KNOWLEDGE to their higher prevalence and significant social impact.

KNOWLEDGE AND AWARENESS ABOUT ORAL HYGIENE AMONG NURSING STUDENTSTYPE OF MANUSCRIPT: survey articleRUNNING TITLE: Knowledge and awareness about oral hygiene status among nursing students.AUTHOR NAME:MADHUMITHAA SIVARAJANUndergraduate studentSaveetha dental collegeSaveetha university,Chennai,IndiaTelephone number:- +91 9566910029Email:- [email protected] AUTHOR:-Dr. DHANRAJDepartment of prosthodonticsSaveetha dental collegeSaveetha university, Chennai, IndiaTelephone number:- +91Email:-ABSTRACT:TOPIC: Knowledge and Awareness about oral hygiene among nursing studentsAIM AND OBJECTIVE:The objective of the study is to create an awareness of oral hygiene among nursing students.BACKGROUND AND REASON:Oral disease qualifies as major public health problems owing to their higher prevalence and significant social impact. Oral health is considered as fundamental to general health and well-being. A healthy mouth enables an individual to speak, eat and socialize without experiencing any active disease, discomfort or embarrassment. Oral health knowledge is considered to be an essential prerequisite for health related behavior. Little is known about oral health attitudes and behaviors of nursing students especially of those who are great supporters of this field. Owing to the high stress levels the nursing students may find it difficult to maintain perfect oral hygiene. Hence this study was initiated to assess the oral hygiene status and create improved awareness in them.KEYWORDS:Oral hygiene, awareness, survey, statisticsINTRODUCTION:Health is the complete state of physical, mental and social well-being and not just the absence of disease or infirmity. Health is a common theme in most of the cultures with an emphasis on the fact that health is a fundamental human right and a worldwide social goal necessary for an improved quality of life. 1 Oral cavity is an important diagnostic area not just because it contains derivatives of almost all of the primary germinal layers and tissues not demonstrable anywhere else in the body, but also because of its role played in diagnosing various diseases just because of their oral manifestations.2,3 Studies have shown that brushing, especially with fluoride tooth pastes, can reduce dental caries,17 but the effect of oral hygiene on periodontitis has not yet been clearly demonstrated.18Oral health is the standard of health of the oral and related tissues which enables individual to eat, speak and socialize without active disease, discomfort or embarrassment and which contributes to general well-being.4 There have been rapid changes in the pattern of oral diseases during the past decade.5,6 One of the primary concerns of dental health care professionals is to impart positive oral health knowledge and behavior in the society and to create an environment to shift the responsibility of public health from the shoulders of health professionals to the people’s own hands. Good oral health is essential for health and as has a positive influence on physical, mental and social wellbeing. Oral hygiene plays a very important factor in prevention of oral disease. Poor and bad oral health can cause extreme pain, interruption of sleep, affects the ability to consume a healthy diet, has an impact on social interaction and cause difficulty with speech. Also, it can have a huge effect on other health conditions.10Periodontal disease may contribute to cardiovascular disease, low birth weight, aspiration pneumonia, and nutritional deficiencies in children and elders are some of the examples.8 Oral health consequences of using smokeless tobacco which is lesions in the oral mucosa and an increased risk of oral cancer, have been  recognized.15Oral hygiene has always been considered as a risk indicator and a risk factor for various oral problems and also for access to oral health has been a  complex issue involving barriers such  as  inability to afford services to various cultural preferences, from lack of adequate services to various technological setbacks. 9Association between smoking and periodontal problems has been studied and researched for  as far back as the 1940’s,11 yet there has ended a  prevalence  as to the role of smoking in periodontal disease up to 1980’s.16The most confirmed risk factors for periodontitis are cigarette smoking and diabetes.14 Regular dental checkups12 and non-smoking13 are recommended for maintaining optimal oral health.Students related to this health franchise play an important role in oral health care and promotion. People in Nursing play a very important role in health promotion, and therefore it is important that their oral health knowledge be good so that the community can also be benefited eventually. It is found that very few studies have collected data regarding the dental/oral hygiene knowledge of medical practitioners. 7 Therefore, the aim of this study was to assess the oral health knowledge, attitude and practice (KAP) of nursing students. Health beliefs and attitudes of the people in nursing field will not only affect their oral self care habits but can also give motivation to their patients to maintain their oral hygiene19. There are many other factors that can influence attitude and behavior of an individual20.Knowledge is defined as level of understanding of an individual towards the facts,information,skills etc. 22 . Therefore, knowledge that is associated to dental health during training period is important especially for the future nurses. Besides all that, socioeconomic status and educational level will also affect people’s oral health behavior 23.The objective of the study is to create an awareness of oral hygiene among nursing students.MATERIALS AND METHODS:A questionnaire was prepared. The survey was conducted among the nursing students of Sri Ramakrishna college of nursing and saveetha nursing college to assess the knowledge, attitude and awareness on oral hygiene. A simple sample size of 100 students were used. Questions based on the dental knowledge and their attitude towards oral hygiene were asked to the students. The survey was created on surveyplanet. The questionnaire consisted of a basic 11 questions.INCLUSION CRITERIA Students of age group 18-22 years. Only nursing students who were in their under graduation studies.EXCLUSION CRITERIA:Post graduation students and drop outs.RESULTS:The results indicated that most of the participants are concerned about their oral hygiene for a healthy body. Yet, they did not take enough steps to improve their oral hygiene.CONCLUSION:This study says that 98% of the students do care about their oral hygiene. And about 90% of the students are aware of the advantages of good oral hygiene. 66% do realize that refusing to go to a dentist does have an influence on their oral hygiene. Yet only 33% go to a dentist for a regular checkup. Hence this study makes me conclude by saying that even though the participants are aware of the certain consequences of bad oral hygiene, sufficient steps are not being taken by the students to improve their oral hygiene. DISCUSSION:The below tabulation and charts show the questions asked to the participants,the number of participant to each response and the percentage for each response.QUESTIONS OPTIONS PARTICIPANTS PERCENTAGE1 .How much times  do  you brush a day? 1.once2.twice3.more than twice 63460 42.2%57.8%2. Did you know that the way you brush also has an impact on how healthy your teeth are? 9910 90.8%9.2%3. Do you use mouthwash or do you floss everyday? 1.mouthwash2.floss3.both4.none 3291751 29.4%8.3%15.6%46.8%4.How many times have you visited a dentist in the last one year? 1.never2.once3.twice4.more than twice 44272117 40.4%24.8%19.3%15.6%5.During the past 12 months was there a time when you needed dental care and could not get one? 1.yes2.no3.didnt know if I needed one4.refused 1472230 12.8%66.1%21.1%6. Do you think refusing to go to a dentist has an influence on your oral hygiene? 7237 66.1%33.9%7. Do you go to a dentist for regular checkup for a healthy mouth? 1.yes2.no3.not concerned 365616 33.3%51.9%14.8%8. In the past three months,have you noticed a teeth that did not look right? 1.yes2.no3. yes ,I did notice. I’m not concerned about it 277110 25%65.7%9.3%9.not cleaning your teeth everyday can cause 1. decay2. gum disease3. bad breath4. all of the above5. nothing6. don’t know 5398813 4.6%2.8%8.3%80.7%0.9%9.8%10. How long do you normally take to brush your teeth? 1.about 30 secs2. about a minute3. more than a minute4. don’t know. 1142534 10%38.2%48.2%3.6%11. Do you think oral hygiene is also important for a healthy body? 1. yes2. no 1062 98.1%1.9%Chart 1 Chart 2: Chart 3 Chart 4Chart 1When asked if refusing to go to a dentist had an influence on their oral hygiene, 66.1% accepted that it did and the rest 33.9% answered that it did not influence on their oral hygiene.Chart 2When asked about the consequences of not cleaning the teeth every day, 80.7% knew the consequences. This shows that most of the participants are indeed aware of oral hygiene. 4.6% chose that they’d get decay,2.8% chose that they’d get gum disease,8.3% chose that they’d get bad breath,0.9% chose that they’d get nothing, and 9.8% chose that they didn’t know any of the options nor the consequences.Chart 3When asked if oral hygiene was also important for a healthy body, 98.1% answered that it was important. This shows that almost all participants are concerned about their oral hygiene.Chart 4When asked if the way they brush also had an impact on oral hygiene, 91% accepted that it did have an impact and 9% denied that it didn’t.From this survey, it has been seen that people are indeed aware of oral hygiene, its advantages, yet they don’t take enough steps to improve their oral hygiene ie; only a few go to a dentist for a regular checkup. Hence as participants of dental field, it is our responsibility to spread more awareness about dental hygiene to everyone and not just to the supporters of this field (nursing students).The results indicated that most of the participants are concerned about their oral hygiene for a healthy body. Yet, they did not take enough steps to improve their oral hygiene.REFERENCE:1. Park K. Textbook of Preventive and Social Medicine. 23rd edition. M/s Banarsidas Bhanot publishers. 20152. Cheraskin E (1958) Oral manifestations of systemic diseases. J Natl Med Assoc 50: 241-247.3. Epstein JB (1980) The mouth: a window on systemic disease. Can Fam Physician 26: 953-957.4. Udoye C, Aguwa E. Oral Health Related Knowledge and Behavior Among Nursing Students in a Nigerian Tertiary.5. Kaira LS, Srivastava V, Giri P, Chopra D. Oral healthrelated knowledge, attitude and practice among nursing students of Rohilkhand Medical College and Hospital. Journal of Orofacial Research. 2012;2(1):20-3.6. Darout IA. Article O. Knowledge and behavior related to oral health among Jimma University Health Sciences students , Jimma , Ethiopia. European Journal of General Dentistry. 2014;3(3):185-9. DOI: 10.4103/2278- 9626.141663.7. Naidu RS, Juman S, Rafeek RN, Singh R, Maharaj K (2008) Oral and dental conditions presenting to medical practitioners in Trinidad and Tobago. Int Dent J 58: 194-198.8. Dental Service, Department of Health, Government of South Australia (2012) Heath promotion practice guidelines. Available from: Link (cited on Dec 30 2014).9. Freeman R, Maizels J, Wyllie M, Sheiham A: The relationship between health related knowledge, attitudes and dental health behaviours in 14–16-year-old adolescents. CommunityDentHealth1993, 10:397-404.10. Ketaki Kamath, Dr. Pradeepa; KNOWLEDGE, BEHAVIOUR AND ATTITUDE REGARDING PREVENTIVE ORAL HEALTH CARE AMONG DENTAL STUDENTS IN SAVEETHA DENTAL COLLEGE; INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH; Volume-6 | Issue-9 | September-2017 | ISSN No 2277 – 8179 | IF : 4.176 | IC Value : 78.46.11. Pindborg JJ. Tobacco and gingivitis. J Dent Res 1947;26:261-4.12. Richards W, Ameen J. The impact of attendance patterns on oral health in a general dental practice. Br Dent J 2002;193:697-702.13. Petersen PE. The world health report 2003: continuous improvement of oral health in the 21st century – the approach of the WHO global oral health programme. Community Dent Oral Epidemiol 2003;31:3-23.14. Genco RJ. Current views of risk factors for periodontal diseases; Periodontol 1996;67:1041-9.15. Pindborg JJ, Reibel J, Roed-Peterson B, Mehta FS. Tobacco-induced changes in oral leukoplakic epithelium. Cancer 1980;45:2330-6.16. V.Gopinath; Oral hygiene practices and habits among dental professionals in Chennai;ijdr; January 26, 2018, IP: Marcus SE, Drury TF, Brown LJ, Zion GR. Tooth retention and tooth loss in the permanent dentition of adults: united states, 1988-1991. J Dent Res 1996;75:684-95.18. Bakdash B. Oral hygiene and compliance as risk factors in periodontitis.J Periodontol 1994;65:S539-44.19. Mani PM, Swarmy RM, Manjunath GN, Venkatesh G, Venkateshappa c, and Naveen Kumar, Attitude of Dental Students towards Their Oral Health Care, Research Journal of Pharmaceutical, Biological and Chemical Sciences , January-March 2013, Volume 4 Issue 1.20. Kassak KM, Dagher R, Doughan B.Oral hygiene and lifestyle correlates among new undergraduate university students in Lebanon. J Am Coll Health 2001;50(1):15-20.21. Fahmida binti Abd Rahman; A Questionnaire Study on Oral Hygiene Among Dental Students in Chennai, India; IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 6 Ver. II (June. 2016), PP 58 64.22. Kay E, Locker D. A systematic review of the effectiveness of health promotion aimed at improving oral health. Community Dent Health 1998;15:132-44.23. Morrison V, Bennet P, An Introduction to Health Psychology, Essex: Pearson Education Limited; 2012.

Patients 21 patients with acute lymphoblastic leukemia.Group (2) (healthy

Patients and Methods:-Study Design:-Patients and Control:-The study was conducted in the bone marrow transplantation unit (department of clinical hematology at Ain Shams university hospital) during a period from June 2015 to August 2016.Participants were grouped into:-Group (1): included 100 patients with lymphoproliferative disorders who underwent BMT in our unit, 79 patients underwent autologus transplant and 21 underwent allogeneic transplant, 30 patients with NHL, 10 patients with HD, 39 patients with multiple myeloma and 21 patients with acute lymphoblastic leukemia.Group (2) (healthy control group): included participants without known cardiovascular disease, hypertension or DM. They were matched 1:1 based on age, sex, blood pressure and surface area with the cases.Group (3) (positive control): 50 patients with lymphoproliferative disorders who received chemotherapy without undergoing BMT. They included 25 males and 25 females, 46% had MM, 42% had NHL and 12% had HD.Informed consents were obtained from all participants. The study was conducted in accordance with the stipulations of the local ethical and scientific committees of Ain Shams University and the procedures respected the ethical standards in Helsinki declaration of 1964.Methods:-All patients were subjected to full history and physical examination including the presence of B-symptoms like weight loss, fever, drenching sweats and pruritis, anemic manifestations or bleeding or the presence of bone fractures and the presence of lymphadenopathies or hepatosplenomegaly.To confirm the diagnosis of NHL and HD:-? Excision lymph node biopsy for fresh frozen and formaline-fixed samples for histopathological assessment.? Immunohistochemistry for B-cell markers like CD20,CD19,CD79a,CD10 and T-cell markers like CD3,CD4,CD8,CD7,CD5,CD2 , markers of immature lymphoblast like TdT, immunoglobulin Kappa and Lambda light chain restriction and for CD15 and CD30 for characterization of Reed-Sternberg cells.? Chest X-ray, contrast-enhanced CT scans of the neck, chest and pelviabdomen.? Baseline, interim and end of therapy PET was carried out whenever available for staging and response assessment.Bone marrow aspiration and trephine biopsy.? Cytogenetic analysis using conventional cytogenetics and FISH for certain specific chromosomal abnormalities.? Staging is carried out according to Ann-Arbor staging system Examination.? Cerebrospinal fluid and triple intrathecal chemotherapy prophylaxis was given to certain patients like: (1): patients with DLBCL with bone marrow, testicular, paranasal and epidural involvement. (2): lymphoblastic lymphoma. (3): primary CNS lymphoma.? Upper GI endoscopy in those with suspected GI involvement eg. Mantle cell lymphoma.To confirm the diagnosis of multiple myeloma:-? Complete blood counts and serum chemistries especially for serum calcium, serum creatinine to detect CRAB features.? Detection of monoclonal M-protein in the serum and urine by serum protein electrophoresis.? Characterization of heavy and light chains in the serum and urine sample by immunofixation.? Bone marrow aspiration and biopsy to evaluate the percentage of plasma cells.? Conventional chromosomal analysis and FISH for high-risk myeloma like t(4;14), (14;16) and 17p.? Skeletal survey for evaluation of lytic bone lesions using X-ray of spine, skull, pelvis, humerus and femur.? MRI to evaluate symptomatic bony sites even if skeletal survey is negative or in case of spinal cord compression.? Serum free light chains and Kappa/Lambda ratio for the detection of stringent CR whenever possible.To confirm the diagnosis of acute lymphoblastic leukemia:-? Complete blood count and differential for the detection of peripheral blasts.? Bone marrow aspiration and trephine biopsy for the detection of the percentage of blast cells.? Immunophenotyping for lymphoid and myeloid markers.? Conventional cytogenetics and FISH for Philadelphia chromosome.? CT scans for the neck, chest and pelviabdomen.? CSF examination and triple intrathecal chemotherapy for prophylaxis and/or therapy in case of CNS involvement.Patients who underwent autologus transplant were subjected to:-? Complete blood count using (LH Beckman coulter).? Serum chemistries including liver and renal function tests (AU 680 chemistry autoanalayzer).? Viral markers for hepatitis B, hepatitis C and HIV using Rosh diagnostics and performed by copus instruments.? Polymerse chain reaction (PCR) for CMV using kits supplied by Qiagen and performed by rotor gene instrument for automated real time PCR.? Serology for herpes simplex (HSV), Toxoplasma and Ebstein Bar virus (EBV).? Pulmonary function tests.? Renal scan.? Electrocardiogram and echocardiography.? Mobilization was done using different regimens ranging from G-CSF alone to G-CSF and cyclophosphamide or other chemotherapeutic regimen depending on the specific disease.? Conditioning regimens: for patients with MM high dose melphalan 200mg/m2 on day -2, for patients with NHL and HD they received a conditioning regimens consisted of cyclophosphamide 60mg/kg/d -3 and -2, etoposide 15mg/kg/d -3 and -2, carboplatin 400mg/m2 -3 and -2.In addition, patients undergoing allogeneic transplant are subjected to:-? Donors received (after informed consent) 4 days of treatment with SC G-CSF (10ug/kg/d) before stem cells were collected.? Mononuclear cells were isolated using a Cobe Spectra separator (Lakewood, Co, USA).? The number of CD34 cells transfused was calculated using flowcytometric analysis.? GVHD prophylaxis consisted of cyclosporine and methotrexate.? Engraftment was defined as absolute neutrophilic count of more than 500 for three consecutive days.? Chimerism analysis by variable number of tandem repeats (VNTR) was done at +28 and +56 after transplant.Conditioning regimen consisted of TBI 2.5GY days -7 to -4 /Cyclophosphamide 60mg/kg days -3 and -2, TBI 2.5 GY days -7 to -4 /etoposide 60mg/kg d-3, Fludarabine 30mg/m2 days -6 to -2 /oral Busulfan 1mg/kg/6hours days -6 to -3.All patients in both autologus and allogeneic transplant were treated using the same anti-infectious and transfusion policy of our transplant center.Transthoracic echocardiography:-? All patients were evaluated during transplant in case of occurrence of any minor or major cardiac events according to the international guidelines recommended by ACC and AHA.? Transthoracic echocardiograph was done before transplant and 6 months after transplant.? Transthoracic echocardiography was carried out using 2-4 MHz phased array transducer attached to a vivid S5 echocardiography machine by a cardiologist who was blinded to clinical details of each subject. Inter-observer variability was reduced by taking the mean of three reading during each echocardiography.? The following parameters were examined: left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD), intraventricular end-diastolic diameter (IVSDD), posterior wall end-diastolic diameter (PWEDD), right ventricular end-diastolic diameter (RVEDD), left atrium diameter (LA) and aorta diameter (Ao). The systolic function was determined by left ventricular ejection fraction (LVEF) using M-mode and modified Simpson’s formula. Left ventricular diastolic function was evaluated with pulsed Doppler and tissue Doppler imaging (TDI). The following parameters of the diastolic function of left ventricle were determined: early filling velocity E wave (E) and A wave (A) of mitral inflow, Doppler-derived mitral deceleration time of early filling (DT), isovolumetric relaxation time (IVRT) and early diastolic velocity of mitral annulus wave (E0).Statistical analysis:-? All analyses of the present study were done using SPSS version 17 software.? Statistical presentation and analysis of the present study was conducted, using the mean, standard deviation, student t-test, chi square.? Data were expressed as mean value ± SD for continuous variables, and as percentages for categoric variables. In this study, statistical significance was established as follows: p?0.05 insignificant, p?0.05 significant, p?0.01 highly significant.? Comparisons between continuous variables were performed using the paired t-test or unpaired t-test. For comparisons of categorical variables, frequency tables and chi-square tests were used.

The to ” Where to win in Emerging markets”.

The discussion was very fascinating between three Experts. Scott D. Anthony is the Managing Partner of Innosight, Bruce Brown is the Chief Technology officer of P&G, and after that Erich Joachimsthaler Vivaldi accomplices CEO. Subsequent to viewing the video, I reached the conclusion that I am agreed to the point of Bruce and Erich. Rather every one of them had extremely solid perspective in regards to ” Where to win in Emerging markets”. Be that as it may, as Scot D. Anthony said that ”Middle class has huge potential of growth, we need to only recognize the needs and build the business model accordingly” and by one means or another he had exceptionally solid point about this that as by 2030 the middle class rate will increment by 1.2 billion yet at the same time my perspective is that we can’t just enter any market based on class in light of the fact that no one but class couldn’t give the ideal data to make any proper Strategy. Also, additionally middle class has very straightforward wish that procure enough to finish your necessities. So in the event that we go for finding the requirements and wants of individuals and after that make a procedure and item in like manner that how to finish their necessities and fulfill their wants. By one means or another focusing on middle class , they may give you high benefit as they acknowledge development rapidly with a specific end goal to keep up their status in Society. yet, as ERIC JOACHIMSTHALER and BRUCE BROWN that we don’t have a similar perspective of the middle class everywhere throughout the world. “Middle class” isn’t any appropriate word if there is any individual who has an extraordinary salary yet at the same time wish to spare cash by acquiring an ease result of good quality. Along these lines, one don’t need to focus on the working class just, you should focus on client’s interests, emotions, needs, needs and wants. As Bruce expressed that “look deeply to their needs, wants and desires, also, we need to look at their incomes how much they can afford and how to gain maximum profits by giving them satisfaction”. Along these lines design items to meet their necessities in light of the fact that in the event that we begin focusing on a class we will be blended with their conditions which could be unique in relation to each other yet in the event that we design products by remembering that their needs and wants, so that would be more beneficial and customers will get it more.

The forward relative to the femur. The ACL also

The anterior cruciate ligament (ACL) is one of the key ligaments that help to stabilize the knee joint. It runs diagonally through the centre of the knee joint and attaches to the back of the femur (thigh bone) and to the front of the tibia (shin bone). The function of ACL is to prevent tibia from sliding forward relative to the femur. The ACL also assists with preventing excessive knee extension, knee varus and valgus movements, and tibial rotation. According to Naraghi & White (2016), the ACL is the most commonly reconstructed knee ligament and one of the most commonly injured knee ligaments. An intact ACL will protects the menisci from shearing forces that occur during athletic maneuvers, such as landing from a jump, pivoting, or decelerating from a run (LaBella et al. 2014 ). Common sign and symptoms of ACL tear is usually include a loud “pop” or a “popping” sensation in the knee. A torn ACL is often accompanied by hemarthrosis (bleeding into the joint space) which may be visible as a large tense swelling of the knee (Sports Medicine Australia, 2015). This will cause a person to have severe pain and inability to continue activity, loss of range of motion and feeling of instability or “giving way” with weight bearing.Approximately 70% of ACL tears are as a result of non contact injuries, with 30% caused by a direct impact to the knee. (LaBella et al, 2014). Non contact ACL injuries occur due to the position of the knee, the ground reaction force, and quadriceps loading, and valgus/ varus and rotatory forces on the knee. It usually occur when hips are internally rotated and adducted, tibia are externally rotated, and feet are everted. In contact sports the ACL can be injured when a direct blow is applied to the outside of the knee.The meniscus plays a vital role in protecting the integrity of the knee, with contributions to shock absorption, load transmission, joint nutrition, and stability. meniscal tears are frequently seen in the athletic population either as an isolated finding or in conjunction with ligamentous injuries (Naraghi & White, 2016). Not all meniscal tears are symptomatic or require treatment. It has been shown that meniscal tears may be seen in up to 63% of asymptomatic knees. The mechanism of menisci injury usually due to degenerative or traumatic. Degenerative tears occur as part of progressive wear in the whole joint or as a result of habitual, prolonged squatting. In the older adult, the tear may be due to a natural degeneration of the menisci that occurs with age. The traumatic type of injury is quite common in the athletic setting. Functional instability after anterior cruciate ligament (ACL) injury can be successfully treated with ligament reconstruction. It is important to perform the surgery within 12 months after injury because prolonged time to surgery will increase the risk of medial meniscus injury and decreased repair rate (Chhadia, 2011). Meanwhile the treatment options for meniscal tears fall into three broad categories; non-operative, meniscectomy or meniscal repair (Mordecai et al, 2014). Partial meniscectomy is suitable for symptomatic tears not amenable to repair, and can still preserve meniscal function especially when the peripheral meniscal rim is intact. Meniscal repair shows 80% success at 2 years and is more suitable in younger patients with reducible tears that are peripheral (e.g., nearer the capsular attachment) and horizontal or longitudinal in nature (Mordecai et al, 2014). LITERATURE REVIEWMeniscal injuries commonly occur in conjunction with anterior cruciate ligament (ACL) tears. The association of meniscal tears with ligamentous injuries has been most extensively studied in the setting of ACL tears. Based on a research conducted by Kelly et al. (2012), nearly equivalent incidence of meniscal injury in acute and chronically injured knees. This shows that the medial and lateral meniscus has similar rates of injury associate with ACL deficient injured knee. However, a recent study conducted by Hagino et al. (2015) demonstrated that lateral meniscal tear was commonly associated with acute ACL injury, while medial meniscal tear with chronic ACL injury. Therefore, the lateral meniscus has higher rate of injury in acute ACL injury rather than the medial meniscus.An article by Drogset et al (2006) suggested that early surgical intervention for ACL deficient knee would be beneficial because the knees at an early stage had far less cartilage damage than did knees with late surgery. Besides, a literature review by Snoeker et al. (2013) & Church et al. (2005) has shown a strong evidence for an increased risk for medial meniscal tears was found when time between ACL injury and reconstruction surgery was greater than 12 months. Thus, the ACL reconstruction surgery should be carried out within 12 months of injury to minimize the risk of meniscal tears.Therefore, my case study for this musculoskeletal posting will be discussed about an individual who having ACL reconstruction with meniscus repair due to ACL and meniscus tear. CASE PRESENTATIONSUBJECTIVE ASSESSMENTMrs L is a 32 years old Malay female who was diagnosed with left anterior cruciate ligament (ACL) tear and medial meniscus tear. She was managed operatively and conservatively. The operative done by doctor is arthroscopic ACL reconstruction with medial meniscus repair. The conservative management including medications and refer for physiotherapy. On 13 November 2017, full assessment followed by treatments was carried out to Mrs L in the physiotherapy gym at Physiotherapy Department at International Islamic University Malaysia Medical Center (IIUMMC). The chief complaints was pain at the incision site and posterior of knee especially during bending the knee.. Figure 1 below shows the body chart for anterior and posterior view (red dots indicate the area of pain).      For present history, it has been day 6 post athroscopic ACL resonstruction and medial meniscus repair. Operation had ben done on 7th November 2017. Currently, patient was undergo physiotherapy treatment and this is the second visit. Previously patient had history of been kicked by opponent during netball games and cause injury at lateral side of knee in 2015. At that time, pt just seek for traditional treatment. The injury at left knee become worst when she had alleged fall with twisted knee when playing zumba in March 2017. This incident had brought her to IIUMMC for further investigation.Patient has no any medical illness. She took painkiller only when needed. For family history, there are no history of ACL and meniscus tear in her family. For social history, Mrs L was already married and having 3 children. She work as admistrative assistant at Pejabat Tanah Pahang. They stayed at single storey house, no stairs and equipped with sitting toilet. Mrs. L is an active person. She practicing an active lifestyle by involving in zumba, netball and hiking. Mrs. L had done MRI Left knee on 20th April 2017. The findings show there are posterior horn of medial meniscus tear and ACL tear with associated posterolateral corner injury. There is also lateral tilt and translation of patella with tear of the lateral prepatellar fat and suspicious injury of medial patella retinaculum.For pain assessment, the area of pain is at the anterior and posterior of left knee joint. The nature of pain is throbbing pain which has VAS of 4/10. The aggravating factors are bending the knee and when patient want to stand from sitting position. The VAS for aggravating factors increased to 8/10. The ease factor is by applying ice pack at the effected area. The VAS is reduced to 2/10. The severity is high while the irritability is medium. The pain is non specific . It is on and off pain which only on when aggravated. Besides, the functional activities also effected as the patient unable to fully bend the knee. So she has to pray by sitting on the chair.   OBJECTIVE ASSESSMENTGenerally, Mrs. L is a moderate size Malay female came to department accompanied by her husband. She walk using crutches with no weight bearing. Patient wear knee braces on her left knee. Patient has normal posture. No muscle wasting seen for bilateral upper and lower limb. Surgical site secured with bandage. Redness and swelling were noted over left knee.On palpation, mild tenderness noted with moderate palpation on left knee. There is  increased in warmth also on left knee. For the range of motion (ROM), the left knee flexion is limited with end range pain. Generally patient can perform active full range of motion (AFROM) for both upper limbs and lower limbs. Her muscle power was graded using modified medical research council scale. For both upper limbs was scored 5/5.  For lower limbs generally scored 5/5 except for knee flexion and extension with scored 3/5. Patient has an intact sensation. The other tests unable to perform because patient’s left knee is secured with bandage. So the test will be performed on next visit.For outcome measure, Lower Extremities Functional Scales was done to Mrs. L during the assessment. According to Dingemans et al. (2017), the lower extremity functional scale (LEFS) is a well-known and validated instrument for measurement of lower extremity function. For LEFS, patient able to score 16/80 which equivalent to 20 percent. Thus, she has lower score which indicates greater disability of lower limbs.   ANALYSISFor physiotherapist impression, firstly is throbbing pain over left knee due to sore of the surgical incision. Secondly, reduced range of motion of left knee flexion due to pain. Thirdly, weakness of quadriceps and hamstring due to lack of activity.Short Term GoalLong Term Goal1. To reduce pain within 1/72. To reduce swelling within 3/71. To optimize functional activities such as praying without pain and limitation3. To improve range of motion within 1/52.4. To improve strength of knee flexor and extensor within 2/52.2. To return back to sport specific activities with no pain. PLAN OF TREATMENTS & INTERVENTIONSFor Mrs. L, a list of treatments was planned to be carried out based on rehabilitation protocol for ACL reconstruction with meniscus repair by Northon Orthopaedic Specialists. Those treatments were ice therapy, isometric strengthening exercise such as static quad exercise, inner range quadriceps, and straight leg raises. Other treatment are gait training, home exercise program, and patient education. Some treatments and its techniques were done to her including:1. Icepackpt in half lying, apply icepack on left knee for 20 minutes. 2. Static quadriceps exercisept in half lying, ask pt to pushing down into the bed with the back of the knee, hold for 10 sec. Do for 10 times for 3 sets.3. Inner range quadricepspt in half lying with a towel rolled under knee, ask pt to gently press the knee straight down into the towel as pt raise the foot. Hold for 10 sec. Do for 10 times for 3 sets.4. patient educationeducate pt the importance of maintaining exs level, educate pt to be consistent to do exs as prescribed, educate pt the correct way of performing the exs 5. Home Exercise Programme (HEP)Teach and ask pt to do strengthening exs (SQE and IRQ exs )at home. Hold 10 sec. Do 10 reps for 3 session per day. Encourage pt to apply icepack at the surgical site after exs for 10-15 minutes.EVALUATION & REVIEWDuring the evaluation after the treatment session ended, patient claimed that he feel better and able to complete all the exercises given. There is no increase in ROM and muscle power but the pain is reduced from VAS: 4/10 to 3/10. Thus, in the next session, review will be done for range of motion, muscle power and muscle girth measurement. Progression of treatments will focus on strengthening, partial weight bearing, and ROM exercise.Next Follow-up: 21 November 2017 No new active complaints from patient. Patient came to physio gym with partial weight bearing and there is no bandage around the knee. The swelling still occur, but only mild swelling. There is also no warmness over left knee. For range of motion, there is increase ROM for left knee from previously. There is also improvement in muscle power of left knee flexor and extensor from 3/5 to 4/5. The patellar mobility for left knee is reduced compared to the right knee. It indicates the stiffness of patella tendon of left knee. For outcome measure, Mrs. L score 20/80 for LEFS equal to 25 percent which indicates a slight improvement in lower limb function.  The interventions that had been given to patient included:1. Icepack: patient in long sitting. Apply icepack on left knee for 10 minutes2. static cycling: patient sit on ergometer. Ask patient to cycling for 20 minutes3. gait retraining with partial weight bearing: teach patient to walk using crutches with partial weight bearing4. step ups exercise:patient in standing position while holding the stairs bar. Ask pt to step up by leading with the operated leg and then step down. Make sure patient just put partial weight bearing on operated leg. Repeat exs for 100 times5. Ultrasound: patient in long sitting. Apply ultrsound of  1MHz, 0.8 W/cm2 on anterior knee joint and distal thigh for 5 minutes.6. home exercise programme: Teach and ask pt to do strengthening exs at home 3 times per day. Educate and encourage patient to continue ROM exercise by sliding heel on bed at home minimal 2 times daily At the end of treatments, range of motion of left knee flexion improved from 65 degree to 70 degree of flexion.The number of repetitions and sets given to patient is 10 repetitions for 3 sets. The American College of Sports Medicine (ACSM) recommends that a strength training program should be performed a minimum of two non-consecutive days each week, with one set of 8 to 12 repetitions for healthy adults or 10 to 15 repetitions for older and frail individuals.  DISCUSSIONThe discussion will focus on several treatments have been given to Mrs L throughout my posting period at IIUMMC.The first treatment is icepack. In addition to medication, exercises, postsurgical compression wraps and elevation, cryotherapy help to reduce postsurgical pain (Grinsven, 2010). According to Dambros et al. (2012), they said that cryotherapy in the immediate postoperative period in association with an exercise protocol was effective in reducing pain and improve range of motion of the knee in adults submitted to ACL reconstruction surgery, with application time of 20 minutes and carried out twice a day. In my opinion, cold therapy are effective in minimizing postoperative pain and reducing the swelling because cold treatment reduces the blood flow to the injured area thus reducing the risk of pain and swelling.Besides that, isometric strengthening such as static quad exercise and inner range quad also help to regain the muscle control around the operated knee. Grinsven (2010) claimed that :”Without endangering the ACL graft, muscle control can be regained and should be initiated in phase 1 by isometric, closed chain (safe range 0°– 60° ) and open chain (safe range 90°- 40°) exercises without additional weight. In addition, static cycling is one of the treatment that had been given to the patient in order to improve patellar mobility besides improving the knee joint stability. Rissels et al. (2013) said that cycling has an additional impact on balance, over and above what is gained through other physical activity. Thus, cycling may further reduce falls risk even among adults who are already physically active.Gait retraining with partial weight bearing are one of the important treatment that I gave to my patient. Partial weight bearing should be given in early postoperative week. According to Carter (2009) based on the rehabilitation protocol of ACL rereconstruction and meniscus repair, weight bearing should be limited on the operative knee by using crutches for first week post operative. Toe-touch weight bearing only is allowed during this first week. After the first week, full weight bearing is allowed only while wearing the hinged brace locked in full extension (0 degrees). Crutches may be discarded when the knee is comfortable enough to walk with no limp gait. Besides, early weight bearing is also beneficial to reduce the pain and thus reducing the graft laxity (Menski et al., 2012).The next treatment is step ups exercise. Step ups exercise is a closed chain exercise which may help to reduce pain as it put less tension on the knee joint.  Adams et al. (2012) claimed that in early post operative phase of ACL reconstruction, treatments incorporate weight-bearing (closed-chain) activities such as wall slides and stepups in pain-free ranges (typically 0°-60°), have been shown to be safe and effective, to possibly place less stress on the healing graft, and to cause less patellofemoral pain. Daniel (2016) also said that:”close knee chain rehabilitation within the first 6 weeks post-surgery might allow for better patellar tracking with minimal stress on the ACL and can help maintain good joint congruency”Besides, I also give therapeutic ultrasound treatment for the patient. Ultrasound is believed to improve range of motion. Morishita et al., (2014) conducted a study and proved that ultrasound affected the sensitivity of sensory receptors such as muscle spindle and high threshold mechanoreceptors in skeletal muscle and this led to the increased ROM. In addition, patient education also had been given to patient. It is important to educate the patient in the rehabilitation process as it may promotes early recovery of the knee function. Menski et al. (2012) claimed that “Education about postsurgical exercises, reasons for limited motion and crutch use and cryotherapy all will help stimulate early functional recover of knee function and help the patient create a realistic image about the rehabilitation process in general”.Furthermore, home exercise programme is vital in order to achieve maximal performance of the exercise. According to Keun (2017), prevention of ACL injuries and rehabilitative exercise training can help to achieve optimal exercise performance while avoiding the risk of sports-related injury.To conclude, further research in this field should focus on selecting the most appropriate treatments method which shown promising results. Rehabilitation following ACL reconstruction should be based on clinical science and the best available evidence. Therefore, research on the effectiveness of various treatment in the rehabilitation of ACL reconstruction and meniscus repair is recommended for the future.   

What another. Some think personal identity is physical, taking

What is personal identity? This inquiry has been
approached and bantered by philosophers for a considerable length of time. The
issue of individual character is making sense of what conditions and qualities
are key and adequate for a person to exist as the same being at one time as
another. Some think personal identity is physical, taking a materialistic
perspective assuming that bodily continuity or physicality is the thing that
makes a man, a man with the view that even mental things are caused by a type
of physical occasion. Others adopt a more visionary strategy with the
conviction that mental continuity is the sole factor in building up personal
identity holding that physical things are only impressions of the brain. One
more viewpoint on personal identity and the one I will attempt to clarify and
defend in this paper is that personal identity requires both physical and
mental continuity; my argument is as per the following:

1) Bodily
continuity is needed for the capacity of mental continuity. 
2) Psychological continuity is necessary in
defining personal identity. 
Therefore, mental and physical continuity are
both necessary and sufficient for defining personal identity. 


These premises, both of
which are true, support the conclusion of this argument. The first premise
states that bodily continuity is required for the capacity of mental
continuity; this is obviously valid as all mental movement is created inside
the mind whose work depends on sufficient operation of the body. Moreover, in
the second premise it is noticed that psychological continuity is fundamental
in characterizing personal identity. Psychological continuity as it identifies
with individual personality is a blend of memory and consciousness. Memory is at the core of the way a great many people consider
personal identity. It is on account of I remember the firsts throughout my
life that I think I’m the same person from that awkward adolescent. On the
off chance that I had no memory of past encounters, the feeling that I existed
in the past would be significantly traded off. Memory additionally is at the
core of philosophical discussions of personal personality. Maybe the most
prominent record of personal identity, attributed to Locke, holds that these
sorts of memories are (a piece of) what make me the same as the person I
was in the past. Memories of past activities go towards
constituting personal identity.


Philosopher Locke, whose immediate
philosophical opponents, Reid and Butler, rejected the constitution
thesis. But they didn’t shrink from relying
on memory to ground judgments of personal identity. One issue that can be
raised is that there appear to be gaps in our consciousness: we overlook
things, and once in a while our consciousness is interrupted, by rest or a
trance like state. A young child may grow up into an old man
who remembers nothing from his childhood and is of an entirely different
nature, by Locke’s theory the consciousness would be unique and hence the
old man and child would be not be indistinguishable. In addressing this, Locke
adheres to his fundamental theory: same consciousness measures up to personal
identity. A man is a similar individual when he rests as he is the point at
which he wakes, because his conscious is indistinguishable, and by a
similar token the young child and the man who remembers nothing of his
childhood are not by and by indistinguishable, on the grounds that they are not
a similar conscious. Locke additionally contends that realists still see
individual way of life as something besides the physical issue; generally,
there would be no concept of individual character, as the issue all
through our body (counting that affecting our brain and hence our thoughts)
is continually evolving. Locke extends his argument to ontological systems
that posit insignificant substances: whatever the substance in which
thought happens, be it material or unimportant, “the same consciousness being
preserved, whether in the same of different substances, the personal identity
is preserved” (Locke). If there is a technique for exchanging consciousness, it
is also keeping up personal identity. The so-called
memory-criterion of personal identity is often contrasted with the criterion of
the spatiotemporal continuity (bodily continuity) of a living body.


An objection to that is to bodily continuity
is, let’s say, my body lasts longer than I do. Or perhaps I last longer than
it. Certainly we don’t last the same amount of time. How then can we be the
same? Second, the proposed criterion now seems to ride intolerably roughshod
over the memory criterion. If memory is as irrelevant as it now seems to be,
how did it ever get into the discussion at all? Thirdly, there is the feeling
that my identity cannot possibly be the identity of a body I can clearly
imagine myself exchanging for another body, or even imagine myself losing
altogether.  The body is in a steady condition of progress, cells supplanting cells
by the thousands at any given time; how at that point can real coherence even
be if the body is in an interminable condition of progress? How might one be
viewed as a similar individual if the parts are always being supplanted? So far
as that is concerned, consider the possibility that a man loses an limb and
gets a prosthetic, would they be a similar individual then? Bodily
continuity as I comprehend it is the association or example of parts that make
up the entire, not simply the parts. The parts may supplant themselves after
some time, yet it doesn’t upset progression or character since the motivation
behind the ‘new’ parts are to keep up the capacity of the first structure. But
memory theorists do not differ from bodily theorists in thinking in terms of
possible clashes of memory and bodily criteria. In this part I shall argue that
a scale of bodily continuity is not the only or the best kind of spatiotemporal
criterion for persons-another is available, and that no correct spatiotemporal
criterion of personal identity can conflict with any correct memory-criterion
or character-continuity criterion of personal identity. It is this which
prevents the notion of person from falling in two.


In conclusion mental and
physical continuity are both important and adequate for characterizing personal
identity. From adolescents onwards a person isn’t the “same” however
that does not mean they aren’t the same person. By change, individuals are
growing, however will dependably have similar memories, and same body parts
that make them their identity as a person. Working
in conjunction with memory is consciousness, consciousness is simply the
meaning of the self; it is simply the mind’s ability to point, separating
amongst itself and a question making consciousness of “I” all through
bodily and memory changes. Consciousness is the center of unrestrained choice
and expectation; it is in charge of the capacity of a man to pick. All things
considered, it is my belief that characterizing personal identity depends both
bodily and mental continuity. 

Javier them over the next century thought that women

Javier Otero

Professor Rosalie Yezbick

English 102

21 January 2018

The Power of Words: A Compelling Speech to Congress on Women’s Suffrage

By Carrie Chapman Catt

Why were women excluded from voting? The originators of the Constitution and those that succeeded them over the next century thought that women were immature and lacked the ability to think independently or vote prudently. By the beginning of the 1840s, women started voicing their opinions about their right to vote. During the 1880s women’s suffrage took a giant leap forward when activist Carrie Chapman Catt, a former teacher and superintendent in Iowa joined the cause. She was the president of the National Woman Suffrage Association (NAWSA) in 1900-1904, and 1915-1920. Catt furthered the movement with organized campaigns, a strong volunteer force, and powerful speeches. She founded the League of Women Voters and was the primary reason for the victory on woman’s suffrage in 1920. Carrie Chapman Catt’s “Address to Congress on Women’s Suffrage” on November 4, 1917 is compelling and affirms her argument that Women’s suffrage is inevitable. Catt uses an antanagoge strategy to deliver her message effectively.

Carrie Chapman Catt starts of her speech by using pathos and logos when discussing Americas history. She argues that “Women suffrage is inevitable” (Carrie Catt). She emphasizes that “Suffragists knew it before November 4, 1917; opponent’s afterword” (Catt). She outlines three clear-cut causes that made it unavoidable. She uses pathos to depict the early history of our country and reminds Congress that America was “born of revolution and rebellion against a system of government so securely entrenched in the customs and traditions of human society that in 1776 it seemed impregnable” (Catt). She talks about the tyranny that the American Revolutionists were under and that governments are empowered by the people. Catt talks about the colonist’s victory and our newly formed nation’s ability to preserve the key principles of democracy. Catt furthers her argument by using logos and states, that eight years after America was born Abraham Lincoln said these words “Ours is a government of the people, by the people, and for the people” (Catt). She then goes fifty years into our history when president Woodrow Wilson told the world “We are fighting for democracy, for the right of those who submit to authority to have a voice in their government” (Catt). She brilliantly displays that political leaders have had strong convictions in their statements without judgement for 141 years.   

Catt uses the backdrop of American history to state that our nation cannot escape the logic it has always followed when women call for the vote. She asserts that “Taxation without representation is tyranny,” and with the others seizing the billions of dollars paid in taxes by women to whom he refuses “representation” (Catt). She strengthens her argument by affirming the impact that women have on society through their contributions, including teaching the same young men that vote about how to be Americans, while Uncle Sam denies women a voice in its government. Catt declares, “the suffrage for women already established in the United States makes women suffrage for the nation inevitable” (Catt). She talks about a statement made by Elihu Root, the president of the American Society of International Law “The world cannot be half democratic and half autocratic” (Catt). These words were significant and backed Congress into a corner because voting against Women’s suffrage would contradicts America’s principles of a democratic government that represents everyone. Catt states that the leaders of our country are obligated to allow women the right to vote. She points out that the world is watching and states that “It is a death grapple between the forces which deny and those which uphold the truths of the Declaration of Independence” (Catt). She continues to explain that the U.S. is the only democratic country where suffrage is completely denied as is the case in certain states.

Catt uses a pathos approach to remind Congress that educated women must rely on uneducated men who cannot read for their rights and states “Do you realize that such anomalies as a college president asking her janitor to give her a vote are overstraining the patience and driving women to desperation?” (Catt). She continues with the pathos approach and asks Congress to fight for them and they will be better allies and a happier country. She adds that delaying this measure will not make it go away and that it is inevitable. She boldly tells Congress that they will meet opposition and talks about the women haters amongst them and that some have been there to long. Catt uses pathos to prompt action from Congress “Are you willing that those who take your places by and by shall blame you for having failed to keep pace with the world and thus having lost for them a party advantage” (Catt). She uses logos to remind Congress that there is no valid reason or political gain for their party delaying the inevitable and strongly implies that doing so will cause defections amongst women and liberals from their party.    

Carrie Chapman Catt delivers a compelling speech that solidifies her argument for women’s suffrage and the fact that it is “inevitable”. She brilliantly uses antanagoge to highlight America’s democratic history and at the same time bring to light Americas democratic negatives that hinder women’s suffrage.  Catt delivers a speech filled with emotion, and logical insight that solidifies her argument.  

This This model consists three simple questions: what happened,

This essay is a critical reflection of my current skills as a Psychological Wellbeing Practitioner (PWP) that I undertook during the videotape recorded formal skills assessment, using reflective model (Driscoll’s, 2007, refer appendix-1). This model consists three simple questions: what happened, so what, and now what: further quick questions provide the critical reflection by stimulating in-depth enquiry leading to form action plans. Using this model, I elaborated purpose of a recorded patient-centred assessment (PCA) with comprehensive structured and content framework for Improving Access to Psychological Therapies (IAPT). Then critically analysed mixed interpersonal skills and the end section of PCA to explore learning, and ended the essay with highlighted learning needs with an action plan to develop my knowledge and skills for future practice. In my experience, reflection helps to perform PCA and identify discrepancies within the practice which can lead to continuous practice development. John, C (2000) explains the practitioner can focus self within the context of own lived experience that enables to confront, understand, and work towards resolving the contradictions within own reflective practice: between desirable and actual practice. Similarly, Driscoll (2007) describes reflection enhances professionalism rather than competes with the traditional form of knowledge, generate practice-based experience, learning, value professional’s work, shared practice, and service improvement. Inversely, he also explains that reflection might not fit with own learning style, passive resistance, e.g., too busy, incapability of time management and possibilities of exposing thoughts and ideas in public.


What happened?

The IAPT programme was established in 2008 to enable people with common mental health problems to access evidence-based treatments deliver by PWP within “step 2 care” (refer appendix-2) recommended by National Institute for Health and Care Excellence (NICE) (IAPT, 2014). My rationales behind the assessment are: to identify patient’s eligibility, problem and impact, lifestyle issue, COM-B (refer appendix-3) and risk management etc. Now, based on gathered information, I act as a coach to support, motivate and encourage patients to help focus on self-management using low-intensity intervention such as guided self-help, behavioural activation, psychoeducation and other appropriate intervention or signposting (IAPT, 2014). IAPT (2015) helps to identify the purpose of PCA: person’s eligibility for service, the allocation urgency, degree of risk and management, provisional and possible secondary diagnosis, mental health cluster distribution, standardise measures, shared problem’s understanding, the shared decision as to agreed goal and type of and treatment.

Following the GP referral, I undertook the PCA of the allocated actor who pretended as a depressed patient reported feeling deficient and found difficult to cope with his life. NICE (2013) recommendation of patient centred care (PCC) is: a patient should provide with opportunities to make an informed decision about their care and treatment with regards to their needs and preferences, with the cooperation of their healthcare professional. Eventually, to further develop therapist skills (PCC), the term reflection started to make an appearance in the low-intensity curricula from 2000 (Bennett-levy, 2003 cited Bennett-Levy et al., 2009). Research indicates that PCC interview practice correlated with patient satisfaction and improvement (Lovell and Richard, 2000).


Assessment starts with an”Introductory session”. I begin PCA by adopted crib sheet which contains the “assessment structure and treatment” (Richard and Whyte, 2011) to enhance the performance of PWP assessment. Introduction section includes confirming patient details, PWP role, agenda, and length of assessment, risk and limitations of confidentiality, note taking, supervision and GP contact etc. Patient and I agreed on collaborative agenda setting increases consumer-centeredness, shared-decision and to provide effective care (Franklen, 2013).

To inform confidentiality limitations, I gained consent from the patient to share information if required such as risk. In some situation, statute or common law may require healthcare professionals to break confidentiality (Myles et al., 2007).  


Next section of “Information Gathering” focuses on the problem by using questioning skills and collaboration etc. James et al., (2010) mentioned that within cognitive behaviour therapy (CBT), questions are used to explore the problem from different angles, create dissonance and facilitate revaluation beliefs, and to build adaptive thinking style. To identify patient’s difficulties, I collaboratively used 4’Ws’ (refer appendix-4) questions along with funnelling. Working together collaboratively benefits both the patient and the therapist in developing a robust therapeutic relationship (Dattilio and Michelle, 2012). I used funnelling technique include the open questions and encouraged the patient to talk in detail about their problem and patient also outlined a range of distressing symptoms and impact on ABC-E (refer appendix-5) which I covered alongside with the interpersonal skills, nonetheless use of closed questions to develop therapeutic alliance (Richard and Whyte, 2011).However, I repeatedly battled with time pacing skill throughout the assessment (reflected in next part of the model). Beck (2011) explains that actively collaborate, demonstrating empathy, caring and understanding, therapeutic style and alleviate stress throughout the assessment and elicit feedback at the end help to build the therapeutic alliance with the patient.


Suicide can result from various factors, for example, psychiatric disorder, negative life events, psychological factors, alcohol and drug misuse, family history, physical illness, the suicidal behaviour of others, and access to self-harm which I thoughtfully included in PCA (Howton at el, 2012). Therefore, risk assessment (refer appendix-6) is a core component of PWP skills. Here, I followed a systematic approach to assess patient’s current risk and ensure to cover all areas of risk which improve the outcome of the patient: helping to keep them safe, peace of mind and confidence (Laura et al., 2012). In this section, I was unclear with impulsivity question, and mislead between suicidal thoughts and meaning of the thoughts on risk and this may due to my questioning style. Nonetheless, I establish the current risk of the patient is minimal.At present, suicide trend seems going down from 6,233, 6,122, 6,188 to 5,965 since 2013 to 2016, respectively (ONS, 2013–2016). However, Papworth (2013) state that the great challenge for the practitioner is predicting the risk of the severe event. DH (2009) provides the ‘Risk Management framework’ based on the principle that risk assessment should structure, evidence-based and consistent across the settings and services.


During the assessment, I also collected PHQ-9 and GAD-7 outcome-measures (OM, refer appendix-7) as a part of Minimum Dataset questionnaire which is also collected at every session (IAPT, 2011). Within the IAPT services, PWP also collects information on phobia scale, employment and work and social adjustment scales (W) which I covered in lifestyle questions. Then subsequently review the appropriateness and intensity of treatment, identify therapeutic targets, and manage the therapy process or therapist, is indicated (IAPT, 2011). Patient and I collaboratively analysed pre-completed PHQ-9: discussed primary diagnosis depression, cross-verified ABC-E, and patient’s expectations.  Provided feedback on scores helped patient to understand about their condition as how it changes over time which can improve with support and develop the therapeutic relationship (IAPT, 2011). Consequently, if OM has not collected regularly may lead to services systematically over-estimating their effectiveness and risks missing information apparently crucial to improving the quality of the service in future (IAPT, 2011).


Alongside the social and psychological needs, PWP also required to consider co-morbidities. Mentally ill people are likely to have reduced physical health which may due to high health risk behaviours such as high caffeine intake, smoking, alcohol, and substance misuse (DH, 2011). I managed to cover these factors in the assessment and identified that patient’s caffeine intake increased, and alcohol intake is same, but the pattern of drinking had change (more frequent). I offered support with caffeine intake and sleep interference and also offered signposting to specialist alcohol service if the patient would want to work.


Next section of “Information giving”: With five areas model (refer appendix-8), I focused on summarising information from previous sections to consider treatment options (Papworth, 2013). Regrettably, I didn’t have enough time to explain five areas in detail; nevertheless, I saw patient the interconnected chain of five areas in their problem and maintenance of symptoms which can break if he acts on the behaviour such as taking a shower and dressing up more often and highlighted “Behaviour Activation intervention”. Williams et al., (2002) provide a seven-step approach to overcome problems by reintroducing activities, re-engage and reduce unhelpful behaviours.

Problem statement (PS) encompass the critical elements of problem-focused; shifts from fact-finding to collaboration; and provides a reference point for future contacts (Richards and Whyte, 2009). Collaboratively, I created PS includes triggers, symptoms, and impacts of the problem and an ultimate statement of the patient to priorities of problem which steers shared decision making, as treatment progress, therefore, it is also useful to monitor change (Papworth, 2009). The accuracy of PS needs to be check with the patient (Papworth, 2013­) which I didn’t manage to include due to my inability cover in PS in allocated time and lost marks on this section.

Farrand and Woodford, (2013) describe new, realistic things and plans can achieve by goal setting which is evidence-based, and then progressively work towards them in a structured way that puts the patient in charge. I asked reasons for seeking help, motivation, barriers, avoidance and use COM-B to help patient identifying specific goals (Michie et al. 2014). Moreover, when working together on five areas, I explored on patient’s goals and future possibilities for patient rather than difficulties they exist in present (Papworth, 2013)


Finally, the assessment ends with “Shared Planning” and “Decision-Making Competencies” (reflected in next part of the model) which I did not able to cover.

Once the patient makes a choice, PWP takes an active role to ensure that the patient understands the appropriateness of the treatment by giving accurate information which is evidence-based and discussing the matter to arrive at an informed shared decision (Richards and Whyte, 2011). I failed on this section as my whole assessment became disaster due to the barriers to access time, constant building anxiety and lack of coordination with time management which left me grieving. Bennett-Levy et al., (2010) explain the length of the assessment should reflect the time limits imposed by PWP, rather than comprehensive evaluation.


Due to the words limit and focusing on to significant areas of learning, I reflected upon the mixed feeling of interpersonal skills (covered well and less well) along with time management, and overall impact on PCA including last section.


So, What?

Reflecting on the recorded PCA saw my cognition of wanting to get through the comprehensive assessment rather than coordinating the assessment’s length within the given a time frame, is crucial to note. When gathering information, I felt the patient is not giving precise knowledge of problem and impact of being off sick and low mood. Therefore, I used the in-depth funnelling technique for eliciting information in patient-centred manner and practitioner should use it often throughout the interview (Richard, and Whyte, 2011). Contrarily, James and Barton, (2004) argue the trainee PWP may ask too many questions at the “theory building” and get “stuck in the assessment and re-conceptualisation loop” generating more examples of negative thoughts and beliefs, without making an intervention which may cause further depression. However, asking more open questions on 4’Ws’ and ABC-E, I identified patient’s COM-B and provided opportunities to express “common factors” throughout the assessment which produced therapeutic alliance. Lambart et al., (2001) describes common factors such as empathy, warmth, and therapeutic relationships correlate highly with patient outcome than specialised treatment interventions. I also received good feedbacks from assessor with the frequent use of empathy, warmth, non-verbal cues, and normalising patient’s experience with an attempt to carry out collaborative session. Papworth, (2013) explains “collaborative empiricism” in therapeutic relationship in CBT allows a PWP and patient to develop a shared understanding of their difficulties, and to make discoveries together to effect change in cognition and behaviour. National curriculum (IAPT, 2011) explains the importance of skills training further develop PWPs “common factors? expertise of active listening, questioning style, engagement, coherence building, patient-centred: information gathering, information giving and shared decision making.


Somehow with critics, I also felt continue asking too many prompt questions and questioning styles (information gathering section), repetitions for reassurance, I ended giving little time to the patient to reflect on their answer. As a result, I adopted deter behaviours which entangled me into the assessment along with poor time management skills. As an outcome, I received remarks a “NOVICE” competent of time-pacing. James et al., (2010) concludes that asking questions in therapy is a complex, under-thought skills and they provide frameworks to identify helpful and unhelpful questioning skills. As an issue, I would consider to work on this skills which explained in next section of the model.


However, I also would like to challenge critics rather than only accusing interpersonal skills. Trifoni and Shahini, (2011) report students are usually affected by test anxiety gives rise to physical and psychological distress can affect motivation and concentration. Here, I also strongly consider the environmental factors such as access to clock arrangement, the ergonomic skill (refer appendix-9) of the actor, allowed time for the student to deal with test anxiety before the exam etc. Trifoni and Shahini, (2011) said instructors’ attitudes are key factors in reducing test anxiety such as test techniques, specific orientation before the test and information.  

On the other hand, ergonomics training enhances employees’ skills in the use of office-workplaces environments by rearranging their workspaces to support their tasks, job demands, minimise distraction and increase privacy, and ultimately produce individual support, sense of control, work collaboration and environment satisfaction (Hung et al., 2004).

In the middle of the session, I realised inability to coordinate time due to barriers to access clock and time pressure which generated further nervousness and I lost confidence in time management. Trifoni and Shahini, (2011) state factors which provoke anxiety such as time limitation and pressure, negative evaluation. Although, the IAPT programme, does place a lot of demands on time so this skill assessment could see in fact mirror real-life by me. Here, I also perceive the initial nervousness at the beginning of the PCA made me unable to assert myself beforehand, and I felt too weak and late to take any action in the middle of the running session, for example, move a clock. Giasvand et al., (2017) report it is essential to plan for improving time management skills in order reduce anxiety students and strengthen academic motivation among students. Finally, I also consider working on time management skills along with other elements of interpersonal skills such as questioning style and dealing with test anxiety etc.


Finally, time efforts started hiring me unfavourably from ‘information giving’ section and disapprove me to cover the last section of shared planning and decision making, and left with incomplete PCA. For this section; I already offered treatment (BA) when explained five areas earlier but unable to agree with plans and actions with the patient and ended session unprofessionally. Despite, knowing mental health disorders and the evidence-based therapeutic options available, I didn’t leave with any opportunities to communicate this philosophy to help patients to make informed treatment choices (IAPT, 2011).

If I reflect, these could increase patient’s vulnerability if it were a real-life situation due to the vague ending of therapy which increases the susceptibility of patient’s dropout. One in five patients will drop out of psychotherapy before completing treatment, according to 2012 studies (Swift, and Greenberg, 2012 cited in Chamberlin, 2015).According to research study, that novice practitioners are more bound to lose patients at early stage, with high dropout of 75 percent (Chamberlin, 2015)

On the whole, I couldn’t pass the skills assessment as I didn’t able meet the “National curriculum requirement for the education of PWPs during summative skills assessment” (IAPT, 2011) to work within time limits of 45mins.


Now what?

From reflection on recorded evidence has solely feature that for me it is significant to understand my current incapacity of practice as a PWP, to become a safe practitioner. I have already put action plans in place and started working on every single element of interpersonal skills such as questioning style, funnelling skills; avoid repetition, and test anxiety-nervousness, time management skills.

To achieve these, I must practice focussing on building self-confidence, self-awareness, self-reflection, evidence-based learning, practising more role play, use an audio tape recorder, observe another practitioner, welcoming feedback from supervisor and experienced colleagues and reflective practice. Formal and informal learning (Manuti, 2015), mental well-being (NICE, 2009) and management practice (NICE, 2015) at the workplace are essential for improving my communication skills; offer invaluable support through which I can improve my skills and achieve competency requirement as PWP and overcome unproductive practice. Apart from these, I have also started using interventions learnt at universities such as problem-solving, dealing with worries, breathing technique to gain self-control in various challenging personal and professional life situations. Overall, with whole experience, I have learnt to prepare for improving and appearing successfully to pass the exam on the second attempt.

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Introduction of the report

    Kun Opera is one of the oldest surviving forms of opera in China which was originated in Kunshan, Jiangsu Province at the end of the Yuan Dynasty and the beginning of the Ming Dynasty. It is referred to as “the mother of traditional Chinese Opera” due to close relation to the development of other styles of Chinese Opera.  Kun Opera was listed among the Masterpieces of the Oral and Intangible Heritage of Humanity by UNESCO in 2011.
    After watching several Kun Opera performances in China recently, Mushroom Culture Company decided to introduce this art of performance into Australia for entertainment and cultural communication. It is believed that Australia has wide cultural diversity and enough market to promote this performance art. However, the company recognises that there may be cross-cultural issues in transferring a traditional Chinese art into a Western context.
   This report will provide a comprehensive description of the constitutions of Kun Opera, analyse potential issues may arise from differences between Chinese and Australian cultures and make recommendations to minimise problems.

Kun Opera in China
   Kun Opera in China has two systems including performing and teaching.
As a performance art, Kun Opera consists a complex of attributes, such as melodious and lyrical songs, soft and graceful dances, traditional dramas, classic costumes, and has its long-history learning modes and performing locations.

Even Kun Opera has been widely performed all over the world, the songs, accompanied by traditional instruments, have been sung in modified Mandarin with some features of the regional dialect.

Throughout (Naoyuki Miyashita et al), from the Journal of

Throughout the article, “Detection Failure Rate of Chest Radiography for the Identification of Nursing and Healthcare-associated Pneumonia” (Naoyuki Miyashita et al), from the Journal of Infection and Chemotherapy, there is conflict as to whether a chest radiograph or CT scan would be better at diagnosing nursing and health-care associated pneumonia (NHCAP). Certain populations were assigned into groups in order to assess the success of a chest radiograph versus a CT scan in diagnosing pneumonia. It is important to keep in mind when reading this article, that it was conducted in Japan and the research method should be scrutinized. The importance of this study is that pneumonia is the third leading cause of mortality in Japan, with 97% being elderly. After conducting the study and reviewing the results, it can be concluded that CT is better at detecting NHCAP than a chest radiograph. However, this cannot be generalized to all patient populations, as it pertains mostly to an elderly population with mobility deficits and co-morbid conditions.  This study initially included 318 patients, however, only 208 of those were actually diagnosed with pneumonia-related lesions. From January 2013 to September 2014, patients who visited the Kawasaki Medical Center/Hospital and showed symptoms of pneumonia were included in the study. The participants were divided into 4 groups; A) Residents of a nursing home, B) Residents discharged from the hospital within 90 days, C) Elderly or disabled receiving nursing care and have limited to no mobility, and D) Persons receiving regular treatment as an outpatient. All of these patients, regardless of their group, have been diagnosed with pneumonia. In addition to these groupings, the pneumonia was also classified into one of four categories; mild, moderate, severe, and very severe. “Among the pneumonia severity groups, chest radiography identified pneumonia cases significantly less often than HRCT in the moderate group” (Miyashita et al). More specifically, aspiration pneumonia is thought to be the most frequent cause of NHCAP. A variety of speech tests were conducted to confirm a swallowing dysfunction, such as dysphagia. “Usually, chest radiography is the first imaging technique utilized for the evaluation of acute respiratory symptoms, and this method is still recommended as the standard reference method for confirming the diagnosis of pneumonia” (Miyahshita et al). If an abnormal shadow is not identified, this can lead to misdiagnosis and thus, fatal consequences. For this study, however, both chest radiography and chest CT scans were used in order to compare results. For the chest radiograph, a postero-anterior view was utilized and for the chest CT scan, the patient was in supine position, both suspended breathing at the end of inspiration.  Within a few days of examination, two radiologists, with each over 20 years of experience, reviewed the images. There was found to be greater inter-rater reliability when assessing a chest radiograph than a CT. For groups A and C, a chest radiograph had a lower detection rate than CT. The majority of the population in these two groups were elderly with limited mobility. This is important to the study, since there may be a correlation between insufficient mobility and functioning and the low detection rate of pneumonia in chest radiographs. On the other hand, groups B and D showed a better detection rate for a chest radiograph than CT. However, this was generally a younger population with adequate mobility and functioning status. Nonetheless, the detection rate for each modality is thought to be depended on the age group and functional status of the individual

Active Sankari1 Dr.P. Sripriya2 M.Phil Research Scholar Associate Professor

Learning through Social Media :     A

S. Sankari1                                                                              Dr.P. Sripriya2

                   M.Phil  Research Scholar                                                      
       Associate Professor

of Computer Application                                               Dept of Computer

                        VELS (VISTAS)                                                                         VELS (VISTAS)

3-City, Country                                                                line 3-City, Country

[email protected]                                                       line 4-e-mail
address if desired




                The arrival
of new technologies in different field has lead to the huge amount of rough
data storage in various formats like plain text, binary files, image file
formats, audio file formats, zip, metafile and so on 1. The processing of
collected huge volume of data from different sources is challenging and the
data are useless if it is not converted into some useful information. To convert
the raw data into some useful information data mining is introduced in the
database community in 90’s. The process of extracting needed
information/knowledge from the huge amount of data is referred a data mining. The
main goal of data mining is to explore knowledge and to find hidden information
from the raw data. Data mining uses knowledge discovery from data (KDD) to discover
unseen patterns and finding knowledge in rough data. Data mining techniques are
used in various fields to mine data and needed information from vast data
quickly 2. The major applications of data mining are financial data analysis,
banking industries, telecommunications, retail industry, sales/marketing, biological
data analysis, medicine, education and so on. Some of the real time example
applications for data mining are Google, yahoo, Amazon, eBay etc.

challenge in the educational institutions is to handle student’s details and
records in effective manner. Data mining helps educational institutions to
identify and discover unseen patterns by using educational data mining.
Educational data mining (EDM) is one of the applications of data mining which explores
data from the educational content. EDM mainly focus on solving problem related
to education. The main goal of EDM process is

to predict student future learning

reflection of educational support

discovering or reconstructing domain

elevate student information

Now a day’s educational system has
evolved and students started learning from various sources. Internet become
very popular and most of the students started learning new things via Social
media’s. Social media is a web based application which creates interaction
between the peoples from various countries and these media facilitate sharing
of thought, own ideas, sharing of information and to promote our brands. When
compared to olden days now it is easy to share information’s by using social
media’s.  These sites provide lot of
options for spreading information’s from one place to another through network
easily. Social media provides good platform for students to express his/her
feelings and thoughts. through this institutions can easily find out the
difficulties faced by their students .thus, helps educational institutions to
improve the success rate of learning and the standard of the education 3. Some
of the most popular social media sites are Facebook, WhatsApp, Twitter,
YouTube, Orkut, Instagram, Blogger, Google and so on. Social media’s also
provide students to learn from various sources like community member article,
literatures related to studies.


Fig-1 Types
of E-Learning





Learning Network (SLN)


        SLN is a type of social network
implemented among learners, teachers and modules of learning. SLN provides open
online courses and corporate training given important questions about SLN. Assembling,
examining, leveraging data about SLN will give potential answer to these
queries with the help of modelling languages and design methods like social
network theory , science of learning and education information technology. students
can create profile in SLN using  their
details. facebook ,twitter, Google+ are the familiar networking sites among the








Programme on Technology Enhanced Learning (NPTEL) is started by the seven IIT’s
in India to plan and guide the science and engineering courses. NPTEL provides
online course content in engineering and science. The concentrated area for
NPTEL projects are,

Higher education

Distance education

Professional education

Open learning for the reference

        NPTEL mainly focus on five streams of
engineering(civil, computer, electrical, electronics and communication,
mechanical). Work force demand for trained engineers and technologists is way
over the amount of qualified graduates that Indian technical institutions will
offer presently. Only few institutions having fully qualified and trained
tutors and most of the institution have young , inexperienced tutors. therefore
it is really needed for those institutions to disseminate teaching/learning
content of high quality through all available media. Educational institutions
needs many more qualified teachers for effective higher education in
professional courses. A wide range of students who are unable to attend
scholarly in institutions , NPTEL will have access to quality index for them.
The major advantage of using NPTEL is that course contents are free for
individuals , contents in the site updated frequently and provides contents for
the teacher training. In future NETEL plans to extends the course contents for
all the engineering courses and tries to bring all the best tutors under one


Flipped Classrooms

Flipped classrooms are reversal of traditional teaching and
a combination of traditional learning and online learning.

Fig: Opportunities of Flipped Classroom

Learners need to watch taped seminar
video’s at home and in school they do task related to the watched video. By this
process of learning students gain some background knowledge of that topic. The
main aspect of flipped classes are when the learner need teachers more. Mostly
students need tutor’s help while doing homework’s but in traditional learning tutors
only available at the time of introduction of the topic and they unavailable
during homework. This leads to lack of basic knowledge of topic and students
started mug upping the contents. This problem is overcome in flipped classrooms
and lectures are replaced by video’s which creates some interest towards the
studies. Students engagement among the traditional learning is also restricted
to activities but in flipped classes students can work individually or in a
small teams on task designed by tutor which enhance the skills of the students
widely. This type of teaching leads students to involve some work like
functioning a concept by working for example outside school.


Fig 3: Theoretical Structure

Flipped classrooms have so many advantages in modern
learning and create new way to teaching methods but it also have some drawbacks
like most of the students don’t have facilities to watch online video’s,
increases the internet usage among students even though flipped learning gives stress
less environment for the students.



kumar Baradwaj, Saurabh pal. ” Mining Educational data to Analyse Students
Performance”. International Journal of Advanced Computer Science and Applications,
vol.2, no.6,2011.

A.S.Kejkar, S.M.Tandore. “Data Mining : Task,Tools,Techniques and Applications”.
International journal of Advanced Research in Computer and Communication
Engineering . volume 3,issue 10,oct (2014) : 2218-1021

Siemens and P. Long, “Penetrating the Fog: Analytics in Learning and
Education,” Educause Rev., vol. 46, no. 5, pp. 30-32, 2011.






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