in mental position Dysphagia Stooling form and consistence Vomiting or gastroesophageal reflux Recurrent febrilities Dysuria, urinary frequence Activity degree, ability to maintain up with equals Beginning: Duggan C.46DIFFERENTIAL DIAGNOSIS OF FAILURE TO THRIVE1. Familial short stature Although kids with familial short stature frequently are in the 3rd percentile on the growing chart, they have normal weight-to-height ratio and growing speed bone ages equal to their chronological ages and they look happy and healthy.47 Their growing curve runs parallel to and merely below the normal curves.48 2. Constitutional growing hold In constitutional growing hold, weight and height lessening near the terminal of babyhood, parallel the norm through in-between childhood and speed up toward the terminal of adolescence.48 Growth speed during childhood is normal, bone age is delayed, pubescence is delayed, wellness is otherwise normal and normally they have household history of delayed growing and puberty.47 3. Early oncoming growing hold Approximately 25 % of normal babies will switch to take down growing percentile in the first two old ages of life and so follow that percentile.11,49 This should non be diagnosed as failure to boom. Smith DW et al13 reported that 30 % of healthy, full-term, white babies cross one percentile line and 23 % cross two lines as they move from birth to age of 2 old ages. In both the history and physical scrutiny, there are no singular findings except that similar characteristics may be found in other siblings in the family.23 Although in some kids puberty may be delayed, normal pubertal growing jet occur subsequently in adolescence.23 The bone age corresponds to the tallness age.23 4. Specific infant populations Preterm babies and those who suffered intrauterine growing limitation may show growing failure in the immediate postpartum period50,51 but catch-up growing has been reported to happen during the first 2 to 3 old ages of life.52,53 As long as the kid ‘s growing follows a curve with a normal interval growing rate, FTT should non be diagnosed.54 Over diagnosing of growing failure can be avoided by utilizing modified growing charts developed for specific populations such as preterm infants,55,56 entirely breast fed infants,57,58 specific ethnicities ( e.g. , Asians ) 59,60 and babies with familial syndromes such as Down61 and Turner62,63 syndromes. The usage of these charts can assist reassure the doctor that these kids are turning suitably. In preterm babies, their chronological age should be corrected by gestational age until age of 24 months for weight measurings, 40 months for length, and 18 months for caput circumference.1 This is a petroleum method because it does non capture the variableness in growing speed that really low birthweight babies demonstrate.48 Entirely breast-fed babies tend to plot higher for weight in the first 6 months of life but comparatively lower in the 2nd half of the first year.48 5. Diencephalic Syndrome This syndrome must be differentiated from psychosocial FTT. The Diencephalic syndrome usually presents in the first twelvemonth of life with failure to boom, bonyness, increased appetite, euphoric affect and nystagmoid oculus movements.64,65 Clinically they differ from FTT because in contrast to their hapless physical status they are watchful, happy, active, associate easy and are non depressed.65 The Diencephalic syndrome consequences from neoplasms in the country of the hypothalamus and the 3rd ventricle.64 6. Psychosocial short stature ( Psychosocial nanism ) Psychosocial nanism is a syndrome of slowing of additive growing combined with characteristic behavior perturbations ( sleep upset and eccentric eating wonts ) , both of which are reversible by a alteration in the psychosocial environment.66 Normally the age at oncoming is between 18 and 24 months.66 Affected kids are frequently diffident and inactive and typically down and socially with drawn.5 The short stature may or may non be associated with accompaniment FTT.5MANAGEMENT OF A CHILD WITH FAILURE TO THRIVETreatment of FTT is both immediate and long-run and should be directed at both the baby and the mother/family. A good intervention program must turn to the followers: 1. The kid ‘s diet and eating form 2. The kid ‘s developmental stimulation 3. Improvement in care-giver accomplishments 4. Nursing considerations in the intervention of FTT 5. Presence of any implicit in disease 6. Regular and effectual follow up 7. Consultation and referral to specializers 1. The kid ‘s diet and eating form The pillar of direction of failure to boom, irrespective of aetiology, is nutritionary intercession and feeding behaviour alterations. For breast-fed babies, feeding interval should non be greater than four-hourly and the maximal clip allowed for suckling should be 20 proceedingss. Beyond this clip the baby would pall. Behavioural alteration should center on bettering feeding techniques, avoiding big sum of juices and extinguishing distractions such as telecasting during meal times. Fruit juice is an of import subscriber to hapless growing by supplying comparatively empty saccharide Calories and decreasing a kid ‘s appetency for alimentary repasts, taking to decreased thermal intake.67 Successful direction of FTT is followed by catch-up growth19 Catch-up growing refers to deriving weight at greater than 50th percentile for age.68 For catch-up growing, kids with FTT require 1.5 to 2 times the expected Calorie intake for their age.25Calculation of catch-up requirement30Kcal or gm protein for weight age ten ideal organic structure weight Actual weightAgeKcal/kggram protein/kg0 – 6 months 115 2.2 6 – 12 months 105 2.0 1 – 3 old ages 100 1.8 4 – 6 old ages 85 1.5 Beginning: Vinton NE et al30 Age Weight 3rd Catch-up growing fiftieth 97th Figure 1: Failure to boom and catch-up growing related to weight centile Beginning: Poskitt EME19 Some kids with FTT are anorectic and finical feeders. They may, hence, non be able to devour this sum of Calories in volume and therefore necessitate calorie-dense provenders. Toddlers can have more Calories by adding taste-pleasing fats such as cheese or butter ( where non executable palm oil ) to common yearling nutrients. In add-on, vitamin and mineral supplementation is required. Although some practicians add Zn to cut down the energy cost of weight addition during catch-up growing, the informations about its benefit are mixed.69,70 Meals should be pleasant, on a regular basis scheduled, and the kid should non be fed excessively quickly or excessively easy. Get downing with little sum of nutrient and offering more is preferred to get downing with big measures. Bites need to be timed in between repasts so that the kid ‘s appetency will non be spoiled. The type of thermal supplementation must be based on the badness of FTT and the implicit in medical status. For case, the sum of protein in the diet must be carefully monitored in kids with nephritic failure.3 Children with terrible malnutrition must be re-fed carefully to forestall re-feeding syndrome.3,67 For older babies and immature kids with psychosocial FTT, repast times should be about 30 proceedingss, solid nutrients should be offered before liquids, environmental distraction should be minimized and kids should eat with other people and non be forced-fed.71 The primary doctor may see confer withing a pediatric dietitian to assist supply calorie-dense diet.Monitoring nutritionary therapyThe first precedence is to accomplish ideal weight-for-age. The 2nd end is to achieve catch-up in length to that expected for the age. Stairss in the intervention are directed towards both immediate and long-run normal growing of the child.72 Effectiveness of therapy is monitored by addition in weight. Weight addition is response to adequate thermal eatings normally establishes the diagnosing of psychosocial FTT.3,23 If FTT continues in infirmary despite equal dietetic input, supernatural organic disease is most likely and requires farther investigation.23 Adequacy of weight addition varies with age ( see Table 5 ) .Table 5: Acceptable weight addition for age per twenty-four hoursAge ( months )Weight addition ( gram/day )Birth to & lt ; 3 20 – 30 3 to & lt ; 6 15 – 22 6 to & lt ; 9 15 – 20 9 to & lt ; 12 6 – 11 12 to & lt ; 18 5 – 8 18 to 24 3 – 7 Beginning: Brayden et al 2 Calculation of day-to-day or monthly growing such as weight addition in gms per twenty-four hours ( see Table 5 ) allows more precise comparing of growing rate to the norm.48 Although length growing is harder to measure, it should be 0.2 to 0.4mm per twenty-four hours in most children.73 2. The kid ‘s developmental stimulation: Organized programme of intensive environmental stimulation and fondness during waking hours using parents, voluntaries and child-life ( societal ) workers is necessary.33 Temporary or lasting Foster place may be required to extinguish inauspicious psychosocial environment. Surveies have shown that appropriate psychosocial stimulation is of import for cognitive development, both early and later in the kid ‘s life.74,75 3. Improvement in care-giver accomplishment Parents should be counselled about household interactions that are damaging to the kid. Pay attending to the care-giver ability to acknowledge the kid ‘s cues, reactivity and parental heat and allow behavior towards the kid. Guaranting that the nutrient is suitably prepared and presented and doing allowances for any troubles that the kid has in masticating and get downing may all take to improvement.3 Introduction of solids in little frequent provenders is utile. Babies should be fed in semi-upright position.76 All members of staff must work constructively with the parents, progressively go throughing duty back to them. They should avoid judgmental vocalizations. Prosecuting the parents as co-investigator is indispensable. It helps further their self-esteem and avoids faulting those who may already experience defeated and quilty because of sensed inability to foster their kid. 4. Nursing considerations in the direction of FTT: A nursing-care program should include careful charting of consumption, weight, and observations of the female parent ‘s eating manner and interaction with the kid. The nursing staff should teach the female parent on how to better behaviours that may be deprivational, including instructions on how to keep the infant stopping point during eating. The female parent should be taught how to cook locally available nutrients. Feeds should be thickened to increase its thermal denseness and therefore consumption. Educate the parents about the kid ‘s nutritionary and psychological demands. The kid should be stimulated by maternal attention, fondness and societal interaction with playthings and equals. Home visits by a community wellness nurse to measure household kineticss and economic state of affairs is of import. Parental anxiousness about the kid ‘s FTT can be allayed by reassurance by the nurse. 5. Underliing organic disease: Treat smartly any identified implicit in organic disease. Often the implicit in cause of FTT syndrome remains ill-defined, and an empiric test of nutritionary therapy by a individual experienced in feeding babies along with careful observation and support of the household is necessary. Children with FTT must be evaluated treated quickly and adequately for infection. The interactive relationship between nutritionary position and infection are peculiarly evident during babyhood. 6. Regular follow up: Upon discharge, near follow up with place visits is indispensable to guarantee care of nutritionary position. In this respect, Wright CM et al77 have shown that place nursing visits is associated with better results. Follow up should guarantee that the kid is so now booming physically by detecting their growing parametric quantities, utilizing the appropriate growing charts. It besides ensures that the kid continues to have equal nutrition at place. Cognitive development should be monitored and, where necessary, extra stimulation provided at place or in a preschool installation. The period of recuperation which should embrace calorie-dense diet is indispensable for full recovery of kids with FTT. Regular effectual follow up is critical in that accomplishing nutritionary and growing recovery in infirmary is likely less hard than keeping equal long-run nutritionary consumption and developmental stimulation at home.37 Children with FTT should be followed up at least every 4 hebdomads un til catch-up is demonstrated and the positive tendency maintained. 7. Consultation and referral to specialist ( s ) : For kids who are non bettering because of undiagnosed medical status or a peculiarly ambitious societal state of affairs, a multidisciplinary attack may be required.10,78Algorithm of an attack to direction of the kid with FTTDetailed History ( including itemized psychosocial reappraisal )Child with FTTThorough Physical Examination ( including auxological parametric quantities )Admit to infirmary with primary caregiver/motherInitial probes include FBC, ESR, uranalysis, urine civilization, stool for egg cell, cyst of parasite. Screen for HIV infection, TerbiumTest of nutritionary therapy with calorie-dense dietFeeds goodFeeds illFeed goodPoor or no weight addition in 4-5 yearssReassess ( farther physical test and probe )Good weight addition infirmary in 4-5 yearssGood weight addition in infirmary in 4-5 yearss Poor or no weight addition in infirmary in 4-5 yearss inNo organic diseaseReassess ( farther physical test and probe )Organic diseasediagnosedNegativeconsequencesSee psychosocial job and interveneRegular followup with growing supervising e.g monthlyRegular followup with growing supervising e.g monthlyOrganic diseasediagnosedInvite appropriate specializer ( s ) for disease-specific interventionSee psychosocial job and interveneRegular followup with growing supervising e.g monthlyInvite appropriate specializer ( s ) for disease-specific interventionRegular followup with growing supervising e.g monthlyPrevention OF FAILURE TO THRIVEPromotion of sole chest eating for early babyhood followed by optimal complementary eating in the presence of good hygienic patterns diminishes the hazard of infections, promotes infant growing and prevents child undernutrition.79 Community attempt to educate and promote people to seek aid for their societal, emotional, economic and interpersonal jobs may assist cut down the incidence of psychosocial FTT. Promoting rearing instruction classs in secondary schools every bit good as educational community programmes may assist new parents enter parentage with an increased cognition of an baby ‘s nutritionary and other demands. Early sensing of FTT and intercession can cut down the badness of symptoms, heighten the procedure of normal growing and development and better the quality of life experience by babies and kids. Prevention of LBW ( a hazard factor for FTT ) through balanced energy-protein supplementation, micronutrient supplementation, intervention of infection/malaria, surcease of smoke and intoxicant consumption in gestation are major intercessions capable of forestalling LBW.80Complication1. Malnutrition-infection rhythm: Perennial infection exacerbate malnutrition, which in bend leads to greater susceptibleness to infection. Children with FTT must be evaluated and treated quickly for infection. 2. Re-feeding syndrome: Re-feeding syndrome is characterized by unstable keeping, hypophosphataemia, hypomagnesaemia and hypokalaemia.68 To avoid re-feeding syndrome, when nutritionary rehabilitation is initiated, Calories can safely be started at 20 % above the kid ‘s recent intake.68 If no estimation of thermal consumption is available, 50 to 75 % of the normal energy demand is safe.68 If tolerated, thermal consumption can be increased by 10 to 20 % per twenty-four hours with monitoring for electrolyte instabilities, hapless cardiac map, hydrops, or feeding intolerance.68 If any of these occurs, halt further thermal additions until the kid ‘s clinical position stabilizes. 3. Chronic, terrible undernutrition in babyhood may deject caput growing, an baleful forecaster of subsequently cognitive disability.3PrognosisThe timing of abuse, continuance and badness of the disease doing growing failure find the ultimate outcome.25,30 The extent to which full catch-up growing occurs is frequently debated. A short period of hapless growing is likely to decide wholly if sustained equal nutrition is supplied for accelerated growth.19 On the other manus, drawn-out period of hapless growing is likely to take to persistent little size, peculiarly if it occurs early in babyhood when it may be hard to do up the immense increases in size of the first 6 months of life.19 When growing wavering occurs during or merely prior to puberty, there is merely a limited period of clip during which catch-up growing can happen, finally taking to incomplete catch-up growth.19 Repeated episodes of growing wavering without catch-up growing will take to clinical marasmus if decease from overpowering infection does non intervene.19 There are a limited figure of outcome surveies on kids with FTT, each with different definitions and designs, so it is hard to notice with certainty on the long-run consequences of FTT.81 In a big case-control survey of kids aged 7 to 9 old ages from an industrial economic system who had FTT in babyhood, Drewett et al82 confirmed continued lower attainments in weight, tallness and caput perimeter but non important differences in intelligence quotient. Other systematic reappraisals concluded that the long-run result of FTT is a decrease in intelligence quotient ( I.Q. ) of approximately three points, which is non of clinical significance.83 Long-term effectsA on tallness and weight look more pronounced than on I.Q.84 Children with past history of non organic FTT have been found at the age of five twelvemonth to be shorter and lighter than their matched controls.85 Regardless of aetiology, FTT in the first twelvemonth of life is peculiarly baleful, because maximum postpartum encephalon growing occurs in the first 6 months of life.3 Approximately a 3rd of kids with psychosocial FTT are developmentally delayed and have societal and emotional problems.3 The forecast is mor e variable in organic FTT depending on the specific diagnosing and badness of FTT. Merely one tierce of kids with FTT are finally judged to be normal.86 A possible account is that making optimum potency may be hard given that the socioeconomic and cultural environment in which these kids live is non easy changed.DecisionAlthough definitions of FTT vary, most governments agree that merely by comparing tallness and weight on a growing chart over clip can FTT be assessed accurately. Laboratory rating should be guided by history and physical scrutiny findings merely. The direction of FTT should get down with a careful hunt for its aetiology. Nutritional intercession utilizing calorie-dense diet is the basis of intervention of FTT, irrespective of aetiology. Social issues of the household and associated medical jobs most be addressed. A careful and timely hunt for cause of FTT and aggressive caloric supplementation are of import in obtaining the best possible result in kids with FTT.

Hockey in Canada: The Nation’s Passion

Hockey In Canada: A Nations Passion Culminating Activity: Canadian History Essay In 1994, the Canadian Federal Government compromised and voted to make hockey Canada's national winter sport, and lacrosse Canada's national summer sport. Which sport should be named Canada's true national sport? Sport should be named Canada's true national sport? It Is Important to know which sport should be named Canada's true national sport because of its relevance in focusing to improve Canada's athletic skills.By knowing the sport, it will help determine the sport Canada should emphasis upon to be more successful. It Is believed that hockey should be named Canada's national sport due to the appreciation that Canadians have toward their winter climate and well-known winter sports. Also, hockey has maintained Its status as the most popular sport in Canada, while encouraging many women to participate. These reasons are believed to be the major factors that contribute to why hockey should be titled Cana da's true national sport. The history of modern hockey goes as far back as the early sass's.Many regions have claimed to be the birthplace of hockey, but the best-supported cases re in Windsor, Nova Scotia, and Kingston, Ontario, which hold by far the earliest written accounts of a game that has ever been played. Many assumptions were then made that hockey first originated within these three clues. When you think of Canada, what is the first thing that comes into your mind? For many individuals it is hockey. A country's climate has big influences on the type of athletic activities that can occur. In Canada, the climate revolves around cold and bitter weather, which can last up to half a year.Fortunately one of the many advantages is the ability to pursue any of Canada's winter sports such as skiing, snowboarding, bobsledding, figure skating, and most importantly hockey. As a result, it is not a surprise to Canadians when managing to score highly in many of the winter Olympics; in fa ct many Canadians often take this for granted. As seen on February 28, 2010, at the Vancouver winter Olympics, Sydney Crosby stated on CATV â€Å"l just shot it, I didn't really see it to be honest. † This of course, was after the terrific win team Canada pulled against the united States.The victory of this hockey game once again, caused Canadians to legalize the beauty of how successful Its winter sports became. The landscape and weather conditions also contribute to the significance of hockey in the nation. Although it is estimated that there are approximately 2500 indoor and outdoor hockey rinks in Canada, many Canadians still build their own backyard ice rink on behalf of the passion for this sport. Adam shepherd grew up playing hockey, and now with his own family In Whites, Ontario, he wanted to share his experience with his children.Adam states, â€Å"l get real enjoyment watching my kids out here having fun. † 1 OFF January and February, and that's when the weat her is coldest. † Luckily Canada's climate allows the building of an outdoor skating rink to be successful. Tremor, Dam's 9 year old son stated that he loves to be outside playing hockey with his family, and that the cold never bothers him. Hockey plays an important role in people's lives whether winning a gold medal, being able to build hockey rinks, or spending quality time with family.Hockey has become more than Just a sport in Canada; over a period of time, it has become a huge part of Canadian Culture. In the eighth game of he 1972 summit series, Canadians practically came to a standstill as everyone wanted to see the outcome of the final game between Soviet Union and Canada. As a result, Canada pulled another big victory, and after this day hockey became an even more popular sport. Canadian â€Å"Hockey Night† as seen on CB sports airs every Saturday night. Since 1998, more than four million Canadians tune in to watch this show.The number of sales for televisions has increased by the value of seven billion dollars since the year 2000, due to the influence of this shows popularity to improve the development of technology. This is one of the positive impacts toward Canada's economy, which has caused many technological companies to rise. Also, hockey night is a great way for families to bond while supporting Canadian radios such as CB whom broadcasts details about regular hockey games. Another aspect is the number of viewers that watch Canada's hockey games, for example the number of viewers who watched the U.S vs.. Canada hockey game at the 2010 Vancouver Olympics. As said before, the love and support for this sport is undeniable which influences its fame. Family and friends that have gathered together to watch this special game caused a hit of 27. 6 million views; one of Canada's most viewed hockey games in all time. Generally, these reasons verify the admiration Canadians have toward hockey. 0 When looking back in Canadian history, women wer e not known for independence as men were considered â€Å"persons† while women were not.This did not come to an end until 1929, when Emily Murphy took action and brought the persons case to court. Although some action had been taken, it did not prevent women's stereotype during the sass's. At that time, it was necessary for women to have feminine qualities, which included the disability to play â€Å"masculine sports. † Hockey was one of the most influential sports that encouraged many individuals to take a step toward women's rights. Canada's national women's hockey team has been on the world stage, winning nine world titles, three Olympic gold medals and twelve 3 nations/nations cups.Its successful Journey has caused its reputation to rise internationally with their only losses being against United States and Sweden. Cassia Campbell, a professional hockey player on Canada's women's hockey team says â€Å"In 1998 we went to the first ever Olympic for women's hockey, and as a Canadian hockey player and Canadian hockey team we were by far the favorites going in, and we lost. We brought home a silver medal and felt like we let down our entire country; we were embarrassed and extremely disappointed.I remember I ran into a great Canadian speed skater Susan Such, when she congratulated me on the silver medal. While seeing the disappointment in my eyes, Susan said something to me that I'll never forget â€Å"do you know how many people in this world don't get a chance to be Olympic athletes, and how many Olympic athletes don't get a chance to be medalist? I realized what we big reason to why we won gold in Salt Lake City in 2002. † This inspiring speech given by Cassia motivated women all over Canada to never give up on their dreams, even if it meant challenging women's stereotype.Although it did take time, hockey is the only sport in Canada that truly represents a successful women's sport team. Long story short, hockey is indispensable to Cana da and its people. Women are better – respected because of the success of its hockey team, while technological industries broadcasting about this sport are emerging. Families bond whether by playing cocky outside their own backyard rink or by watching hockey night together. It is evident that hockey has an essential role in Canadians lives and should be titled Canada's true national sport because of the reasons stated in this piece.

Ethics within any organization of the world is an important Essay

Ethics within any organization of the world is an important manifestation - Essay Example What is needed is courage and vigor to do things right and that too with a sense of understanding and empathy. As far as an individual ethical definition is concerned, nearly every human being has a distinctive meaning for the same. There are certain people who believe in it while others do not care much. However, what is definitive is the fact that ethics shall be embedded within the lives of the people in their personal and professional realms, because they are answerable to others and to their religious perspectives nonetheless. The workplace domains are therefore reliant on the ethical repercussions because ethics takes care of how well these organizations would comprise of success and how boldly they can defy the negatives which come their way. What is important is to realize that the ethical discussions are held in good stead, and without much trouble at any end. The people who are behind such discussions should always be taken seriously because they are doing something worthwh ile, and must therefore be accepted for who they are and what they bring to the organization in essence. As far as an evaluation of my own ethical values is concerned, I am one of the few people around who comply fully with whatever comes under the aegis of ethics. This is the reason why I have always believed staunchly in the ethical manifestations and have given my best no matter how difficult it has been. This has made me into a strong-willed and determined moral individual, which remains significant to me than anything else. I can easily translate the same within my professional domains since my personal one is covered in a proper manner. I have understood that if people are treated fairly, then they respond in a positive way. However, when the dealing is more on the negative lines, the feedback that is received from them is all the more critical and this is where one can draw the line between the ethical realms and the unethical behaviors. It is important that the people realiz e the kind of ethical consequences they are looking forward to receiving at the hands of others. This is the reason why ethics is deemed as something that brings true value for the people no matter how tough it is to document. Ethics is therefore being seen as a major force that if employed properly, can bring about success for one and all. It can draw in productivity towards the workplace settings and give solace to the ones who actually believe in it quite a lot (Rasberry, 2000). Then again, there are some individuals who might not completely adhere with it yet somehow or the other have inkling that ethical undertakings are geared to be incorporated in the most righteous way. I am of the belief that ethics should always be employed because it has a sense of optimism attached with it that benefits the people and their work related measures in entirety. I have always envisioned ethics to be one of the most desired forms of human behavior. This is because it completes an individual a nd makes him feel empowered in the most basic way. It allows him to manifest his truest self without the fear of anyone, which is very significant if seen within the related scheme of things. When the same understandings are reached upon in an organizational setting, the focus seems all the more pertinent. There is reason enough to believe such a premise, largely so because the ethical boundaries are defined by the actions and the people who undertake

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See the instruction - Essay Example nked to this area has the agreement of the Russian elites, and finally because conflicts in Middle East have sensitive implications for Russia’s domestic problems (Ehteshami 66). The G. Bush administration was capable of rallying the military industrial complex, the oil lobby and the Zionist movement in a huge project: to secure a control of the oil fields that run from the Horn of Africa to the Caspian Sea by re-designing the political map on basis of small ethnic states. The region, demarcated not for its populace but for the reserves under its soil, was initially called â€Å"Crescent Crisis† by Bernard Lewis, a University professor and later George W. Bush called it â€Å"Greater Middle East† (Halliday 13). Washington did not hold back on its Middle East â€Å"re-modeling† project. Huge sums of finances were invested in hiring local elites so as their personal interests would be before national interests in the globalized economy context. Most significant was the deployment of a vast military force to Iraq and Afghanistan in order to interrupt Iran, the main actor around the region that outlooks up to the empire. The maps of the region were drawn up and distributed by the Chiefs of General Staff. Every country in the region, including US allies, could be viewed being broken up into innumerable emirates, incapable of protecting themselves, while overpowered Iraq would get divided into 3 federate states ( a Sunni, a Shiite, a Kurdish) imposed by the White House (Ehteshami 23). When it appeared that nothing could stop that domination process from moving forward, the Pentagon handed Israel a task of destroying every secondary fronts before they attacked Iran. The aim was to end the Lebanese Hezbollah and overthrowing the Syrian government. Nevertheless, after submitting a third of the territory of Lebanon under a shelling campaign the likes that which had never been seen before since the Vietnam War, the Israelis were forced to retreat without attained any of its

Summary Research Paper Example | Topics and Well Written Essays - 1500 words

Summary - Research Paper Example The nature of a designer personality has been understood in a variety of contexts. Broadly speaking, it’s understood that designer personalities constitute personalities or behavioral patterns that are ‘treated’ through a variety of pharmacological options. The late 20th century witnessed an explosion in this realm of health care. Still, it’s noted that, â€Å"the idea that personality is mediated by biological chemicals is not new; it dates back to Hippocrates and the ancient Greeks† (Carson 2008). Today, however, a myriad of personality characteristics are treated through pharmaceutical options. Such treatments began with chemical responses to such severe mental disorders such as schizophrenia. Chemical treatment for severe dysfunctioning soon gave way to chemical options for a variety of elements of personality. In these regards, pharmaceutical options exist prominently for the treatment of depression and anxiety symptoms, with Prozac and Zoloft, being among the most prominently prescribed drugs (Baghai & Rupprecht 2006). In addition to depression and anxiety, traits such as attention-deficit disorder are regularly treated through chemicals. There are a variety of advantages and disadvantages to the modern tendency towards ‘designer personalities’. Obvious advantages can be witnessed in individuals who contain severely debilitating personality disorders. For instance, it would be impossible for many individuals with schizophrenia, bi-polar disorder, or severe social anxiety to function without the aid of chemical intervention. Still, it’s clear there are a number of disadvantages. Perhaps the most prominent negative aspects of this occur with the glut of children diagnosed with attention-deficit disorder. Rather than restructuring the education system to adapt to the students, society has attempted to re-wire human consciousness. Another concern is that diversity of personality is an important part of a c reative and innovative culture. In simply medicating society to a perceived ideal, important and unique personality characteristics are being eliminated. In conclusion, this essay has examined what are termed ‘designer personalities’. In this context of understanding, it’s revealed that designer personalities are already a prevalent part of the contemporary cultural climate, as individuals are readily medicated for depression, anxiety, and a variety of personality ‘shortcomings’. Ultimately, while there are advantages for individuals with severe dysfunction, the disadvantages are the threat of a monotone culture. References Baghai TC, Moller HJ, Rupprecht R (2006). "Recent progress in pharmacological and non-pharmacological treatment options of major depression". Curr. Pharm. Des. 12 (4): 503–15. Carson, S. (2008). "designer" personalities . Retrieved from http://www.psychologytoday.com/blog/life-art/200807/designer- personalities 2. One of th e largest-scale scientific undertakings in recent years has been the human genome project. The Human Genome Project is a multinational effort to identify and map the approximately 20,000 – 25,000 genes of the human genome (McElheny 2010). The project was launched in 1990 and in 2000 a working draft of the genome was announced (McElheny 2010). 2003 witnessed the development of a complete draft of the human genom

Creative Arts Essay Example for Free

Creative Arts Essay This lecture enhances the creativity of the students by cultivating their interest in music. Various activities using different mediums like listening to CDs or watching musical shows help in having a better understanding of the lecture. Though the lecture may seem filled with fun activities, the lecture also focuses on teaching about the technical terms commonly used in studying music. Analysis In this lecture, I have learned that it is important to have interaction with the students in order to determine their learning progress. Also, having an activity that would sum all the lectures would be beneficial in measuring the students learning curve. Week 1 Visual Arts Description The teaching strategy used to teach the visual arts is methodical wherein the basic ideas are introduced about visual arts followed by an activity to put into practice what the students learned in class. More so, to teach kids about visual arts, use examples that theu can easily relate like cartoons or anything that is related to the interest of children. Meanwhile, for an older audience, use images or samples that apply to their generation so that they can quickly understand the lesson. Analysis Going through the lesson plan, I have noticed that beyond the explanation of basic visual art terminologies and the description of numerous artworks, art appreciation was also included. Art can be very subjective so the interpretation of a piece of art can be derived from ones opinion. Because of this art appreciation can be very limited but by teaching the objective and academic way of assessing artworks, ordinary people can obtain a better understanding and respect for the world of visual arts. Week 4 Dance Description This lecture shows how and why students should learn the art of dancing. I personally like the part that encourages students to craft their own moves to express their knowledge and judgment about dancing. Through this, one can really value the importance of this art form in a particular culture. Analysis I have learned that dancing can enhance or stimulate several types of intelligence including visual-spatial, interpersonal and others. Also, I have realized that dancing is not just movement but it also help in boosting self-esteem and enhancing social skills. Week 6 Drama Description Teaching drama requires focus and self-discovery. Students can use words or images to invoke emotions. To do this, one still needs to conduct research in order to realistically play a specific role. Also, it would be better to perform in front of other people so that you will be given criticisms on how to improve your acting skills. This will also be an opportunity to interact with other actors. Analysis Prior to reading this lecture, I have always associated drama with just acting out roles like what I see in the movies and television programs. Drama is more than what it seems. It involves a lot of concentration, dedication and understanding about different things in life. More so, every part of the body is used in this art form to convey a message or a story. Week 10 Arts and Literacy Description This lecture provides provide children with holistic and meaningful learning experiences. It uses integration to make the change from learning facts to understanding and applying concepts to developing generic skills for living and working. Analysis I think syntegration is a great way to teach arts and literacy. This is a process wherein subjects are working together synergistically to explore a theme, concept or focus question, while achieving their own outcomes as well as generic outcomes. Through this, students are able to value and fully appreciate what they learn in class. Week 11 Thematic Integration Learning Description A simple element like the colors of the rainbow can be used to learn about the different forms of art. Through definition and application, students can determine how to relate one form of art to another. Analysis I like the idea of having different stages in learning. First by exploring, then followed by developing the skills involved and lastly would be reflecting on the end results. Through this, students can have the freedom to discover things at their own space and they can interpret their findings based on their own opinions. This teaching strategy is simple and direct but it is a very effective learning tool.

Behaviour through a lifespan perspective

Behaviour through a lifespan perspective What are the advantages and disadvantages of viewing behaviour through a lifespan perspective for social work practice? This assignment will look at the advantages and disadvantages a social worker viewing behaviour through a lifespan perspective may encounter. It will look at developmental theories that relate to the chosen service user group, and how, as a social worker, this knowledge would increase understanding of the service user and how this in turn may affect the role of a social worker in practice. The service users age group being explored in this assignment will be older adults aged from 65+. Lifespan development starts from conception and finishes with the death of each individual. During each individuals lifespan there are constant changes and developments taking place, the majority of stages and life changes each individual passes through are due to their common psychological and biological heritage as humans and are shared by all people. Culture and social class, and the individuals environment are all factors that help shape the course of development (Niven. N.1989). There are five main theoretical approaches for lifespan development; these are biological, cognitive, humanist, behaviourist and the psychodynamic approach. Ageing in late life is shaped by the accumulation of life events and the proximity of death; a misperception about ageing is that disability and poor health in later adult life are inevitable (Davies, M, 2002). During each individuals lifespan, they will experience a series of crises and life transitions. Throughout the lifespan there are certain periods or stages where each individual will face a transition from one state to another. These periods have been referred to as life crises by some psychologists, each crisis needing to be resolved in order to progress to the next stage. Each individual proceeds through the stages of development, and the way in which they deal with each crisis in each stage of development shapes their personality (Niven, N, 1989). Other approaches agree that there are certain stages in development that have significance for each individual, but they state that there are also other events that can also shape development these being experienced by some indiv iduals but not all. Retirement is just one of a number of changes that need to be adjusted to in late adulthood, among the others are declining health and physical strength along with physical and sensory impairment which can result in increased dependency on others in late adulthood (Beckett.C.2002). Several physical and cognitive changes also take place in old age (Bee Mitchell, 1984) cited in (Sugarman. L. 1990. Pg 53). The bodily changes that are associated with ageing are summarized in five words- slower, weaker, lesser, fewer and smaller. As ageing occurs experience gained throughout the lifespan helps the individual and they learn to compensate for the many gradual declines that accompany old age. (Corse 1975) cited in (Sugarman. L. 1990. Pg 53) concludes that experience, intelligence, and education can help maintain normal perceptual and sensory functioning. Many changes in appearance take place in old age. Outward appearances begin to show ageing, older peoples skin begins to lose elasticity, which causes lines and wrinkles to appear, hair loss and grey hair may be one of the first signs of ageing, and hearing and eye sight now begin to deteriorate (Windmill.V.1987). Internally the kidneys, lungs, heart and intestinal tract all begin to function less and there may be deterioration of muscles which can literally cause old people to shrink. The reduction of calcium in the bones makes the old person more prone to fractures and brittleness of the bones is also a problem in the older population. Arthritis is one of the more serious health problems affecting older people and for most people these changes may be gradual (Windmill.V.1987). A social worker needs the basic insight of childhood studies, as without them it would be difficult to assess adults on adulthood theories alone. Freud is credited with beginning the psychoanalytic approach. The central assumption of this approach is that behaviour is governed by the unconscious as well as the conscious processes; some are present at birth while others develop over time. (Beckett.C.2002) The second assumption of the psychoanalytic theory is that our personalities have a structure that develops over time. Freud proposed three parts of the personality- the id, the ego, and the superego. Freuds key assumptions were that adults personalities depend on childhood experiences; he assumed children go through five psychosexual stages. The first being the oral stage, the second the anal stage, and the remaining stages being the phallic stage, the latency period and the genital stage. (Beckett.C.2002). When looking at human lifespan development, Erik Eriksons theories can be of use to a social worker. Erikson was a student of Freud; however he had some very different ideas. He thought development was psychosocial and due partly to maturation and partly due to society. Erikson also thought that personality development continued across the lifespan, unlike Freud, who suggest personality development finished in adolescence. Erikson (1980) cited in (Niven, N, 1989, pg 155) proposed eight stages of development which he called developmental crises, these being viewed more as a period of difficulty or dilemma. They are times when individuals face a turning point or transition in their lives often involving a degree of stress associated with having to resolve each dilemma. Not only do these transitions of change affect the individuals behaviour they also affect their family and friends. Eriksons stages are phrased in terms of an opposition between two characteristics and each individual mu st successfully negotiate the task or stage in order to be able to move on to the next one. Erikssons eighth stage (late adulthood) is integrity vs despair; this suggests if the individual has managed to negotiate the previous stages, then the individual will have developed a sense of integrity. This refers to the acceptance of the limitations of life, with the sense of being a part of a larger whole which includes previous generations. It enables the individual to approach death without fear, if one looks back on ones life and sees it as unsatisfactory, despair occurs and a feeling of what if prevails. Erikson suggests that at each transition individuals may need to revisit unresolved issues from previous stages. The main strength of Eriksons theory is that it offers a framework for explaining changes in childhood and adulthood. His work has been criticised in that it represents a set of assumptions instead of precise descriptions of relationships and causes. A disadvantage here is the lack of empirical evidence- this is also another criticism of Eriksons work. The advantages for a social worker using Eriksons theory is that it provides markers for those events in a service users life that may be proving difficult and in using this approach, social workers can highlight the problems that are likely to affect people during specific stages of their life. (Niven. N. 1989). An area of life course development most associated with older adults relates to end of life issues. In the later stages of adulthood the end of life is expected. Death is the end of biological and physical functioning of the body. Factors to be taken in to account for social workers working with service users who have suffered a loss, are gender and cultural differences, as these can affect a social workers understanding of what may count as a loss and what in turn can be done about it (Currer. C 2007). Each individuals reaction to grief and emotional trauma is as unique as a fingerprint. When thinking about bereavement and loss it is useful to look at attachment theory, Bowlbys (1946) cited in (Davies, M, 2002), major work was Attachment and Loss; sadly it is the case for many individuals in later adulthood that there is a price to pay for the benefits of forming attachments. According to Bowlbys attachment theory adults, who as children had secure attachments with their carers, are able to form satisfactory relationships in adult life and this will help them to cope with the pain of bereavement in later life. Bowlbys aim of this originally was to explain the consequences for personality development and how severe disruption of attachments between infant and mother could have negative effects on development. (Butterworth. H. Harris. M. 2002). Adults who did not have secure attachments as children can be identified, according to Howe (1995) cited in (Davies, M, 2002), who suggests that avoidant individuals are the ones who show self reliance. They may display delayed reactions to grief, they attempt to be emotionally self reliant and are wary of forming relationships. This means the loss of someone who is close to them usually triggers defence mechanisms- they may not cry or appear to be upset but are vulnerable to future losses. Exaggerated reactions to grief can be accounted for when the individual has not adjusted or come to terms with earlier loss of an im portant attachment relationship. On the other hand ambivalently attached individuals may experience self-blame and guilt when their partner dies. Where there has been an insecure attachment in childhood (an attachment that does not meet the childs needs- the need for safety and security etc) Bowlby (1998) cited in (Beckett. C. 2006) suggests the anxious child will try to protect themselves against anxious situations. The child uses a variety of psychological manoeuvres and this results in what Bowlby called a faulty working model of themselves and of other relationships. To maintain this model the child will use defensive exclusion to avoid feelings that may threaten the childs already precarious stability. Attachment theory is backed up by empirical evidence. This is beneficial as it can help social workers identify causes from an individuals past and this helps to provide explanations for present behaviours and their ability to deal with change (Beckett. C.2006). Each individuals reaction to grief and emotional trauma are as unique as a fingerprint. When looking at loss it is important to remember that older people may lose friends, abilities, connections and many other things that are important to them. The significance of grief and loss in old age is dismissed by the ageist stereotype that older people will be used to loss because they are at an age where they have experienced lots of it. However the reality is that loss can be cumulative at this age and this results in negative experiences for those whose loss or grief is not recognized or addressed (Thompson.N. et al. 2008). It is important that social workers take a holistic approach to understanding life course development in older adults, as life course is central to any understanding of ageing. A social worker should be aware that an individuals life experiences and life course developments are affected by several factors- these include economic and social aspects, historical, cultural, psychological, and cognitive and physiological influences. (Crawford, K, Walker, J, 2007). All transitions expected or unexpected, sudden and unplanned, present opportunities and challenges for the individuals development and growth. Each individual will have different experiences of transitions even when the life event is common to many in society, each person will respond and adapt to that change in a unique way. (Crawford, K, Walker, J, 2007). There are disadvantages for social workers when viewing individuals through a lifespan perspective as most of the theories being used are Euro centric (European studies) and cannot be applied to all cultures. As a social worker care must be taken when using any of the behavioural approaches as they raise the issues concerning the use of power and oppression. The social worker should not focus too much on narrow behavioural issues at the expense of the larger picture (Beckett.C.2006). It is in a social workers interest not to oppress or discriminate service users but to treat them with unconditional positive regard, not forgetting to treat each service user as an individual with their own opinions and values. The theories used do have limitations as not all individuals or cultures fit the suggested norms and each person develops at a different rate. As a social worker knowing about the different viewpoints from theorists and their suggested viewpoints may enable a better understanding of what problems a service user may be experiencing. When working with service users from any age range, it is important that the social worker does not influence these transitions with their own life experiences. References Beckett.C.(2006).Essential Theory for Social Work Practice. Sage Publications Ltd. London. Beckett.C. (2002). Human Growth Development. Sage Publications Ltd. London. Bee.H. Boyd. H. (2003) 3rd Ed. Lifespan development. Pearson Education Inc. Boston. USA Butterworth. G. and Harris. M. (2002). Developmental Psychology. A Students Handbook. Psychology Press Ltd. Hove. East Sussex. Crawford. K. Walker. J. (2007) 2nd Ed, Social Work and Human Development. Learning Matters Ltd. Exeter. Currer. C. (2007). Loss and Social Work. Learning Matters Ltd. Exeter. Davies. M. (2002) 2nd Ed. The Blackwell Companion to Social Work. Blackwell Publishing Ltd.Oxford. Niven. N. (1989) Health Psychology. An Introduction for Nurses other Health Care Professionals. Churchill Livingstone. Sugarman. L. (1990). Lifespan development. Concepts, Theories and Interventions. Routledge. London. Thompson.N. Thompson. S. (2008) The Social work Companion. Palgrave Macmillan. Basingstoke. Windmill.V. (1987). Human Growth Development. Hodder and Stoughton Ltd. Kent.

Cardiovascular System in Parabolic Flight and Spaceflights

Cardiovascular System in Parabolic Flight and Spaceflights Human Spaceflight: Alterations of the cardiovascular system during parabolic flights and spaceflights The purpose of this research is to identify the changes occurring during parabolic flights and spaceflights, where theres weightlessness. The importance of the cardiovascular system in space, is recognised as well as some of its fundamentals based on past researches. In addition, since parabolic flights are a way of experimenting physiological alterations in the human body, instead of actual spaceflights, the procedure needed for the airbus to reach microgravity conditions is indicated as well. Findings, such as low plasma volume, circulatory pressure, central venous pressure, stroke volume and also the heart rate of the cardiovascular system are stated from past investigations. Also countermeasures, such as exercise and diet are also briefly discussed. Introduction Microgravity is the phenomena where objects or people experience weightlessness. Astronauts and objects face microgravity in space, where the gravity is very small (micro) and they float (free fall). Even though astronauts are relatively heavy, they can move easily inside or outside the spacecraft (Wall, 2015). Under microgravity circumstances, the physiology of the cardiovascular system changes and it reacts unlikely relative to the gravity of the Earth leading to body alterations such as redistribution of blood, cardiac arrhythmia and orthostatic hypotension (Zhu, Wang, and Liu, 2015).These changes may occur pre-flight, in flight or post-flight and they may impact the astronauts health. Moreover these changes can affect either healthy astronauts or astronauts with past heart diseases. Due to the environment, the body of the astronaut learns how to adapt under the new conditions and works relatively quickly. In order to investigate and analyse the changes of the human physiology, various microgravity based researches were conducted, not only by spaceflights but also by parabolic flights and bed rest studies. Measurements are taken in three stages of the astronauts body, pre-flight, in-flight and post-flight, known as the long duration since astronauts are sent to space missions while these measurements are taken. Although, for more data, investigators managed to create microgravity condition for 20-30 seconds, using parabolic flights, known as the short-term duration, which is clearly a cheaper way to collect data. Another way to study the adaptation of human physiology in space is bed rest studies, where volunteers spend up to 2 months in a bed, with their head end at an angle of 6ÂÂ ° beneath the horizontal axis. All volunteers eat, shower and exercise while they are in bed. The cardiovascular system In order to analyse the cardiovascular system in space, some fundamentals of the heart should be noted. A healthy cardiovascular system is essential for astronauts going to space, since the heart functions differently in microgravity and it is responsible for many main functions of the body. The physiology of the cardiovascular system in space, therefore will be altered and this can impact the function of the system. Transporting nutrients (e.g. oxygen O2, food) to the tissues of the body, waste removal (e.g. carbon dioxide CO2, by-products) and controlling heat distribution between the body core and the skin (temperature) are some main function of the cardiovascular system (Evans, 2012). Heart is one of the muscles in our bodies which is constantly in action and it is part of the cardiovascular system. This system also includes arteries, veins and capillaries, all known as blood vessels. Additionally, O2 and CO2 are delivered and collected, respectively, to and from various organs, through blood vessels pumped by the heart.ÂÂ   Furthermore, the cardiovascular system is responsible for the blood pumped towards the heart, due to the muscles of the legs (Evans, 2012). The cardiovascular system in weightlessness When an astronaut is bare in space, the cardiovascular system learns how to function in such an environment.ÂÂ   The cardiovascular system changes in microgravity, since the downward force of gravity does not exist anymore, as it existed on Earths environment. Therefore, due to the lack of the gravitational force, blood and body fluids are not uniformly distributed in the body, but more importantly in the legs, where all these fluids shift upwards, towards the head, resulting for astronauts to have puffy faces and less leg circumference (bird legs), as shown in Figure 1. Fluid shift in the body, leads to the increase of the size of the heart, initially, in order to handle the increase of the blood flow. This occurs during the first day of exposure in microgravity. In addition, due to the upward direction of the fluids, astronauts do not feel as thirsty, resulting to the reduction of the fluid levels after the first day and the heart shrinks (Lujan, Bartner, and White, 1994). Figure 1: Illustration of fluid shift level. The fluids are distributed uniformly, pre-flight (left), fluids shift, during flight (bird legs and puffy faces)(middle) and post flight, the pressure is lower in the upper body, due to gravity, causing faintness to the human. (Watenpaugh and Hargens, 1996) Parabolic flights and the cardiovascular system Airbus A300 Zero G is the aircraft used by the French company Novespace for simulation of microgravity through parabolic flights, between 1997 and 2014 as shown in Figure 2. Agencies such as the European Space Agency (ESA) and the German Aerospace Centre, performed researches using this airbus in the stated period of time, but by 2015 the new Airbus A310 Zero G replaced it. Figure 2: The Airbus A300 ZERO-G as it is flying in an incline of 40ÂÂ ° to reach 0g. (Pletser, et al., 2015) These aircrafts, were built for researches due to testing results before or after space missions, by achieving parabolic flights under weightlessness for 20 seconds (Pletser, et al. 2015). More specifically, the airplane from a steady horizontal altitude, pulls up at an angle approximately 40ÂÂ ° in a period of 20s, resulting to an acceleration between 1.8 g and 2 g and therefore, the engines start to slow down, which leads to microgravity conditions inside the aircraft as it reaches the peak of the parabola. Finally, the aircraft generates an acceleration of 1.8 g to 2 g, while flying back down with roughly 40ÂÂ ° again for 20s and then before returning to its initial steady altitude, repeats the manoeuvre from the beginning, as shown in Figure 3 (ESA, 2004). In addition, parabolic flights can investigate how the cardiovascular system of the human body reacts under 0-g conditions, within this period of time by spending relatively less money than actual spaceflights. Figure 3: This figure illustrates the manoeuvre which the aircraft (thick-black line) follows to generate microgravity conditions and demonstrates the acceleration and the microgravity level as well. (ESA,2004) Between 2010 and 2012, Novespace undertook an experiment based on the reaction of the cardiovascular system during a parabolic flight, using the Airbus A300 Zero-G. The test presents a short duration of microgravity, where the fluids inside the body are distributed. The heart is pumped with more blood than usual resulting to an increase of the blood pressure in the ventricles of the heart. The stoke volume of the cardiovascular system remained constant but the heart rate decreased by 14 min-1. Furthermore, it was stated that astronauts were in an environment, where the body lacked sufficient oxygen supply, known as hypobaric hypoxia condition (HH) and since the study is under a parabolic flight, the gravity was shifting as well. This kind of environment influenced the cardiovascular system, where the data obtained for the plasma volume showed a decrease mostly due to HH, from -52 ml (hypobaric chamber) to -115 ml (parabolic flight) (Limper and Gauger ,2014). Another research, compare d the data for humans in supine posture, under normal gravity and microgravity in parabolic flight (0G), which showed an increase in cardiac filling pressure resulting to the diameter of the left atrium to increase by 3.6 mm. At the same time the central venous pressure (CVP) decreased by 1.3 mmHg but the transmural CVP increased by 4.3 mmHg. Finally, as soon as an astronaut returns to Earth, due to the gravity, the blood flow is reduced and that can cause the astronaut to collapse (Watenpaugh and Hargens, 1996). These results were obtained by researches, in order to investigate the consequences of the cardiovascular system under weightlessness, by avoiding actual spaceflights, where these changes are only temporarily. The cardiovascular system during spaceflights As soon as astronauts enter space, the fluid levels in the body are not uniformly distributed as they were on Earth, which results to alterations of the cardiovascular system. As it was mentioned in parabolic flights, the astronauts are under hypobaric- hypoxia conditions, meaning that the oxygen saturation decreases (SaO2) and hence the oxygen in the blood. It has been stated that the concentration of O2 in the blood can drop down to 75%, where usually this levels should be more than 80%, but if the astronauts stays in space for longer, this concentration will increase back to 85% (Opatz and Gunga, 2014). Moreover, the mass of the heart decreases during spaceflights and therefore the heart rate is less than that on Earth. In 1996, it was reported that the heart rate would increase as the astronaut continuous to be under microgravity circumstances, during a long-term spaceflight (Charles, Frey, and Fritsch-Yelle, 1996). In weightlessness, significant effects were also realised, the c ardiac output increased whereas the systolic and diastolic pressure decreased (Hamilton, Sargsyan, and Martin, 2011). Hence, stroke volume is also reduced, due to hypovolemia which is responsible for hypotension and atrophy of the heart (Levine, 1997). Investigators postulate that plasma volume decreases from the first day and it continuous to reduce throughout the whole spaceflight by 17%. This occurs, because of the negative fluid distribution and the fluid movement towards the extravascular space and therefore the orthostatic intolerance (Alfrey, Udden, and Leach- Huntoon, 1996). A study reported by J.C Buckey et al. 1996, studied the central venous pressure (CVP) in space and stated that the CVP increases during the launch and more in the spaceflight. The left ventricular end-diastolic volume (LVEDV) was also analysed in order to figure out how it is affected by microgravity. Furthermore, it was stated that as astronauts enter space, the LVEDV and therefore the total heart volume increases significantly. While the astronaut is in space, the body adjusts to the environment resulting to the LVEDV to decrease (Buckey Jr. and Gaffney, 1996) Countermeasures For short duration exposure, effects are less than actual spaceflights where the duration could be more than 6 months. It is really important for astronauts to be healthy during a mission, therefore some actions should be taken in order to counteract these threats of their physiology. It has been reported that somatic stress in weightlessness effects the cardiac arrhythmia (Romanov et al., 1987). The astronauts must exercise and have a healthy diet, before and during the spaceflight, to ensure the appropriate volume for extravehicular action (Hargens, 2009). Also, the lower body negative pressure (LBNP) should be exercised regularly since it increases the plasma volume (Watenpaugh and Hargens, 1996) and in fact, aerobic exercise keeps the aerobic volume (peak of VO2) constant. For long-term exposure in microgravity, exercising machines, provided in the spacecraft can reduce the consequences of the physiology of the astronaut after returning to Earth. Although, studies have not shown the particular amount and type of exercise, that astronauts should perform, yet (Schneider and Watenpaugh, 2002). Discussion and Conclusion Researches within the last 20 years, examined how the cardiovascular system adapts under microgravity conditions, in order to provide astronauts with a safe working environment and physiology. Astronauts are sent to space to test experiments for the future of science, but their lives shouldnt be at risk. Due to microgravity, several characteristics of the cardiovascular system are affected. The fluids in the body of an astronaut exposed in microgravity, shift head-wards due to the missing gravitational force. Therefore, plasma volume and mean circulatory filling pressure are decreased. Hence, there are effects on the central venous pressure (CVP) and stroke volume, which both are reduced during weightlessness. The heart rate is also declined due to these changes, in order to maintain the arterial blood pressure and metabolism. Some of these parameters can affect significantly the astronauts health and in rare cases may lead to tragedies, since they are long- term flights. Although, w hen subjects are under investigation in parabolic flights, these changes are only temporarily. Also, countermeasures, such as aerobic exercises and healthy diet, before, during and after the spaceflight are required. These actions may reduce the orthostatic hypotension of astronauts during flights but also as they return back to Earth. More experiments will be conducted in the future, where researchers will have an even better understanding of space environment and the physiology in it. References Alfrey, C.P., Udden, M.M. and Leach- Huntoon, C. 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