Essay --

During my 3 years at Hindustan Petroleum Corporation Limited (HPCL) as a Maintenance Planning engineer, I inhaled arranging and sorting out. Working for a multi-billion dollar undertaking, I saw the impacts of operational efficiencies on the accounting report. This pertinent introduction has molded my choice to seek after a vocation in Industrial Engineering, a field that endeavors to build profitability and efficiencies by orderly examination and development. Working at HPCL’s 7.6MMTPA treatment facility, I was a piece of the group that guaranteed that all units were kept up well to work at ideal limit, nonstop. I was liable for getting ready calendars and making arrangements for the men, hardware and material for support exercises. It was in this job I encountered firsthand, the need and appropriateness of experimentally oversaw and advanced procedures in the business. During a blackout of the Fluidized Catalytic Cracking Unit (FCCU), a defective extra gasket had kept the beginning up of the unit on hold. I was picked to get the substitution, for which I needed to fly 500 miles on a second's notification, dealing with the gasket as my baggage. This excursion was fulfilling, not on the grounds that it cut down the potential misfortune edges from $250,000 to $70,000, but since I took in the significance of prudent arranging in mitigating misfortunes. After this, I drove a 4 man group to index and update hardware save parts in a database. With exercises mastered during the past blackout, I gathered an agenda that use the database to smooth out and twofold check the material arranging process, decreasing the likelihood of a very late crisis. 28 months and 7 significant unit shutdowns later, in January 2013, I was made group captain for arranging a patch up of a Crude h... ...nt of seeking after alumni examines is to upgrade my current information and aptitudes, so I can understand my vision of opening the capability of procedure advancement in little and medium scale endeavors in countries with creating economies, for example, India. For the time being, however, my attention is on collecting specific information and abilities and assisting my industry experience. UC-B is a school with proficient aptitude like no other. Being a piece of the Graduate people group at UC-B with their collective between social network will help build up my character. The showing approach at UC-B of empowering by challenge is perfect for an energetic student like me. With an expectation that you will locate the intense blend of ability and assurance in me as something that will enhance the inheritance of UC-B, I am anticipating be a piece of the regarded UC-B graduate network.

The Paradox in US-China Relations

The Paradox in US-China Relations The Paradox in the US-China Relations: A Commentary Very nearly 10 years and half back, one of the main mastermind and key master on China; Gerald Segal prophetically depicted the ramifications of Chinese force particularly in the East Asian district. He contended, â€Å"There is not any more profound vulnerability for East Asia, than the eventual fate of China. In the event that China lurches in the midst of administration battles and maybe even breaks down as an express, the district will fear mass movement and spreading mayhem, if China continues onward with a twofold digit development, East Asia will fear the ramifications of Chinese power[1] Segal in the closing comments of his article titled, â€Å"Tying China into International System† (Survival; 1999) introduced scarcely any suspicions. He predicted that the uncontrolled financial development in China would bring about an expanding need and want to exchange with the outside world and China should be integrated with the worldwide framework based on these suspicion about China’s future. One of them was a) that it won't break down in disarray, will have a looser political framework b) second that East Asian locale will neglect to build up any genuine multilateralelism. There will be a lot of talk in the area about the need to work all the more intently at the ASEAN and CSAP discussion on the security of the locale, anyway no genuine activity was seen. Shockingly the East Asian district will have repercussion of the Chinese force and the lead in managing China in the coming years would not be started by the East Asian nations. This would leave China unchalle nged in the area. He additionally stated that China would likewise liable to have a significant long haul ill-disposed relationship with the west. The previously mentioned examination portrays a portion of the truth of the Chinese ascent starting today. Beijing has positively not broken down into disorder, through a consistent projection of its impact, it has built up that it is in reality a rising force and would keep on doing as such. The West particularly the US might not have a direct ill-disposed relationship with China yet all that isn't hunky-dory in the Sino-US relationship. Strikingly this becomes apparent when the direction of the reciprocal relations is examined at a significant level. Both the US and China are yearning nations undoubtedly. China is the main nation which has straightforwardly tested the US authority after Soviet Union. In the post-Cold War time of multipolarity the decay of the West (US) has additionally been compared with the ascent of the rest (China) even by American researchers. (Zakaria; 2008). While the US was distracted with the worldwide war on dread crusade and trapped itself in Iraq and Afghanistan; the People’s Republic adequately used this advantageous snapshot of US occupation furthering its potential benefit by expanding its universal associations and boosted its stock of partners in the global political framework. The Chinese impact in the universal legislative issues was respected noteworthy to such a degree, that US also reacted to the rising danger talk with a pleasing perspective. In a Congressional Report (2008) and the US Quadrennial Defense audit (QDR-2001), the US organization was guided to embrace ‘engagement’ as the most ideal approach to incorporate China into winning worldwide framework. Today, China is connecting with itself with the universal network more than ever by making a large number of respective understandings and associations. Beijing has looked for exchange understandings, oil and gas contracts, logical and innovative participation, and true multilateral security game plans with nations both around its outskirts and around the globe, for example, Africa, Asia, and Latin America. It has likewise separated oil and gas investigation contracts with Brazil, Ecuador, Bolivia, Colombia, Venezuela, and Cuba; and with Central Asian states, for example, Uzbekistan and Turkmenistan; in quest to satisfy its longs for vitality security Global Negotiations Diplomacy The development of numerous focuses of intensity in the universal legislative issues have not just declined the pre-prominence of the American power yet have likewise made space for China to applies it impact in different circles, for example, worldwide economy, global arrangements on huge issues, for example, environmental change, the South East China Seas and even in the atomic domain. On every one of these issues China has taken an amazing stand. For example on the issues of cash, China keeps up a low conversion scale of its money for its monetary development. Monetary specialists from both US and Europe have called China to permit its money to rise. This conclusion was resounded even by the US President himself during his first visit to China in 2009. That year Presidents of significant banks like Europen Central Bank; Jean-Claude Trichet, and Dominique Strauss-Kahn; the previous overseeing executive of the IMF have likewise required a more grounded yuan however China didn't modify its money in light of a remote pressure.[2] China has intensely faced the US on the issue of Climate Change as well. It is alluded as the world’s biggest Green House Gases (GHGs) producer and experiences a poor record most definitely. Actually China involves a remarkable situation in the Climate Change arrangements. It is probably the biggest producer of Co2 yet it is additionally a creating nation and has a legitimate case of option to additionally create like the US. It is one of the significant voices in the Climate Change talks and a few specialists has proposed that it was China that hindered the last Copenhagen (2009) talks by requesting a horrifying arrangement with the end goal that western chiefs can leave and along these lines making an impasse. At the Copenhagen it not just demanded evacuating the coupling focuses for itself yet in addition for other countries.[3] The unusual strategic maneuver by the Chinese assignment can likewise be seen as a push to debilitate the Climate Change guideline system. Recently the UN Climate Summit at New York was closed in which both the US and China appears to have conceded to agreeing on diminishing emanation from 26 to 28 percent for the United State by 2025 and China to arrive at the outflows warming top by 2030 or earlier[4]. Being a top producer of Co2 China’s move towards a significant situation on outflow cuts ; simply after the US has vowed to make a stride ahead on discharge reflects only geopolitics showing at the arrangement table. Atomic Relations A comparable Chinese conduct of pushing the US to do its bit initially can likewise be found in the domain of atomic security also. Atomic capacity represents power in universal legislative issues. While China is far away from coordinating the US stock of atomic weapons, it can't be overlooked that being the main P-5 that is expanding its atomic arms stockpile; China’s potential in affecting the atomic discussion at the universal multilateral gathering stays solid. It is intriguing to note here that the official Chinese situation on atomic weapons contest is that, â€Å" the atomic weapon states with the greatest stores ought to attempt unique duty regarding atomic demilitarization and take lead in decreasing their atomic munititions stockpiles and conveyance systems,†[5] China anticipates that the US should initially clear route for the other atomic weapon states to join the atomic demobilization process. Besides the 2013 atomic note pad of the Bulletin of Atomic Scientists depicts the Chinese atomic capacity as developing gradually and expanding in ability. Numerous in the US assume that the developing Chinese atomic ability particularly the long range rockets which incorporates the same number of upwards of 60 LRBMs can arrive at some segment of the United States. Indeed as per the US knowledge network expectation by the mid-2020s, China could have in excess of 100 rockets equipped for undermining the US.[6] Actually the American specialists for atomic issues accept that there is a need to keep up a drawn out soundness in the US-China atomic relations despite the fact that the atomic elements between the two nations are generally steady at the present. The types of such thought have put together their judgment with respect to the US worries about the Chinese development of the quality and amount of its atomic weapons store. The investigation of US-China atomic relations by the working gathering uncovers a potential increase of key weapons contest between the two nations. This may show in expanding the vulnerabilities about the atomic discouragement and along these lines emergency the executives between the two must produce results. Truth be told it is encouraged to the US government to take up casual approaches to shape China’s atomic choice making.[7] Geopolitical Ends at the Asia Pacific Region The present Chinese Ambassador to the US; John Kerry in his comments portrayed the respective relations as â€Å"the generally significant just as the most delicate, the most exhaustive just as the most mind boggling, and the most encouraging just as the most testing †[8] and alluded it as the most important one deciding the state of the 21st century world. While authorities from the White House have expanded descriptive words to depict delightfully the US-China cooperative energies, they have additionally recognized the distinction the two nations have a two recognized nations. In addition, these two separated nations likewise have similar force interests in the equivalent land element called the Asian Pacific locale. For both the nations the district is a pivotal one and the most encouraging undoubtedly. The US has outrightly declared its rotate to Asia Pacific so as to execute its rebalancing methodology. One must figure that in the ongoing years China also has begun taking a gander at the locale all the more conspicuously. The US has completely reported its reservations on the Chinese confident international strategy conduct in the South and East China Seas district. Despite the fact that th

ISFP Personality Characteristics, Myths & Cognitive Functions

ISFP Personality Characteristics, Myths & Cognitive Functions Theories Personality Psychology Print ISFP: The Artist (Introverted, Sensing, Feeling, Perceiving) An Overview of the ISFP Personality Type By Kendra Cherry facebook twitter Kendra Cherry, MS, is an author, educational consultant, and speaker focused on helping students learn about psychology. Learn about our editorial policy Kendra Cherry Updated on May 10, 2019 Myers-Briggs Type Indicator Overview Intuitive-Thinking INTJ INTP ENTJ ENTP Intuitive-Feeling INFJ INFP ENFJ ENFP Sensing-Judging ISTJ ISFJ ESTJ ESFJ Sensing-Perceiving ISTP ISFP ESTP ESFP In This Article Table of Contents Expand Key ISFP Characteristics Cognitive Functions Personal Relationships Career Paths Tips for Interacting With ISFPs View All ISFP is a four-letter code representing one of the 16 personality types identified by the Myers-Briggs Type Indicator.?? People with an ISFP personality are frequently described as quiet, easy-going and peaceful. Illustration by JR Bee, Verywell According to David Keirsey, the creator of the Keirsey Temperament Sorter, approximately 5 to 10 percent of people have an ISFP personality type. ISFP is the opposite of ENTJ. Key ISFP Characteristics ISFPs like to keep their options open, so they often delay making decisions in order to see if things might change or if new options come up.According to Myers-Briggs, ISFPs are kind, friendly, sensitive and quiet. Unlike extroverts who gain energy from interacting with other people, introverts must expend energy around others.?? After spending time with people, introverts often find that they need a period of time alone. Because of this, they typically prefer to intermingle with a small group of close friends and family members.While they are quiet and reserved, they are also known for being peaceful, caring, and considerate. ISFPs have an easy-going attitude and tend to accept other people as they are.ISFPs like to focus on the details. They spend more time thinking about the here and now rather than worrying about the future.ISFPs tend to be doers rather than dreamers. They dislike abstract theories unless they can see some type of practical application for them and prefer learnin g situations that involve gaining hands-on experience. Strengths Very aware of their environment Practical Enjoys hands-on learning Loyal to values and beliefs Weaknesses Dislikes abstract, theoretical information Reserved and quiet Strong need for personal space Dislikes arguments and conflict Cognitive Functions The MBTI identifies four key cognitive functions (thinking, feeling, intuition, and sensing) that are either directed outwardly (extraverted) or inwardly (introverted). The hierarchical order to these functions is what determines each individuals unique personality. Dominant: Introverted Feeling ISFPs care more about personal concerns rather than objective, logical information.People with this personality type deal with information and experiences based upon how they feel about them.ISFPs have their own value system and create spontaneous judgments based upon how things fit with their own idea. Auxiliary: Extraverted Sensing People with ISFP personalities are very in tune with the world around them. They are very much attuned to sensory information and are keenly aware when even small changes take place in their immediate environment. Because of this, they often place a high emphasis on aesthetics and appreciate the fine arts.They are focused on the present moment, taking in new information and then taking action. They have a strong sense of their immediate surroundings, often noticing small details that others might overlook. When remembering events from the past, they are able to recall strong visual imagery and sights, smells, and sounds can evoke powerful memories associated with those senses. Tertiary: Introverted Intuition This function tends to run in the background, feeding off of the extraverted sensing function.As ISFPs take in details about the world, they often develop gut feelings about events and situations. While they generally do not like abstract concepts or ideas, this introverted intuition function may lead them to experience epiphanies about themselves and others. Inferior: Extraverted Thinking One weakness that ISFPs may have is in organizing, although they may use this function more prominently in certain situations.This function is all about looking for the most efficient way to do something. An ISFP might become focused on being very precise about the details and finding the most effective way to express an idea. ISFPs You Might Know Marilyn Monroe, actressAuguste Rodin, sculptorDavid Beckham, soccer playerNeil Simon, playwrightHarry Potter, fictional character Personal Relationships ISFPs are introverted. They tend to be reserved and quiet, especially around people they do not know well. They prefer spending time with a close group of family and friends. ISFPs are very private and keep their true feelings to themselves. In some cases, they may avoid sharing their thoughts, feelings and opinions with other people in their life, even their romantic partners. Because they prefer not to share their innermost feelings and try to avoid conflict, they often defer to the needs or demands of others. ISFPs have strong values but are not concerned with trying to convince other people to share their point of view. They care deeply about other people, particularly their closest friends and family. They are action-oriented and tend to show their care and concern through action rather than discussing feelings or expressing sentiments. Career Paths People with ISFP personalities love animals and have a strong appreciation for nature. They may seek out jobs or hobbies that put them in contact with the outdoors and with animals. Because ISFPs prefer to focus on the present, they often do well in careers that are concerned with practical, real-world problems. Jobs that offer a great deal of personal freedom and autonomy are especially appealing to ISFPs. Popular ISFP Careers ArtistComposer or musicianChefDesignerForest rangerNurseNaturalistPediatricianPsychologistSocial workerTeacherVeterinarian Tips for Interacting With ISFPs Friendships ISFPs are friendly and get along well with other people, but they typically need to get to know you well before they really open up.You can be a good friend to an ISFP by being supporting an accepting of who they are.ISFPs can be light-hearted and fun, but they are also quite intense at times. Recognize that there will be times when your friend wants to share and times when he or she will want to retreat to a more personal space. Parenting ISFP children tend to be perfectionists and can be their own harshest critics.Because they place such high expectations on themselves, they often underestimate or undervalue their own skills and talents.If you are a parent to ISFP child, you can help your child by encouraging them to be kind to themselves and recognize their value. Relationships ISFPs are very considerate in relationships, often to the point that they will continually defer to their partner.Because they are usually not good at expressing their own feelings and needs, it is important that you make an effort to understand your partner.When making decisions, ensure that your partners voice is heard and his or her feelings are given equal weight.

Creating Value Internal and External Factors - 1257 Words

Discussion Board 2: Valuation Charles E. Sullins, Jr. Managerial Finance – BUSI 530_B10 Liberty University INTRODUCTION The purpose of this thread is to discuss the factors that lead to a valuation of a company’s worth compared to that of the financial statements, and how company executives create the most value for all stakeholders. Value is formed by different internal and external factors. This discussion will examine some of these factors in an effort to determine how a company’s worth is measured. This discussion will also include views from a faith-based standpoint and how human success must glorify God. â€Å"Love not the world, neither the thingsthat are in the world. If any man love the world, the†¦show more content†¦When this is the case, its usually because the market has lost confidence in the ability of the companys assets to generate future profits and cash flows. In other words, the market doesnt believe that the company is worth the value on its books. Value investors often like to seek out companies in this category in hopes that the market perception turn s out to be incorrect. After all, the market is giving you the opportunity to buy a business for less than it’s stated net worth. 1. Market Value Greater Than Book Value: The market assigns a higher value to the company due to the earnings power of the companys assets. Nearly all consistently profitable companies will have market values greater than book values. 2. Book Value Equals Market Value: The market sees no compelling reason to believe the companys assets are better or worse than what is stated on the balance sheet† (para. 6). CREATING VALUE FOR SHAREHOLDERS Executives play a major role in creating value for stakeholders. Creating value for stakeholders is the primary role of an executive. The first thing executives must do is build trust. This element is essential to all positive aspects of value. Gaining trust is accomplished through strong work ethic, sound values, accountability, and leading by example. Not only will this develop strong working relationships, it will also aid in ushering in the next generation of managers. It will help gain confidence in the financial markets asShow MoreRelatedInternal Environment Resources and Capabilities of an Organization1034 Words   |  4 Pagespaper mainly focuses on the internal environment, resources and capabilities of an organization. It highlights the two main analyses which are essential for any organization and which plays a main role in the formulation of a strategy. In addition to this, it also describes the primary and support activities of an o rganization. Two key factors, which are important in doing an internal analysis, are Resource Based View framework (RBV) and Porters Value Chain. These factors are also described. The ResourceRead MoreHow to Conduct Strategic Analysis Essay1099 Words   |  5 PagesOne critical piece of the Strategic Planning process is Strategic Analysis. It is an integral part of a company’s evaluation program; it provides managers with a comprehensive assessment of the organization’s capabilities and market factors; revealing growth opportunities and vulnerabilities. With this information, managers can more effectively choose from strategic alternatives and create the greatest future reward potential. A) Company Mission – Vision The first step I would take as part of myRead MoreThe System Dynamics Diagram Below Illustrates The Interactions And Activities Of The Business769 Words   |  4 Pagesmanagement and purchasing are two closely linked internal factors in the business vital to providing quality products. Purchases are reliant on stock levels and must have management approval. Factors such as quality control, availability of produce, seasonal customer preferences, supplier availability and supplier relationships all play a role in the ability for the business to create value through these internal functions. Some of these external factors can be partially controlled; for example availabilityRead MoreExternal and Internal Environmental Analysis Strategic Planning and Implementation1213 Words   |  5 PagesExternal and Internal Environmental Analysis Strategic Planning and Implementation STR/581 External and Internal Environmental Analysis Apple Inc. is a computer product company that was launched into the market through the collaborative efforts of Steve Jobs and Steve Wozniak in the year of 1976 and is aimed at reaching the diverse global community. The changes in the external environment of the company determine the decisions that the corporation will make. Apple Inc. has reputableRead MoreProduct Features Of Value Chain Essay1514 Words   |  7 PagesVALUE CHAIN: The concept of Value Chain was introduced by Michael Porter which involves a process of adding value to a product or service at every stage. A value chain may exist within one firm or may extend over an expanded supply chain that includes various firms. It enables to identify the Primary and Secondary activities which can increase the value to end customers and thus facilitate business organisations to gain a margin over input cost. The Primary activities are important to acquire theRead MoreEffective Methods Of Effective Ways Of Communication767 Words   |  4 PagesAs a part of execution, company leaders translate strategy into measurable objectives. Communication plays an important role in sharing the strategy details with necessary external as well as to all internal employees. This communication mechanism allows creating a feedback system and also gives an opportunity for the leaders to align with the rewards and recognition process. It is necessary to use an effective way to communicate the strategy for a greater success. According to Everse (2011), effectiveRead MoreInternal And External Factors Affecting A Business Organization1365 Words   |  6 Pagescompanies to evaluate the internal and external factors affecting a business organization. With this useful tool they are able to set future goals, define strategic plans and collect information about the social environment in which they operate. This strategic tool is classified by internal factors (Strengths and Weaknesses), means that the company has total control of it and external factors (Opportunities and Threats), the company cannot control it. Internal factors mean that the company hasRead MoreEssay about Airstar Case Study1139 Words   |  5 Pagesmanagers is not working effectively and employees have been working up their own job description. Because of that, goal accomplishment is fast becoming obsolete and decisions are being made on the basis of practicality. Also, the company is facing external threats from major competitor such as General Electric and Pratt amp; Whitney. The stagnation from top managers is causing chaos internally, because business environment is constantly changing and most managers have been in the company for moreRead MoreCan Organisational Culture Be Changed?1376 Words   |  6 Pagessame time, it is a very difficult and demanding task. This is where the four main functions of managing come into play; planning, controlling, leading and organising. Robbins at al (2009, p.94) defines organisational culture as â€Å"a system of shared values, principles, traditions and ways of doing things that influence the way organisational members act.† This essay will further look into how and if an organisation’s culture can be changed, weighed up against organisation’s resisting change, how thisRead MoreExternal Factors And The Business Model1545 Words   |  7 Pages External Factors and the Business Model In order to build a successful business model, the organization must analyze the business environment for external forces. Osterwalder and Pigneur (2010) discuss the importance of understanding the external factors in the business environment when developing a business model; the organization must be able to adapt quickly to the changing environment. External factors of demand play a critical role in developing a business model, an organization

A Discourse Community As A Group Of People That Has An...

John Swales defines a discourse community as a group of people that has an agreed set of common public goals, ways to communicate with its members, to provide information and feedback, genre(s) that the group may further communicate its goals, lexis, and a threshold level of members (220-2). The group I chose to study St. Luke Church of God in Christ, St. Luke COGIC, bears the qualifications to be a discourse community. Founded in 1925 by Millissis Shannon and her husband Charles with only twelve members, pastoring St. Luke COGIC is Elder E. A. Shannon with over eight hundred members (St. Luke Church of God in Christ). This church is a great church to attend and has several activities, groups, departments, and ministries for any person at any age. Some of them include Sunday School, music, men’s, women’s, youth, children’s, and Bible Study and they all help to reach the community and lead people to Christ. The church’s mission statement states that their p urpose is, â€Å"to function as a Christian fellowship where the gospel of Jesus Christ is preached and the ordinances and doctrine of the church is taught and administered†¦Ã¢â‚¬  (St. Luke OB). My goal while observing and interviewing people was to figure out how people praise and worship the Lord at St. Luke COGIC on a Sunday. Watching with minimum participation and just watching at what the church members did (McCarthy page 234) is how I observed St. Luke COGIC. On Sunday, services start at 8:00 a.m. and end at around 9:00 p.m.Show MoreRelatedThe American Sign Language Community Essay1221 Words   |  5 Pagescertain communities. School, jobs, families, sports, extracurricular activities, and many other communities are just a few we come into contact with. Although these may seem to appear the same, there are specific types of communities such as a discourse community. A discourse community is a group of people involved in and communicating about a particular topic, issue, or in a particular field (Webcourses, N.d, Website) that has a share a common set of goals and attempt to achieve these goals (SwalesRead MorePurdue University s Own Boiler Bhangra1233 Words   |  5 Pagesis one of the many distinct discourse communities on campus. The team was founded back in the spring of 2006, in an effort to shar e the unique culture and dance style of bhangra with the body of Purdue, as well as to compete on levels that range from local to national. The Boiler Bhangra team is a perfect example of Swales’ definition of a discourse community; that is, the team perfectly follows the requirements for a group to be considered a discourse community, as set by John Swales. One of theRead MoreQuestions On Pharmacy Discourse Community1560 Words   |  7 Pages2016 Project 1: Pharmacy Discourse Community †¢ What is a discourse community? 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According to Swales, there are six characteristicsRead MoreThe Franklin Road Church Youth Groups Are More Than Just a Religion1681 Words   |  7 PagesRoad Church of Christ youth group consists of youth of all ages. The group is divided into three subgroups: Tots for Christ (TFC), Kids for Christ (KFC), and the Senior Youth Group (SYG). In particular, for this essay I will be explaining how the Senior Youth Group is a discourse community. Franklin Road’s SYG consists of the ages 11-18. Within the group we do various things such as going to youth retreats, youth conferences, and many more; just to name a few. The group has been around for many yearsRead MoreThe Discourse Of A Discourse Community1224 Words   |  5 PagesA discourse community is defined as a group of people involved in and communicating about a particular topic, issue, or in a particular field. We all belong to multiple discourse communities.To earn a position of a discourse community one must possess accura te knowledge, establish reliability of members to be accepted and learn to persuade other members of the community. The discourse community that I identify with personally and the profession I plan to pursue is the world of film production. HoweverRead MoreDiscourse Community Essay1098 Words   |  5 PagesEnglish 101 section 61 9/16/14 A Discourse Community Have you ever been among people who are very much like you? That it does not matter what differences you have you all have a lot more in common. A member of 4-H constitutes a discourse community because of an agreed set of common public goals, level of membership, and something that provides information and feedback. An agreed set of public goals for our community is that as a whole group we do a lot of community service. For a couple of yearsRead MoreSpringboard Diving As A Discourse Community2107 Words   |  9 PagesSpringboard Diving as a Discourse Community The world of diving has been around since the 1800’s and has been seen at the Olympic games since 1904. It first started off being called â€Å"fancy-diving† where the aim was to plunge into the water and see who could achieve the furthest depth underwater. It then progressed and became more complex involving specific skills and dives which first only men were allowed to participate in, and later women came into the society. To this day, diving is one of theRead MoreThe Fantasy Football League1355 Words   |  5 PagesFantasy football is one discourse community that I participate in every year along with my friends and family. If a stranger were to listen to any conversations we were having about fantasy football, they may not understand some of the knowledge that is required of someone to contribute to the fantasy football domain. This is true because within a fantasy football league there are many different phrases and terminology that we would not use on a regular b asis. I would like to start off by explainingRead MoreLife As A Social Worker1574 Words   |  7 PagesSocial Worker Growing up, I would watch the people in my community. I picked up on the things we considered to be socially acceptable. My community is predominantly filled with Latino and African American culture. Though, both come from two different ethnic groups, beliefs and practices, they share a common socioeconomic factor. I remember observing the gang violence, prostitution, drug and alcohol abuse, and children wandering the streets. Most people coming from a higher income status would be

The Implementaion of Reverse Policy for Discrimination Free Essays

string(77) " rhetoric that pits equality of opportunity against the equality of results\." Should we be punished for the mistakes of our ancestors? In recent times, Affirmative Action has implemented policies of reverse discrimination to help oppressed minorities gain an advantage over majority groups in college admissions and in employment. The term â€Å"Affirmative Action† was originally used by President John F. Kennedy in 1961 when referring to his executive order that required all federal contractors treat their employees and applicants â€Å"without regard to their race, creed, color or national origin. We will write a custom essay sample on The Implementaion of Reverse Policy for Discrimination or any similar topic only for you Order Now † In 1965, President Lyndon B. Johnson issued Executive Order #11246 at Howard University that required federal contractors to undertake Affirmative Action to increase the number of minorities that they employ. He wanted to ensure that minorities were recruited to have real opportunities to be hired and then eventually get a promotion. In 1969, the Department of Labor exposed widespread racial discrimination of the Construction Department so President Richard M. Nixon decided to incorporate a system of â€Å"goals and timetables† to evaluate federal construction companies according to Affirmative Action. This idea of â€Å"goals and timetables† provided guidelines for companies to follow and comply with Affirmative Action regulations. During the presidency of Gerald R. Ford, he extended Affirmative Action to people with disabilities and Vietnam veterans but there were no goals or timetables for these two groups. This type of Affirmative Action required recruitment efforts, accessibility, accommodation and reviews of physical and mental job qualifications. President Jimmy Carter consolidated all federal agencies that were required by law to follow the Affirmative Action play into the Department of Labor. Before Carter did this, each agency handled Affirmative Action in its own individual way, some were not as consistent as other agencies were. He created the Office of Federal Contract Compliance Program (OFCCP) in 1978 to ensure compliance with the Affirmative Action policies. Affirmative Action began to go downhill when Ronald Reagan and later George Bush came into office. Affirmative Action lost some gains it had made and was more or less ignored by the Republicans in the White House and in Congress. Affirmative Action was silently being â€Å"killed† by our federal administrators. In the Civil Rights Act of 1964, initiated by Kennedy, and the Equal Opportunity Act of 1972, equal opportunity was established. While there was little controversy over equal opportunity, the main issue with Affirmative Action was equal results. Although equal opportunity was established with Kennedy’s original executive order in 1961, the statistical results showed that the number of minority workers employed or in certain higher level positions was not in proportion to the surrounding population, making the actual existence of equal opportunity suspect. As a result of this discrepancy, it became necessary to create more aggressive legislation that ensured equal opportunity and equal results. Title VII of the Civil Rights Act of 1964 required both, and new Affirmative Action programs were instituted to further support this. These programs range from encouraging minorities and women to apply for certain positions to setting up actual numerical goals, such as quota systems and set-aside programs. However, is Affirmative Action, as many critics assert, just passing on the oppression? The basis behind Affirmative Action is that because of past discrimination and oppression, such as the dispossession of Native Americans, the unequal treatment of women, and the enslavement of Black Americans, minorities and women have difficulty competing with their white male counterparts in mainstream American society. But is this true? Why must white males be oppressed by Affirmative Action just because their ancestors enslaved and oppressed another race and gender, and be victims of reverse discrimination in college admissions and employment? The U. S. Supreme Court has faced many cases regarding this controversial issue, including The Regents of the University of California v. Bakke. Bakke, a white medical student, was denied admission to a University of California medical school because of a quota system. Bakke claimed that he was a victim of â€Å"reverse discrimination† and sued. In a close decision, the Court ruled that schools might not enforce a rigid quota system if whites are not allowed to compete equally. The issue was still muddied, however, because in the same decision, the Court ruled that race could be used as a factor. The various regulations and court rulings have made Affirmative Action one of the most paradoxical issues facing America. On one hand, differing local, state, and federal laws require employers to avoid discrimination in up to nine criteria: race, color, sex, age, national origin, sexual preference, handicap, veterans’ status and religion. On the other hand, Affirmative Action rules also require certain employers, such as companies with federal contracts, to give preference to racial minorities, women, and others. Consequently, when considering both sides of the issue, it becomes apparent that reverse discrimination and preferential treatment of minorities is absolutely ludicrous when people are preaching equal rights and that â€Å"all men are created equal,† and that Affirmative Action should be outright abolished from all aspects of society as an unnecessary evil in order to ensure an equal playing field for all. Those who wish to retain Affirmative Action regulations argue that America has a moral obligation to right the wrongs of the past – that Blacks and other minorities, whose ancestors have suffered institutionalized discrimination for hundreds of years, have earned preferential treatment. Race-neutral hiring, say proponents, actually discriminates against minorities because the majority of available jobs are not advertised. Rather, they are learned about by word-of-mouth, and minorities are not plugged into the â€Å"old-boy networks† through which they might hear of these jobs. Affirmative Action must be maintained for minorities to rise above the glass ceiling to management positions, and for poor minorities to rise from poverty and unemployment. Affirmative action has been the subject of increasing debate and tension in American society, and through this heated debate, the fight between Angle males and minorities actually sets the two groups apart instead of bringing them together. However, the debate over affirmative action has become ensnared in rhetoric that pits equality of opportunity against the equality of results. You read "The Implementaion of Reverse Policy for Discrimination" in category "Essay examples" The debate has been more emotional than intellectual, and has generated more tension than shed light on the issue. Participants in the debate have over examined the ethical and moral issues that Affirmative Action raises while forgetting to scrutinize the system that has created the need for them. Too often, Affirmative Action is looked upon as the panacea for a nation once ill with, but now cured of, the virulent disease of racial discrimination. Affirmative Action is, and should be seen as, a temporary, partial, and perhaps even flawed remedy for past and continuing discrimination against historically marginalized and disenfranchised groups in American society. Working as it should, it affords groups greater equality of opportunity in a social context marked by substantial inequalities and structural forces that impede a fair assessment of their capabilities. However, its failure highlights the potential for an aura of racism in this country which may perpetuate for many generations on. As Martin Luther King once said, â€Å"I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin, but by the content of their character. † Affirmative Action would make this dream virtually impossible, bringing race in as a factor in judging college admissions and employment. Those who want to eliminate Affirmative Action regulations argue that preferential programs encourage racial tensions when white students and workers feel they are not getting fair consideration. Why should whites suffer for society’s past mistakes? ask Anti-Affirmative Action activists who also note that Affirmative Action programs make whites the victims of reverse discrimination. Affirmative Action works against minorities, the argument continues, because it is assumed that an individual who benefits from such programs is automatically considered inferior to other candidates for jobs or schools, and because the majority who benefit from Affirmative Action are already middle-class, those most in need of the programs, rural and inner-city blacks, have gained nothing. Protestors against Affirmative Action have already taken steps to abolish the abominable doctrine through the passing of Proposition 209 in California. The measure would eliminate Affirmative Action programs used to increase hiring and promotion opportunities for state or local government jobs, where sex, race, and ethnicity are preferential factors in hiring, promotion, training, or recruitment decisions. In addition, the measure would eliminate programs that give preference to women-owned or minority-owned companies on public contracts. Contracts affected by the measure would include contracts for construction projects, purchases of computer equipment, and the hiring of consultants. These prohibitions would not apply to those government agencies that receive money under federal programs that require such Affirmative Action. The elimination of these programs would result in savings to the state and local governments. These savings would occur for two reasons. First, government agencies no longer would incur costs to administer the programs. Second, the prices paid on some government contracts would decrease. This would happen because bidders on contracts no longer would need to show †good faith efforts† to use minority-owned or women-owned subcontractors. Thus, state and local governments would save money to the extent they otherwise would have rejected a low bidder–because the bidder did not make a †good faith effort†Ã¢â‚¬â€œand awarded the contract to a higher bidder. The measure also could affect funding for public schools (kindergarten through grade 12) and community college programs. For instance, the measure could eliminate, or cause fundamental changes to, voluntary desegregation programs run by school districts. (It would not, however, affect court-ordered desegregation programs. ) Examples of desegregation spending that could be affected by the measure include the special funding given to †magnet† schools (in those cases where race or ethnicity are preferential factors in the admission of students to the schools) and designated †racially isolated minority schools† that are located in areas with high proportions of racial or ethnic minorities. Up to $60 million of state and local funds spent each year on voluntary desegregation programs may be affected by the measure. In addition, the measure would affect a variety of public school and community college programs such as counseling, tutoring, outreach, student financial aid, and financial aid to selected school districts in those cases where the programs provide preferences to individuals or schools based on race, sex, ethnicity, or national origin. Funds spent on these programs total at least $15 million each year. Eliminating Affirmative Action programs in America would thus save the government a substantial amount of money and pave the road for truly equal opportunity and treatment of all races. In light of the conflicting arguments for and against Affirmative Action, it is readily apparent that Affirmative Action essentially implements reverse discrimination as an â€Å"acceptable† solution to racial inequality in America, giving preferential treatment to minorities and women, and should thus be forbidden morally and legally if there is to be any sense of â€Å"color-blindness† in race relations in the future. As Daniel Boorstin once said, â€Å"The menace to America today is the emphasis on what separates us rather than what brings us together. † Truly, doing so would further separate embittered races and pit them against each other in heated debate and controversy. Calling for an alternative to Affirmative Action, Randall Kennedy states, â€Å"†We ought to construct a society and set of laws that focus on an individual’s character, not color of skin. If Affirmative Action should be banned and society should be â€Å"color-blind,† there should be an alternative to Affirmative Action to ensure this. There are a few possible alternatives to Affirmative Action, some of them are very simple and some are a little more complex. The alternatives include reconstruction of civil society in minority communities, increasing minority and female applicant flow, and most importantly promotion of broad policies for economic opportunity and security that benefit low- and middle-income Americans, both black and white. Building up civil society means strengthening ‘intermediate’ institutions, lying between the state and the individual, such as community associations, schools, media, and independent social agencies, which provide the organizational foundation for collective development and effective public representation. † If the same capital was made available for minority institutions as other institutions, they would be able to develop in the society and eventually become a strong part of the minority community. These institutions would give direction and guidance that is needed by all to play a major role in their community. Increasing minority and female applicant flow would be very easy for a company to do. They simply need to include minority colleges and universities in campus recruitment programs, place employment opportunities in minority oriented print and broadcast media, and retain applications of unemployed minority applicants to be reviewed as a position opens. This would be a great opportunity for applicants and employers. We should work toward broad based economic policies by consistently emphasizing broad-based, race-neutral policies; for example, public investment, national health reform, an enlarged earned income tax credit, child support assurance, and other policies benefiting families with young children. Widely supported programs that promote the interests of both lower- and middle-income Americans and that deliver substantial benefits to minorities on the basis of their economic condition will do more to reduce minority poverty than narrowly based, and poorly funded, measures for minority groups or the poor alone. These efforts can also be designed to coincide with intermediate institutions and thereby to contribute to the overall process of civil reconstruction and renewal. Ultimately, if there is to be any sense of racial equality and equal opportunity in this world, we must abolish Affirmative Action and ensure an equal playing field for all races in America. How to cite The Implementaion of Reverse Policy for Discrimination, Essay examples

Therapeutic Interventions for Parkinson s Disease

Table of Contents Introduction Therapeutic Interventions Common Symptoms and Management Contemporary Attitudes Towards Treatment Suggested Treatment Conclusion References Introduction Parkinson ’s disease (PD) is a serious progressive disease that was first described in 1817 by James Parkinson. Many years passed before it was established that disappearance of doperminergic and non-doperminergic nerve cells in the substantia nigra of the mid brain was a primary feature in PD patients (Jankovic, 2008).Advertising We will write a custom essay sample on Therapeutic Interventions for Parkinson ’s Disease specifically for you for only $16.05 $11/page Learn More This disappearance results the depletion of dopamine in the striatum. These nerve cells are responsible for controlling movement. Statistics indicate that PD as a neurologenerative disorder in the United States is only superseded by the Alzheimer’s disease (Scott Stacy, 2009).T he mean age marking the onset of the disease is 57 year and it affects about 1 to 2% of the population above 60 years (LeWitt, 2008). The actual cause of the death of these cells to date remains unconfirmed. It has been suggested a number of contributing factors may include, genetic mutations, abnormal handling of some proteins by ubiquitin-proteasome and autophagy-lysosomal systems , mitochondrion dysfunction, inflammation , environmental factors, and other pathogenic mechanism (Jankovic, 2008). There are many forms of parkinsonian disorders categorized into four groups namely: primary (idiopathic)parkinsonism, secondary (acquired,symptomatic) parkinsonism heterodegenerative parkinsonism and the multiple system degeneration type(Jankovic,2008). PD impairs motor and non-motor function in patients predisposing them to significant physical, economic and emotional burdens that is manifested by disability, deficit in health-related quality of life (HRQOL), and increased risk of early mo rtality (Scott Stacy, 2009). This papers aims to deeply examine the present therapeutic interventions for Parkinson’s disease. In the first section, various aspects of cognitive, pharmacogical and alternative treatments for this disorder will be presented. The second part will try to relate the clinical manifestations of the disorder with the above treatments and a personal opinion for treatment will be offered. The last section before the conclusion covers contemporary attitudes towards the above treatments. Therapeutic Interventions To date, there are no known neuroprotective agents for PD. Although some agents have yielded promising neuroprotective effects in cell cultures and animals, their effects have been inconclusive in humans. In recent years PD therapy has focused on modifying disease progression other than controlling neurological symptoms (Scott Stacy, 2009). Treatment for PD may involve pharmacological, functional surgery or rehabilitation procedures (physical therapy, speech therapy and Occupational therapy). Unlike surgery and alternative treatment, Most pharmacological interventions are designed to replenish and enhance delivery of dopamine to the affected areas of the brain .Because dopamine is unable to cross the blood brain barrier, pharmacological formulations use Levodopa ,the precursor of dopamine.Advertising Looking for essay on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More The efficacy of levodopa has been established in the decades proceeding its first introduction in the 1960s (Oertel et al. 2011).The delivery of this precursor to the brain is made by coupling it to Dopa Decarboxylase inhibitors (DDI) such as Carbidopa or benserazide or Catechol-O-Methyltransferase (COMT)(e.g, Entacapone and Talcapone). This coupling enhances the efficacy of levodopa by preventing its peripheral conversion and increases it bioavailability in the brain (Scott Stacy, 2009). Over the years, Levodopa has become the preferred drug for the treatment of motor signs and symptoms of PD (LeWitt, 2008). Patients are known to recover from impairment of speech, gait and dexterity 15 to 30 minutes after administration of oral dose. For this reason, this response is also used as a confirmation criterion for proper diagnosis of PD (LeWitt, 2008 ). Both pharmacological and surgery (Deep Brain stimulation) have been shown to provide symptomatic benefits by reducing tremor ,rigidity ,stiffness and slowed movement (LeWitt, 2008). However, most levodopa users experience motor complication with continued usage of the drug. This has been attributed to its direct neuromodulatory and neurotransmitter actions (LeWitt, 2008). Apart from pharmacological and surgical treatment many patients of PD also receive rehabilitation assistance in the course of the disease (Oertel et al., 2011).The efficacy of this therapy is not conclusive. The rehabilitation involves specialist drawn from the fi elds of occupational therapy, occupational therapy and speech-language therapy. These rehabilitations may be in form of monotherapy or as part of a team of approach (Oertel et.al., 2011). They can also be engaged as part of adjunctive treatment with drug therapy or as mainstay treatment for symptoms that are resistant to other therapies (Oertel et.al., 2011). Physical therapy can reduce dependence on caregivers and improve the quality of life in PD patients by improving movement, enhancing function and lessening pain (Scott Stacy, 2008) Physical therapy is limited in that can only address issues such as balance, lack of coordination,fatigue,gait,immobility and weakness. It can also be used to develop exercise program for PD patients before motor problems arise. Recent studies have shown that exercise has a positive effect on motor sign and gait (Oertel et al., 2011). On the other hand, occupational therapy can help patients learn to perform mundane activities affected by the diseas e such as handwriting and use of various appliances. Emerging evidence has also shown that gait could be significantly improved through cued training , treadmill training in addition to cultural alternatives such as Tai Chi and Qijong (Oertel et al., 2011).Advertising We will write a custom essay sample on Therapeutic Interventions for Parkinson ’s Disease specifically for you for only $16.05 $11/page Learn More Most drug therapies and surgical treatment are temporary although the later has been shown to produce much longer beneficial symptoms. The response to levodopa changes after two years and motor fluctuation and dyskinesias develop within 5 years of administration. To counter this effect, a combination therapy of levodopa and doperminergic agonists has been suggested in the initial treatment of PD (LeWitt, 2008). Another management alternative suggested involves delaying the introduction of levodopa in early PD when symptoms are mild and to lerable. This strategy requires that levodopa be introduced only when the progression has reached levels of serious discomfort and disability (LeWitt ,2008 ). In the United States, levodopa administered together with AAD inhibitor, carbidopa on permilligram basis is efficacious Pharmacological therapy, just like surgical and rehabilitation procedures also involves a combination of an array of regimens for optimizing symptomatic relief (LeWitt, 2008). Adjunctive therapies are common features of parkinsonism (Oertel, 2011).In stable PD, Efficacy for most drug agents is enhanced by supplementation with other medications (Oertel, 2011). For advanced PD, Levodopa may be combined with dopaminergic agonists, amantadine ,MAO-B inhibitor or COMT inhibitor (LeWitt, 2008). Pharmacological therapy unlike surgery which is only a viable option in late PD, has been shown to be effective for early and advanced stages of PD. Drug therapy is the primary treatment for PD (Hayes Fung, Kimber, Oâ€℠¢Sullivan, 2010). Higher doses of Levodopa produce greater improvements but predisposes the patient to earlier ‘wearing off’. Dopaminergic agonists are an alternative to levodopa as they do not produce motor fluctuation and dyskinesias . However, they require augmentation with levodopa within two years to use to produce symptomatic improvement. Clinical trials have shown cholinesterase inhibitors produce beneficial improvement in cognitive and psychotic symptoms (Hayes et al., 2010).Drug therapy for PD can also trigger of aggravate a range of neurophychiatric symptoms (Hayes et al., 2010). In such cases drug therapy using clozapine has been shown to reduce psychotic symptoms. Recidivism in more pronounced in drug therapies than in other interventions. Levodopa , administered thrice daily, offers symptomatic control throughout the day. However after years of treatment, motor complications typically, dyskinesias and motor fluctuations result. A meta- analysis by Oertel an d colleagues (2011) found 40% likelihood or motor fluctuations and dyskinesias after 4-6 years of levodopa therapy.Advertising Looking for essay on health medicine? Let's see if we can help you! Get your first paper with 15% OFF Learn More Surgical treatment may be considered when pharmacological intervention fails to slow down PD progression and severe motor fluctuations and dyskinesias persist. In recent year Deep Brain Stimulation (DBS) has gained importance due to its beneficial effects in certain motor symptoms. According to Deuschl and fellow researchers (2006) the administration of continous electrical impulses to the subthalamic nucleus by a surgical implant has produced improvements in motor symptoms in advanced stages of PD .DBS appear to produce long lasting beneficial effects on motor symptoms such as tremor, bradykinesia and dyskinesias although its efficacy has not been conclusively established (Hayes et al., 2010). However, surgical treatments have not been shown to improve other symptoms such gait dysfunction and fall. In some cases some symptoms have worsened after the surgery (Hayes et al.,2010). Common Symptoms and Management Rest tremor, bradykinesia, rigidity and postural dysfunction are the prima ry motor signs of PD (Jankovic ,2008). These features indicate a positive diagnosis as they are unique from other related parkinsonian disorders. Secondary motor symptoms include hympmimia, dysarthria, dysphagia, sialorrhoea, micrographia, shuffling gait, festination, freezing,dystonia and glabellar reflexes (Jankovic, 2008). Non motor symptoms are autonomic dysfunction, cognitive abnoramalities,sleep disorders and sensory disorders such as anosmia, parasthesias and pain (Jankovic, 2008). For brevity ,the following sections only present the motor symptoms of PD. This symptoms result primary from impairment of motor control and levodopa – dopeminergic agonist therapy usually are the first pharmacologicall intervention taken. Functional surgery and rehabilitation therapy can also be considered when the drug therapies fail to control symptoms. Bradykinesia (slowness in movement ) is a distinguishing clinical feature of PD and is said to be the hallmark of basal ganglia disorders (Jankovic ,2008). It features difficulties in planning, initiating and executing movement and with performing tasks that require fine motor control (Jankovic, 2008). It is also manifested by loss of spontaneous movements,drooling,dysarthria ,impaired blinking ability and hypomimia (Jankovic, 2008). Rest tremor is also a prevalent symptom of PD. It mostly occurs at extremities but may also involve lips, chin,jaw and legs (Jankovic, 2008). However proper diagnosis is essential to distinguish it from other forms of tremors such as Essential Tremors. Clinical pathological studies have shown that patients with PD have degeneration of a subgroup of mid-brain (A8) neurons (Jankovic, 2008). Though rarely used, clinical trial have indicated that Thalomotony may improve tremor (Oertel,2011). Rigidity is characterized by increased resistance in movement of limbs and also in the neck, shoulders, wrists, ankles and hips. In PD patient’s movement in these parts may be accompanied with pai n (Jankovic, 2008). Rigidity of the neck and trunk may result in abnormal axial postures, Striatal limb deformities may also develop in some patients. Deformities of the hand are characterized by ulnar deviation, flexion of metacarpophalangeal joints and extension of the distal interphalangeal joints (Jankovic ,2008). Foot deformities are characterized by extension of flexion of the toes. Postural instability occurs in advanced PD and is as a result of loss of postural reflexes (Jankovicl, 2008). It is said to be the main contributing factor for falls and ensuing fractures (Jankovic, 2008). Other factors cited to influence postural instability in PD patients include: orthostatic hypotension,age related sensory changes and Kinesthesia (Jankovic, 2008). Treatment has involved doperminergic therapy and functional surgery (pallidotomy and Deep Brain Stimulation). However these interventions have been known to produce scant improvements (Jankovic, 2008).Physical therapy has also been cit ed as potentially effective in improving postural instability (Oertel et.al., 2011) Freezing is one of the most disabling clinical features of PD though its occurrence is not universal (Jankovic, 2008). It commonly affects legs and is characterized by inability to walk which normally occurs at the initiation of movement and during movement. It is a common cause of falls (Jankovic, 2008). The main subtypes of freezing are: start hesitation, turn hesitation, hesitation in tight quarters, destination hesitation and open space hesitation (Jankovic, 2008).It is mostly severe during OFF periods but can be subdued by levodopa therapy (Jankovic, 2008). It is more common in women than men. Risk factors for freezing include rigidity, bradykinesia, postural instability and generally advanced stage of PD. Rehabilitation therapy are mostly used to treat freezing due to its poor response to pharmacological therapies. Cued training has been found to be effective in reducing the severity of freezin g of gait (Oertel et.al., 2011). A reduction in dopeminergic therapy has been recommended for ON freezing although this strategy may negatively impact on â€Å"wearing of† (Oertel et al., 2011). Other pharmacological therapies for freezing include strategies such as adjustment of levodopa dose/formulation (standard and CR formulation), dopamine agonists and COMT/MOA-B inhibitors (Oertel et al., 2011). Contemporary Attitudes Towards Treatment The choice for a therapeutic intervention for PD is usually a subjective one (Rascol, Goetz, Koller, Poewe, Sampaio, 2002,). Medical practitioners may base their selection on past experiences of a particular therapy. Other noted considerations include age, perceived expectations, comorbidity, safety, efficacy, technical experience and cost (Rascol et al., 2002). In de novo patients there is always concern about how long to delay the introduction of levodopa for efficacy purposes and the long term motor complications that arise. In early PD characterized by absence of motor complications, adjunct therapy with relative safety implications is usually acceptable while in advanced PD patients, treatment decisions is normally based on the present motor fluctuations and dyskinesia (Rascol et al., 2002). It is common practice to delay non-pharmacological interventions; especially functional surgery unless motor complication failed response to drug therapies persists. For surgical interventions such as DBS, application is only acceptable if the symptomatic benefits are considered greater than the nature of risks from surgery and that there is strong likelihood that the procedure will be more beneficial than convential drug therapies (Deuschl et al., 2006). Witt, Kutin, Timmermann, Zurowski and Woopen (2011) have also found out that the risk of ‘altered personality’ is especially alarming for patients, caregivers and clinicians. Suggested Treatment For early PD, I recommend a monotherapy of immediate or controll ed releases of dopamine argonists (e.g pramipexole, piribedi, ropinirole) .These drugs have been found to be effective in early PD. Clinical trials data also indicate that there is low risk for developing complications with introductory dopamine argonist therapy (Oertel et al., 2011, p. 224). Controlled Release (CR) Levodopa should only be introduced when motor symptoms have worsened to an extent of great discomfort and possible disability. This mode is based on clinical evidence that early usage of levodopa may contribute to early emergence of motor fluctuations and dyskinesias. Adjunct therapies of amantadine, COMT (entacapone only) and MAO-B inhibitors can also form part of the early interventions. Amantadine has been shown to induce symptomatic improvements while MAO-B inhibitors are well tolerated and have low daily doses. For patients with persistent or emerging disabling tremor, DBS at the subthalamic nucleus can be considered. For advanced/late PD, I recommend a combination of immediate release levodopa with MAO-B and COMT Inhibitors. Levodopa has been established as the most effective treatment for motor fluctuations that is common during this stage. The inhibitors serve to enhance the efficacy of levodopa. Another upside of levodopa is that it has also been shown to be effective in advanced PD patient with cognitive dysfunction in addition to possessing anti-hallucination properties. For persistent dyskinesias, Amantadine can be used in addition to reducing the daily doses of levodopa and MAO-B/COMT inhibitors. Dopamine agonists can also be considered to compensate for reduce doses of levodopa. However, it adverse effects of inducing hallucination and psychosis should be noted. For severe motor fluctuations DBS by stimulation of subthatllamic nucleus can be considered when drugs therapies have failed to contain it. Alongside medical and surgical interventions, rehabilitation therapies such as cognitive movement training and cued training are also adv ised. Late PD also present with a host of non-motor symptoms. The suggestion in this section is only for the motor symptoms which greatly impair the quality of life. Conclusion PD is a serious progressive disease that results in a much reduced quality of life in victims. To date the discovery for a neuroprotective agent for PD remains elusive. Current pharmacological therapies are the first line of intervention in initiation of treatment. However as the disease progresses, pharmacological agents lose their effectiveness. Apart from their symptomatic benefits of therapeutic drugs for PD also produce an array of side effects hence necessitating a combination of different regiments. Clinical trials for modern surgical interventions such as Deep Brain Stimulation have produced positive results so far and their usage is gaining acceptance in many quarters. However the effects of such invasive procedures have not been well established. Rehabilitation measures can only be used as supplemen tary therapy with surgical or pharmacological therapies. References Deuschl, G., Shade-Brittinger, C., Krack, P., Volkmann, J., Schafer, H., Botzel, K., Vojes, J. (2006). A randomized trial of deep brain stimulation for Parkinson’s disease. New England Journal of Medicine, 355,896-908. Hayes, M.W., Fung, S.V., Kimber, T.E., O’Sullivan, J.D. (2010). Current concepts in the management of Parkinson’s. Medical Journal of Australia, 192(3), 144-149. Jankovic, J. (2008). Parkinson’s disease: clinical features and diagnosis. Neurosurgery and Psychiatry, 79, 368-376.doi: 10.1136/jnnp.2007.131045 LeWitt, P.A. (2008). Levodopa for the treatment of Parkinson’s Disease.New England Journal of Medicine, 359, 2468-2476. Oertel W.H., Berardelli, A., Bloem, B.R., Bonucelli, U., Burn, D., Deuschl, G., Dietrichs, E., Fabbrini, G.. Trenkwalder, C. (2011) .Early (uncomplicated) Parkinson’s Disease/ Late (complicated) Parkinson’s Disease. In Gilhus, N.E., Brainin, M. (Eds.) European Handbook of neurological management (Vol 1, pp. 217-267). Chicago.Blackwell Publishing. Rascol ,O., Goetz, C., Koller, W., Poewe, W., Sampaio, G. (2002). Treatment interventions for Parkinson’s Disease: an evidence based assessment. Lancet, 359, 1589-98. Scott, B.L., Stacy M.A. (2009). The management of parkinsons disease in the primary care setting. Elsevier Internal Medicine News. Web. Witt, K.,Kutin,J., Timmermann, L., Zurowski, M., Woopen,C. (2010). Deep Brain Stimulation and the search for Identity. Neuro ethics. Doi: 10-1007/s12152-011-91-00-1. This essay on Therapeutic Interventions for Parkinson ’s Disease was written and submitted by user Noe D. to help you with your own studies. You are free to use it for research and reference purposes in order to write your own paper; however, you must cite it accordingly. You can donate your paper here.