Infectious Diseases within Inmate Populations Essay

Infectious Diseases within Inmate Populations - Essay Example The research has been carried out this way to give more of an interpretation on the realism of the prison environment and what is currently proving adverse and hard to control. The conclusion summarizes the main points and brings emphases to the strategies that have been implemented in the last few years to keep down the rate of infectious diseases among the inmate population. In just the past five years the amount of people being incarcerated in America has increased dramatically, topping the statistics of other countries who incarcerate individuals on a yearly basis. Because of this continuing problem disease has become eradicate in the prison environment and there are times when the attempt to control it is overwhelming to prison and public officials (Needels et al 2005). However, in years dating back to the mid 1900's, the spread of disease in prison was even more intensive than it is today. The only difference was the occurrence of disease was kept concealed and many people were exiting the prison system with infectious diseases without being aware of them. ... Therefore in order to appropriately detour disease in the prison and jail systems in the future there needs to be extreme precautions and remedies put into affect in today's time before this issue expels over into the community as an epidemic of disease related illnesses. Of course, one of the most difficult infectious diseases within the prisons in the United States is the wide spread illness of HIV. In fact it has been a difficult disease to try and combat for many years but this is due to the fact of the activities within the prison systems that can lead to the acquisition of HIV in the inmate population. For instance, many prisoners engage in activities such as homosexual acts, unsterilized needle usage for tattooing and drug use, unsanitary habits, etc; within the prison environment which leaves them open to contracting a major disease such as this one and therefore the contraction of it within an inmate population is extremely high and very difficult to keep at a minimal level. However peer education has proven to be an essential way to provide prisoners with literary materials that help them to understand how to protect themselves from contracting such serious illnesses like Hepatitis and HIV (UNAIDS 1996). Nevertheless, there are still many p rison and jail systems that are highly lacking in intervention methods to control infectious diseases. This poses many concerns for the officials who work inside the prison for not only are the inmates health issues a concern but the health of those trying to maintain law and order within the prison environment, and those who visit inmates from the neighboring communities becomes a major problematic area for health officials trying to keep disease to a minimum. This is why it was previously stated that

Unit 6 Assessment professionalism Essay Example | Topics and Well Written Essays - 500 words

Unit 6 Assessment professionalism - Essay Example The person simply withdraws from the whole situation or sidesteps it. Compromising refers to when a person looks for a solution that works for both of the parties concerned in the conflict. It is sort of loose- loose situation where both parties cooperate and work together to get a solution. Accommodating means taking in the other party’s concerns more than your own. It has a higher level of cooperation than assertiveness and is a perfect style when the other party is an expert in the situation leading to the conflict. Collaborating is when both parties in conflict work jointly to tackle the situation and come up with the best resolution to the situation. This style has equal levels of cooperation and assertiveness. In most conflict management situations, I prefer the collaborating strategy of conflict management because it comes up with a resolution that is mutually satisfactory to both parties in a situation. This is a win-win situation. Collaborating is still the best style in my opinion especially when it involves a long-term relationship, and it means that the problem will be actually solved. Conflict management means preventing unproductive conflicts in the work place and addressing those conflicts that cannot be prevented (Raines, 2013). Burnout is a condition of emotional, psychological, and bodily fatigue caused by extreme and extended stress. It comes about when a person feels weighed down and incapable to meet regular demands. As the stress builds up, the levels of motivation and productivity reduce. It leads to distrust and indifference. Some of the signs of burn out I would be on the lookout for including frequent fatigue and feeling drained most of the time. This means that the person feels a lack of energy and feels emotionally and physically exhausted. Another sign is that the person has reduced concentration and higher levels of forgetfulness. This later leads to a point where your

Martin Luther King, Obama, and Douglass Essay Example for Free

Martin Luther King, Obama, and Douglass Essay Countless have said that all men were created equal, but what about the prodigious black men of all time. Were King, Douglass, and Obama all created equal, or were these men chosen to be predestined for greatness? What constitutes greatness in politics? Names that come readily to mind, like Martin Luther King, Jr. , Frederick Douglass, and Barack Obama, are those who rose to inspire their countries in times of turmoil and change; so it seems that circumstances are just as important as character. Their personal characteristics, and even morals, differed widely but they were able to anticipate and articulate their nations needs and aspirations. One thing King, Douglass, and Obama, all three were involved with civil rights’ of all who were oppressed. These three men helped show America that a change was in order for all to feel free and all were created equal. Each of these three men became American Icons in many ways, such as King, Obama, and Douglass had prodigious speaking skills, leadership expertise, and opinionated dispositions. Obama, Douglass and King are revered in the sense that they led a major change in American History. Through their speeches and movements to the world, Obama, Douglass, and King, have directed a movement of change and optimism through the heart and soul of America. All three men are eloquent speakers, such as Frederick Douglass was not only a powerful speaker but a master of subtleties of the talent. Those who heard him were surprised at the sharpness of his mind, his self-confidence and ease on the podium, noting especially his skill at humor, imitation, and sarcasm. Such was his skill as a speaker that audiences began to doubt his credibility. Martin Luther King Jr. ’s public-speaking abilities, would become well-known as his importance grew in the Civil Rights Movement, developed slowly during his educational years, however, professors praised King for the powerful impression he made in public speeches. Barack Obama has awed the American people from the moment he ran for presidency. Many have written reviews about this great man such as â€Å"Last night our president delivered his first official state of the union address: he was brilliant. Years from now speech instructors will be playing tapes of his speeches for their students; in fact; it’s probably happening already on many college campuses. Years from now books will be written compiling many of his speeches; some given even before he became one of the most historic of all our presidents. From here on in Barack Obama will be the standard by which great speakers are measured. He is undoubtedly one of the best public speakers ever† (Hackshaw). All great speakers share a common trait: They learned to be great by studying those that went before them. Although people are enamored by the oratory skills of public figures from time to time, none was born with the ability to persuade or inspire. Speeches can be prepared for anyone, but it takes a person to be groomed or determined to succeed in those beliefs to make a person a great speaker. The inspirational voices came from wanting to make a change in history, the aspirations of each of the men, whether it was slavery abolishment, segregation, or economic decline. These great men made history in one way or another. Great leaders such as Douglass, King, and Obama, do not sugar coat reality, they engage the heart, refuse to accept the status quo, and create a sense of urgency. In fact, many would say that this is the defining characteristic of real leaders. Douglass was considered one the great leaders of his time, not only did he campaign for the abolishment of slavery, he later began campaigning for women’s rights. Douglass was leading and gifted in the anti-slavery movement. Born a slave, Douglass managed to educate himself, grasp the ideologies that allowed slavery to succeed in America, identified the way to free himself at a very early age and not only freed himself but helped others along the way. He set a determined goal of seeing American slavery abolished in his lifetime and he saw his goal accomplished. Douglasss courage, intellectual honesty and independence propelled him from slave to orator, editor and intellectual leader. Average leaders focus on results, and thats it. Good leaders focus also on the actions that will get the results. And great leaders focus, in addition, on the reactions that will drive these behaviors. One emotion that shapes our behavior is anger, and Martin Luther King Jr. , knew of the power that came packed in this emotion. King had reason enough to be aggravated, time and again. He was physically threatened and attacked by prejudiced people, repeatedly jailed by state authorities, sometimes on trivial traffic violations, harassed by the FBI, and even criticized by fellow black leaders who favored more violent forms of resistance. Peter Ling studies Kings leadership role during his fight for harmony and justice and states, â€Å"There were many leaders in the civil rights struggle, but Martin Luther King was more than just the most conspicuous and eloquent among them† (Ling). President Barack Obama, in his State of the Union address, showed the country why he is without question the best individual to lead this country in this time in our history. He was eloquent, forceful, realistic, honest, and inspirational. Only those people who watched through their masks of hate can say otherwise. There were many highpoints for me and below are some quotes that were particularly good. â€Å"Despite our hardships, our union is strong. We do not give up. We do not quit. We do not allow fear or division to break our spirit. In this new decade, its time the American people get a government that matches their decency, which embodies their strength† (Transcript: Obamas first State of the Union speech). Great leaders are not passive; leaders are active and are unwilling to accept to the circumstances. Leaders are impatient, in a good way and refuse to just sit by and let things take their natural course. Many have a sense of urgency and communicate it very well. Each of these men has an opinionated personality. This is what made all three men great. Many people may ask, â€Å"What is an opinionated personality? † An opinionated personality is considered, someone who isnt afraid to give their personal opinion. It doesnt have to be a bad thing. Its just someone that doesnt stay quiet, if a person doesn’t agree with something. One great example is when Martin Luther King Jr. wrote in his â€Å"I have a Dream Speech,† King wrote, â€Å"Actually, we who engage in nonviolent direct action are not the creators of tension. We merely bring to the surface the hidden tension that is already alive. We bring it out in the open, where it can be seen and dealt with. Like a boil that can never be cured so long as it is covered up but must be opened with its ugliness to the natural medicines of air and light, injustice must be exposed, with all the tension its exposure creates, o the light of human conscience and the air of national opinion before it can be cured (Shelly). Frederick Douglass voiced his opinions on slavery, no matter the cost, such is shown in this excerpt, â€Å"I have taken a sober view of the present anti-slavery movement. I am sober, but not hopeless. There is no denying, for it is everywhere admitted, that the anti-slavery question is the great moral and social question now before the Ameri can people† (Koeller). Douglass, King, and Obama have all the characteristics of men who believe in the things they speak about. Their opinionated voice resonates with all Americans even from the grave. Many Americans have listened to the speeches performed by all of the three men and felt the emotion that was made to pull your emotions to the front. President Barack Obama is probably one of the most opinionated people, but is not all Presidents or politicians for that matter. Their opinions and views are what gets them elected into government positions. Out of all the speeches given by these three great men, the emotions and personal interests come out and make people feel that a change is needed. Obama came at a time when America was eager for a change, but King and Douglass had to suggest the change, for all white Americans were content with the world. Most of us, being United States citizens, would like to believe that everyone in this country is living in conditions of utmost freedom and equality. Although according to the constitution this is true, anyone who has ever been the victim of oppression knows not to take equality for granted. Our society has slowly grown to accept the different types of people that live in our country; it is now a lot less common to see people s rights such as freedom and equality being abused. This would not be possible without the perseverance of many great men and women, who have strived, against all odds to make those beliefs come true. Frederick Douglass and Martin Luther King Jr. , would never have dreamed that one day a black man would become president. The day that President Barack Obama was sworn into office was a great stride for all black Americans. This showed that the world today had hanged and was not the same it used to be in the 1800’s or even in 1950. It takes a lot to stand up to adversity and make a stand, to voice your beliefs in front of millions who disagree with the color of your skin. Obama said it best in this quote, â€Å"It’s been a long time coming, but tonight, because of what we did on this day, in this election, at this defining moment, change has come to America† (Johnson). Through great leadership comes great responsibility and King, Douglass, and Obama, all took on this responsibility to make the world a better place for all Americans. Today we are a United Nation, of all races and colors, all having equal rights. Some still have trouble letting go of those beliefs that one race is more dominate than the other, but it has almost become a thing of the past. America will go through many more changes in the future, it is exciting to set and dwell on the times and changes to come. Will Obama hold up to his promises? Has Obama accomplished enough of his goals for re-election? Will gay marriage be accepted? These are the questions people ask today. Which change will be coming in the future?

Pain Sensation: Nociceptive receptors and transduction

Pain Sensation: Nociceptive receptors and transduction Pain is a subsystem of somatic sensation which includes a wide range of unpleasant sensory and emotional experiences usually associated with actual or potential tissue damage (Das et al., 2005). Over the years, by means of the evolutive process of natural selection, nature has made sure that pain is a bodily signal we cannot ignore. As a matter of fact, sensitivity and reactivity to noxious stimuli are essential to the well-being and survival of an organism. In dangerous circumstances pain tells the subject to get out of that situation immediatly, this is its main function. Without these attributes provided by pain mechanisms, the organism would have no means to prevent or minimize dangerous circumstances (individuals congenitally insensitive to pain are easily injured and most of them die at an early age1). While most of the sensory and somatosensory modalities are primarily informative, pain is a protective modality. Pain perception (also called nociception) doesnt come from excessive stimulation of the same receptors that generate somatic sensations, as someone could even think, it is a properly devoted subsystem. Nociception (from the Latin nocere, to hurt) in fact depends on specifically dedicated receptors and, due to its vital importance, this kind of information travels through redundant pathways. Pain also differs from the classical senses (hearing, smell, taste, touch, and vision) because it is both a discriminative sensation and a graded emotional experience. In the big picture, pain appears as a more complex whole experience than simple somatic sensation; that is why there are still many obscure aspects not completely understood, especially in the field of pain physiology and pharmacology. For this and other reasons, even nowadays, nociception remains an extremely active area of scientific research. 2. Pain Sensation Nociceptive receptors and transduction Pain sensation begins with relatively unspecialized free nerve cell endings called nociceptors. Like other somatic sensory receptors, they transduce a variety of noxious stimuli into receptor potentials, which in turn trigger action potentials in the pain nerve fibers (afferents). These action potentials are transmitted to the spinal cord and then, through the brainstem, to the thalamus and the somatic sensory cortex according to specific pathways2. Nociceptors are widespread distributed, they also show different degrees of sensitiveness and specialization. There are nociceptors in the skin, in the joints and also in visceral organs, but none of them is found inside the central nervous system (CNS)1. In contrast with somatic sensory receptors (responsible for the perception of innocuous mechanical stimuli), the axons associated with nociceptors conduct relatively slowly, being only lightly myelinated or, more commonly, unmyelinated2. Thus, according to the different kind of axon, there are faster or slower pain pathways. In particular, pain receptors can fall into four major categories depending on their response to the different types of stimulation caused by the damage: mechanosensitive nociceptors: respond to mechanical stimulation and have A-delta fibers, bigger axons with faster conduction velocity; mechanothermal nociceptors: respond to thermal stimuli, A-delta fibers; chemical nociceptors: respond to chemical substances, A-delta fibers; polymodal nociceptors: respond to high intensity stimuli of the previous three types and have C fibers, smaller and unmyelinated axons with slower conduction velocity. The cell bodies of these primary pain-neurons are located in the dorsal root ganglia (for body afferents) and in the trigeminal ganglia (for face afferents)1,2. The transduction of nociceptive signals, which starts with the nociceptive receptors, is a complex task. Tissue damage results in the release of a variety of chemical substances which triggers the response of nociceptors. Some of these substances activate the transmembrane transient receptor potential (TRP) channels, which in turn initiate action potentials2. Another characteristic feature of nociceptors is their tendency to be sensitized by prolonged stimulation, making them respond to other sensations as well in certain circumstances. This prolonged stimulation increases the release of chemical substances, making nociceptors sensitized and reducing their response threshold. Actually, within a few seconds after the injury, an area of some centimeters around the injured site shows reddening caused by vasodilation. This inflammation becomes maximal after about ten minutes and this region shows a lowered pain threshold (hyperalgesia) in response to additional noxious stimuli. This effect is also referred to as peripheral sensitization, in contrast to central sensitization that can occur at higher levels in the dorsal horn1. Although it is still unknown whether nociceptors respond directly to the noxious stimulus or indirectly by means of one or more endogenous chemical intermediaries released from the traumatized tissue, the activation of nociceptors initiates the process by which pain is experienced: these receptors relay information to the CNS about the intensity and location of the painful stimulus. Pain classification The result of sudden painful stimulation can be divided into two categories of sequential sensations separated by a short time interval. A sharp first pain, immediately after the damage, its followed some seconds later by additional, diffuse and longer-lasting second pain sensation. The temporal interval between these two separate sensations is due to the difference between fast transmitting A-delta fibers and slow transmitting C fibers. This phenomenon is also known as double pain sensation. Pain has also been classified into three major types1: Pricking pain: is also called fast pain or sensory pain (first pain) and arises mainly from the skin, carried by A-delta fibers which permit discrimination and localization of the pain. Burning pain: is caused by inflammation, burned skin and is carried by C fibers. This type of pain is a more diffuse, slower to onset, and longer in duration (second pain). Like pricking pain, burning pain arises mainly from the skin, but it is not distinctly localized. Aching pain: is a sore pain which arises mainly from the viscera and somatic deep structures. This pain is carried by the C fibers from the deep structures to the spinal cord and is not distinctly localized. Pain pathways The neural pathway that conveys pain (and temperature) information from the periphery of the body to the higher centers of the CNS is often referred as the anterolateral system (or ventrolateral column). This pathway is physically separated from the system that conveys mechanosensory information like touch and pressure (dorsal column-medial lemniscus pathway). However, even though the dorsal route has been always considered a touch pathway functionally separate from the anterolateral pathway, recent reports indicate that the dorsal column can carry noxious information from the viscera and widespread skin regions as well1. Anyway, the main difference between these two systems remains the site of decussation: while the dorsal column is an ipsilateral tract until the medulla (where synapses and decussates), the anterolateral system makes early synaptic connections and decussates right away in the spinal cord, becoming a contralateral tract. Composing the anterolateral system, there are three major ascending tracts: the neospinothalamic tract (the main, central pain pathway, phylogenetically younger, with few synapses), the paleospinothalamic tract and the archispinothalamic tract (which constitute minor parallel pain pathways, phylogenetically older and multisynaptic tracts)1. Every pain tract is made of three kinds of pseudounipolar neurons: first-order, from free nerve endings (nociceptors) to the dorsal horns of the spinal cord; second-order, from the dorsal horns to the thalamus; and third-order, from the thalamus to the primary somatic sensory cortex. The cell bodies of first-order neurons are located in the dorsal root ganglia (DRG) for all three pathways. a) The neospinothalamic tract (central pathway) constitutes the classical anterolateral system. This pathway is responsible for the immediate awareness of a painful sensation and for the understanding of the exact location of the painful stimulus. The first-order nociceptive afferents enter the spinal cord via the dorsal roots of the DRG and, when these projecting axons reach the dorsal horns of the spinal cord, they branch into ascending and descending collaterals, forming the tract of Lissauer2. Once within the dorsal horn, these afferents make synaptic connections with second-order neurons located in Rexeds laminae (layer I to V). Axons of these second-order neurons then cross the midline of the spinal cord, decussating in the anterior white commissure, and ascend to the brainstem in the contralateral (anterolateral) quadrant. Most of the pain fibers from lower extremities of the body and below the neck terminate, through the brainstem, in the ventral posterior lateral nucleus (VPL) of the thalamus. The VPL, which serves as a relay station, is thought to be mainly concerned with discriminatory functions1. Finally, here axons of second-order neurons synapse with third-order neurons that send the signal to the primary and secondary somatosensory cortex (SCI and SCII, respectively). Unlike the rest of bodily afferents, first-order nociceptive neurons from the head, face and intraoral structures have somata in the trigeminal ganglion. Trigeminal fibers enter the pons, descend to the medulla (forming the spinal trigeminal tract) and make synaptic connections in the spinal trigeminal nucleus, then cross the midline and ascend as trigeminothalamic tract (or trigeminal lemniscus). Axons from the second-order neurons terminate in a variety of targets in the brainstem and thalamus, but the discriminative aspects of facial pain are thought to be mediated by projections to the ventral posterior medial nucleus (VPM) of the thalamus and by projections (from here) to primary and secondary somatosensory cortex2. All of the fibers terminating in VPL and VPM are somatotopically oriented and still here the information supplied by different somatosensory receptors remains segregated. Axons from the thalamus synapse with third-order neurons of the SCI, which includes Brodmanns Areas 3a, 3b, 1 and 2. Each of these cortical areas contains a separate and complete representation of the body: they are somatotopically organized maps representing the human body (from the foot up to the face) in a medial to lateral arrangement2. b) The paleospinothalamic tract is a parallel pathway where the emotional response to pain is mediated1. This tract also activates brainstem nuclei which are the origin of descending pain-suppression pathways which regulate the sesation of noxious inputs at the spinal cord level. In the paleospinothalamic tract the majority of the first-order nociceptive neurons make synaptic connections with second-order neurons in Rexeds layer II (substantia gelatinosa). These second-order neurons also receive input from mechanoreceptors and thermoreceptors, and thats why the anterolateral system is also responsible for temperature perception1. The nerve cells that compose the paleospinothalamic tract are multireceptive or wide dynamic range nociceptors. Most of their axons cross and ascend in the spinal cord primarily in the anterior region and thus form the anterior spinal thalamic tract (AST). These second-order fibers contain several tracts and each of them makes a synaptic connection in different locations: in the mesencephalic reticular formation (MFR) and in the periaqueductal gray (PAG), forming the spinoreticular tract; in the tectum, also known as the spinotectal or spinomedullary tract; in the midline thalamic nuclei, forming the spinothalamic tract. Altogether these three fiber tracts are thus known as the paleospinothalamic tract, which is in part bilateral, because some of the ascending fibers do not cross to the opposite side of the cord1. Finally, from the thalamic nuclei, these fibers synapse bilaterally in the somatosensory cortex. Pain is a complex experience processed by a diverse and distributed network of neurons and brain regions. In addition to the sensory-discriminative aspects (carried by the neospinothalamic tract) there are also affective-motivational components of pain2. In the paleospinothalamic pathway there are extensive connections between the thalamic nuclei and the limbic areas such as the cingulate gyrus and the insular cortex. The insular cortex integrates the sensory input with the cognitive components. The limbic structures (amygdala, superior colliculus) project to the hypothalamus and initiate visceral responses to the pain. The thalamic nuclei also projects to the frontal cortex, which in turn is linked to the limbic structures involved in processing the emotional components of pain1. c) The archispinothalamic tract is another parallel pathway, phylogenetically the oldest that carries noxious information1. The characteristics of this tract are very similar to the ones found in the previous pathway. First-order nociceptive neurons make synaptic connections in Rexeds layer II (substantia gelatinosa). From here, second-order fibers ascend and descend in the spinal cord surrounding the grey matter to end synapsing with cells in the reticular formation and in the periaqueductal gray. Further diffuse multisynaptic pathways ascend to the diverse nuclei of thalamus and send collaterals to the hypothalamus as well as the limbic system nuclei. These fibers, like for the paleospinothalamic tract, mediate visceral, emotional and autonomic reactions to painful stimuli. In short, because of the importance of warning signals of dangerous circumstances, several nociception pathways are involved to transmitting these signals and some of them are redundant. The neospinothalamic tract conducts fast pain (via A-delta fibers) and provides information of the exact location of the noxious stimulus. The multisynaptic paleospinothalamic and archispinothalamic tracts conduct slow pain (via C fibers), a pain which is chronic and harder to localize. Through these patways, pain activates many different brain areas which link together sensation, perception, emotion, memory and motor reaction1. 3. Pain Modulation When talking about pain, we always have to consider and keep in mind the discrepancy between the objective reality of a painful stimulus and the subjective rsponse to it. Modern studies have provided considerable insight into how circumsatnces affect pain perception-interpretation and, ultimately, into the pharmacology of the pain system2. For many years it has been suggested that somewhere in the CNS there should be some neuronal circuits modulating incoming painful informations. Evidence for an intrinsic analgesia system was demonstrated by intracranial electrical stimulation of certain brain sites1,3. The circuit consisting of the periaqueductal gray matter (PAG), the raphe nuclei (RN), the locus coeruleus (LC) and the caudate nucleus (CN) contributes to the descending pain suppression mechanism, which inhibits incoming pain information at the spinal cord level6. Stimulation of such areas produce analgesia without behavioral suppression; indeed, touch, pressure and temperature sensation remain intact1. At the interneuronal level, opiate receptors activation causes hyperpolarization of the neurons, which in turn results in the inhibition of firing and in the release of substance P (a neurotransmitter involved in pain transmission) that blocks pain transmission1. In addition to descending projections, also local interactions between mechanoreceptive afferents and neural circuits within the dorsal horn can modulate the transmission of nociceptive informations to higher centers2. Observations by Melzack and Wall led to the idea that concomitant activation of the large myelinated fibers associated with low-threshold mechanoreceptors can mediate the flow of pain. This mechanism, also known as Gate Control Theory13, predicts that (at the spinal cord level) non-noxious stimulation will produce presynaptic inhibition on dorsal root nociceptor fibers and thus blocking incoming noxious information from reaching the CNS1 (i.e. non-painful input closes the gates to other painful inputs, which results in prevention and suppression of pain sensation). This explains also why if you, for example, stub a toe, a natural and effective reaction is to vigorously rub the site of injury for a couple of minutes2. However, there are many different factors that can influence the way we understand pain. Doubtless, three of these are: drugs, prior injuries and, more broadly speaking, circumstances. a) Drugs The brain has a neuronal circuit and endogenous substances to modulate pain. There are two primary types of drugs that work on the brain: analgesics and anesthetics1. The term analgesic refers to a drug that relieves pain without loss of consciousness, whereas the term anesthetic refers to a drug that depresses the CNS. Anesthetics are characterized by the absence of perception for all sensory modalities, including loss of consciousness, but without loss of vital functions. The areas that produce analgesia when stimulated are also responsive to exogenously administered opiate drugs2. As a matter of fact, the most effective clinically used drugs for producing temporary relief from pain are the opioid family, which includes morphine and heroin1. Unluckily, several side effects resulting from opiate use include tolerance and drug dependence (addiction). In general, these drugs modulate the incoming pain information as well as relieve pain temporarily, and are also known as opiate producing analgesia (OA). Opioidergic neurotransmission is found throughout the brain and spinal cord and appears to influence many CNS functions: opioids exert marked effects on mood, cognition and motivation1 (e.g. producing euphoria). The analgesic action of opiates implied the existence of specific brain and spinal cord receptors for these drugs long before the receptors were actually found. Since such receptors are unlikely to have evolved in response to the exogenous administration of opium and its derivates, the convinction grew that endogenous opiate-like compounds must exist in order to explain the evolution of these receptors in the body2. Nowadays, three classes of opioid receptors have been identified: ÃŽÂ ¼ (mu), ÃŽÂ ´ (delta) and ÃŽÂ º (kappa). All three classes are widely distributed in the brain, and particularly in the PAG, which is the site for higher cortical control of pain modulation in humans8. Moreover, three major classes of endogenous opioid peptides that interact with them have been recognized in the CNS: ÃŽÂ ²-endorphins, enkephalins and the dynorphins. Enkephalins are considered the putative ligands for the ÃŽÂ ´ receptors, ÃŽÂ ² endorphins for the ÃŽÂ ¼-receptors, and dynorphins for the ÃŽÂ º receptors1. The opioid peptides modulate nociceptive input mainly in two ways: blocking neurotransmitter release by inhibiting Ca2+ influx into the presynaptic terminal; or opening potassium channels, which hyperpolarizes neurons and inhibits spike activity. The various types of opioid receptors are distributed differently within the central and peripheral nervous system and this can explain many unwanted side effects following opiate treatments1. (For example, ÃŽÂ ¼-receptors are widespread in the brain stem parabrachial nuclei, which is a respiratory center. Inhibition of these neurons elicits also respiratory depression). In addition to opiates, the other big family of analgesia producing drugs is represented by the cannabinoids. Like opiates, cannabinoids produce analgesia when microinjected in the PAG and pain itself serves as a trigger for endocannabinoid release3. Results from the study by Walker et al. (1999) indicate that anandamide (an endogenous cannabinoid) fulfills the requirements for a nonopiate mediator of endogenous pain suppression and these data support the existence of endogenous cannabinergic circuitry in the dorsal and lateral PAG. Even if the opiate and cannabinoid mechanisms partially overlap anatomically, the endogenous opiate system is activaetd by intense and prolonged stimuli (such as high threshold electrical stimulation), while endogenous cannabinoids occur mostly in tonic pain suppression, during tests that do not produce significant stress or fear3. Cannabinoids have been used to treat pain for centuries and cannabis is still used despite its illegal status in most parts of the world. The spontaneous and stimulated release of anandamide in a pain-suppression circuit suggests that such drugs may form the basis of a modern pharmacotherapy for pain, particularly in instances where opiates are ineffective3. b) Previous injury A curious effect, well known and documented in clinical literature, is referred to as phantom limb sensation. Following the amputation of an extremity, nearly all patients have an illusion that the missing limb is still present. Although this illusion usually diminishes over time, it persists in some degree throughout the amputees life, and can often be reactivated2. A reasonable explanation for this phenomenon is that the central sensory processing apparatus continues to operate indipendently of the periphery, giving rise to these bizarre sensations. Indeed, considerable functional reorganization of the somatotopic maps in the primary somatosensory cortex occurs immediately after the amputation and tends to evolve for several years2. Neurons that have lost their original inputs respond to tactile stimulation of other (near) body parts, and so it is not unusual for the patient to perceive a phantom limb as a whole and intact, but displaced from the real location. These and further ev idences suggested then that a full representation of the body exists indipendently of the peripheral elements that are mapped2. Anyways, the major problem following phantom limbs phenomena is constituted by the fact that up to 85% of the amputated patients develop also phantom pain4. The description of this common unease can vary from a tingling or burning sensation to some more serious and debilitating issues. Phantom pain, in fact, is one of the more frequent causes of chronic pain syndromes and is extraordinarily difficult to treat2. Neverthless there is no really effective treatment, a study by Jahangiri et al. (1994) demonstrated that preoperative epidural infusion of morphine, bupivacaine and clonidine significantly reduces the incidence of phantom limb pain and phantom limb sensation. Moreover, this kind of treatment has been shown as safe for use on general surgical wards with a low incidence of minor side-effetcs4. Other than amputations, pain perception may also be modulated in certain stressful situations. Exposure to a variety of painful or stressful events produces an analgesic reaction, and this phenomenon is called stress induced analgesia (SIA). It has been considered that SIA can provide insights into both the psychological and physiological factors that activate endogenous pain control and opiate systems1. (For example, soldiers wounded in battle or athletes injured in sports events sometimes report that they do not feel pain during the battle or game; however, they will experience the pain later after the battle or as game has ended). Some studies demonstrated in animals that electrical shocks cause stress-induced analgesia3 and it has been suggested that endogenous drugs, (opiates or cannabinoids) released in response to stress, inhibit pain by activating the midbrain descending system1. Based on these and other experiments, it is assumed that the stress experienced by the soldiers and the athletes suppressed the pain which they would later perceive. c) Circumstances The experience of pain is highly variable between individuals: this highly subjective perception has a complex and often non linear relationship between nociceptive input and pain sensation5. From human experimentation we know that a variety of pain modulatory mechanisms exist in the nervous system, and these systems can be accessed either pharmacologically or through contextual and cognitive manipulation7,6. Various mental processes such as attention, emotional state, past experiences, memories, beliefs and feelings have been shown to influence pain perception and bias nociceptive processing in the humain brain9. All these top-down factors can be grouped together in the category of circumstances that either enhance or diminish pain sensation in regard to dedicated modulatory circuits. Among the cognitive variables influencing pain, the brain mechanisms underlying attentional control have been probably the most extensively studied5. A number of reports show the important role of attentional state in modulating the activity of primary somatosensory areas7. Thus, pain is perceived as less intense when individuals are distracted from it, as proved in an interesting study by Das et colleagues (2005). This research provides strong evidence supporting virtual reality (VR) based games in providing analgesia and positive influence on children with acute burn injuries, with minimal side effects10. VR can be considered an intermediary between reality and computer technology, and its ability to immerse the user interacting with the artificial environment is central in this kind of approach. However, attentional processes interact with mechanisms supporting the formation of expectations about pain and reappraisal of the experience5. The ability to predict the likelihood of an aversive event is an important adaptive capacity11. Our subjective sensory experiences are thought to be heavily shaped by interactions between expectations and incoming sensory information12 and this cognitive factor is important also for pain perception: positive expectations (i.e., expectations for decreased pain) produce a reduction in perceived pain that rivals the effects of a clearly analgesic dose of morphine12. These evidences provide also a neural mechanism that can, in part, explain the positive impact of optimism in chronic disease states. In fact, perceived control, attentional control and the descending pain modulatory system are involved in the placebo-induced analgesia, which is a clinical example of cognitive pain modulation that decreases pain intensity and cerebral responses to pa in5. Such top-down modulatory mechanism is a robust and clinically important phenomenon, which can be demonstrated in approximately one-third of the population9. Moreover, placebo analgesia requires the activation of endogenous opioid-mediated inhibition and neuroimaging techniques showed that there is also overlapping among brain sites activated by opioids and those that are activated during placebo analgesia9. Also the emotional state driven by the (experimental) context alters the attitude of patients and can produce powerful effects on pain perception7. In general, negative emotions increase pain, whereas positive ones decrease it14,7. Neverthless the brain mechanisms underlying these effects remain largely unknown, the prefrontal cortex, as well as parahippocampal and brainstem structures, are thought to be involved in the emotional regulation of pain14. According to Roy et al. (2009) cognitive and emotional processes induced by pleasant or unpleasant pictures interact with pain perception and modulate the responses to painful electrical stimulations in the right insula, paracentral lobule, parahippocampal gyrus, thalamus, and amygdala14. Not only, recent studies suggested that emotionally laden images representing human pain had a unique capacity to enhance pain reports15, in the suggestive perspective that search for the neural bases of human empathy with huge social implications. Thus, even though is well-established that mood selectively alters the affective-reactive response to pain (also called pain tolerance), the interpretation for some of these studies is sometimes difficult, since they do not always clearly dissociate changes in mood from changes in attention7. In fact, other studies showed that emotions can have a direct effect on attention to pain, leading to what is called attentional bias toward pain-related informations, which does not ensure the absence of covariate processes7. In the end, the available data indicate that emotion and selective attention may both interact modulating pain perception and cortical responses. But the observations that emotional manipulations alter pain unpleasantness more than pain sensation, while attention alters both pain sensation and unpleasantness, suggest that different modulatory circuits are involved7 and that they act through at least partially distinct mechanisms, which can be separated by appropriate experimental settings15. All this multiplicity of mechanisms underlying the emotional modulation of pain is reflective of the strong and reciprocal interrelations between pain and emotions, and emphasizes even more the powerful effects that emotions can have on pain perception14. 4. Conclusions In conclusion, in the CNS, much of the information from the nociceptive afferent fibers results from excitatory discharges of multireceptive neurons. The pain information in the CNS is controlled by ascending and descending inhibitory systems that can exert both facilitatory and inhibitory effects on the activity of neurons using endogenous opioids or other substances as mediators. In addition, a powerful inhibition of pain-related information occurs in the spinal cord. These inhibitory systems can be activated by brain stimulation, intracerebral microinjection of morphine, and peripheral nerve stimulation1. However, pain is an extremely complex perceptual and cognitive experience that is influenced also by many top down factors such as past sensations, expectations, the context within which the noxious stimulus occurs, the attentional and emotional state. Therefore, for all these reasons, the response to pain can often vary considerably from subject to subject. Case Report: Use of Valproate in Kleine Levin Syndrome Case Report: Use of Valproate in Kleine Levin Syndrome Successful use of Valproate in Kleine Levin Syndrome: a case report and review of cases reported from India Abstract Kleine-Levin Syndrome (KLS) is characterized by recurrent episodes of hypersomnia and other symptoms and it is a really challenging for the physician, since its causes are not yet clear, and available treatment options are not having adequate support. Here we are reporting a case with successful use of Valproate in KLS and also reviewing the cases reported from India. Introduction Kleine-Levin Syndrome (KLS) is a rare disorder which mainly affects adolescent boys and characterized by recurrent episodes of hypersomnia, and sometime along with hyperphagia, behavioral and cognitive disturbances, and hypersexuality (Yao et al., 2013). Several medications (stimulants, lithium, valproate, antipsychotics, antidepressants) have been reported to provide variable benefit in different symptoms, with lithium being the most widely used drug (Arnulf et al., 2005 2012). We are presenting a case of KLS, who had complete remission with valproate and also reviewing the cases reported from India. Case details: A 17 year old single male student of 12th standard, presented to our psychiatric outpatient clinic in September 2004 with hypersomnolence, low mood, decreased appetite and interest in studies, social and sexual disinhibition (such as singing obscene songs loudly at home, and touching unconsenting females’ including mother’s body parts- limbs, face and genitalia). Onset was acute, without any elicitable precipitating factor and course was episodic with average 7-10 days episode in every month for last four months and he maintained completely well in interepisodic period. Provisional diagnosis of recurrent depressive disorder (brief episodes) was kept and he was started on Sertraline (50 mg), on which he responded well. He remained asymptomatic for nearly nine months, but started having similar episodes again from mid 2005, due to which Sertraline was gradually hiked up to 150 mg/day, but of no use. Hence he was admitted in our inpatient setting in March, 2006 for diagnostic evaluation and further management. After detailed evaluation, it was found that his sadness was not pervasive and depressive cognitions and associated disturbances were not present and hypersomnia remained predominant complaint as initially he was sleeping 16-20 hours per day. He was also not responding with these medications, hence differential diagnosis of KLS vs. depression was kept and later finalized to KLS. His heamogram, renal functions, liver functions, blood sugar, routine urine, thyroid functions were within normal limits and chest X ray, ECG, EEG, and MRI brain were nor mal. In view of good literature support Lithium was started from 600 mg/day and hiked to 900 mg/day (serum level 0.8 mEq/liter). On which he has shown significant improvement initially for six month but later again started experiencing similar symptoms. He also had three episodes of fall, unresponsiveness and epileptiform discharge in EEG twice. Hence in view of seizure disorder and lack of response, Neurologist’s consultation was sought, who opined to start antiepileptic medication. Hence lithium was switched to Valproate (750 mg/day) in December 2006, on which he maintained completely well for 4 years, except brief reemergence of symptoms on discontinuing Valproate, which improved completely on resuming the medication. Valproate was gradually tapered and stopped in January 2011 on insistence of patient and family with discussing its pros and cons. Now index case has been maintaining well off Valproate for last three years without any episode of hypersomnolence, sexual disin hibition, sadness, or epileptic seizure. Discussion Based on historical reports by Kliene and Levin, KLS was essentially described and termed by Critchley (1962). Thereafter many researchers have reported their cases and reviewed cases with KLS (Arnulf et al., 2005 2012). Here we are reporting a case with KLS, who responded well with Valproate, after diagnostic dilemma and different psychotropic medications and also reviewing the other cases reported from India. In our electronic search for Indian studies on Kliene-levin syndrome, by using PUBMED and Google Scholar, we could find 15 cases reported from India (Aggarwal et al., 2011; Mendhekar et al., 2001; Prabhakaran et al., 1970; Shukla et al., 1982; Sagar et al., 1990; Narayanan et al., 1972; Agrawal Agrawal, 1979; Malhotra et al., 1997; Gupta et al., 2011). Of them 13 were males and 2 females, similar to male preponderance reported in the literature (Arnulf et al., 2005 2012). While presenting to psychiatric services their age was between 9 to 26 years and they had onset between 7 to 24 years of age. In two-third of patients (10 out of 15 patients) it was preceded with fever and their episodes of somnolence were lasted from 3 days to 10 weeks. Hypersomnia and hyperphagia were present in all, while two-third of patients also had social and sexual disinhibition (11 out of 15 patients). Other symptoms were cognitive disturbances (low intelligence quotient, impaired memory, confusion, and a cademic decline), irrelevant talk, and perceptual disturbances. Nearly one-third of patients improved spontaneously without any medication, while rest was given lithium, carbamazepine, methyl amphetamine, dextro amphetamine, and modafinil. Longest asymptomatic follow-up period is reported for 2 years (Aggarwal et al., 2011) (as depicted in table-1). Though literature supported lithium for higher response rate (Arnulf et al., 2005 2012), but index patient had remarkable response with Valproate, not with lithium, like earlier two reports (Crumley, 1997; Adlakha Chokroverty, 2009). Like earlier report (Adlakha Chokroverty, 2009), index patient also improved on lower dose of Valproate (divalproate 750 mg vs. 500 mg Valproate). Compared to other cases reported from India (Aggarwal et al., 2011; Gupta et al., 2011), index patient had longest follow-up (7 years) and remained asymptomatic in this period, except small exacerbation on discontinuation of Valproate treatment, which improved completely on resuming the drug. Similar to our patient, anticonvulsants (like Valproate) are the preferred treatment for KLS patient, and may also offer benefits in case of comorbid epilepsy (Yao et al., 2013). Valproate may be a good alternative to lithium in terms of efficacy as well as side effect profile. References Yao, C.C., Lin, Y., Liu, H.C., Lee, C.S., 2013. Effects of various drug therapies on Kleine–Levin syndrome: a case report. Gen Hosp Psychiatry. 35, 102.e7-102.e9. Arnulf, I., Zeitzer, J.M., File, J., Farber, N., Mignot, E., 2005. Kleine-Levin syndrome: a systematic review of 186 cases in the literature. Brain. 128, 2763-76. Arnulf, I., Rico, T.J., Mignot, E., 2012. Diagnosis, disease course, and management of patients with Kleine-Levin syndrome. Lancet Neurol. 11, 918-28. Critchley, M., 1962. Periodic hypersomnia and megaphagia in adolescent males. Brain. 85, 627–56. Aggarwal, A., Garg, A., Jiloha, R.C., 2011. Kleine-Levine syndrome in an adolescent female and response to modafinil. Ann Indian Acad Neurol. 14, 50-2. Mendhekar, D.N., Jiloha, R.C., Gupta, D., 2001. Kleine-levin syndrome : a report of two cases. Ind J Psychiatry. 43, 276-8. Prabhakaran, N., Murthy, G.K., Mallya, U.L., 1970. A Case of Kleine-Levin Syndrome in India. Br J Psychiatry. 117, 517-519. Shukla, G.D., Bajpai, H.S., Mishra, D.N., 1982. Kleine-levin syndrome: a case report from India. Br J Psychiatry. 141, 97-98. Sagar, R.S., Khandelwal, S.K., Gupta, S., 1990. Interepisodic morbidity in Kleine-Levin syndrome. Br J Psychiatry. 157, 139-141. Narayanan, H.S., Narayanan Reddy, G.N., Rama Rao, B.S., 1972. A case of Kleine-levine syndrome. Ind J Psychiatry. 14, 356-358. Agrawal, A.K., Agrawal, A.K., 1979. Kleine-levin syndrome: a case report. Ind J Psychiatry. 21, 286-287. Malhotra, S.M., Das, M.K., Gupta, N., Muralidharan, R, 1997. A Clinical Study of Kleine-levin syndrome evidence for hypothalamic-pituitary axis dysfunction. Biol Psychaitry. 42, 299-301. Gupta, R., Lahan, V., Srivastava, M., 2011. Kleine-Levin syndrome and idiopathic hypersomnia: Spectrum disorders. Ind J Psychol Med. 33, 194-8. Crumley, F.E., 1997. Valproic acid for Kleine-Levin syndrome. J Am Acad Child Adolesc Psychiatry. 36, 868-9. Adlakha, A., Chokroverty, S., 2009. An adult onset patient with Kleine-Levin syndrome responding to valproate. Sleep Med. 10, 391-3. Table-1: Reported cases with Kleine Levin syndrome from India

Alexander the Great Essay -- essays research papers

Alexander the Great was born in June, 356 BCE in the ancient capital of Macedonia called Pella. He was the son of Philip II, King of Macedon and Olympia, Princess of Epirus. Alexander inherited his father’s excellent organization skills and his mother’s hot temper. When Alexander was a young boy his mother had taught him that Achilles was his ancestor and that his father is a descendant from Hercules. This inspired Alexander to learn the Iliad by heart and always carry with him. Alexander showed signs of fearlessness and strength at a very early age. He tames the horse Bucephalus, which was a horse that nobody touched or rode. Later in his life Alexander rode Bucephalus to India, where it died. He then built the city of Bucephalus on the Hyphasis River in memory of his horse. Alexander’s parents saw the potential in their son to be a great leader, so they hired Aristotle as his personal tutor. Aristotle and Alexander studied together at Mieza, a temple 20 miles from his palace in Pella. Alexander learned philosophy, politics, ethics and medicine, as well as played sports and exercised daily to develop a strong body. Aristotle also sparked Alexander’s interest in other countries and races of people. When he was eighteen, Alexander commanded part of his father’s cavalry at the battle of Chaeronea.   Ã‚  Ã‚  Ã‚  Ã‚  In 335 BCE, Philip II was assassinated, and at the age of twenty Alexander ascended to the Macedonian throne. When Alexander took the throne many peopl...

The Pearl :: essays research papers

Kino’s lack of material items did not keep him from happiness. That is until he thought it was possible to acquire a greater amount of wealth and increase his happiness through the pearl. In turn, this resulted in the downfall of Kino and his family.   Ã‚  Ã‚  Ã‚  Ã‚  Kino’s life before the pearl brought him satisfaction and contentment. He was a loving husband and father. â€Å"Juana is driven, although instinctively as a woman to heal the family, nevertheless in reality to act for the man to protect the family.† (Karsten 6) He raised and took care of them. Kino loved Coyotito; His son was his pride and joy. He brought together Kino and Juana and made them a family. There is also Juan Tomà  s, Kino’s brother, who supported Kino throughout his life. â€Å"We do know that we are cheated from birth to the overcharge on our coffins. But we survive. You have defied not the pearl buyers, but the whole structure, the whole way of life, and I am afraid for you.† (Steinbeck 70) Kino had few possessions. He had his home, a brush hut, which provided protection and shelter. In addition, a canoe, this is a family heirloom. It was passed down from grandfather to father to son. â€Å"Kino and Juana came slowly down to the beach and to Kino’s canoe, which was the one thing of value he owned in the world.† (Steinbeck 19) â€Å"It was once property and source of food, for a man with a boat can guarantee a woman that she will eat something.† (Steinbeck 19) Kino also had the song of the family. The song brings a feeling of unity â€Å"... the Song of the Family is identified along with other unnamed songs, the heritage of Kino’s people, in the calm beginning of the story... (Karsten 2) Many changes and alterations were brought about by the pearl. Kino immediately began to make a list of things that he wanted to buy with the pearl’s wealth. He has an opportunity for social mobility and acts upon it. Among the many things on his list were an official marriage, new clothes, a rifle, and education for his son. Instantaneously, Kino’s desires became cloudy. â€Å"There was no certainty in seeing, no proof that what you saw was there or was not there.† (Astro 29) Kino then started doubting his dreams and the pearl became misty and cloudy. Kino’s community thought of him differently because of his sudden acquired wealth.

The Human Resource Management

This paper is written from the perspective that Human Resource Management (HRM) practices are continually evolving to meet the changes of dynamic work environments. New technologies, increasingly rapid exchanges of information, social paradigm shifts and the restructuring of family systems contribute heavily to the need to find and apply methods of HRM that meet the needs of industry, workers and consumers. To do so effectively, vision and creativity are required in addition to on-going awareness of the bottom line. At the opening of the 20th century, the majority of jobs in America were held in two areas, agriculture and industry. Population distribution tables for that time demonstrate that most of the nation inhabited rural areas rather than urban areas. This continued to be the trend up until WWII, when men left the country to fight and women left rural America to fill factory jobs as their contribution to the war effort. This movement was the beginning of nationwide workplace and societal changes that have accelerated during the last half of the 20th century. The move from rural to suburban environments changed the way we did business as a nation. Where extended families resided in and supported each other in culturally defined rural settings, nuclear families found themselves alone in homogenous neighborhoods. (1) This created a demand for goods and services that were formerly provided by extended family and community members, opening up new markets and creating jobs. It also created the need to recognize the management of workers as a separate and formal discipline. As we move into the 21st century we can trace our nations† business growth over the last 100 years. We moved from an agrarian base to an industrial one. By the mid-50s† the majority of jobs were found in factories. Manufacturing suffered heavy blows during the late 60†³s and early seventies and was displaced by the service industry. With the closing of the 20th century those services have become increasingly technological. Surviving those changes requires adaptation, not only in the retooling of physical plants and the retraining workers, but also in the way we manage those workers. Some feel that there appears to be an underlying theme in books and papers on the subject of HRM, that there is only one correct way to manage people. (2) Maslow on Management offers a much different approach, demonstrating conclusively that one size does not fit all; i.e., that different people need to be managed differently. HMR models operating on the assumption that there is a single right way to manage people are using workplace criteria that are quickly becoming a thing of the past. The â€Å"one way† model views people working for an organization as employees who work full time and are solely dependent on that organization for their livelihood and their careers. These employees generally were viewed as subordinates with limited or very narrow skill sets. (3) These images of the worker may have been valid several decades ago. However, today every one of these images has become insupportable. While the majority of people working for an organization may be classified as employees, a very large and steadily growing minority – by working for the organization – no longer work as employees, but instead as outsource contractors. The concept of subordinate positions is fading as well, even in those areas that are considered fairly low level. As technology becomes increasingly more complex special knowledge is required in all operations. Subordinates, increasing their skill sets, become associates. The secretary, with knowledge of specialized software, becomes the Administrative Assistant. In order for the organization to run smoothly, the individual who does his job well, often has more knowledge about his job than his boss. (4) For example, the vice president of marketing may know a great deal about selling, but nothing about market research, pricing, packaging, service, or sales forecasting. Workers in these positions may report to the vice president, but are often experts in their own areas. Formerly, lower technological expectations and a firmly established hierarchy allowed general managers to delegate narrowly defined personnel responsibilities to those functioning as specialists. Today however, such practices would be inefficient to the point of being considered static, and must be replaced. To fail to do so would be to ignore and fail to address the many unprecedented pressures that demand a comprehensive and more strategic view in relation to the organizations† human resources. From the view point of General Management, what does the organization need? The General Mangement picture of HRM is viewed from a global perspective, as demonstrated by a survey of Fortune 500 CEOs in 1989. The results of that survey determined that effective management of Human Resources must address corporate needs in the eight following areas: 1. Increasing international competition makes the need for greatly improved human production mandatory. The crisis experienced in both the automobile and steel industries serve as clear illustrations. Foreign management practices, particularly Japanese management models, are being used to guide developing HRM techniques, especially those that seem to increase employee commitment while providing companies with a long term source of workers with necessary competencies and skills. 2. As organizations increase in size and complexity layer upon layer of management has resulted in expensive, but not particularly effective, bureaucracies. Multiple layers of management also serve to isolate workers from the competitive environment in which organizations operate as well as company policy makers. It†s hoped that a reduction of middle management layering will put workers closer to the competitive environment, fostering commitment to the organization as well as sharpening the competitive edge. Multinational companies have additional challenges in managing human resources, and need to adapt policies to work within diverse cultures and vastly different social values. 3. Some companies may face declining markets or slower growth, handicapping the organizations† ability to offer advancement opportunities and job security. How then to attract and retrain a competent and highly skilled work force? 4. Greater government involvement in human resource practices generates a need to re-examine HRM policies and mandates the development of new policies. For example, the Americans with Disabilities Act forced the revision of HRM policies in companies across the nation. 5. America†s workforce has become increasingly more educated making it necessary to rethink assumptions about employee capabilities and the delegation of responsibilities. Under utilization of employee talent is a major cause of workforce turnover. 6. Expectations and the values of the workforce are changing, particularly those values and expectations relative to authority. This fosters a need to reexamine how much involvement and influence workers should be given. Means of voicing employee concerns and addressing those concerns with due process need to be provided. 7. As workers become more concerned with life and career satisfaction corporations are revisiting traditional career paths and seeking more alternative career paths that take into consideration employee lifestyle needs. 8. Demographic shifts in the workforce, particularly the infusion of women and minorities into organizations, are causing corporations to reexamine all policies, practices and values that impact the treatment, responsibilities, and advancement of these groups. (5) How do universal General Management issues affect HRM departments and practices? While narrower in scope than those concerns voiced by General Management, impact areas identified by HRM professionals closely mirrored major corporate needs identified by General Managers. Human Resource professionals, in an effort to meet the needs of both worker and organization, have examined ways to ensure a desired working environment while increasing productivity. In the early 1990s, the advisory board of the Commerce Clearing House were asked to identify the issues that they felt would shape the role of human resource functions in the next decade. Commerce Clearing House advisory board members saw four main HRM areas where current issues would influence the role of the human resource function in the near future: compensation; communication and personnel practices; employment relations; and Equal Employment Opprtunity requirments. (6) Compensation issues focused on the diversity of worker needs, pay-for-performance plans, and the regulation of employee benefit plans. Flexibility and adaptability in HRM practices are primary keys in addressing worker needs. Job sharing, staggered scheduling and flex time are some of the outcomes generated by creative approaches to HRM practices. Pay-for-performance plans hold the allure of rewarding productivity while providing monetary motivation. Successful implementation of such practices, however, require effective performance evaluations. To attempt such compensation without valid, reliable, and standard assessment instruments is to court litigation. Fairness is a national concern strongly affecting human resource managers. Personnell plansfocused soley on organizational needs must be abandoned to benefit workers and organizations alike. One example is the growing social phenomena of two career couples. As the numbers increase nepotism policies must be reexamined. Managing change and preparing people for change also require HRM professionals to rethink policy. New demands for an increase in functions such as retraining evolve as workers move through change. Training and professional development are crucial in all areas of operation. Even the lowest clerk needs to stay abreast of the latest innovations brought on by technical advancement. The march of technology, however, not only changes jobs, it makes some of them redundant or obsolete. In an era of company reconfiguration it becomes apparent that layoffs and divestirtures will occur when retraining isn't an option. Outplacement policies must be considered and developed in preparation of the need. HRM professionals also understand the need for the development of effective HR auditing instruments to measure employee perceptions of management fairness and the climate for effective communication within the company. The information obtained by employee attitude surveys can be greatly beneficial to supervisors, but only if they've been trained to use it. (7) The legal environment of personnell management is many fingered and quite comprehensive. In addition to regulations stemming from the Occupational Safety and Health Act (OSHA), passed in 1970, HRM is greatly affected by the broad umbrella of Equal Employment Opportunity (EEO) regulation. As well as protecting workers form discrimination based on race, color, or creed, EEO serves workers in many other areas. Age discrimination also falls under this umbrella. With an increasing number of age discrimination suits, organizations need to develp a sensitvity to age issues and policy specific to older employees. A recent off shoot of EEO is the American with Disablities Act (ADA). ADA has created a need for new policies and procedures in accommidating employees with handicaps and disabilities. The emerging legal view that Acquired Immune Deficiancy Syndrome (AIDS) is a handicap brings policy questions about AIDS testing to the forefront. There is great potential for conflict in providing for the needs of other employees and creates an HRM channel that must be carefully navigated. Benefit plans that are regulated by the Employee Retirement Income Security Act (ERISA) require special attention. Companies must be prepared to provide resources that not only offer such plans but also impeccably manage those employee benefit plans. Failure to do so will lead to subsequent suits by employees challenging plans that are out of compliance with ERISA disclosure, reporting and fiduciary standards are problematic. Governemnt regulation is also partly responsible for shifting attention from union group representation to regulations and policies that emphasize the rights of individual employees. It is mandatory that this factor be taken into consideration in personnel planning and policy making. The role of unions as bargaining units is on the decline and will continue to diminish as bargaining relationships become increasingly stable. This translates to decreased strike activity and fewer actions filed with the National Labor Relations Board (NLRB). While that is a positive outcome the trade-off must be recognized, prepared and accounted for. While businesses will see fewer strikes, they can expect to see increasing numbers of employment-at-will and wrongful discharge suits. An additional considertion affects employers who contract temporary employees. This practice is experiencing an increasing number of suits by temporary employees alleging unlawful activity. This surely influences staffing policy decisions. It should come as no surprise that such pressures have created the need for a greater emphasis on the human aspect of business. With something so seemingly obvious the qustion is why hasn't this human aspect been addressed before? It may be due, in part, to the tendency to educate, develop, and train managers to fixate on analytical and technical aspects while assuming that â€Å"business as usual† in dealing with employees was sufficient to promote productivity. So why are companies now hoping to find solutions to business problems in the human side of enterprise? The answer lies in part to growing societal pressures. Concern over the condition of blue-color jobs in the 1930s, as well as civil rights and equal opportunity legislation in the 1960s and 1970s, has paved the way to revamping HRM policies to recognize and respond to shifting social values. More simply put, other approaches to improve employee productivity and organizational effectiveness haven†t worked. (9) The area of single most impact on worker performance lies outside of the work environment. Family needs are the primary cause of absenteeism, tardiness, and lower productivity. (9) The here are several factors creating this phenomena. First there is the steady flow of women into the work place. In 1970, 20.2% of women worked outside the home. That figure grew to 73.8% in 1995. The increase in two career couples has assisted families in reaching financial stability and filled a need for personal satisfaction. It has also, however, created a void in care giving that was traditionally a woman†s role. Another major cause of family issues impact is the increasing number of single parent homes. Single parent homes have grown from 12% in 1970 to 49.8 % in 1995. (10) As the sole burden of child rearing is placed on a worker, childcare arrangements, school obligations, and childhood illnesses are far more likely to interfere with attendance and productivity. Another social phenomenon, which strains workers and, in turn, disrupts the workplace, is increasing longevity. As the population grows older the phenomena of living longer allows workers the luxury of postponing marriage and having children. It†s relatively common today for couples to postpone their first child until their late thirties or early forties, a time formerly used for the preparation of an empty nest. Instead of retiring to grandparenthood these later in life parents are dealing with teenagers and how to get them through college. A large percentage of the workforce now finds itself in the position of not only having children to care for, but elderly parents as well. Add to the list of family pressures the moral and financial obligation workers must contend with in providing for the wellbeing of two generations. The American worker is now faced with a double whammy in the attempt to meet family needs. When looking at the increasing longevity of the workforce, one must consider that piece of the big picture which has to do with the rate that people retire. It†s estimated that within the next twenty to thirty years the retirement age in developed countries will, by necessity, move up to seventy-nine or so. Seventy-nine, in terms of health and life expectancy, correlates with the age of sixty-five and the health and life expectancies of 1936, when the United States, the last western country to do so, adopted a national retirement plan (Social Security). (11) As America continues to gray, a significant percentage of the work force will develop unprecedented needs that are geriatric in nature, impacting worker expectations of benefit packages. The question facing business in the future is determining what that age and experience are worth in terms of monetary compensation and benefits. This is a dilemma currently being faced by the Armed Forces, with many branches finding themselves to be top heavy with senior officers. The funding resources dedicated to personnel are not distributed in a fashion that attracts and retains military members, seriously jeopardizing the productivity of military organizations. (12) This is relevant in that many private organizations as well as public and government agencies are finding themselves in the same position. Retirement Incentive bonuses have become common place and are a primary tool used by organizations to cull the workforce. Will this remain a viable means of thinning an aging workforce? In addition to family pressures, and salary and benefits needs, there is a growing concern throughout the nation†s work force concerning quality of life. While benefits and compensation are key to employee satisfaction, and therefore productivity, a strong value is placed on the emotional satisfaction one finds professionally. These emotional perks come out of all areas, and are as solid as additional training and added responsibility or as intangible as recognition, appreciation, and creativity. (13) Business must take into account the social implications of such information, as it becomes essential to address staff needs and to determine successful strategies that should surround any HRM policy. The management of human resources centers on a single basic function of the management process: staffing. The HRM professional is charged with matching the right person to the job. While recruitment is an exacting area of HRM, a more significant piece of employee productivity lies in motivation. Motivation methods are key to fashoning successful HRM models. Motivation is a deceptively simple concept but probably one of the most complex components of human resource management. Motivation is simple in terms of human behavior. People are basically motivated or driven to behave in ways that they find rewarding. So the task seems easy; just find out what they want and hold it out as a possible reward or incentive. It becomes complex when trying to find a universal incentive in a very diverse workforce. What has value to worker A may be meaningless to worker B. And what has value at one point in time may become insignificant at another. For example, everyone has a need to eat. A big steak dinner, as an incentive to succesful completion of a task, is motivation – as long as your hungry! Had you just eaten, a steak dinner would hold no interest . An additional factor in the motivation equation has to do with the reality of obtaining the reward. Telling a person that they will be promoted to sales manager if sales in that jurisdiction increase is empty if that task is percevied as virtually inpossible. Two conditions must be met for motivation to occur, according to Vroom's expectancy theory of motivation. First the value of the particular outcome (such as recieving a promotion) is very high for the person and, secondly, the person feels that there is a reasonably good chance of accomplishing the task at hand and obtaining the outcome. This is the process of motivation. (14) Theories of motivation center on a a single basic question: what do people want? Abraham Maslow states that humans have five basic categories of need; physiological, safety, social, ego, and self-actualization. These needs have been arranged in order of there importance to humans. When the basic physiological needs, food, drink, etc., are met, they no longer serve as motivation. Instead, those urges toward safety, i.e., protection and security, become the driving force. Human beings move up this needs ladder as basic needs are met. Frederick Herzberg has divided Maslow's hierarchy into two planes, the lower meeting physiological, safety and social needs, and the higher meeting those needs surrounding ego and self actualization. Herzberg believes that the best motivation lies in satisfying those higher level needs. Based on his studies, Herzberg believes that factors that satisfy lower level needs, which he identifies as hygiene factors, are markedly different from those, reffered to as motivators, that satisfy higher level needs. Herzberg states that if hygeine factors are inadequate workers will become disgruntled, but once satisfied there is no incentive to perform. Therefore, hygiene factors are necesary for preventing dissatisfaction, but very inefficient in encouraging motivation. Job content, however is the source of motivating factors. Opportunities for achievement, recognition, responsibility, and more challenging jobs motivate employees. Motivating factors work because they appeal to higher level needs that are never completly satisfied. According to Herzberg, the best way to motivate employees is to build challenge and opportunities for achievement into their jobs. Herzberg reffers to this method of applying his theory as job enrichment. Basically, job enrichment consists of building motivators like opportunity for achievment into the job by making it more interesting and challenging.