ITALIAN ROMAN MOVIE Essay Example | Topics and Well Written Essays - 1750 words

ITALIAN ROMAN MOVIE - Essay Example De Sica’s perspective of Italy and the neorealist elements of the film are explored at the last section of this paper. 1. Vittorio de Sica’s Life Vittorio de Sica, born on July 7, 1902 and died on November 13, 1974, was a director, actor, and a leading figure of the Italian Neorealist movement (Britannica Online). He used to be a theater actor who loved performing light comedies before establishing his company, and eventually becoming a director (see fig. 1). De Sica acted in about 150 films and directed 35 films of which the most critically acclaimed was â€Å"The Bicycle Thieves†. As handsome as he was, he played leading man roles in films like â€Å"What Rascals Men Are!† One of his films, â€Å"Umberto D.†, didn’t do well in the box-office although it was one of his finest works. Jason Ankeny stated that â€Å"De Sica's career as a filmmaker was critically damaged† (New York Times Online). He went on to act in different films which include â€Å"A Farewell to Arms†, â€Å"It Happened in Rome†, and â€Å"Indiscretion of an American Wife†. He returned to directing in the 1960’s and created the films â€Å"La Ciociara†, â€Å"Ierri, Oggi, Domani†, and â€Å"Caccia alla Volpe† which were critically acclaimed and award-winning. Fig. 1. Vittorio de Sica; Holocaust; Dan.Romascanu.net, n.d.; Web; 7 March 2011. 2. Vittorio de Sica and the Neorealist Movement â€Å"The roots of Neorealism—an emphasis upon simple, honest story lines, a documentary style, the frequent use of children as protagonists, on-location shooting, social themes, and faith in the brotherhood of man† are displayed in De Sica’s films (Britannica Online). As one of the founders of the neorealist movement, De Sica stayed true to the ideals of neorealism which was reflected in a lot of his films. Budget constraints led him to shoot on location, employ untrained actors, and appropriat e simple camera work. â€Å"The Bicycle Thieves† was a simple story that resonated the themes of poverty, economic standing, and class differences. â€Å"Though critical favourites, the films of the Italian Neorealist movement never attained popular acceptance† (Britannica Online). I think the reason behind this was that people were not brave enough to face the realities of life that De Sica showed in his films. He was showing poverty, helpless men, suffering women, etc. which were all hard to bear seeing on screen. His films, I think, also somehow criticized Italian society. He displayed the weaknesses and vulnerabilities of Italian people on screen. â€Å"The Bicycle Thieves† in one scene at the restaurant showed how rich people indulge in drinking and eating while a lot of their countrymen are suffering in poverty. The film also showed the lack of police power as represented when Antonio reported the missing bicycle. But the greatest critique of the movie, I think, is the representation of a man who is slowly losing his dignity because of poverty. The young man who stole the bicycle was the most obvious representation of that. In the last scene of the movie, however, we see Antonio steal a bicycle himself and eventually lose all that he had – dignity and honor. And the cycle of poverty continues. The Italian society must play its part, then, in order to rise above the difficulties of poverty. 3. Postwar Italy Diana Pinto stated that â€Å"Italy in the postwar period has experienced a tormented social and political development spanning the entire gamut of western hopes and

What Are the Challenges That Face a Psychotherapist Working with Self-Harm or Eating Disorders Essay Example for Free

What Are the Challenges That Face a Psychotherapist Working with Self-Harm or Eating Disorders Essay I begin this study by assessment of the presenting problem and significant issues pertaining to his mental health state at this point in time. Mr G is at present suffering from depression. Due to the depression he will have a lack of motivation, self neglect, low self esteem, and at times hopelessness, and helplessness. He will possibly have anxiety, which, due to his fatigue with his illness, will be exacerbated because of the stress reaction and increase in adrenalin. This will cause him to be exhausted and possibly in need of sleep most of the time. His self esteem issues will have an impact on his relationship with his wife due to the fact that he will become more reliant on her. This will make him feel disempowered. Mr G will have to get used to the idea that his wife has to care for him more, and this will have an impact on his own personal values and beliefs. Within their relationship there may be frustration from both parties, but there might not be opportunity to discuss such issues because of the embarrassment or depression that Mr G has at present, or it may be that doesn’t happen in their relationship whereby they discuss their feelings and emotions. Due to the stress surrounding these issues, Mr G finds the impact of this affects the sexual part of their relationship and now has a dysfunction causing him more distress and making him feel a failure. He doesn’t feel he can become intimate with his wife because of this factor and feels there is a large part of their relationship missing at present. All these factors become heightened at times, making the depression more intense, leaving him feeling vulnerable and worthless. Before looking at a care plan for Mr G, I need to assess the importance of all these issues and how they impact on him as a person. Then using my theoretical knowledge put those in order of preference to enable Mr G begin to take control of his life and increase his self worth. As a therapist I would begin to explore the relationship Mr G has with his wife and how he sees the relationship. Mr G will have his own thoughts and pre conceptions as to how she sees the relationship but he may not have explored that with his wife. The therapist at this point has to remain neutral as it would be easy to collude with the client with their presenting issues. The therapist is there to support the client and help the client explore and evaluate the relationship for themselves. We may begin by looking at the balance of the relationship. I would use the `set of scales? theory to explore this. Mr G would have to identify where the relationship was on a set of scales. Would the balance be even or would one side be higher than the other? Who is putting most energy into the relationship? Was one person more committed than the other? Is there equity in the relationship? By using this method I would gain insight as to the issues concerning Mr G and if they were negative statements because of his depression or self defeating in context, or if Mr G has communication problems with his wife or other issues. This would help with his explorations with his perceptions of the presenting issues or self awareness of how he alone sees the problem and the evidence he has to back up the thought s he is having. The therapist can also talk through with the client their perceptions of their own contributory factor to the present problem with the relationship which is very important to regain empowerment. As a therapist working with only one person in the relationship may not bring about great change but explorations with the one party can make that person look at the relationship and challenge or discuss with their partner the changes that need to come into play to enable the couple to function together, making their relationship more whole, each being aware of how the other one thinks, behaves, and knows each other’s likes and dislikes, their needs and beliefs, and in harmony with each other. My parents have this wholeness between them and are in a situation like that of Mr G. My father is disabled and relies on the use of a wheelchair and relies on mum to care for him. Their wholeness allows them to have a relationship which is special and one which most people comment on because the contentment and dedication to each other becomes very apparent when around them. In some relationships this wholeness can never be, due to the fact that trust is missing from the relationship, and trust is paramount to any relationship. Statistics say that 80% of marriages suffer due to one party or the other having an affair. There is still widespread belief that monogamy is natural and expected in marriages and in committed relationships, however, that doesn’t stop some from engaging in affairs. But why do they? One of the main reasons is they are not getting their needs met in their relationship. People become bored within the relationship, they may have a need to feel attractive to others, or they may not feel attractive to their partner. In some parts of society men feel they are not real men if they turn down the advances of a female. Some people find it hard, if not impossible committing to one person. Some people are thrill seekers and have affairs because they cannot pass up an opportunity for a thrill. A person may not be in love with their partner but fall in love with someone else. For some people with low self esteem when they meet someone who appears to care about them it’s a way of increasing their self esteem. As well as these factors there may be other issues that drive people to having affairs. The affairs can cause scandal and excitement in the media, as we are all enthralled by the affairs of the famous and powerful. This could encourage people to enter into affairs of their own. As we grow and reach puberty we are often not in receipt of suitable education around sex and relationship issues which can lead to some people not being able to talk openly about sex with their partners. In order to avoid affairs the couple need to be honest with each other, not slip into complacency in the relationship, and keep the relationship alive by communicating with each other about all aspects of the relationship in order to build a close emotional and sexual foundation within the relationship. In the case of Mr G, once we know how he sees the relationship with his wife, we would have a good understanding of how the equality is within the relationship from his perspective. As I have said previously his awareness of the relationship and his contributions within it will be a place to begin work and exploration. If the relationship has equality and wholeness there will be no evidence for Mr G that he is not contributing in a good way to the relationship. His negative thoughts towards the relationship will be unfounded in this case. Mr G will have great self esteem issues due to his sexual dysfunction and his age will play a big part in that too. As we get older we have to accept that some parts of our bodies begin to show signs of weakness and wear and tear, and in relationships, harmony, support, understanding, companionship and love of an unconditional nature all play a big part. If these are in place there may be very little need for sexual desires to take over and become as important as it may have done in teenage years. The sexual desires can be explored with the couple and referral to sex therapy may be the answer depending on the couple and their perspective on the problems. It may e that just cuddling, heavy petting and general physical contact within the relationship is what may be lacking. Once a physical disability is diagnosed that person may begin to feel helpless and not worthy of anything. Their negativity may escalate to the point that they don’t see or feel that life is worth living, as what is described in the case of Mr. G. A therapist has to try and get the client focused on what they can do with slight changes within their lifestyle rather than what they can’t do. When looking at this the first hurdle is acceptance of their disability. During this process the therapist will work on self esteem issues and acceptance of them as a person from within. The acceptance of the way their life may have changed since the disability plays a big part in their attitude and mental state towards their immediate future. A person who feels negative and unable to function may want to withdraw from society, will have low mood if not addressed, leading to clinical depression, will procrastinate and neglect themselves, all of which a therapist will address within the counselling sessions. In addressing these issues the client will begin to see a future and look towards it with a more positive attitude. The relationship between Mr. G and his wife and her attitude towards him and his disability will have great impact during this process, and it may need to be suggested that she seeks counselling in her own right to address issues she may have, to enable the couple to eventually work together. It may be they need couple counselling but to enable this to work successfully addressing their own personal issues beforehand will be a way forward with this. Looking at a ? time map` can help with both parties. The client can map out their emotional stressors and look into their partners stressors throughout life and it allows exploration of these stressors and the effects offlife events. When we look at sexual relationships and intimacy within the couple there are many factors to consider. The communication between each other about their individual sexual needs may be something they find difficult to discuss. It may be their upbringing is different causing problems later in life. When I look at my relationship with my husband communication plays a big part in our marriage but something which causes most problems. My husband carries core beliefs that we keep things between ourselves and problems encountered are kept within close family not discussed with extended family. I hold core beliefs that families go through things together and support each other without being judgemental. My family have always been open about their problems and share them together. These discrepancies can cause problems. Looking back at the case study Mr G may have core beliefs different to Mrs G causing problems and preventing them from discussing their sexual difficulties due to their upbringing and beliefs interjected by their parents and maybe similar problems, around not discussing certain issues including sexual relationships within a couple. Intimate problems should be discussed without prejudice or judgement and the couple should aim to discuss this in an adult manner without taking things out of context or as a personal criticism. Mr G could be blaming himself for his body not reacting to stimuli when Mrs G is not doing anything to make the stimulus happen. One partner may not want sexual intimacy but more kissing and cuddles. All these things have to be discussed between the couple in order to make the relationship work. Factors and life changes like operations, changes in medication, mental health difficulties grief and loss, stress and general fatigue can all affect the sexual drive and if not discussed between the couple can cause misinterpretation with regards to how one person feels towards the other creating disharmony. Couple therapy can help with these issues if the couple find it hard to converse with each other for whatever reason but the onus is on the counsellor to explore and make sure it’s what both parties want or else it may cause friction and the counselling becomes non productive. When couples go to a counsellor with sensitive or intimate problems the counsellor has to be both mindful and broadminded. As long as the couple both agree to the act and give each other consent to the specific behaviours then it will be part of their intimate and physical relationship. Any dysfunction then may need exploration and possible referral to qualified sex therapist who is experienced in such matters. Psychotherapy may help initially. With the exploration during this process the therapist has to check with the client that they have discussed the problem with their G. P and that there is no medical problem preventing sexual function. Also the client needs to be aware that an expectant success rate for erectile dysfunction is generally around 85%. During the counselling process the therapist will discuss what the client perceives as a fully functional sexual encounter. For some people they may need to adjust their perceptions on this. It is not essential for a women to have orgasm at each sexual encounter but their partner may well feel they have not concluded a satisfying encounter without an orgasm being present for a women. An important step in therapy is often to take the pressure away from the need for conclusive penetrative sex and concentrate on other forms of stimulation and pleasure with the consent of both parties. Men may want to go down the medication route to address their erectile dysfunction but this doesn’t allow exploration of other psychological issues which may be preventing resolution of the problem. Research has indicated that the best quality sex is experienced in married couples even though it is considered by society to represent a routine and boring way to indulge in sexual gratification. Men are thought to be at their sexual peak between the ages of 16-22yrs. As men age this youthful sexual functioning begins to change into a mature way of being. It becomes pleasure not performance orientated. Sex now comes with emotional intimacy, eroticism and spiritual union that were absent before. The sexual part of the relationship brings pleasure and there becomes a greater bond between couples as they become more committed to each other. When reading this I began to think of my parents and how committed they are to each other. They have such a strong bond and concrete relationship. They share everything, their thoughts and feelings, and are so open and honest in their relationship with each other. They have no barriers with each other. They joke about their sexual incapability’s due to both of them having physical problems but the harmony between them is such that they have no embarrassments, and are free to discuss exactly what is on their mind with no one taking offence. They sort every problem they may have had in their relationship by talking and being open and honest with each other and resolving it before going to bed that evening. A core belief of my parents is they never ever go to sleep on an argument, and they never do. Maybe if more couples spoke to each other about their problems in relationships and had this special bond with each other whereby they could trust and not be worried about offending their partner there wouldn’t be the need for so much couple counselling or people having affairs to give them what is missing from their current relationship. In the case of Mr G maybe the key to the way he may be feeling at present is communicate more with his wife. He may need to look at his own negativity and how that manifests itself within the relationship and look at reframing his thoughts about his sexual unctioning. i. e. `I am afraid to have sexual contact with my wife in case I let her down by not having the ability to have an erection? to `I know my wife will understand if I don’t have the ability to gain an erection and we can use other methods to gain sexual fulfilment and be close to each other?. After work on his self esteem this will become easier. The client needs to decide whether to inform his partner of the changes they want to make in order to address their mental health at this present time or the things their partner can do to help. Small achievable goals have to be put in place to enable the client to make changes at an appropriate level. Mr G would probably have a plan looking a little like this to work through. If I was the therapist working with Mr G I would present this to Mr G as a pie chart giving Mr G the chance to choose which he felt he needed to work through first giving him autonomy and empowerment to take charge of his life giving him self worth and a focus in his life. Identification of presenting problems, Acceptance of lifestyle changes needed to accommodate recent physical health problems Being aware of contributing factors that can affect mood and cause depressive symptoms, and to explore these factors including suicidal ideation and risk factors. Understanding anxiety and how to be mindful of his anxiety levels Addressing procrastination and setting small goals Looking into relationship difficulties and sexual problems Looking towards future goals and support networks for both him and his wife. Explore options for future aspirations as a couple including holidays and things they can do together given deterioration in Mr G, s physical wellbeing. This Plan would hopefully give Mr G insight into his presenting problem, and, depending on the work I would be completing, and which piece of pie I would be working through, would determine my approach in therapy. At the beginning of counselling a person centred approach is important, and allowing the client a safe space to discuss their problems is paramount. With the core conditions set down, the client has the safe space and this approach will develop naturally. When looking at the history of a client, and how their past events may influence the present, working in a psychodynamic way would help the client explore their core beliefs and thinking patterns. A c. b. t. model may be helpful when challenging negative thoughts, reframing, and assessing anxiety levels. This model will also be very useful when looking and working with future goals. I feel there is a lot of support we can offer Mr G with his problems. What initially is presented as a big problem, can be explored and broken down into segments, each segment can then be used to work towards a more manageable and successful resolution.

Orthopaedic Management Of Cerebral Palsy Health And Social Care Essay

Orthopaedic Management Of Cerebral Palsy Health And Social Care Essay The condition of cerebral palsy refers to a varied group of permanent disorders of movement and posture caused by injury to the immature brain in utero, at birth or in the first years of life. These lesions are static not progressive and can be caused by a wide variety of factors such as intrauterine infections, trauma, neonatal stroke and genes, often in combination. Reflecting the varied aetiology and sites of injury cerebral palsy is often accompanied by neurological disturbances in cognition, behaviour, sensation and epilepsy. Most significantly from the orthopaedic perspective is that it leads to a progressive musculoskeletal pathology and abnormalities of muscle strength, tone and joint movement. These tend to be hidden at birth and are only revealed during the rapid growth of childhood as spasticity leads to abnormal posturing and thus secondary contractures and impaired torsional bone remodelling. Eventually this process leads to problems such as scoliosis, hip dislocation an d the development of fixed contractures.1 It is here that orthopaedic surgery can intervene by correcting fixed deformities leading to improved function and appearance. Cerebral palsy is the most common cause of referral to elective paediatric orthopaedic units.2 This essay will discuss the various surgical techniques that can be employed to tackle the musculoskeletal problems caused by cerebral palsy. Classification Cerebral palsy is classified based on the type of movement disorder present. The spastic form is the predominant type and can be divided into the subcategories of hemiplegic, diplegic or quadriplegic depending on topography. Appropriate management varies between these forms based on the level of functional outcome that can be expected; the most significant factor being whether the child is ambulant or not. It was the advent of gait analysis in the 1990s that revolutionised treatment of ambulatory cerebral palsy. Prior to this surgical intervention to improve gait was a matter of opinion, and often led to unexpected new problems which were even more intractable. The systematic empirical approach of gait analysis, however, enabled both more targeted and precise interventions and also critical evaluation of the outcomes of surgery.3 http://www.cpl.org.au/images/default-source/research/cp-body-map-graphics.jpg?sfvrsn=2 [Image 1: Distribution of symptoms in subtypes of cerebral palsy. Source: Cerebral Palsy League4] Modern gait analysis takes place in a specialised laboratory and includes a standardised physical exam, video recording, kinematic and kinetic measurements, electromyography, pedobarography and estimation of the energy consumption of walking.5 Age Generally speaking surgery for ambulant CP is not attempted until after the age of 7 by which time a mature gait pattern has developed. Between this age and the onset of the growth spurt in adolescence bone surgery is sometimes required in order to stabilise the bony levers of progression in the leg. These include femoral or tibial derotation osteotomies, intertrochanteric derotation of the femur and stabilisation of the subtalar complex.6 It is between the ages of 8 and the main adolescent growth spurt (12-13 in girls, 13-14 in boys) that soft tissue surgery is undertaken, the ideal timing remaining contentious.7 Increasing maturity and awareness allow for more complex surgeries that require strict compliance with rehabilitation programmes to succeed. Yet this must be balanced against the effects of the rapid growth of bone and muscle that may exacerbate and complicate deformity. Surgery for spastic diplegia Despite advances in the usage of botulinum toxin A, intrathecal baclofen and selective dorsal rhizotomy to reduce spasticity most children with cerebral palsy still develop progressive musculoskeletal deformities as they grow. These include fixed joint contractures and bony deformities collectively referred to as lever arm disease and which can only be treated effectively surgically.8 In the past a child with spastic CP typically presented with toe-walking and was managed by lengthening of the tendo Achillis. Although this procedure successfully levelled the foot it often led to a crouch gait as contractures of the knee and hip developed progressively in late childhood. Nowadays there is a strong consensus that the best approach is to gait correction is to address all deformities simultaneously in what is known as single-event multi-level surgery.9 Correcting fixed contractures is achieved by either fractional lengthening or muscle-tendon recession. Established procedures include tenotomy (lengthening) of the psoas muscle at the pelvic brim, rectus femoris transfer to semitendinosus or sartorius and fractional lengthening of the medial hamstrings. To correct bony torsional abnormalities necessitates rotational osteotomies. For femoral anteversion and concomitant hip internal rotation, femoral derotation osteotomy has proven to produce very effective and durable results.10 In order to correct a valgus foot deformity there are two options; a lengthening osteotomy of the os calcis or more commonly an extra-articular subtalar joint fusion utilizing an autogenous graft of bone from the iliac crest combined with a screw fixation .11 Spastic hemiplegia The most common joint deformities in the upper limb include internal rotation of the shoulder, elbow flexion, forearm pronation, wrist flexion and ulnar deviation, and swan-neck and thumb-in-palm deformities in the digits .12 Muscular injection with BTX-A can be useful in managing stiffness and increasing range of movement but is not effective at improving function.13 As with gait correction deformities in the upper limb are treated in a one-stage multilevel operation combining muscle releases and tendon transfers. The most common procedures are biceps aponeurosis and pronator teres release for pronation of the forearm, tendon transfers to extensor carpi radialis longus or brevis for ulnar deviation/wrist flexion (with first web z-plasty) and first dorsal interosseous and adductor muscle release with tendon transfer for thumb-in-palm.12 Patterns of gait in spastic hemiplegia have been classified comprehensively by Winters et al. and can be used to plan surgical management. In groups I and II the primary abnormality is drop foot due to equinus contracture which can be treated by lengthening of the gastrocsoleus muscle and appropriate orthosis. The situation is more complex, however in groups III and IV which require multilevel surgical intervention and gait analysis due to the involvement of proximal muscles leading to jump knee gait and in the case of group IV fixed hip flexion on top of equinovarus. These can be managed in the same way as soft tissue deformities in spastic diplegia by fractional lengthening or muscle-tendon recession.14 [Image 2: Saggital gait patterns in hemiplegia: classification and management. For each group: contractures shown in orange text, orthoses in green, surgical correction in red. Adapted from Winter et al.14] Tendon transfers to correct muscle imbalances are also employed in hemiplegia. This is most useful for equinovarus deformity, which is treated with split tendon transfer of the tibialis posterior (useful in the younger patient with more flexible deformity) or anterior combined with lengthening of the gastrocsoleus and tibialis posterior (better for older children with stiffer deformity).15, 16 Another possible problem in hemiplegia is limb shortening, presenting most commonly in the tibia and ranging from 1-3 cm. If necessary operative correction can be achieved by epiphysiodesis at the end of growth plates proximal to the knee at the appropriate age.7 Spastic Quadriplegia Surgical management of a child with spastic quadriplegia is particularly challenging owing to the presence of multiple co-morbidities such as epilepsy, osteopenia, respiratory disease and nutritional deficiencies. As such it requires the close co-operation of a multi-disciplinary team to manage possible complications as well as follow-up in terms of pain and intensive care. A variety of tests are important to help assess suitability for surgery. Lung function tests are used to evaluate the likely necessity of protracted assisted ventilation after the operation. Testing serum total protein and albumin levels is used to spot malnutrition associated with poor wound healing and infection. Detection of osteomalcia due to anti-epileptic medication is important and must be treated, and improving general nutritional state through supplementation is often desirable. Finally, identification of the degree of osteoporosis due to disuse is relevant in assessing the stability of any surgical fixat ion desired.7 Hip Management Hip displacement is rarest in spastic hemiplegia at 1%, uncommon in spastic hemiplegia at 5%, but much more common in spastic quadriplegia with an estimated incidence of 35-55%.17 If left untreated it may lead kyphotic sitting posture and pelvic obliquity increasing the risk of spinal deformity as well as chronic hip pain and increased difficulties in activities of daily living. In hemiplegia and diplegia the gait is so severely impacted that subluxation is identified early due to rapid orthopaedic referral. In quadriplegia, however, due to the higher visibility of issues such as seizures and feeding difficulties and the fact hip displacement is hidden in the early stages, it often can go undetected. Thus systematic radiographic screening is vital to detect it early with one study recommending commencing at 30 months and following up every 6 months thereafter.18 When abnormality is detected it is best to intervene early to try to prevent dislocation. The favoured soft tissue surgical approach is adductor and psoas tenotomies.19 If dislocation has already been established more drastic intervention is required with a single-stage open reduction of the hip, combined with a varus shortening derotation osteotomy of the proximal femur, which relieves pressure from the rim of the acetabulum stimulating growth and balancing the soft tissues by re-tensioning the hip abductors and relaxing the adductors, and a pelvic osteotomy to improve the shape and coverage of the acetabulum.20 Although this procedure offers the best long-term prognosis in terms of stability, further dislocations are not infrequent.21 Scoliosis Scoliosis in cerebral palsy can be non-structural secondary to femoral and pelvic muscular spasticity or structural secondary to contractures of the intrinsic spinal muscles. In non-ambulant patients it often extends to the sacrum and is associated with poor sitting posture, pelvic obliquity and hip dislocation. Prevention of these is thus vital to reducing the risk of distortion of the spine. Surgically the established management of severe scoliosis is instrumented posterior fusion along the length of the spine to the pelvis.6 Conclusion As surgical techniques for correcting deformities have proliferated and been refined in recent decades so the orthopaedic management of cerebral palsy has progressed from art to science. We are now in the pleasing position of having a tried and tested toolbox of procedures to deploy in the common musculoskeletal pathologies induced by diplegia, hemiplegia or quadriplegia. Yet a tool is only useful if it is used in the right place and so it is arguably the standardised assessment provided by gait analysis as well as improved understanding of the development of gait that has made the most difference by allowing clinicians to target interventions precisely temporally and anatomically to ensure the best outcomes. Although validated evaluations exist for the upper arm they have yet to reach the same level of reliability and universality as gait analysis, a desirable goal for future research. It is also important to remember that orthopaedic interventions can only ever ameliorate rather than solve the lifelong disabilities caused by cerebral palsy. For this reason it is vital that management first and foremost takes into account the desired outcomes of patients and carers including concerns such as cosmesis and independence. Likewise it is important to emphasise functional outcomes rather than abstract measures of deformity as these are in the end more important to patients.

Identifying and Solving Bulimia Essay -- Health, Eating Disorders

â€Å"In Fiji, before television came about in 1995, the island had no reported cases of eating disorders. Within three years of obtaining American and British television programming, more than two-thirds of the Fijian girls developed eating disorders and three quarters of the girls felt fat† (Hall 1-2). Now, eating disorders are becoming more and more common as the years go by. Bulimia has been around for thirty years and people are still not very familiar with the harm it can do physically and emotionally. Bulimia nervosa can destroy not only a person's life but others around them, and it can be stopped with support and counseling. â€Å"Eating disorders in America are common. One or two out of 100 students will struggle with one† (â€Å"Eating Disorders† 1). A person is affected physically, mentally, and emotionally by bulimia. The signs of bulimia can be mistaken for the signs of other disorders or can be easily dismissed as something minor. Physically, bulimia causes extreme exhaustion and weakness. The person will have frequent sore throats and bloodshot eyes due to their blood vessels popping from the excessive throwing up. They will also vomit blood and experience constipation  regularly. Indigestion and bloating are common occurrences. The bulimic person will have swollen glands in their neck and face. The person will also have clear looking teeth and calluses or scrapes on their knuckles due to their extreme methods of vomiting. In addition to the physical signs a bulimic person has, it may be hard to tell if they are bulimic or not because a bulimic person can be thin, overweight, or at a normal weight. Along with the physical signs are the mental signs. Bulimics are obsessive thinkers about food. They have a pattern of becoming ... ...Health care professionals want everyone to know that it may take time for the Prozac to go into effect. â€Å"To be effective in treating bulimia, Prozac may need six weeks before seeing any improvement† (â€Å"Prozac†¦Ã¢â‚¬  1-2).  Bulimia is a serious eating disorder that needs to be dealt with. It affects not only the bulimic, but their friends and family. There are so many solutions to this problem but they go unnoticed because people chose to ignore bulimia and the seriousness of its effects. We need to spread the word. We need to make people aware of the things they chose to ignore. We need to make these resources more accessible and easy to find. Do not be scared or embarrassed to reach out to a friend or family member. They want to help in any way they can. No one wants to sit back and watch a loved one suffer, especially if there is something they can do about it.

American Apparel Case Analysis Essay

Key Facts of the Case (no analysis) -Who is the decision maker? (Remember: in analyzing a case you have to put yourself in the position of the decision maker and try to figure out what YOU would do in his/her position). -maximum 5 key facts that summarize the case. Key Decision Maker Board of Directors (AA is a publicly traded company) Key Facts American Apparel minimized their use of outsourced labour. They localized their manufacturing activities and were known for their anti-sweatshop practices The company was also praised for their environmentally friendly practices such as using organic and recycled materials in several of their products, and participating in charitable causes Their advertising campaigns stirred up a lot of controversy for the company, as some consumers believed them to be too sexual and borderline pornographic Charney (CEO) took the ad pictures himself using women he found on the streets or his own employees. As a hiring practice, employees were required to provide full length self-portraits to him Charney brought heat to the company via sexual harassment lawsuits and by creating a hostile working environment (using foul language, walking around in his underwear, flirting with employees, etc.) Problem(s) Statement -What is the main problem(s) or opportunity(s) that you (as decision maker) must deal with? -How urgent and how important is this issue and why? Main Problem The main problem presented for American Apparel is that there are discrepancies between their controversial advertisements and workplace practices and their positive business initiatives, which has resulted in a loss of sales for the company. They must determine how they are going to move forward and inspire a turnaround. Urgency Moderately urgent The company forecast a turnaround by 2015 (3 years to the future) Problem(s) Analysis -What is the background that has led to the problem(s)? -What are the key points that the decision maker must consider when figuring out a solution? (eg. constraints that limit the possible solutions or opportunities that could arise) -If a financial analysis is required, outline that in this section. -Perhaps a different format for analysis is more appropriate? (eg. SWOT, PEST, Porter’s Five Forces). Background American Apparel strived to promote raw natural beauty. To do this, they used real, non-photo-shopped, airbrush-free models in their advertising campaigns Their signature advertisements featured women in racy outfits and poses Charney took the pictures himself and either found women on the streets or used his own employees Charney said it was the company’s way of marketing to millennials, targeting contemporary adults who desired sexual freedom, and fighting against the pressures on women to achieve perfection Charney’s strange and inappropriate workplace behaviours made some employees feel uncomfortable SWOT Strengths Pro-labor practices Anti-sweatshop Made in USA label Pay their employees nearly double minimum wage Provide job security and good benefits for employees Environmentally friendly practices Use of organic and recycled materials Strong international presence – 253+ retail stores in 20 different countries Reasonably priced and good quality products Weaknesses Provocative advertisements Store environment makes some customers feel uncomfortable – â€Å"reeked of sexual sin† CEO Dov Charney’s workplace behaviour and practices which have led to complaints and lawsuits The company’s cost of production is likely higher than their competitors because of their â€Å"made in USA† policy High labour costs $120 million in debt Opportunities The company has the opportunity to tame their provocative advertising campaigns They can also steer the focus back onto their positive business initiatives Ethical buying habits are on the rise – consumers are becoming more conscious of the environment Expand online and catalog business sectors – Focus product lines – eliminate those that aren’t as successful and profitable – Reform advertising campaign – focus more on AA’s  positive political activism and â€Å"homegrown† products – Restructure corporate-executive-suite and construct a more positive public image Expand online and catalog business sectors – Focus product lines – eliminate those that aren’t as successful and profitable – Reform advertising campaign – focus more on AA’s  positive political activism and â€Å"homegrown† products – Restructure corporate-executive-suite and construct a more positive public image Threats Their competition who offer similar products at equal or lower price points, and have cheaper production costs Threats of lawsuits against Charney which create a negative public image Threats of consumers shopping elsewhere due to dissatisfaction with AA’s sexual advertisements SWOT Findings: The SWOT analysis shows that American Apparel needs to bring the focus back onto the strengths of the company. They need to remind consumers of the ethics the company was built on and their goodwill and valuable contributions. Their weaknesses primarily revolve around being too overtly provocative, whether this is towards consumers or within the workplace itself. The company clearly cannot continue with this controversy, as they risk overshadowing the positive aspects of their business. Decision Criteria for Solutions -What goals or objectives must be achieved by any potential solution to the problem? (eg. Must maximize market share) -What constraints limit the range of solutions (eg. Can’t cost more than $1 Million) Goals and Objectives The goal is to save the company’s reputation which will in turn stop their money-losing streak Constraints Must not incur further debt 10 Identification of Realistic & Practical Alternatives available to the Decision Maker – In most situations there will be at least 3 alternatives, one of which can be status quo. One or two short sentences to describe each. – Each alternative MUST be a stand alone solution to your problem(s). Alternative 1: American Apparel should fire their current CEO, Dov Charney,  and elect a replacement. Alternative 2: American Apparel should change their advertising strategy by toning down their sexual nature and focusing on their business strengths to create positive publicity. Alternative 3: American Apparel should continue with their current advertising strategies. Pros and Cons of each Alternative Alternative 1 Pros Charney’s provocative vision and proneness to scandal will leave the company with him It shows that AA will not stand for sexual harassment and inappropriate workplace behaviours The company can bring in a new vision and have a fresh start Cons The company may lose customers who supported Charney and his vision The replacement CEO may not be any better than Charney at running the business Alternative 2 Pros It helps AA to fix the disconnect between their ethical and unethical practices It reminds consumers of the company’s positive values Cons Charney may not go for the new vision; he may push back It doesn’t solve the issue of unethical workplace incidents The company may lose customers who support the provocative and â€Å"natural† ads Alternative 3 Pros No changes will need to be made, therefore employees will not need to be trained or guided through any change The controversy surrounding the company may actually bring in customers Cons Discrepancies of the company’s business practices will not be solved Consumers who do not like the provocativeness of the company may continue or  start to avoid it Recommendation & Implementation Plan – You must have a sentence that says, â€Å"I recommend alternative†¦Ã¢â‚¬  – Do not combine alternatives. Pick just one. – Defend your choice of alternative. Explain WHY it is better than the others. – If applicable, explain how the alternative will be implemented. (who, what, where, when, how) Recommendation I recommend alternative 1 – firing Dov Charney. I do not believe alternative 3 is an option because the unethical advertisements and workplace practices would likely catch up with the company and really affect their performance in the long run. The reputation of American Apparel would just continue to deteriorate if nothing is changed, which would deter consumers from shopping there. Alternative 1 is a better path to take than alternative 2 because it really gets at the root cause of all the issues – Dov Charney. The provocative and controversial advertisements were largely inspired by the CEO himself. Simply changing the company’s advertising campaigns is good and well, but there is no guarantee that Charney will even go for that. And what’s to say he wouldn’t go back to his old ways in the future? Also, alternative 2 doesn’t fix the issue of employee complaints and sexual harassment lawsuits that have given the company a bad image. Alternative 1 has the potential to resolve both the advertising strategies and the inappropriate workplace incidents. Implementation Who Board of Directors What Fire Dov Charney Where At a board meeting When As soon as possible How Gather all documentation of Charney’s inappropriate behaviours Review the termination agreement that was made at the time of hiring Charney Review the company’s succession plan for the CEO – determine who may be able to take Charney’s place in the interim Seek counsel from the company’s lawyers on the best method to fire Charney Overall Quality (logical consistency & readability)

Exponential Decay and Percent Change

Exponential Decay and Percent Change When an original amount is reduced by a consistent rate over a period of time, exponential decay is happening. Here is an explanation of how to work a consistent rate problem or calculate the decay factor. The key to understanding the decay factor is learning about percent change. Here’s an exponential decay function:    y a(1-b)x y: Final amount remaining after the decay over a period of timea: The original amountx: TimeThe decay factor is (1-b).The variable, b, is percent change in decimal form. Because this is an exponential decay factor, this article focuses on percent decrease. Three Ways to Find Percent Decrease The percent decrease is mentioned in the story.The percent decrease is expressed in a function.The percent decrease is hidden in a set of data. 1. The percent decrease is mentioned in the story. Example: The country of Greece is experiencing tremendous financial strain. They owe more money than they can repay. As a result, the Greek government is trying to reduce how much it spends. Imagine that an expert has told Greek leaders that they must cut spending by 20%. What is the percent decrease, b, of Greece’s spending?   20% What is the decay factor of Greece’s spending?Decay factor: (1 –b)   (1 - .20) (.80) 2. The percent decrease is expressed in a function. Example:   As Greece reduces its government spending, experts predict that the country’s debt will decline. Imagine if the country’s annual debt could be modeled by this function:   y 500(1-.30)x, where y is in billions of dollars, and x represents the number of years since 2009 What is the percent decrease, b, of Greece’s annual debt? 30% What is the decay factor of Greece’s annual debt?Decay factor: (1 –b) (1 - .30) .70 3. The percent decrease is hidden in a set of data. Example:   After Greece reduces government services and salaries, imagine that this data details the country’s projected annual debt. Greece’s Annual Debt 2009: $500 Billion2010: $475 Billion2011:   $451.25 Billion2012: $428.69 Billion How to Calculate Percent Decrease A. Pick 2 consecutive years to compare: 2009:   $500 Billion; 2010:   $475 Billion B. Use this formula: Percent decrease   (older– newer)/older: (500 Billion – 475 billion)/500 billion .05 or 5% C. Check for consistency. Pick 2 other consecutive years: 2011: $451.25 Billion; 2012: $428.69 Billion (451.25 – 428.69)/451.25 is approximately .05 or 5% Percent Decrease in Real Life: Politicians Balk at Salt Salt is the glitter of American  spice racks. Glitter transforms construction paper and crude drawings into cherished Mother’s Day cards; salt transforms otherwise bland foods into national favorites. The abundance of salt in potato chips, popcorn, and pot pie mesmerizes the taste buds. Unfortunately, too much flavor and bling can ruin a good thing. In the hands of heavy-handed adults, excess salt can lead to high blood pressure, heart attacks, and strokes. Recently, a lawmaker announced legislation that will force us in the land of the free and the brave to cut back on the salt that we crave. What if the salt reduction law passed, and we consumed less of the white stuff? Suppose that each year, restaurants will be mandated to decrease sodium levels by 2.5% annually, beginning in 2011. The predicted decline in heart attacks can be described by the following function:   y 10,000,000(1-.10)x , where y represents the annual number of heart attacks after x years. Apparently, the legislation will be worth its salt. Americans will be afflicted with fewer strokes. Here are my fictional projections for annual strokes in America: 2010: 7,000,000 strokes2011: 6,650,000 strokes2012: 6,317,500 strokes2013: 6,001,625 strokes (Note:  The numbers were made up to illustrate the math calculation! Please contact your local salt expert or cardiologist for real data.) Questions 1. What is the mandated percent decrease in salt consumption in restaurants? Answer: 2.5%Explanation:   Be careful, three different things   sodium levels, heart attacks, and strokes are predicted to decrease. Each year, restaurants will be mandated to decrease sodium levels by 2.5% annually, beginning in 2011. 2. What is the mandated decay factor for salt consumption in restaurants? Answer: .975Explanation: Decay factor: (1 -  b) (1-.025) .975 3. Based on predictions, what will be the percent decrease for annual heart attacks? Answer:   10%Explanation:   The predicted decline in heart attacks can be described by the following function:   y   10,000,000(1-.10)x  , where  y  represents the annual number of heart attacks after  x  years. 4. Based on predictions, what will be the decay factor for annual heart attacks? Answer: 0.90Explanation: Decay factor: (1 -  b) (1 - 0.10) 0.90 5. Based on these fictional projections, what will be the percent decrease for strokes in America? Answer:   5%Explanation: A. Choose data for 2 consecutive years:   2010: 7,000,000 strokes; 2011: 6,650,000 strokes B. Use this formula:   Percent decrease (older – newer)  / older (7,000,000 – 6,650,000)/7,000,000 .05 or 5% C. Check for consistency and choose data for another set of consecutive years: 2012: 6,317,500 strokes; 2013: 6,001,625 strokes Percent decrease   (older – newer)  / older (6,317,500 – 6,001,625)/6,001,625 approximately .05 or 5% 6. Based on these fictional projections, what will be the decay factor for strokes in the America? Answer: 0.95Explanation: Decay factor: (1 -  b) (1  - 0.05) 0.95 Edited by Anne Marie Helmenstine, Ph.D.