Study of a Diabetic with Type Two Diabetes and a Leg-Ulcer The WritePass Journal

Study of a Diabetic with Type Two Diabetes and a Leg-Ulcer Introduction Study of a Diabetic with Type Two Diabetes and a Leg-Ulcer IntroductionREFERENCESRelated Introduction This essay will focus on a type two diabetic patient with leg ulcer as the effect of the complications of diabetes. Limited mobility caused by leg ulcer will be discussed as the health deviation. My patient is Mrs B, 54 years old who was diagnosed with type two diabetes 13 years ago and lives with her husband and two daughters’ ages 18 and 16. She works as a senior staff for a beauty company. I chose this client because my sister died of complications of foot ulcer and my grand father died of diabetes.   I came from a country where health services are not free and due to poverty, my sister was not diagnosed till she died and my grand father was only diagnosed in his old age when intervention was too late. Herbal medication was used for both my grandfather and my sister but failed due to lack of knowledge of the condition (Yodar 1989). All confidentiality will be maintained and informed consent form is included in the appendix. This health deviation was also chosen because it is a costly problem in the UK with an increasing prevalence. National Health Service (NHS) spent approximately  £400 million a year on treatment on leg ulcers (www.journalofwoundcare.com). Andrew et al (2010) estimated that by 2025, people suffering from diabetes mellitus would have rapidly increased from 2.6 million at present to 4million. The understanding of this condition and how it impacts on individual will prepare me for the future as I will be in a position to care for people with diabetes and also to educate them on the impact the illness can have on their well being. Type 2 diabetes is accompanied by peripheral resistance to insulin in muscle cells, increased production of glucose by the liver and altered pancreatic insulin secretion (Steven and Michael 2008). Increased tissue resistance to insulin generally occurs first and is eventually followed by impaired insulin secretion.   Looking at the pathophysiology of Mrs B’s leg ulcer which resulted in limited mobility. Insulin is produced by the pancreas but could not be used due to inhibition of insulin resistance. This results in accumulation of glucose in her bloodstream not being used by target cells thereby leading to hyperglycaemia. Leg ulcer is caused by poor diabetic management and can either be venous or arterial (Tim and Sudhesh 2010). According to Mustoe (2004), accumulation of glucose in Mrs B’s bloodstream over a period of time causes increase in blood viscosity and leads to blockage and damage of the small vessels and peripheral nerves. This then lead to decrease in cir culation to her peripheral vessels and causing the pressure in her vein to increase (venous hypertension). Arteries loose their normal higher pressure due to venous hypertension and this allows inflammatory exudates to escape into the subcutaneous tissues of the crus subsequently breaks down the tissue. Walking barefoot at home is part of Mrs B’s upbringing. In addition to the pressure in her foot, she hit her foot against her daughter’s scooter and the skin break down. Venous hypertension stretches the veins and result into leakage of blood protein into the extra vascular space and leaving out the extracellular matrix molecules (venous insufficiency). Venous insufficiency causes build-ups of white blood cell (leukocytes) in smaller blood vessels which plug the vessel and contributes to ischemia in the limbs. Leukocytes can also release inflammatory factor, further contributing to chronic wound formation (Mustoe 2004). Diabetic mellitus is characterised by autonomic, s ensory and motor neuropathies. There are various complications for client with diabetes mellitus (type 2) due to inability of retaining control of their blood glucose (Palfreyman 2008).   Mrs B developed a reduced mobility due to damaged peripheral vessels and nerves caused by decrease circulation as a result of increase glucose level in the blood. Reduced mobility can have a great impact on day to day activities as this also reduces the individuals independent and control of ones life. Mrs B as the bread-winner in her family now finds it extremely difficult to cope and to provide for her family since her husband also has a heart condition which prevents him from working. This is also distressing due to her children’s needs not being met and her inability to function effectively as a mother because of reduced mobility. Mrs B is on insulin, lansoprazole for prevention of gastric acid and fentanyl patch for pain killer (www.diabetes.co.uk/treatment and bnf) Leg ulcer cost NHS approximately  £400m a year of which community nursing services accounts for. Research has shown that 80-85% of client with leg ulcer are venous leg ulcers whilst 10-20% are arterial leg ulcers (www.journalofwoundcare.com). According to Simon et al (2004), leg ulcers are on rapid increase in the UK and have a huge impact on NHS budget.   Immobility is also on increase because of inadequate bed in the hospital to admit such client for close monitoring. This results in district nurses spending more time on caring for client with ulcer in the community and yet most patients do not receive appropriate care. Chapman (2008) states that about 1.2%-3.2% in 1000 people suffers from chronic leg ulcer, which means 80,000-198,000 people in the UK suffers from venous leg ulcer. A UK study examined the prevalence of venous ulcer and it was 0.4/1,000 in men and 0.6/1,000 in women. The increase of leg ulcer is related to age. Same study shows that in men over 85 years old, the rates were 8.29/1,000 and 8.06/1,000 in women and 55% of patient had leg ulcer for more than one year (Moffatt et al, 2004). Research in Canada estimated that 2.0/1000 Canadian suffers from leg ulcer, of which 40% are homebound due to immobility caused by chronic leg ulcer and this has been a huge cost to the Ministry of Health (MOH). Approximately, $5,868 is spent on each client under standard community care thus, coming up to $511 million spent annually by the MOH on leg ulcers (Shannon 2007) Mrs B often becomes have low mood and becomes tearful because of the state of her health. According to Rotter (1965) cited in Mamlin et al (2001), it is believed that the client has an external locust of control. This is related with depression, fear and inability to cope with stress. Mrs B’s diabetes was diagnosed 13 years ago following her admission in St George’s hospital for a removal of gall stone. During her observation, the health care assistant informed the nurse that her blood glucose reads 19.4mmol/L. The nurse did a fasting glucose level test on her and it reads 10.9mmol/L. Her urine was tested and glucose was present in it. It was also noticed during her stay in the hospital, her increase in thirst was alarming. Random blood glucose tests, fasting blood glucose tests, urinary analysis for glucose and ketones, Hba1c level and formal glucose tolerance tests such as plasma glucose are procedures carried out to confirm the diabetes state of client. Eye test is also checked to confirm diabetic retinopathy whilst other cardiac investigations to rule out or recognise the presence of cardiac diseases (www.doh.gov.uk). Mrs B does not require surgery and does not fall in the categories of people who go through referral because her diagnosis was con firmed in the hospital. Her General Practitioner (GP) will also be informed so that h/she can refer her for follow up. Patient with diabetic type 11 will normally be referred by their to their local GP within 8 weeks to external bodies like out-patient where they will be able to see a diabetes specialist nurse for follow up (www.doh.gov.uk). Diabetes research in the UK is funded by the Juvenile Diabetes Research Foundation, the charity Diabetes UK and other private companies sectors. Diabetes specialist nurse specialised primarily with clients with diabetes and their aim is to educate, help client understand, control and manage their diabetes; and also provides physicians care for them (David 2010). The client was met on her admission to the ward for advance medical treatment for her leg ulcer which is also limiting her mobility. Mrs B is now finding her activities of daily living very hard to keep up with and has to depend on her husband who also suffers from heart condition and panic attack for her care. Her reduced mobility has become a challenge and concern for her as she is unable to meet the needs of her children and this stress is worsening the husband’s condition. According to National Institute for Health and Clinical Excellence (NICE), a consultant’s visit from GP’s referral should be within 9 week at best and at least, 18months (www.nice.org.uk/Gps). Health care professionals are undergoing stress, whilst NHS are target driven rather than effective treatment and consultants are trying to meet these target (www.doh.gov.uk). Palfreyman (2008) interviewed 266 people with the history of leg ulcer and identify the huge impact it has on ones quality of life even the ones with healed leg ulcer has a lower quality of life in comparison with people who has no history of leg ulcer. According Briggs and Fleming (2007) 8O% of patient with leg ulcer caused by complications of diabetes type 11 have excruciating pain, 75% of them have exudates, 65% of them suffer from depression, 56% of them have an offensive smell and 65% insomnia. Mrs B is experiencing reduced quality of life. The weight of bandage on her leg and exudates is burdensome. The smell is intimidating and embarrasing and leads to the client being withdrawn and hiding themselves. The pain is also mentally and emotionally disturbing which is also putting strain on her physical moveme nt (reduced mobility); also her being overweight is worsening her reduced mobility. Limited mobility has been the focus of concern for Mrs B. As the breadwinner of her family, anxiety, fear of the unknown and depression has increase rapidly in her life as she is experiencing extreme difficulties in mobilizing and in carrying our her day to day activities. According to Gavard et al (1993), â€Å"Depression occurs frequently in people with diabetes, especially in those with complications†.   The Quality and Outcome Framework (2010) has introduced depression screening into regular diabetes surveillance (www.nhsemployers.org). Mrs. Book’s relationship with her husband and two daughters is affected as she gradually deteriorated and lost her independent. Her dependence is now on her husband who cannot engage in stressful work due to his heart condition and also the children are having problems with socializing because they have to rush home after school to help their mother. Mrs. Book condition has had great impact on her children as they struggle to maint ain previous level of performance in their education. Limited mobility has leaded a strained relationship between Mrs. Book’s and her children. She cannot spend much time with them as she use to; taking them to the park, cinemas, shopping and holiday has also reduced. The weight of the bandage on her leg is burdensome at she often have to change the bandage when it is wet. She conceives her despair and was afraid to engage her husband because stressful situation can trigger his panic attack. This often led to conflict between her and her husband as the husband struggles to understand her. Research shows that supportive families can help client with chronic illness cope with behavioral or psychological disorder that may occur as a result of the illness. Same research shows that open expression of emotion such as crying might make the family member to empathize (Hanson et al 1992). On the contrary, this can be argued depending on the level of maturity of the family member. In Mrs. B’s case, open expression of emotions might not be appropriate in the presence of her children. Her children ages 18 and 16 years old fall in the 5th stage of Eric Erickson’s psychosocial theory of Human development (identity v Role confusion). This adolescent’s stage is when they start resolving identity and direction and also becoming a grown-up (businessballs.com/erik_erikson_psychosocial_theory.htm). Open expression of emotion of can be stressful to Mrs. B’s children in addition to the stress adolescent experience due to hormonal changes in their body (Seiffge-K renke 2001). Mrs B’s finance is also affected. As a senior staff of a growing beauty company, she finds it hard to return to work as she is unable to move around to assist customers as her job demand. Abiding with her company’s uniform conduct is also a problem for her, although the manager has agreed for her to wear a trouser instead of a skirt, yet she has to take breaks often to change the bandage when it’s wet. She also has to wear a special shoe because she wasn’t fitting in her normal shoes because of the extent of the bandage on her ankle. Her condition contradicts her working environment. This might cause stereotyping and make her feel odd. Mrs B felt she is loosing control of her life as she is also not free to wear any clothing she want and has to wear clothing’s that covers her leg. As a result of her limited mobility, she feels guilty and sees herself as a failure for letting herself and family down.   A study/ statistics was carried out by (Murray and Fortinberry 2005) in Australian and it shows that problems encountered by the patient are comparable to those of the US and UK. This essay has improved my knowledge on complications of type 2 diabetes on individuals life and how it can ruin once career. I have lived with people with diabetes and got few friends with diabetes type 2, yet my understanding of their condition was shallow which I believe it has limited me in a way i should have help them. I have also come to the realisation of the strain leg ulcer can place on individual. Although I have nursed few patients with leg ulcer caused by their diabetes, I have not provided them with appropriate emotional and psychological support they might have needed due to my limited depth of the condition. Finally, I have deepened my understanding on how culture, upbringing and religion can affect a client’s view of their conditions. In future, when dealing with a patient with leg ulcer, I will put into consideration their culture, religion, job and environment where they live. This will help me to make an appropriate referral to a local group available in th eir area where they can meet other people with the same condition and moreover, people of the same culture. This will give them the opportunity to interact with others and see how they deal with it since they have the same culture. This essay was based on limited mobility caused by leg ulcer in type 2 diabetes patient. Pathophysiology of the health deviation and its effect on the client was discussed, the impact of the health deviation on client’s journey through health care and potential influences of the health deviation on the long term well being of client and family/ significant was also discussed in details. REFERENCES Andrew, S. P. and Anthony P. C (2010) The treatment of diabetic foot infections: Pathogenesis of diabetic foot disease 26, (7). Briggs, M. and Fleming, K. (2007) Living with leg ulceration: a synthesis of qualitative research. Journal of Advanced Nursing; 59: 4, 319-328. [online] Available at nursingtimes.net/assessing-the-impact-of-venous-ulceration-on-quality-of-life/1896181.article. (Accessed 16 Nov, 2010) C.J Currie., C.L Morgan., and J.R Peters (2008). The epidemiology and cost of inpatient care for peripheral vascular disease, infection, neuropathy, and ulceration in diabetes. Nursing Times 6(110) 42-44.7 Chapman. R (2008) Chronic Wound Pain. [online] Available at: painconcern.org.uk/pages/page78.php ( Accessed: 19 Feb 2010) David Uregbula (2010), The Role of a Diabetes Specialist Nurse. [online] Available at:   ehow.com/about_5201899_role-diabetes-specialist-nurse.html#ixzz1DIN4J4hF. (Accesssed:26 Jan 2010) Deborah, A .S., Francis P.D. and Charles N.M (2004). Management of Venous Leg Ulcers. [Online] Available at: bmj.com/content/328/7452/1358.full (Accessed: 10 January 2011) Gavard J., Lustman P. and Clouse R (1993) Prevalence of depression in adults with diabetes: An epidemiological evaluation. [online] Available at: http://care.diabetesjournals.org/content/16/8/1167 16:1167– 1178. INGE SEIFFGE-KRENKE (2001) Diabetic Adolescents and Their Families: Stress, Coping and Adaptation. USA: CambridgeUniversity press Journal of Wound Care (2006): Venous Leg Ulcer. [online] Available at: journalofwoundcare.com/JWC/Supplements/206 ( (Accessed 15 Jan 2011) Mamlin N., Harris, K.R. and Case, L.P. (2001). A methological Analysis in Research of Locust of Control and Learning Disabilities: Rethinking a Common Assumption [online] Available at: www.findarticles.com/cf_o/moHDF/4_3476157546/p1/article.jhtm1. (Assesed: 23 January 2011)   Moffatt, C.J. et al (2004) Prevalence of leg ulceration in a London population. [online] Available at: nursingtimes.net/the-burden-of-chronic-wounds-in-the-uk/527138.article QJM; 97: 7, 431–437: (Accessed on 18th Feb 2010) Murray B.   and Fortinberry A (2005). Depression Facts and Stats. [online] Available at upliftprogram.com/depression_stats.html#statistics, (Accessed: 23 Feb, 2010) Mustoe T (2004). Understanding chronic wounds: a unifying hypothesis on their pathogenesis and implications for therapy. Am. J. Surg. 187 (5A): 65–70 National Institute for Health and Clinical Excellence (2008). [online] Available at:www.nice.org.uk/Gps. (Accessed 15 Jan 2011) Palfreyman, S.J. et al (2007b) Impact of intravenous drug use on quality of life for patients with venous ulcers.   Journal of Advanced Nursing; 58: 5, 458-467. Palfreyman, S. (2008) Assessing the impact of venous ulceration on quality of life. Journal of Advanced Nursing; 104:41, 34-37. Ronald J. Shannon (2007) A Cost-utility Evaluation of Best Practice Implementation of Leg and Foot Ulcer Care in the Ontario Community.[online] Available at: cawc.net/images/uploads/wcc/5-1-Cost-utility_Evaluation.pdf (Accessed on 23 Feb 2011) Stephen R. Baker, and Michael C. Stacey. Article first published online: 21 JAN 2008 The Quality and Outcome Framework (2010) Depression screening into regular diabetes surveillance. [online] Available at: www.nhsemployers.org ( Accessed: 12 Feb 2011) Tim Holt and Sudhesh Kumar (2010). ABC of Diabetes (6th ed). UK. Wiley-Blackwell Yoder RA. Are people willing and able to pay for health services? Soc Sci Med 1989; 29(1):35-42. [online] Available at: ispub.com/journal/the_internet_journal_of_health/volume_8_number_2_12/article/user_fees_in_health_services_in_nigeria_the_health_policy_implications.html. (Accessed on 21 Feb. 2010)

Reference

Reference When you sit down to write an academic paper or business report, how often do you feel totally confident at the outset? Do you pass your paper to friends over and over again, hoping that their edits will catch all of your stylistic mistakes? How often do these methods prove foolproof? Learning to Write Every good writer learns the elements of style. There are so many fine points of grammar and usage that no single writer can know each one, all the time. In fact, the English language is continually evolving, creating the need for further and revised guidelines. The Need for Reference Thats why most writers have a reference book, that they can use whenever they need guidance. From the basic formats for different publications to the specifics of citations, writing reference guides have helped writers hone their craft for years. With modern guides taking technology and a changing world into account, you can be sure to have the most correct format for the present time. Some of the most popular reference guides include the APA Style Guide and the Chicago Manual of Style. These are tried and true resources for the modern writer, and have been relied upon countless times. Once you begin to discover all of the instruction available to you in these guides, you will want to keep them nearby as you write, for ultimate reference.

Independence War 1775 Research Paper Example | Topics and Well Written Essays - 2000 words

Independence War 1775 - Research Paper Example However, the parliament made it clear through the enactment of the Declaratory Act of 1766, that it had the authority to tax the colonies (Bobrick 15). This paper is a critical evaluation of the economic factors, which pushed the colonies to rebel against Great Britain and demand for independence. Economic Factors that Led to the American War of Independence (1775-1783) The War of Independence, or the American Revolutionary War, is a war, which was fought between Great Britain and 13 American colonies between the years 1775 and 1783 (Greene 201). However, it may be important to note that France and Spain were also actively involved in the war as they provided military assistance to the Americans. When the British entered America long before the revolution, they settled in colonies, after which leaders were selected in every one of them as representatives of the British government in England. They were to ensure that the colonies provided sufficient raw materials to the industries abr oad as well as market for the manufactured products. They were also supposed to ensure that the colonies remained loyal to the crown by collecting taxes on behalf of the British government (Alden 20). ... More so because the colonies did not have sufficient machinery and personnel to defend themselves from France and therefore, they needed the protection of their mother country, which was well equipped militarily. Secondly, the Anglo-French war was a highly costly affair and it hurt the British economy deeply (Bailyn 27). It is estimated that in North America, the British government spent approximately 4% of its total spending to protect the colonies from French invasion (Bailyn, 36). The colonials from North America also failed to fulfill their obligations during the war in terms of financial contribution and provision of personnel to engage in the war to defend their territories. Due to this, the British Government decided to come up with a strategy to cover the heavy losses and one way to do this was to increase revenues from the colonies. In 1763, the British government decided to halt the expansion of the colonies by creating borders, with an intention of preserving land belongin g to the Indians (Alden 41). This move was meant to gain favor from the Indians so that they could become consumers of British manufactured goods thereby providing market, which was essential in promoting the economy. In order to achieve this objective, British soldiers were posted on the western lands and were charged with the mandate of expelling all the Americans who had settled there as well as prevent new settlement by the American colonials. Ironically, the soldiers were to be paid using taxes collected from the Americans (Bobrick 22). The colonials did not take this lightly as they perceived it as a move to limit their economic interests and this created discontent and hatred towards Britain as it led to the

Natural Hazards Essay Example | Topics and Well Written Essays - 1250 words - 2

Natural Hazards - Essay Example This discussion highlights that the importance of this earthquake is that it caused severe disaster, leading to the death of thousands of people and damaging most of the buildings in the country. The implication or the consequence of this event is that many of the people became homeless. Several Pagodas which were considered as the symbol of the World Heritage site were destroyed. Several temples were demolished due to the earthquake. The steps or the initiative taken by the government in order to mitigate the damages are the government established a national reconstruction fund by allocating an amount of $ 200 million. But the government aimed to increase the fund to $ 2 billion.This paper stresses that the town was covered with a cloud of ash and smoke. Calbuco is considered as the most active volcano that erupted many times before. But the eruption that occurred in the present year is considered to be much more devastating as compared to the volcanic eruption that occurred in the previous years. The smoke that was generated was harmful for the society as a whole since it polluted the environment. The importance of this volcanic eruption was it occurred for 3 times within 8 days. It caused panic among the people staying nearby. The implication or the consequence of this volcanic eruption is that it increased chaos among the people in that region and also increased traffic jams causing barrier and difficulty for the people going to the supermarkets.

Black Consciousness in the Twentieth Century Essay Example for Free

Black Consciousness in the Twentieth Century Essay Ralph Ellison began his 1952 novel with the sentence; â€Å"I am an invisible man.† (Ellison 3) These five words summed up the way in which the majority of Black Americans felt about their place in society at the time. The Civil Rights Movement was still years away, and the caste of American society had placed the Black American near the bottom. The book is in the first person narrative, narrated by a man who considers himself by society’s view point to be invisible because of his race.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The self-awareness of the Black American was limited to only what the white establishment would allow – and in the majority of the country, that was very little. However, the essence for the change that would occur had already been born. The awakening, in the late 1950s, of the Black American would take place in religion, politics, self-awareness and literature. This would become exemplified by the manner in which women in the black communities were treated. The rise of domestic violence was an issue, even in 1950s America – and in both the homes of blacks and whites.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   There would be, though, differences in which this awakening would manifest itself. For some, like those who would march with Martin Luther King, non-violence and pacifism would be the dominate tool to their awakening. For others, the awakening would come in the form of a religious rebirth, and strong assertion of their place in society. There was a responsibility being neglected in the role of the black male to uphold his place of caregiver to his wife and family – as well as to the community as a whole. This was an important issue to realize, as the teachings of Islam would tell. â€Å"The white man wants black men to stay immoral, unclean, an ignorant†. (223). During the course of the novel the protagonists lists ways in which he has become invisible and the reaction he stirs within society because of his ‘blackness’, and as Ellis illustrates in the prologue of the book, â€Å"I live rent-free in a building rented strictly to whites, in a section of the basement that was shut off and forgotten during the nineteenth century.† (Ellis prologue).   The narrator goes on to state that light is a necessity for him since light to him is equivalent to truth (much as it was in Plato’s cave – so here the reader gains a sense of philosophy and of intelligence from the narrator). Throughout the course of the events that aid in defining the narrator the major first event occurs on his college’s campus.   The epiphany that the invisible man has during this time is that a black man whom he had once aspired to be like (i.e. to leave a legacy for his college) is not at all worthy of his aspiration but instead is merely a black man who has disguised himself enough to be able to ‘survive’ in the white dominated society.   Thus, the invisible man has his first exposure to mis-identities and the almost innate need that black men feel they have to become someone else in order to be a part of white society. In another act of deception in the book, the narrator (after a boiler room ‘accident’) is hospitalized; during a state of consciousness he discovers that he has been experimented upon with shock treatment without his knowledge.   This is a severe breach of his constitutional rights as well as his humanity.   Thus, the narrator finds out that he is not considered to be human, or even subhuman but rather a thing, an object, a less than real entity whose presence is a constant element of scorn and fear to the white race (at least through each of the experiences the invisible man has had with white people). Thus, not only is he destroyed through the perception of white people but through his own culture and race as Dr. Bledsoe has given the invisible man letters of recommendation whose intent was merely to waylay the invisible man from coming back to college and to not (as the invisible man had thought was their intention) to get him a job.   Therefore the invisible man is hoodwinked by a person whom he thought he could trust and this leads him to further epiphanies of himself and his race and either’s misconception. The novel is truly about self-awareness through objective perception.   Although the narrator finds brief solace with the Brotherhood and brother Jack (a black organization seeking to unite the black community in New York), this soon turns into another form of hate through jealousy.   The narrator’s position is replaced and he travels outside of Harlem only to return and find his friend dead.   Despite efforts to try and unite the Brotherhood again, the narrator is soon forced to recognized his grandfather’s maxim, â€Å"over come em with yeses, undermine em with grins, agree em to death and destruction. . . (Ellis). The novel is about a man whose invisibility is plagues by mis-identity, and whose overall undertones of outside prejudices define his life as well as his identity up to a point.   The ‘yes man’ that his grandfather advised him to do was a type of camouflage technique in which a man can exist wholly without being noticed by being, in essence, no one at all – by becoming invisible in order to survive.   The sacrifice that the invisible man does is to waylay his hopes and dreams in order to be nothing so that he may survive, not be gunned down by either Brother Jack or by the police.   In essence Ellis’ book contributed greatly to the recognition of the black consciousness and the state of the Civil Rights movement in order for blacks to not be invisible in order to exist. WORKS CITED Ellison, Ralph. The Invisible Man. Random House Inc. New York.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   1952. Gates, Henry Louis. The Signifying Monkey: A Theory of African-American Literary Criticism.  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   New York: Oxford UP, 1988. Klein, Marcus. After Alienation: American Novels in Mid-Century. New York: World, 1964. McSweeney, Kerry. Invisible Man: Race and Identity. Boston: Twayne, 1988.

To Kill A Mockingbird - Relationship of Two Characters :: Kill Mockingbird essays

To Kill A Mockingbird - Relationship of Two Characters In the beginning, all was good and calm in the lives of the Finches. Members of the family included Atticus, Jem, Scout, Aunt Alexandra, and Calpurnia. The relationship of two of the main characters, Atticus and Jem, is of particular interest. In the beginning section of To Kill A Mockingbird by Harper Lee, the relationship of Atticus and Jem is simple. Jem sees Atticus as older and less active then the fathers of his friends at school. For example, Scout states, "Jem was football crazy. Atticus was never too tired to play keep-away, but when Jem wanted to tackle him Atticus would say, `I'm too old for that, son (89).'" As the story line began to progress, Jem started to admire his father. After the episode with the mad dog, Jem had said, " ` `d you see him, Scout? `d you see him just standin' there?...'n' all of a sudden he just relaxed all over, an' it looked like that gun was a part of him...an' he did it so quick, like...I hafta aim for ten minutes `fore I can hit somethin'...(97).'" Jem no longer felt that his father was useless. The middle section of the book shows many different sides to the relationship between Atticus and Jem. Atticus does not like to tell his children how to behave. This quote shows how Alexandra is making him tell Jem and Scout how to behave. The tension is shown easily. "Before bedtime, I was in Jem's room trying to borrow a book, when Atticus knocked and entered. He sat on the side of the bed, looked at us soberly, then he grinned. `Er-h'rm,' he said. He was beginning to preface some things he said with a throaty noise, and I thought he must at last be getting old, but he looked the same. ` I don't exactly know how to say this,' he began. `Well just say it,' said Jem. `Have we done something?' Our father was actually fidgeting. `No I just want to explain to you that-your Aunt Alexandra asked me... son, you that you're a Finch, don't you?' `That's what I've been told.' Jem looked out of the corners of his eyes.

Autism: Identification and Characteristics

â€Å"Autism spectrum disorder (ASD) and autism are both general terms for a group of complex disorders of brain development† (Unknown, 2013). However, there are multiple definitions of Autism spectrum disorder and autism. The two most accepted definitions are those outlined in IDEA and the Diagnostic and Statistical Manual of Mental Disorders, The IDEA definition of ASD and Autism has these disorders characterized by difficulties in social interaction, verbal and nonverbal communication and academic performance, that can be observed prior to the child turning three years of age. According to the Diagnostic and Statistical Manual of Mental Disorders, these disorders are grouped under Pervasive Developmental Disorder. These disorders include, but are not limited to, autistic disorder, Rett syndrome, childhood disintegrative disorder, and Asperger syndrome (APA, 2000). Characteristics of Autism or ASD include difficulties in language development, ranging from no verbal communication to complex communication, delayed language development, and echolalia. Echolalia is the uncontrollable and immediate repetition of words spoken by another person or sounds in the surrounding environment. It also includes difficulties in Social Development. These difficulties include delays in social interactions and social skills such as, impaired use of nonverbal behavior, lack of peer relationships, failure to spontaneously share enjoyment, interests, and achievements, as well as a Lack of reciprocity. Autism and ASDs are also characterized by repetitive behavior such as obsessions, tics, and perseverations. Those diagnosed with Autism or ASD are also said to display problem behavior such as self-injurious behavior or aggression, a need for environmental predictability, symptoms of sensory and movement disorders, as well as, symptoms of Savant Syndrome. Savant Syndrome is a rare condition in which persons with various developmental disorders, including autistic disorder, have astonishing islands of ability, brilliance or talent in areas such as the fine arts. Many savants are also very good with remembering facts such as phone numbers or birthdays, after only seeing them a few imes. Causes and Prevalence The causes of autism range from different aspects. Some people's perspective about it comes from history which is where the phrase â€Å"refrigerator mothers† comes from. Refrigerator mothers were women who were emotionally frigid to towards their children, showing their children little to no affection whatsoever. However, in the 1970s, researchers had established that autism is c aused by brain or biochemical dysfunction that occurs before, during, or after birth. Today, parents are not seen as the cause of their child's autism, but as partners with educators when helping solve their child's problems. The biomedical causes show that a child that has a sibling is 10 times more likely to develop autism than a child that does not have any siblings. There also seems to be a connection between environmental factors and genes. Parents also report that they see regression in their child directly following an immunization. But with this being said, parents also see a regression in their unvaccinated children. If a pair of identical twins share the same gene, and one has autism, then 9 out of 10 times, the other twin has autism as well. Researchers believe that the biggest causes of autism are vaccinations, environmental exposures, pesticide exposure, parental age, pharmaceuticals, freeway proximity, and limited prenatal vitamin intake. The prevalence of autism suggests a range from 10 to 60 per 10,000 children. Principles of Effective Instruction and Assessment of Progress There are different kinds of effective instructions in order to help out the child that is diagnosed with Autism. Some of the strategies include keyword, pegword, and letter. Keyword strategies â€Å"teach students to link a keyword to a new word or concept to help them remember the new material† (Turnbull, Turnbull, Wehmeyer, ; Shogren, 2013). This allows the Autistic children understand and learn the material a lot easier. Pegword strategy â€Å"helps students remember numbered or ordered information by linking words and numbers that rhyme† (Turnbull, Turnbull, Wehmeyer, ; Shogren, 2013). This strategy is great for students to visual the objects being represented. The last strategy is the letter strategy â€Å"employs acronyms or a string of letters to help students remember a list of words or concepts. Recalling the acronym helps them recall the list or sequence. † (Turnbull, Turnbull, Wehmeyer, ; Shogren, 2013). â€Å"The Autism Screening Instrument for Educational Planning (ASIEP-2) has five components or subtests that enable educators to evaluate a student’s capacity across communication, social interactions, behavior, academic content, and other domains. (Turnbull, Turnbull, Wehmeyer, ; Shogren, 2013). The behavior checklist is used as a screening tool to identify the need for further assessment to determine whether the student has autism. (Turnbull, Turnbull, Wehmeyer, ; Shogren, 2013). These assessments can be used at home and during school hours. These methods are very effective for an Autism child. The technology and methods continue to grow and change for this disability. This particular disability has become more prominent within the United States each and every year. Researchers are becoming more and more familiar with Autism allowing those that have it able to have more help. The progress of this disability has rapidly increased as well as the technology for Autism. Family Issues Autism does not only affect the child, but autism also affects the parents of the child as well. Parents or guardians of children with ASD must place their child’s needs as their primary focus. When parents with autistic children put their full attention in being a caregiver to these children sometimes this adds stress on their marriage, other children, finances, and personal relationships and responsibilities. Also when having a child with ASD with siblings there may be some lack of attention for the other children in the family. In saying this, it is the parent’s job to best respond to the need of the family as a whole in able to show an equal amount of love to each child. Transition into Adulthood Children with autism are just like children without autism. They grow up wanting to make something of their lives, wanting to attend college, to get married, have a family, ect. Having autism makes dreams and goals harder, but not impossible. Young adults on the autistic spectrum may qualify academically for college, but may not be able to handle other aspects of college life. Also when it comes to employment also depending on the severity of his or her symptoms many organizations hire extra help for adults with autism and other disabilities for pay in order to help them grow as a person and help to work everyday tasks. Just little things like going to college with the help of an assistant or having a small job helps to better them and help to make their transition into adulthood smoother and simpler. References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC. American Psychiatric Association. Pelt, J. (2008, September/October). Autism Into Adulthood-Making the Transition. Retrieved from Social Work Today: http://www.socialworktoday.com/archive/090208p12.shtml Turnbull, A., Turnbull, R., Wehmeyer, M. L., ; Shogren, K. A. (2013). Exceptional Lives Special Education in Today's Schools. Boston. Unknown. (2013). Family Issues. Retrieved from Autism Society: Improving the Lives of All Affected by Autism: http://www.autism-society.org/living-with-autism/family-issues/ Unknown. (2013). What is Autism? Retrieved from Autism Speaks: http://www.autismspeaks.org