Justification of Intellectual Property Protection Essay

Support of Intellectual Property Protection - Essay Example The paper illuminates licensed innovation as any difference as a main priority or advancement. This property, possibly an image or a logo, any remarkable name assigned for an organization, imaginative and masterful innovation. Protected innovation is confined or patent advancement. Certain brands utilize a particular exchange imprint and music organizations copyright their sounds and recordings designs, experts do strategies recipes and innovations which are kept in legitimate reports or financial qualities that are utilized monetarily. Licensed innovation is the elusive or deficient unclear property then again extraordinary private and individual property of any individual or an organization is substantial is effectively and obviously characterized. IP is any type of articulation, this incorporates pictures, images, logos, title, mark, strategies, techniques utilized in business industry or trade; programming, music rhythms abstract. This individual exertion is the advancement and f ormation of psyche and showed and showed, it has physical presence and select property rights. Elite property rights incorporate copyrights, trademarks, licenses modern plan rights and competitive advantages, these rights are protected innovation and secure company’s various sorts of inconsequential lawful ideas. The British sculpture of Anne 1710 and sculpture of restraining infrastructures 1623 are the two patent laws, copyrights that are these days utilized individually, these laws were begun in the late twentieth century and from that point forward the word licensed innovation began to be utilized. ... This total security along these lines bargains licensed innovation as genuine property. The World Intellectual Property Organization (WIPO) settlement and other worldwide understandings depend on the way that the licensed innovation rights ought to be secured as it is fundamental to the monetary development. The accompanying reasons are given in the handbook distributed by the World Intellectual Property Organization identified with the licensed innovation laws. One is to give legal articulation to the good and monetary privileges of makers in their manifestations and the privileges of people in general in access to those creations.† Inventions were not the motivation to start the historical backdrop of patent, yet it was in actuality the awards given by the Queen Elizabeth 1 (1558-1603) and other regal relatives for the benefits planned for making imposing business model. about 200 years after the finish of the rule of Elizabeth 1 a patent presently appears and speaks to a leg itimate status to the rights which are acquired by the individual creating something which gives him the option to control that innovation solely, control and confine its creation, deal or any limiting whatever other technique that may make that development accessible for others to utilize freely. (Mossoff, A, 2001, Vol. 52, p. 1255) The point of this paper is to contemplate the defenses or contentions that encompass the development of licensed innovation law. The paper will open conversation with the points of protected innovation law and afterward move to the avocations. The paper will likewise examine the impediments to these supports and at long last, finish up the conversation with a basic assessment of the protected innovation law terms. Points of Intellectual Property Law This segment will manage the assurance of protected innovation motivating forces taken for those

Discuss why and in what ways young people have been treated Essay - 1

Talk about why and in what ways youngsters have been dealt with contrastingly in the criminal equity framework - Essay Example Researchers have thrown questions on the adequacy of the UK fundamental criminal framework in accomplishing positive outcomes with the young people and kids. The general assessment is that the primary criminal equity framework is inconvenient to the prosperity of the adolescent experiencing it (Hill, Lockyer and Stone, 2007). As of now, criminal obligation in the UK begins at ten years old years (Davis, Croall and Tyer, 2010). Wrongdoers between the age of ten and seventeen years are typically taken to Youth Courts for their cases to be heard and decided. Be that as it may, if the offenses carried out are not kidding offenses, for instance furnished theft, murder and assault, at that point the culprits are arraigned in Crown Courts paying little mind to their age gave they can accept criminal obligation (Cavalino, Dignan and Mair, 2013). The UK National Audit Office advocates for all youngsters and youngsters to be dealt with uniquely in contrast to how grown-ups are dealt with. It advocates for the Youth Justice System since it figures out how to find some kind of harmony between the interests of the youngster and those of the network. It defines measures that guarantee early mediation, and accepting proactive measures rather than receptive ones towards guiltiness (Duckley and Loader, 2012). It likewise establishes therapeutic equity quantifies instead of retributive ones utilized by the fundamental criminal equity framework, directs legitimate discipline and gives the vital help to help the adolescent and kids in their restoration procedure (Smith, 2013). This paper examines why youngsters and youthful guilty parties are dealt with contrastingly in the UK criminal equity framework and the manners by which these distinctions show themselves. To accomplish this, the paper begins by posting the reasons why youth take part in wrongdoings and build up a comprehension of whether they ought to be agreed exceptional treatment. The paper at that point talks about the models of

Article review Example | Topics and Well Written Essays - 750 words - 1

Survey - Article Example He underlines on the permitting the staff the opportunity to execute their obligations with inborn knowledge as opposed to keeping a lot of precludes laid by the organization. The preparation staff ought to have the option to affect information in the group of workers with the determination to end absence of data and faltering in playing out the job that needs to be done. Plainly the staff should rehearse basic speculation in different circumstances in order to think of the best answer for an issue being referred to. Such reasoning will empower the representatives to break down the issue, assess it just as survey the methods of moving toward the issue. They utilize own rationale to devise the goals of contention subsequent to taking in the upsides and downsides of the issue. No big surprise the author is quick to outline that staff must be fit for utilizing their own drive to deal with issues in the association. This bit of composing has made a special effort to plot how the issue is to be taken care of. Rather than simply expressing realities, the essayist has taken the torment to expand on how one ought to approach overhauling the client care administration of the whole association. He has given tips for both new businesses and enormous organizations. His pointers are anything but difficult to follow and pertinent to a wide range of undertakings regardless of their size and numbers. This is a basic and very much characterized article with no shrouded significance or languages that could befuddle or control the point laid over. Likewise, the model given is down to earth and attracted from a wealthy association that has demonstrated track accomplishment in their business. One will be progressively disposed to accept what the author is discussing as opposed to peruse the article for recreation. Be that as it may, the article is one-sided as it speaks increasingly about carrier organization and no other. It as though the thoughts were focused for organizations in the carrier business forgetting about different undertakings. This methodology could make one uncertainty the believability of the entire thought delineated in the article causing wavering in the consolidation of the mentality set forth. It is additionally a short composing that will in general leave us holding tight the topic as one is left in view of numerous inquiries. This is appeared after the author records what he realized on the preparation he went to without expanding or including light the issues contacted. He doesn’t address achievement they have picked up from the experience particularly with respect to clients. His hypothesis is coordinated on the representatives without revealing insight into how their activities have brought about the acknowledgment of the ultimate objective. The missing connection in this composing is that examples of overcoming adversity that have emerged out of appropriate client assistance have not been recorded. We ought to have been give n models on reports of the achievement of the training that has been prompted as opposed to simply spreading out the thoughts. Likewise, a progressively worldwide methodology ought to have been taken as it is a nearby acquiring on the topic. Different organizations in different divisions of the business have been closed off as the practicability of the subject has not been demonstrated for their case. We are not persuaded on taking up the issue as it has not been completely depleted as we anticipated that it should be. The beginning was snappy as it was clear and exact however toward the end we are left thinking about whether there was more to it than was spread out. The title sometimes falls short for the composition as one is enticed to imagine that we will discuss the clients who are the individuals of significant worth in the

Digestion and Enzymes free essay sample

Similarly amylase Is a particular protein utilized for sugar substrates. In our analysis, our substrate is starch thus our compound is amylase. I believe that amylase won't work appropriately when warmed at 100C in light of the fact that chemicals need heat for the particles to increase dynamic vitality and slam into one another. At100C, catalysts dont move as quick as could reasonably be expected if the temperature is expanded, and in this way the impact and the response dont happen. Be that as it may, on the off chance that the temperature is Increased over its ideal temperature, at that point the catalysts become denatured. The breaking of a substrate occurs, when a substrate particle fits inside its particular chemical olecule, so when a protein atom gets denatured, the 3D state of the catalyst particle changes thus the substrate can not, at this point inside the dynamic site of the compound particle because of its denatured shape. So I figure the amylase may get denatured when warmed at 800C and along these lines It wont have the option to work. We will compose a custom exposition test on Assimilation and Enzymes or then again any comparative theme explicitly for you Don't WasteYour Time Recruit WRITER Just 13.90/page This reveals to me that amylase will work the best at 400C as It may be amylases ideal temperature. Factors: I will change the temperature, at which the arrangement Is warmed. I will gauge the time it takes for the shade of starch and iodine blend to vanish. The Independent ariable In this trial will be the temperature and the reliant variable time taken between the blending of amylase and starch arrangements and the finish of the test. The control factors will be: Volume of amylase arrangement in each test tube The volume of amylase arrangement In each test tube should be a steady number, in such a case that there Is distinctive measure of amylase In each test cylinder would make It an out of line test as the test tube with pretty much amylase may respond diverse to various temperatures. So a particular measure of amylase ought to be utilized in every one of the test tubes. H esteem: Change in pH can dramatically affect the pace of amylase - catalyzed response. This impact of pH Is on the grounds that the structure ofa protein Is kept up by varlous Donas wltnln tne tnree-almenslonal structure 0T tne proteln. A cnange 0T pH from the ideal qualities changes the holding designs, logically changing the state of the atoms. On the off chance that the atoms are denatured, the response can't occur, the outcome will get questionable. pH worth will be another autonomous variable on the off chance that it isn't controlled. Utilizing pH test strips to test the pH estimation of amylase arrangement and tarch arrangement before the analysis can be useful. Centralization of amylase arrangement in each test tube Concentration of amylase arrangement in each test cylinder ought to be the equivalent. In the event that the volume of amylase arrangement is same in each test tube, the lower fixation implies that there are less amylase particles in that tube. On the off chance that the amylase particles are insufficient to join with starch atoms, starch can't be totally separated, the blended arrangement may at present seem blue-dark shading. Along these lines, it will influence our outcome on the off chance that it isn't controlled. Grouping of starch arrangement in each test tube Concentration of starch arrangement is the substrate fixation. As the substrate fixation builds, the pace of response increments until every dynamic site occupied with catalysis. To keep Concentration of starch arrangement from being a factor of changing the pace of response, it must be controlled. Water level in shower Amount of iodine. Hardware: Test Tubes x6 Beaker Pipette depression Tile Ice 3D squares Water Bath Goggles Gloves Lab Coat Measuring Cylinder Stop Watch Iodine Amylase arrangement Starch. General Indicator. Bunsen Burner 1. Take 5ml of amylase and include it into a test cylinder and include 5ml of starch arrangement into nother test tube. 2. Ensure that the amylase arrangement and starch arrangement you utilized in this examination must have a nonpartisan pH, you may test the pH esteems by utilizing pH general marker. This should be possible when before 3. Wash up and include water and hold up till the temperature arrives at 40 C. . When the temperature is 40 C, place the two test tubes in a water shower for two minutes. 5. In the interim take a pit tile and include a drop of iodine in every pit. 6. Empty the amylase arrangement into the container of starch arrangement. Mix well utilizing a pipette. 7. Utilizing the pipette, expel a little mount of the blend and add a drop to the iodine arrangement in the pit tile 8. Rehash the iodine test at interims of two minutes, washing the pipette with refined water between each test until the blend neglects to give a blue/dark shading with iodine. 9. Record the absolute time taken between the blending of amylase and starch arrangements and the finish of the test. This is the time taken for all the starch to be processed by amylase at 40 C 10. Rehash the entire examination at different temperatures (10 C and 60 C) For temperatures higher than the room temperature utilizing a water shower and when he required temperature is arrived at evacuate the Bunsen burner. Delicate warming at interims might be important to keep up the temperature of the water shower. For the temperatures lower than the room temperature, use ice 3D squares to cut the temperature down. It is significant that for every one of these analyses the amylase and the starch arrangements are warmed or cooled to the necessary temperature before blending them. I will test 10 C, 40 C and 60 C and I will rehash my test multiple times so as to get reasonable and solid outcomes. Hazard Assessment: Risk Hazard How to forestall it? Starch arrangement or iodine. May get at you. Wear goggles. Some water washes are exceptionally hot. Can consume your hand or some other pieces of your body. Dont legitimately contact the water inside the water washes. Utilizing a rack to put test tubes into the water washes. Water and power. On the off chance that water is spilled on a close by switch, it can shock the individual. Keep measuring glasses, test cylinders and water shower away from any electrical gear. Breaking a test tube. Glass pieces can be unsafe to individuals and to you. Keep the gear in the work area and not close to the edges of the table. Additionally try to stand ana ao tne test . unlversal Inalcator. In the event that interacts with eye, may cause eye aggravation. In the event that interacts with skin, may cause skin disturbance. Whenever gulped, can cause visual deficiency and queasiness. Wear gloves while holding the all inclusive marker. Wear goggles to stop the contact with your eyes. Report the instructor quickly if accidently gulped. Hair. It can get plunged into synthetic compounds and may harm your hair. It makes it hard to see, mentioning precise estimations and objective facts practically inconceivable. Tie your hair back. Spilling concoction over your body. Can harm your garments and may potentially interact with your skin which can be exceptionally destructive and may harm your skin. Wear Lab coat. Not tidying up the territory once the test is done. Interacting with synthetic substances. It might be hurtful for somebody who doesn't know about the test and may unwittingly interact with unsafe synthetic substances or may stumble over the hardware causing lethal wounds. Tidy up the exploratory spot and wash your hands to evade others getting any further contact with synthetic germs. Squashed ice can harm your hands. Harm your hand. Wear security gloves.

Staying Agile 5 Best Practices in Software Project Management

Staying Agile 5 Best Practices in Software Project Management When launching a new software project, the chances are it’s been proposed for one of two reasons: either your stakeholder has a groundbreaking idea that they feel will bring unique value to users, or they have a pain-point that they need help solving. What’s also likely is that as the project progresses, these plans that first justified the project will change considerably. As new market information emerges, features, priorities, and timelines will adapt. Perhaps the solution you first had planned for your client is actually too complex for their non-technical team members. Or maybe a competitor has entered the market since development began, making your unique selling point a little less unique. In either scenario, your team members need workflows in place that enable them to be flexible, overcoming hurdles that could otherwise throw a project off-course. This is where Agile project management comes into its own. First introduced back in 2001, mastering the Agile Manifesto has become the holy grail of many project managers. And theres a reason for that. According to the VersionOne 2012 Agile Dev Survey, 90% of participants claimed that implementing an Agile practice improved their ability to manage changing priorities. Other studies have echoed the benefits of Agile, with the approach speeding up delivery time to market by an average of 37% and raising team productivity levels by 16%. However, a lot of things have changed in the business world over the past 16 years, and many teams now struggle to make the original Agile values work for their projects.  To create a modern guide to Agile, we spoke with five successful Agile teams about how they’re putting Agile project management into action in their software development projects and achieving great results. A Modern Guide to Agile Project Management Combining the lessons of five successful Agile teams with over 15 years of experience in Agile, we’ve formulated five best practices in taking an Agile approach to software management. We’ve collated key challenges to watch out for, and have provided  strategies to overcome them. These lessons are now available in our brand new, free white paper: Staying Agile: 5 Best Practices in Software Project Management. Staying Agile5 Best Practices in Software Project Management Download The Free White Paper Looking at how best to implement the 12 values listed in the Agile Manifesto, our white paper includes: Establishing the ‘Why’: How to begin every project with a strategy sprint Too often, teams will jump into a project without a thorough assessment of what’s already available and why the planned product is required. Before development work begins, all teams should implement a strategy sprint to identify either: Which pain point(s) the proposed product would be solving Which unique experience or service the proposed product would support. This strategy will then establish the vision for the project ahead. Within the first chapter of the white paper, we’ve shared why it’s necessary to hold a strategy sprint and included a day-by-day plan for what the sprint should cover. Planning to Perfection: How to develop a realistic project budget As mentioned, with new market information, project plans and expectations will adapt and evolve. However, it’s still essential that project teams first establish a realistic project scope and budget with the client or stakeholder, ahead of beginning development. In the second chapter of our white paper, we provide a step-by-step guide for creating a realistic initial project scope and budget with your client, which will adapt as additional requirements inevitably emerge. Customer Values: How to engage with client and user feedback at every iteration Inviting and embracing customer and stakeholder input at every iteration is the bread and butter of Agile project management. However, accessing, truly listening to, and disseminating this information can prove to be a challenge. In our customer values chapter, we’ll take you through a 3-step plan for integrating user feedback into your project development process at every iteration. We’ll also provide strategies for demonstrating this to your client transparently, through a number of collaboration solutions both online and offline. Collaborating Cross-Departmentally: Enabling communication between business and development When the Agile Manifesto was written back in 2001, the team argued that the best cross-departmental collaboration is done via face-to-face meetings. However, 16 years on, distributed teams are now commonplace across the technology sector, making in-person meetings difficult. In the fourth chapter, we’ll go through a handful of strategies for improving communication between business and development team members, regardless of technical level, in order to prevent departmental siphons. Sustainable Productivity: How to achieve team efficiency long-term While taking an Agile approach to project management, it’s essential that teams are able to streamline their workflows in order to be productive. However, it’s also vital that these productive workflows are sustainable and won’t result in team burnout. In our final chapter, we’ll recommend strategies for holding sprint retrospectives that will get the most out of each development cycle, while ensuring that your team members aren’t overloaded. With these strategies, your team will be able to develop a more refined product, while also avoiding bottlenecks and the risk of causing team stress. Whether you’re new to Agile and looking to persuade colleagues about the benefits, or are already using Agile and hoping to improve your team’s workflows, our Agile guide will provide you with tangible lessons to apply in your team. Staying Agile5 Best Practices in Software Project Management Download The Free White Paper P.S. Did you know we offer a live workshop on Agile project management, too? Learn more and sign up here.

Cutaneous Tuberculosis Disease - Free Essay Example

CHAPTER -1 CUTANEOUS TUBERCULOSIS INTRODUCTION: In this innovative world while progress in medicine has helped up to deal with many diseases Tuberculosis and Cutaneous Tuberculosis is still a challenge for doctors. A resurgence of Cutaneous Tuberculosis in areas of high HIV incidence, drug resistant present in patients with pulmonary tuberculosis and in immunosupressed patients are the main challenges for clinicians. (6) Cutaneous TB is caused by Mycobacterium tuberculosis, Mycobacterium bovis, Bacillus Calmette-Guerin (BCG) vaccinations and the Tuberculids whose pathogenesis is poorly understood. Cutaneous TB is very variable in its clinical presentation, significance prognosis. Factors which effect on variability are: The pathogenesity of the organism involved. The Previous treatment given. The Immune status of the patients which can be related to the presence of Acquired Immunodeficiency Syndrome (AIDS) or Immunosuppressive therapy. The Port of infection. Any Local factors like, the recent Trauma, the lymphatic drainage, the vascularity of area and the proximity to lymph nodes). PREVALANCE: Thirty years ago it was assumed world wide that tuberculosis would be eradicated in the developed countries, as its incidence increased only on by average 6 % in the United States and 10% in Europe between the years 1953 and 1985. However, in 1983 tuberculosis was declared a global emergency by the world Health Organization because of a sharp increase in incidence. (9) Among infectious diseases, Tuberculosis is an important cause of death. Tuberculosis was responsible for 6% of deaths worldwide. Global prevalence of TB currently is greater than 32%. More than 50% of new patient occurrences were in 5 Asian countries, i.e. India (largest worldwide patient load), China, Indonesia, Bangladesh, and Pakistan(ref ?) The current global burden of Tuberculosis is mind boggling. In 1997, the incidence of new Tuberculosis patients approached 8 million in addition to more than 16 million patients already diagnosed. Around 2 million people died of Tuberculosis in 1997 with a global fatality rate of 23%, fatality rates exceed 50% in some African countries in which there is a high HIV incidence. Approximately 8% of tuberculosis patients are HIV infected. (2) Prevalence of tuberculosis infection in 1985, 1995 and 2005 (10) Prevalence of tuberculosis has increased between 1985 and 2005.According to the World Health Organization case reports statistics, in 1985 there were around 3 million patients of tuberculosis of all types with the highest no of cases in Asia and Africa. In Asia the highest numbers of cases were in India, Pakistan, China, Philippines, Bangladesh, Afghanistan and Vietnam. In Africa the highest number of case were in Ethiopia, Nigeria, South Africa, Congo, Morocco and Tanzania. (10) During the last two decades the number of cases increased all over the world. In 1995 the total number of cases increased to 4.6 million and in 2005 to 7.5 million worldwide. In Asia in 2005 the highest numbers of cases were in India, China Pakistan. In Africa in 2005 the highest numbers of cases were in South Africa, Ethiopia Congo. (10) There is an increasing rate of tuberculosis in the developing countries is approximately 500/100,000/y. Great alarm has been the progressive increase in numbers of strains of tuberculosis that are resistant to antibiotics. Since 1984, that incidence of extra pulmonary tuberculosis has increased at even faster rate than that of pulmonary tuberculosis and is considered to be a diagnostic criterion in the case definition for AIDS. Because immunocompromised individual are at increased risk of extra pulmonary tuberculosis, so dermatologist are renewing their historic role in the diagnosis of cutaneous lesions of tuberculosis. (11) EPIDEMIOLOGY: Epidemiological analysis is used to detect the changing trends in the incidence and prevalence of mycobacterial disease in the community. The main objectives of these methods are to determine the natural behavior of disease and factors which affect his behavior and to calculate future trend if possible to help in the design of any control measures and to assess the usefulness of these measure.(8) Even though 1 of 3 individuals on this planet is infected with tubercle bacillus, the incidence of Cutaneous TB appears low. In areas such as India or China where TB prevalence is high, cutaneous manifestations of TB (overt infection or Tuberculids) are found in less than 0.1% of persons seen in dermatology clinics. The frequency of patients with Cutaneous Tuberculosis seen between 1980 and 1993 in a hospital dermatology clinic in Madrid was 16 per 10,304 which was 0.14%. In a ten year retrospective survey of patients seen in governmental dermatology clinics in Hong Kong between 1983 and 1992, the detected incidence of Cutaneous Tuberculosis among patients was 179 per 267,089 which was 0.07%. Among patients with Cutaneous Tuberculosis only15% had classic Cutaneous Tuberculosis and 85% had tuberculids. In that classical cutaneous tuberculosis approximately 5% had lupus vulgaris, 5% had Tuberculosis Verrucosa cutis and 5% had scrofuloderma. (2) In a tertiary-care hospital in northern India, 0.1% of dermatology patients seen between 1975 and 1995 had Cutaneous Tuberculosis. Lupus vulgaris was the most common manifestation around 55%, followed by scrofuloderma 27%, TB Verrucosa cutis 6%, tuberculous gumma 5%, and tuberculids occurred in 7%. (2) FREQUENCY: USA: In the United States, tuberculosis cases decreased from 84,304 cases in 1953, when national reporting was first began, to 22,201 in 1985.   This represented fairly steady decline of about 5.8% per year. However, the turn down in tuberculosis cases stopped in between 1985 and 1992. In 1992 the annual number of cases increased by 20% to 26,673 cases. (12) The increases were concentrated geographically in several states, with over 90% of the 14,871 cases in California, Florida, New Jersey, New York, and Texas and demographically tuberculosi s occurred in racial and ethnic minorities, in people aged 25 to 44, males and in those born abroad. Especially troubling, and indicative of increasing transmission of new infections, was a 36% increase in tuberculosis among children 4 years old or younger. Tuberculosis appears to be on the decline again in the United States as numbers with only 14,871 cases in 2003. (12) Reported tuberculosis cases in United States, 1982-2002 (12) The percentage of Tuberculosis patients who were born abroad individuals was 42%. People born in Mexico, the Philippines, and Vietnam account for one half of born abroad Tuberculosis patients in the United States. The Tuberculosis rate among born abroad people was 4 to 6 times higher than for US-born peoples. Minimum estimates of the proportion of TB patients with coincident HIV infection were approximately 10-15%. Among people aged 25-44 years, this proportion increased to 20-30%. (12) The fundamental origin of this new Tuberculosis epidemic in troubled states reflects a minimum of four major factors including (1) the involvement of Tuberculosis with the HIV epidemic, (2) the increased migration from countries where Tuberculosis is common, (3) the spread of Tuberculosis in congested settings (health-care facilities, prisons, homeless shelters), and (4) the worsening of the basic health-care infrastructure. (2) Molecular typing of Mycobacterium tuberculosis isolates in the United States in a restriction fragment-length polymorphism study suggests more than one third of new patient incidence results from people-to-people transmission, and the remainder result from reactivation of latent infection. Approximately 1 of 13 Mycobacterium tuberculosis isolates currently shows a form of drug resistance. (2) The modern introduction of biological agents that block tumor necrosis factor-alpha in the treatment of rheumatoid arthritis, psoriasis, and several other autoimmune disorders has additional raised about the necessity of t he identification of patients with latent Tuberculosis. At present, several hundred cases of Tuberculosis have been reported in patients who receive these tumor necrosis factor-alpha antagonists. (2) HISTORY: Tuberculosis has an ancestry which can be traced to the earliest history of mankind. It was recognized as a contagious disease by the time of Hippocrates and Aristotle in 350 BC. Signs of skeletal Tuberculosis were identified in Europe since Neolithic times and in ancient Egypt around 3700 BC in mummified bodies. Evidence of TB appears in Biblical scripture, in Chinese literature dating back to around 4000 BC, and in religious books in India around 2000 BC. (5) During1600s and 1800s tuberculosis was known ass the Great White Plague in Europe.   Other names for Tuberculosis were Phthisis which was from Greek term phthinein, meaning to waste away, scrofula which were used for swellings of the lymph nodes of the neck and consumption which were used as progressive wastin g away of the body.(2) In 1826 Laennec first reported cutaneous tuberculosis which he called PROSECTOR WART. Following Laennec, Rokitansky and Virchow described the histological features in detail comparing them to those of visceral tuberculosis. (6) The Incidence of TB increased with population density and urban development so that by the Industrial Revolution in Europe in 1750, it was responsible for more than 25% of adult deaths. Indeed, in the early 20th century, TB was the leading cause of death in the United States. In 1882, a German biologist ROBERT KOCH presented his discovery of the organism that caused TB. NEIL FINSEN won the Nobel Prize in Medicine in 1903 for introducing UV light into the treatment of skin TB. (2) With the help of better living conditions and the introduction of the antibiotic streptomycin on 20th November 1944, the number of reported TB patients in the United States steadily declined around 126,000 TB patients in 1944, 84,000 in 1953, 22,000 in 1984, and 14,000 in 2004.(2) MODE OF TRANSMISSION: Tuberculosis is an airborne contagious disease that occurs after inhalation of infectious droplets expelled from patients with laryngeal or pulmonary Tuberculosis during coughing, sneezing, or speaking. Each cough can generate more than 3000 infectious droplets. Droplets are so small around 1 to 5 micro meter, that they remain airborne for hours. (2) The likelihood that disease transmission will occur depends upon the infectiousness of the tuberculous patient, the environment in which exposure takes place, and the duration of exposure. Roughly 20% of people in the infected household contact develop infection. Micro epidemics have occurred in closed environments such as transcontinental flights and submarines. Tuberculin sensitivity develops 2 to 10 weeks after infection and usually is lifetime. (2) Because Tuberculosis induces a powerful immune response, individuals with positive tuberculin reactions are at a considerab ly lower risk of acquiring new tuberculous infection. In HIV-infected individuals, active Tuberculosis is more likely to occur from reactivation of existing disease than from superinfection with a new mycobacterial strain. (2) Without treatment, an estimated 10% lifetimes possibility exists of developing active disease after tuberculous infection, 5% occurs within the first 2 years and 5% thereafter. An Increased risk of acquiring active disease occurs during HIV infection, Intravenous drug abuse, diabetes mellitus, silicosis, immunosuppressive therapy, cancer of the head and neck, hematological malignancies, end-stage renal disease, intestinal bypass surgery or gastrectomy, chronic malabsorption syndromes and low body weight. Infants younger than two years are associated with increased risk. (2) 1) DIRECT INHALATION: The most common mode of entry via portal in to the lungs usually resulting from the Inhalation of airborne droplets containing a few bacilli, expectorated by individuals with â€Å"open† pulmonary disease.(8) 2) INDIRECT INHALATION: A) Ingestion: Less often bacilli may be swallowed and lodge in to the tonsil or in the wall of the intestine. These infections are chiefly related to the consumption of contaminated milk products. (8) 3) INOCULATION: Cutaneous tuberculosis manifestations depend upon the method of cutaneous inoculations, which may be exogenous that is from an out side source, may occur by autoinoculation, or may be by endogenous .Direct exogenous inoculation in an individual not previously infected with tuberculosis causes primary tuberculosis infection, will led to the tuberculous ‘chancre or to tuberculosis Verrucosa cutis depending upon the immune status of the patient. Another example of exogenous transmission is lupus vulgaris at the site of BCG vaccination. (9) Endogenous transmission can occur by continuous extension of tuberculous process underlying the skin as in scrofuloderma, by the wa y of lymphatic as in lupus vulgaris and by hematogenous spread as in acute miliary tuberculosis or lupus vulgaris. (9) Infrequent mode of transmission is direct implantation in to the skin through cuts and abrasions. These troubles usually in persons, working with infected material or cultures of tubercle bacilli. These skin lesions were called as â€Å"Prosector warts† (8) CLASSIFFICATION OF CUTANEOUS TUBERCUCLOSIS: Cutaneous tuberculosis clinical manifestations comprise a considerable number of skin changes, usually sub classified in to more or less distinct disease forms. Classification depends on morphology more recently mode of transmission or the immunological state of host, but none of them satisfies completely. 1)INOCCULATION TUBERCUCLOSIS (Exogenous Source) Tuberculosis chancre Warty tuberculosis(Verruca cutis) Lupus vulgaris(some) 2) SECONDARY TUBERCULOSIS (Endogenous source) A) Contiguous spread Scrofuloderma B) Auto-inoculation Orifical tuberculosis 3)HAEMATOGENOUS TUBERCULOSIS Acute miliary tuberculosis Lupus vulgaris(some) Tuberculous gumma 4)ERUPTIVE TUBERCUCLOSIS (Tuberculids) A) Micropapular Lichen scrofulosorum B) Papular Papular/Papulonecrrotic TB C) Nodular Erythema induratum(Bazin) Nodular Tuberculids (CLASSIFICATION OF TUBERCULOSIS, MODIFIED FROM beyt et al) (4) CHAPTER-2 CLASSIFICATION OF MYCOBACTERIA: Tuberculosis is an infectious disease which is caused by the Mycobacterium species. Mycobacteria are acid fast, non-sporulating, non-motile weakly gram positive organisms. TEM micrograph of Mycobacterium tuberculosis Table 3: Kingdom Bacteria Phylum Actinobacteria Order Actinomycetales Suborder Corynebacterineae Family Mycobacteriaceae Genus Mycobacterium Scientific classification by Lehmann Neumann. (3) In 1950s Runyon classified the atypical mycobacteria according to their ability to form pigment, their rate of growth colony characteristics. This classification also includes obligate human pathogens and facultative human pathogens. (1) Today more then 60 species of mycobacteria are identified. Around 41 of these were included in the approved lists of bacterial names in 1980. (9) 30 species of mycobacterium are known that can cause disease in humans. The most common causative organism includes: Mycobacterium tuberculosis Mycobacterium Leprae. Atypical mycobacteria. The species which produce disease in tuberculosis primary complex include: Mycobacterium tuberculosis. Mycobacterium Bovis. Mycobacterium Africanum. Sometimes Bacillus Calmette Guerin (BCG) may also cause disease. (1) MEDICAL CLASSIFICATION: For the purpose of diagnosis treatment mycobacteria can be classified in several major groups. Mycobacterium tuberculosis complex, which can cause tuberculosis by the pathogens Mycobacterium tuberculosis, M Bovis, M Africanum M microti. Mycobacterium Leprae, which causes Hansens disease. Nontuberculous mycobacteria are the mycobacteria which can cause pulmonary disease, lymphadenitis, and skin disease disseminated disease. SLOW GROWING MYCOBACTERIA RUNYON GROUP 1)Obligate human pathogens M. tuberculosis-bovis group including bacillus Calmette-Guerin(BCG) M Africanum (not included in runyon classification 2)Facultative Human pathogens M. kansasii I M. marinum I M. simiae I M. scrofulaceum II M. szulgai II M. gordanae II M. avium-intracellualr complex III M. haemophilum III M. Ulcerans III M. xenopi III 3) Nonpathogens M. flavescen II M. terrae complex III M. trivale III M. gastri III RAPIDLY GROWING MYCOBACTERIA 1))Facultative Human pathogens M. fortuitum I V M. chelonae I V M. abscessus I V 2) Nonpathogens M. smegmatis I V M. phlei I V M. vaccae I V others STAINING CHARACTERISTICS OF MYCOBACTERIA: Mycobacteria are aerobic, facultative, intracellular non-spore forming and non-motile curved rods measuring 0.2- 0.5 by 2-4 um. Mycolic acid rich long chain glycol lipids and phospholipoglycans, a mycocides present in the cell wall of mycobacteria protect them. (2) Mycobacteria do not gram stain readily but their most valuable staining characteristic is Acid Fastness. This ability retains carbol fuchin dye after washing with acid or alcohol occurs because of the high content of cell wall mycolic acids, fatty acids other lipids. Other staining methods used include Dietrele, auramine-Rhodamine and phenolic acridine orange stains. Nocardia rhodococcus, legionella dadei, isospora cryptosporidium also share acid fastness. (1) The Ziehl-Neelson acid-fast stain, while highly specific for mycobacteria, is relatively insensitive, and recognition requires at least 10,000 bacilli per mL; most clinical laboratories currently use a more sen sitive auramine-rhodamine fluorescent stain (auramine O). Routine culture uses a nonselective egg medium called Lowenstein-Jensen or Middlebrook 7H10 and often requires more than 3-4 weeks to grow because of the 22-hour doubling time of mycobacterium tuberculosis. Radiometric broth culture, BACTEC radiometric system of clinical specimens significantly reduces time 10 to 14 d for mycobacterial recovery. DNA probes specific for mycobacterial ribosomal RNA categorize species of clinically significant isolates after recovery. In tissue, polymerase chain reaction (PCR) amplification techniques can be used to detect Mycobactereria tuberculosis-specific DNA sequences and thus, small numbers of mycobacteria in clinical specimens. (2) The cell wall of mycobacteria consist of: (3) Outer lipids Mycolic acid Polysaccharides(arabinoglactan) Peptideglycan Plasma membrane. Lipoarrabinomannan(LAM) Phosphatidylinositol mannoside. Cell wall skeleton. PATHOGENESIS: The most common site for Tuberculosis disease is lungs and 85% of TB patients present with pulmonary symptoms. The most common sites of extrapulmonary disease are mediastinal, retroperitoneal, and cervical lymph nodes, vertebral bodes, adrenals, meninges, and the GI tract. Pathology of these lesions is similar to those in the lung. Extrapulmonary TB can occur as part of a primary or late generalized infection or as a reactivation site that may, coexist with pulmonary reactivation. (2) Mycobacterium tuberculosis is an obligate pathogen. It is a slender aerobic rod, characterized by high lipid content. This lipid is responsible for resistance to phagocytosis. Identification of organism is easy in tuberculous chancre, scrofuloderma, orificial lesions and the miliary variant. This may be difficult to find or absent in lupus vulgaris, gummata and warty tuberculosis. The organism is highly resistant to drying to drying and therefore can retain infectivity by inocula tion or contamination of minor wounds. (19) The reaction of the bacterium depends on: the size of inoculum. the virulence of organism. The immune state of patient. After mycobacteria have invaded the host, either they may multiply and caused progressive infection or their multiplication is checked or completely arrested. The balance between bacterial multiplication and damage is depend not only properties of the invading organism but also by the ability of the host to control such infection. (9) Once the bacteria have invaded, the interaction of T-lymphocyte and mycobacteria antigens, displayed on the surface of antigen presenting cells, induces the liberation of lymphokines, interlukins and intereferons. These substances encourage the activation and expression of MHC molecule II antigens and IL-2R on T-Lymphocytes. Macrophages gather and a granuloma is formed. During the initial sensitization T cells generated and these will remain for decades in affected organ and the circulation. (6) In HIV infection, cell mediated immunity is impaired and therefore there may be reactivation of disease. (6) With the onset of host-immune response, lesions that develop around mycobacterial foci can be either proliferative or exudative. Both types of lesions develop in the same host, since infective dose and local immunity differ from site to site. (2) Proliferative lesions develop where the bacillary load is small and host cellular-immune responses dominate. These tubercles are condensed with activated macrophages admixed and are bounded by proliferating lymphocytes, plasma cells, and an outer rim of fibrosis. Intracellular killing of mycobacteria is effective, and the bacillary load remains low. (2) Exudative lesions predominate when large numbers of bacilli are present and host defenses are weak. These loose aggregates of immature macrophages, neutrophils, fibrin, and caseation necrosis are sites of mycobacterial growth. Without treatment, these lesions progress and infection spreads. (2) Even though mycobacteria are spread by blood all over the body during initial infection, primary extrapulmonary disease is rare e xcept in severely immunocompromised hosts. Resistant hosts control mycobacterial growth at distant foci before expansion of active disease. Infants, older persons, or otherwise immunosuppressed hosts are incapable to control mycobacterial growth and develop disseminated Tuberculosis. Patients who become immunocompromised months to years after primary infection also can develop late generalized disease. (2) HISTOLOGY: The tubercle is the feature of the tuberculosis and infections with some of the atypical mycobacteria. In early stages of the skin lesion there is non specific inflammation but tubercle formation occur with in a month. (20) A tubercle granuloma consists of foci of epitheloid cells, containing variable, but usually sparse number of langerhans giant cells, with surrounding by a rim of mononuclear cells. The centre of this tuberculoid granuloma may shown a caseation necrosis which may calcify. (20) Even though tuberculoid granuloma is highly characteristic for several forms tuberculosis, but it is not pathognomic. Syphilis, leprosy, deep fungal infection and some other disease can also produce similar type of lesions. However differentiation of tuberculosis from these conditions sometimes may not be easy. (20) MICROSCOPIC ASPECTS: The involvement of an organ by tuberculosis is related with an inflammatory reaction at the affected site. There are three consecutive stages of inflammation, which are acute, subacute and chronic. These stages have different histological aspects. (21) 1) THE ACUTE PHASE: Infection first leads to a rapid, nonspecific inflammatory reaction apparent by exudative lesions, which are not predominantly specific to tuberculosis. The focus of inflammation is the site of serous-fibrous exudates with abundant macrophages in the centre. (21) 2) THE SUBACUTE PHASE: Lysis of the bacilli liberates the phospholipids from their capsule, provoking a specific tissue reaction and the formation of follicles  "Koester follicles†. Two kinds of follicular lesions may be observed. (21) A) The epitheloid giant cell follicle: These are rounded focus containing numerous epitheloid cells, which are monocyte with egg-shaped centre, abundant cytoplasm and indistinct cytoplasmic edges. Several Langhans giant cells, generally situated din the centre of the follicle. These are large cells with abundant cytoplasm, indistinct edges and multiple centres arranged in the shape of a crown or horseshoe. Langhans cells are formed by the fusion of epitheloid cells. Epitheloid cells and langhans cells created by the monocyte, under the action of lymphokines. There is also a peripheral crown of lymphocytes. (21) This follicle does not contain necrosis and is not specific for tuberculosis. It is common to tuberculous leprosy, sarcoidosis and connective tissue diseases. (21) B) The necrotizing granuloma: The epitheloid giant cell follicle presents with central Caseating necrosis. This lesion is very specific for tuberculosis. Caseating necrosis is a fine-grained, homogeneous eosinophilic necrosis. (21) 3) THE CHRONIC PHASE: The tuberculous follicle gradually develops in to a fibrous follicle. Collagenous fibres invade the tuberculous focus, which is enclosed in a fibrous shell with fibroblast and lymphocytes; forming a fibro-Caseating follicle that is then transformed into a fully fibrous follicle this follicle can become entirely calcified. (21) The key examination for confirming the diagnosis of tuberculosis is bacteriology. Histology does play an important role in confirming diagnosis of extra pulmonary tuberculosis. Combination of both histological techniques and bacteriology increase the yield of histology. (21) MICROBIOLOGY: Tubercle bacilli are aerobic, with lipid-rich walls and a slow rate of growth. They take 20 hours on average to double in number. The lungs, dark and oxygen rich, at a temperature of 37 °C, provide an ideal environment for th e bacilli to replicate .Tubercle bacilli are rapidly destroyed in the ambient environment by ultraviolet rays. It is difficult to stain the bacilli with stains commonly used for other bacteriological examinations. They require special stains that can penetrate the wax-rich wall of the bacillus. For bacteriological examination, the quality of the samples sent to the laboratory is of fundamental importance. For pulmonary tuberculosis: The specimen that should be collected for examination is sputum obtained from the patient after coughing; more rarely the sample is obtained by gastric aspiration or bronchoscopy. As sputum can be contaminated by other bacteria, it must be collected in clean sputum non-sterile containers that can be firmly sealed. For extrapulmonary tuberculosis: Fluid from serous effusion, cerebrospinal fluid or biopsied fragments can be sent to the laboratory for culture. All sampling must be performed in strictly sterile conditions so that culture can b e performed directly without prior decontamination. Samples must never be placed in formol, which kills the bacilli. bacteriological techniques Microscopy A smear of a selected part of a submitted specimen is made on a slide, then examined by microscope after staining †¢ Staining methods There are several staining methods used for the tubercle bacillus; it is important for the method or methods used to be standardized for each country. The stains that are the most effective are Ziehl-Neelsen (ZN) staining and auramine staining. Ziehl-Neelsen staining The smear is covered with carbol fuchsin, and then heated. The smear is then destained successively using sulfuric acid and alcohol. All of the smears must be almost totally destained, and then restained with methylene blue. The bacilli are stained red by the fuchsin and are resistant to the acid and alcohol, hence the name acid-fast bacilli (AFB). Destaining by the successive application of acid and a lcohol can also be done using only 25% sulfuric acid; however, it should be applied several times until the smear is completely destained. This is the method recommended by the IUATLD, as it is less delicate and does not require alcohol (which is not always available in some countries). On microscopic examination of the stained smear, the tubercle bacilli look like fine, red, slightly curved rods that are more or less granular, isolated, in pairs or in groups, and stand out clearly against the blue background. Fluorescent auramine staining The fuchsin is replaced by auramine; the bacilli fix the fluorescent stain and retain it after the acid and alcohol staining. †¢ Reading by microscopy After Ziehl-Neelsen staining The stained smear is examined using a binocular microscope with an immersion lens (magnification  ¥100). The number of AFB per 100 fields ,about one length and one width of a slide are counted. This technique is simple, rapid and fairly in expens ive. After auramine staining The stained smear is examined by fluorescence microscopy with a dry lens of low magnification (*25 or 40). This microscope has an ultraviolet lamp to enable the fluorescent bacilli to be seen: they are clearly visible in the form of greenish-yellow fluorescent rods. The sensitivity and specificity of examination by fluorescence microscopy are comparable to those of microscopy after ZN staining. The main advantage is the easy and rapidity of reading: on the same slide surface, the results of 10 minutes reading by optic microscope are obtained in 2 minutes on fluorescence microscopy. As this technique requires more costly equipment (the microscope itself, and the lamps, which need to be replaced frequently ,on average after 200 hours of use, it is cost-effective only if more than 30 slides are examined each day. A constant electricity supply and trained technicians are also indispensable CHAPTER -3 TYPES OF CUTANEOUS TUBERCULOSIS: INTRODU CTION: Scrofuloderma and lupus vulgaris are the two most common forms of tuberculosis. However, the pattern of cutaneous tuberculosis is changing, as the tuberculid, lichen scrofulosorum, is becoming more common over recent years and has occurs almost as frequently as scrofuloderma and lupus vulgaris. 1) SCROFULODERMA: Syn- Tuberculosis colliquativa, scrofulous gumma. DEFINITION: Scrofuloderma is a subacute form of subcutaneous tuberculosis which causes cold abscess formation and secondary breakdown of overlying skin. PATHOGENESIS: Scrofuloderma results from the contiguous involvement of the skin overlying another tubrculous process for example, tuberculous lymphadenitis, tuberculosis of bone and joints, or tuberculous epididymitis. (9) INCIDENCE: Scrofuloderma may affect all groups but historically, a high prevalence of scrofuloderma was seen in children infected with Mycobacterium bovis from contaminated nonpasteurized milk (which type cow ). CLINICAL FEATURES: Lesions present as firm, painless, subcutaneous nodules that progressively enlarge and suppurate and then form ulcers and sinus tracts to the overlying skin. Typical ulcers have undermined edges and a floor of granulation tissue. Typical tubercles with acid-fast bacilli are found in the lower dermis and the walls of the ulcer or abscess. Tubercle bacilli usually can be isolated from the purulent discharge. Tuberculin sensitivity is usually marked. Natural healing can occur but often takes years and may be accompanied by the formation of hypertrophic scars. Lupus vulgaris may develop in the locality of healing scrofuloderma. (2) Cervical lymph nodes are infected most commonly on the same side of the neck as the primary tuberculous complex. In the neck submandibular, preauricular, tonsillar, postauricular, occipital and supraclavicular lymph nodes are usually implicated. Occasionally discharging sinuses may occur over areas devoid of lymph nodes. Over weeks to mont hs the involved lymph nodes enlarge, turn livid red, suppurate and then perforate with resultant ulceration and fistula formation. (11) Progression of disease with scarring produces irregular adherent masses, densely fibrous in places and fluctuant or discharging in others. Fungating tumors may arise from the excessive granulation tissue and after healing characteristic puckered scaring at the site of the infection. (4) COURSE: Spontaneous healing does occur (what % ? ) but it takes years before it is a completed. The typical cribriform or criss-crossed scarring and localized recurrence are common. 2) LUPUS VULGARIS: Syn: Tuberculosis cutis Luposa DEFINITION: In most reporting publication, Lupus Vulgaris is the most common form of Cutaneous TB and has the most unpredictable presentation. Lupus vulgaris is a chronic and progressive form of Cutaneous TB that occurs in tuberculin-sensitive patients. Hypersensitivity to tuberculin is high although immunity is low to moderate. (11) The mode of infection is not entirely clear in the individual case but it is considered that Lesions appear in normal skin either as a result of direct extension of underlying tuberculous foci, in lymphatic or hematogenous spread, after primary inoculation, after BCG vaccination, or in the scars of old scrofuloderma. INCIDENCE: Traditionally, lupus vulgaris was most common in northern Europe and less common in Asian countries ( figures), with affected females outnumbering males by 2-3:1. All age group affected equally. (2) CLINICAL FEATURES: Lesions are small, sharply marginated; red-brown papules of gelatinous consistency called apple-jelly nodules. This apple-jelly nodule slowly evolves by peripheral extension in to large plaques with central atrophy. Lesions are frequently solitary, and more than 90% involve the head and neck. Re-emergence of new active tuberculosis nodules within earlier atrophic or scarred lesions is characteristic. If the Cart ilage of the nose and ears is involved, it is gradually destroyed. This destruction of tissue is known as lupus vorax. Bone usually is spared. Buccal, nasal, and conjunctival mucosa may be involved primarily or by extension. (2) Lupus Vulgaris is more common in western countries on the face, especially on cheeks, nose, ears, and on the extensor surface of the extremities, also on the breast buttocks. In many developing countries including India the lower extremities mainly the buttocks are the primary site of involvement. Mucous membrane involvement is very rare in Lupus Vulgaris. (11) VARIANTS OF LUPUS VULGARIS: There are many clinical types depending upon the local tissue response to infection. 1- PLAQUE FORM OR LUPUS VULGARIS EXFOLIATIVE: This form of lupus vulgaris is characterized by the plaques. Scaling frequently occurs on the lower legs where it may resemble psoriasis. As the lesion enlarges they become softer. Over a period of time a polycystic or serpiginou s configuration can develop with central clearing and atrophy in the lesion. Irregular scarring is frequent and the active edge may be thickened and hyperkeratotic. (2) 2) ULCERATING AND MUTILATING LUPUS VULGARIS: Scarring and ulceration be the main clinical features. Crusts form over areas of necrosis. Deep tissues and cartilage are invaded and ultimate scarring of the disease produces contractures and distortion. (2) 3) LUPUS VULGARIS VEGETANS OR LUPUS PAPILLOMATOSUS: This form of lupus vulgaris is characterized by necrosis, ulceration, and proliferative and papillomatous granulation tissue. It involves mucous membranes sometimes, and invades and destroys the cartilage when involving nasal and auricular cartilage. (2) 4) NODULAR FORM OF LUPUS VULGARIS: In this form of lupus vulgaris large soft tumors appears usually on ear lobes. These are characterized by an absence of ulceration and scarring. (2) 5) LUPUS POSTEXANTHEMATICUS: It is disseminated, papular an d nodular form that commonly arises after a transient impairment of immunity predominantly after measles.(9) ( complete lesion picture) 6) LUPUS VULGARIS OF MUCOUS MEMBRANE: Mucous membrane tuberculous lesions are extremely rare. These lesions are small soft, gray or pink papules, ulcers or granulating masses that bleed easily. They arise in mucous membrane by direct extension of skin lupus to buccal, nasal or conjunctival mucosa. This form can produce severe destruction can produce stenosis of the larynx and scarring deformities. (9) DIAGNOSIS OF LUPUS VULGARIS: Lupus vulgaris is difficult to diagnose when it occur in unusual sites like popliteal fossa. Special stains and mycobacterial cultures may be having frequently negative in these sites. However, it is possible to reach the correct diagnosis of Lupus vulgaris by using clinical and histopathological findings. In such cases, to confirm the diagnosis at times, a therapeutic trial with antitubercular agents may be re quired. (17) COURSE: Lupus vulgaris is a very destructive disease and without treatment can progress slowly over years or even decades. It can cause severe scarring and disfigurements like Ectropion, and others distortion of the mouth and severe damage to the nose may occur. (11) CUTANEOS TUBERCULOSIS IN CHILDREN: Cutaneous tuberculosis in children is a most important health problem in India. It accounts for about 1.5% of all the cases of extra pulmonary tuberculosis Overall the clinical patterns are comparable with adults. However, children can have widespread and severe involvement because many unusual and infrequent patterns are known to occur in children. Underlying systemic involvement(what invovlment) is more common in children with lupus vulgaris, compared to adults with lupus vulgaris. (13) Cutaneous tuberculosis is extensive in Pakistan but has not been adequately documented. One study was conducted to establish the clinical patterns, incidence and prevalence of the disease in Larkana, Sindh province, Pakistan. This study showed the number of patients was reasonably has large, thus suggesting a high incidence of cutaneous tuberculosis in Larkana. Lupus vulgaris, a form of cutaneous tuberculosis, was extensive in this area and prevalent in adults, while scrofuloderma was prevalent in children. Additionally, the obtainable rate of the disease was higher in children aged under ten years of age and lower in adults. This showed that children are more prone to this disease than adults in Larkana.(complete ratio of patients) (14) Ocular scrofuloderma with orbital tuberculosis is a rarely described presentation of childhood tuberculosis. Bilateral eye involvement had never been reported. One case report from India,in which a three year old boy who presented with bilateral infraorbital swellings of tubercular etiology. Computed tomography (CT) scan of the upper face revealed enhanced soft tissue lesions in both the lower lids of the eyes, wit h extraconal extension into the orbits and with erosion of the right zygomatic bone. The cause was confirmed by using the Ziehl Neelsen staining of the aspirate from the lesions, which was positive for acid-fast bacilli and growth of Mycobacterium tuberculosis in the aspirate culture. The patient showed marked improvement of his lesions on anti-tubercular treatment. (15) Localized tuberculid has been reported occasionally in the data. The majority of these case reports are of papulonecrotic tuberculid localized to the penis, an entity selected as penis tuberculid. In females, such a localized genital tuberculid has not been reported frequently. There is one case report from India, in which an 11-year-old girl with lichen scrofulosorum confined to the vulva, associated with cervical and inguinal tubercular lymphandenitis is reported. (16) UNUSUAL MANIFESTATION OF TUBERCUCLOSIS: Long standing lupus vulgaris can be complicated by Squamous cell carcinoma. Latency period may be 10- 20 years. I am presenting a case report from Romania in which 59 years old farmer lady had lupus vulgaris on right ear lobule, since childhood. which started after her empiric perforation for earrings. The development was progressive, strange, involving the pinna and the right cheek in the meantime. At the time of first examination, a diffuse mass of red-yellowish infiltration was found at the level of the right ear and the right cheek. In the following two years, an ulcer-vegetating tumor developed at the level of the right ear lobule, along with retromandibular adenopathy, of about 1 cm, histopathological examination confirmed the diagnosis of squamous cell carcinoma developed from a lupus vulgaris. (18)

Essay about Concepts of Family and Home in Jane Austens...

Concepts of Family and Home in Jane Austens Persuasion In Jane Austens last completed novel, Persuasion, England is one large family with two distinct branches, the navy and the aristocratic upper class-it is no accident that the two large books consulted in the novel are the Baronetage and the Naval Lists. The naval family poses a threat to the aristocratic family; in fact, undertones of social instability riddle the text, through imagery of death, illness, and accident. The marriages of Anne Elliott, Louisa Musgrove, and Harriet Musgrove reveal a gentry which can only redeem itself through intermarriage with the professional meritocratic class, symbolically taking on their values of utility and social responsibility, and†¦show more content†¦This domestication of the navy as a group renders it an alternative family to the aristocratic class; on the one hand, there is the meritocratic, sea-faring navy, and on the other, the indolent, land-holding gentry. The embodiment of this superficial class is the Elliott family. In using the Elliotts as her prime example of the aristocracy, a family that purchased its nobility relatively recently, Austen undercuts their claim to privilege. This family serves almost as a metonym for the larger aristocratic family in general. Rather than showing the aristocratic family tree as a pyramid of increasing status with increasing responsibility, Austen portrays it as a social food chain of the flatterers and the flattered. For example, when Mrs. Clay quits Bath at the end of the novel, Sir Walter and Elizabeth are shocked and mortified...they had their great cousins, to be sure, to resort to for comfort; but they must long feel that to flatter and follow others, without being flattered and followed in turn, is but a state of half enjoyment (Persuasion 220). 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Is it true that sugar causes or contributes to attention deficit hyperactivity disorder (ADHD)? This is an important question that many parents, teachers and researchers are trying to answer. Sugar has long been suspected to be a cause behind ADHD symptoms. But research has yet to validate the connection. According to the National Institute of Mental Health, the idea that refined sugar causes ADHD or makes symptoms worse is accepted, but more research disproves this theory than supports it. The Journal of Physiology is one of the first to discuss the negative consequence of a diet on learning and cognition (Agrawal Gomez-Pinilla, 2012). The authors investigated the metabolic outcomes of a high glucose diet in combination with a†¦show more content†¦According to the American Psychiatric Association it affects 5% of U.S children and 2.5% of U.S adults. Children with ADHD can t seem to follow directions and are easily bored or aggravated with tasks. They also have a tendency t o move around, are impulsive, and can be quite impetuous. Although these behaviors can be normal in children, they occur more often than usual and are more serious in an adolescent with ADHD. The American Psychiatric association has defined three distinct types of ADHD. The first is the Predominantly hyperactive-impulsive type where the person fidgets, talks a lot and it is difficult to sit still for a very long time. The second type is the predominantly inattentive and this is where the individual displays symptoms of hyperactivity/ impulsivity but not fully. Also children with this subtype are less likely to misbehave or have problems getting along with other children. They may sit quietly, but they are not paying attention to the work they have in front of them. Many times children in this subtype are overlooked and parents and teachers do not notice that he/she may have ADHD. The last type of ADHD is the Combined hyperactive-impulsive and inattentive and this is when the sympto ms of the two previous types are uniformly present in the individual. As with all psychological disorders, the reason of attention deficit disorder (ADHD) is unknown. Many

Hysteria Comparison of the Salem Witch Trials and the...

Andria Garza 11/30/12 English Final Draft Hysteria comparison of the Salem Witch Trials and the Holocaust During both the devastating Holocaust in the Germany and the tragic Salem Witch Trials in the small town of Salem, innocent people were brutally killed, causing hysteria among the people. Both groups of people endured hardships because of the hysteria that occurred among them. This hysteria caused people to react in ways that they would not usually act. Both of these events are very historical and help The United States of America be a unified and prosperous country that it has grown to become today. Hysteria is defined as an uncontrollable outburst of emotion or fear, often characterized by irrationality, laughter, weeping†¦show more content†¦The elderly people in the holocaust had no say so in anything and often they were looked at as a complete waste of space. According the Nazis, the vicious soldiers who ran these brutal camps, the elderly people could easily be killed so that they could make room inside of the often over crowded work camps. Poor people were also were frowned upon during the Salem Witch Trials. Many of the people, who had money and were well off, thought of them as scum. In a lot of cases there are people that tend to think that because someone does not have money they cannot make logical choice or decision. In the Holocaust many people that were poor were imprisoned. These people were not considered important. They were often considered to be the lowest of the low. During both of these events it is sad that just because someone is old or someone that lacks money could be treated as any less of a person that was younger or had money. There were deep rooted issues in both Germany and Salem that led to these dysfunctional occurrences that caused a mass hysteria among the people. Unity was the key factor that lacked among the people in the town Salem and the country Germany. Although Germany was united patriotically they were not united religiously. In Salem the people lacked a religious unity. They were not confident in their faith in God. If they were strong in their faith they would have had some sort of conscience and feel badShow MoreRelatedThe Human Lust For Power By Arthur Miller1689 Words   |  7 Pageshighlights a different facet of power: the means by which individuals strive to obtain it. In particular, he focuses on social power and the use of accusatory labels, such as â€Å"witch,† to obtain this power. The story is also a clear extended analogy for American McCarthyism, comparing the absurdity of the Salem witch trials to the equally ridiculous accusations of â€Å"communist sympathies† that destroyed the careers and reputations of Americans during the 1950s. However, if we limit our view of Miller’s

1984 And Fahrenheit 451 - 1505 Words

In the texts, 1984, by George Orwell, and Fahrenheit 451, by Ray Bradbury, the concepts of totalitarianism and censorship are addressed in various ways. Both texts are of dystopian fiction, set in post-nuclear war nations, although they are somewhat of a different nature. The concepts of totalitarianism and censorship are explored throughout the texts by addressing the issue of ‘knowledge is power’, the use and abuse of technology and the desensitising of society. Although these are mentioned in both 1984 and Fahrenheit 451, they are different in the way they are approached by each totalitarian government, as the government in 1984 is much more severe in the way each of these issues are dealt with in the text. Orwell and Bradbury address†¦show more content†¦Both authors emphasise the message that knowledge is power in order to warn modern society of the damage that can be done by embracing totalitarianism regimes. Orwell is much stronger in portraying it, which is displayed through the party slogan â€Å"who controls the past controls the future, who controls the present controls the past†. Bradbury acknowledges this by removing literature, although people are still free to think. Orwell takes it further by making readers question, what knowledge can be trusted? If all thought is removed, eventually, nobody will be able to have power because if the knowledge is unknown to be true, it cannot be used to form a common argument against the government. In 1984 and Fahrenheit 451, the governments utilise technology to abuse the citizens’ rights to privacy as well as advertise political propaganda. In both texts, television plays an integral part of the use of technology. In Bradbury’s text, a 24/7 TV program includes the audience in order to provide the impression they are an important part of society, whereas in Orwell’s text, the ‘telescreens’ are not only used for propaganda, but also to constantly monitor Oceania’s citizens. This is evident when â€Å"Winston kept his back turned to the telescreen. It was safer, though, as he well knew, even a back can be revealing.† In Fahrenheit 451, the TV programShow MoreRelatedComparing 1984 And Fahrenheit 451928 Words   |  4 Pages1984 and Fahrenheit 451 1984, written by George Orwell, and Fahrenheit 451, by Ray Bradbury, are similar to each other, however they also have several distinct differences. Both 1984 and Fahrenheit 451 are dystopian themed novels that deal with an overbearing and extremely powerful government. The nations in both novels are involved in wars that never seem to end, and their main characters begin to doubt the government and what society expects of everyone. In both 1984 and Fahrenheit 451, theRead MoreFahrenheit 451 Vs. 1984970 Words   |  4 PagesFahrenheit 451 vs. 1984 Ray Bradbury and George Orwell share a very similar theme in their two novels, Fahrenheit 451 and 1984. Winston Smith and Guy Montag work within an authoritarian organization, in which, they have opposing views of the authority. The novels are placed in a dystopian setting that the authority believes is a utopia. The dystopian fictions both have very similar predictions of the future. The predictions from these novels have not happened. However, it could be a short matterRead MoreEssay On 1984 And Fahrenheit 4511323 Words   |  6 Pages Thesis - In the books, 1984, by George Orwell, and Fahrenheit 451, by Ray Bradbury, each show that man has a number of potential ways to destroy itself, like technology, war, and the usage of words. Technology Technology and technological advancements were very prevalent in the book Fahrenheit 451, by Ray Bradbury, and many technological advancements are happening today, including the idea and advancements of artificial intelligences, AI. In the book Fahrenheit 451, there are many indicationsRead MoreComparing 1984 And Fahrenheit 451912 Words   |  4 PagesBoth 1984 and Fahrenheit 451 predict a dystopian future where information is tightly controlled and the populace seems to care little for the fact that they are being lied to and manipulated into working for the ambitions of their government. Both governments in the story have taken control of the media and this the population, and both characters are apart of agencies that help keep the government in control of the people. In Fahrenheit 451 the man is a fireman and burns all of the books that heRead More1984 vs. Fahrenheit 4512544 Words   |  11 Pages1984 vs. Fahrenheit 451 â€Å"Do you begin to see, then what kind of world we are creating? It is the exact opposite of the stupid hedonistic Utopias†¦Ã¢â‚¬  (Orwell 267). 1984 and Fahrenheit 451 are both dystopias, although in each society, the government tells the citizens that it is a utopia. A dystopia is, â€Å"An imaginary place or state in which the condition of life is extremely bad, as from deprivation, oppression or terror† (â€Å"dystopia†). On the other hand, a utopia is described as, â€Å"An ideally perfectRead MoreComparison Between 1984 And Fahrenheit 4511404 Words   |  6 PagesClose examination of the respective protagonists and antagonists of both 1984 by George Orwell and Fahrenheit 451 by Ray Bradbury reveals how the texts in question challenge and restructure the outdated ‘myth’ of moral absolutism through characters which do not comfortably fit the mould of ‘hero’ or ‘villain’. With reference to these characters and e valuation of their morality in relation to three key branches of normative ethical theory – namely deontological ethics, virtue ethics and care ethics–Read More Fahrenheit 451 And 1984 - The Fear Of Utopia Essay1237 Words   |  5 Pagesthroughout the twentieth century. Philosophical optimism of a bright future held by humanity in general was taken advantage of by the promise of a better life through sacrifice of individuality to the state. In the books Brave New World, 1984, and Fahrenheit 451 clear opposition to these subtle entrapments was voiced in similarly convincing ways. They first all established, to varying degrees of balance, the atmosphere and seductiveness of the â€Å"utopia† and the fear of the consequences of acting inRead More Character Comparisons of Winston vs. Guy in Fahrenheit 451 and 1984882 Words   |  4 PagesWinston Smith vs. Guy Montag The two protagonists in Fahrenheit 451 and 1984 both started out somewhere, following the rules and doing what they were told, and towards the end of the book you see them change and become completely different people. In 1984, the reader experiences a nightmarish world that Orwell imagines through the eyes of the protagonist, Winston Smith. In Fahrenheit 451, the protagonist, Guy Montag is on a desperate search to find and understand his own life and purpose. TheseRead MoreAnalysis Of Fahrenheit 451 By Ray Bradbury And 1984 By George Orwell1784 Words   |  8 PagesMENTALITY OF CONFORMITY The societies in Fahrenheit 451 by Ray Bradbury and 1984 by George Orwell clearly show the serious effects of conformity. Despite the lack of freedom to think independently, both societies maintain their general happiness. Conformity is the most common and most persuasive form of social influence. The matching of attitudes, beliefs, and behaviors are signs of conformity. It has become an unconscious, natural part of everyday life; however, it has been occurring for centuriesRead MoreComparing Dystopic Worlds in George Orwells 1984 and Ray Bradburys Fahrenheit 451.2257 Words   |  10 Pagesimage of utopia, and yet to the reader seems like a foreign, inhumane residence dominated by an all-powerful government. George Orwells 1984, and Ray Bradburys Fahrenheit 451 depicts two different dystopic worlds. The settings of both books are different and the characters are unique; however, both of these books are also very similar. 1984 and Fahrenheit 451 are similar dystopic literatures by a common theme of censorship in which the government withholds or censors information, by a similar thread

Collectivism Enforced by the Government Free Essays

Synthesis Essay Halley Dunlop In the books, Anthem, Fahrenheit 451, Harrison Burgeon, and the movies The Hunger Games, and Wall-E, the government contains all of the people to make them equal. They strictly control the societies and allow no differences. Within all of these sources, there are certain individuals who choose to rebel against their government, but with rebellion comes the need to find yourself first. We will write a custom essay sample on Collectivism Enforced by the Government or any similar topic only for you Order Now The pitfalls of the quest for equality are the lack of individuality, inability to be creative, and lack of intelligence. One of the pitfalls is the lack of Individuality. In the book, Fahrenheit 451 by Ray Bradbury, Montage finds himself following the society because that Is the way that he grew up and he believes he is happy doing it. When Montage meets a girl, Claries, she began to help him come to realize that he was unhappy and that he must become an individual. â€Å"Darkness. He wore his happiness as a mask. (peg. 91†² This quote is important because it is the first time that Montage questions the way he is living, and the first time that he thinks about his Individual happiness. Because Claries Is already an Individual, she has to help Montage overcome the governments’ ewer of concealing his personality and help him to be himself. Also, in the book, Anthem by Any Rand, the government restricts all possible factors of being an individual. Equality attempts to showcase his invention of electricity to the council members, and they said, â€Å"What is not done collectively cannot be good. (peg. 73)† This quote is significant because it shows how council believes that any kind of individuality Is a crime. The government has drilled the idea of â€Å"we† Into the minds of their whole society to make sure they have no thoughts about themselves as individuals. In addition to the other books, Harrison Burgeon by Evensong, the government overtakes the society and forces them to wear handicaps so no one person is any better or worse than the next. This act of collectivism restricts all individuality. â€Å"She must have been extraordinarily beautiful, because the mask she wore was hideous. And It was easy to see that she was the strongest and most graceful of the dancers, for her handicap bags were as big as those worn by two- hundred-pound men. peg. 169)† This quote Is Important because It puts an image In our mind about how much the government tries to make sure that every man and woman is stripped of their own selves. Individuality is non-existent in this story because the handicaps given to the society do not allow them to have complete thoughts. The government believes th at when the people have complete thoughts, they might be thinking about themselves, or how to overthrow them, or how to escape their handicaps. In all of these books, collectivism Is present In the society to make it more difficult for someone to stand out, be different, or cause someone to be jealous. Equality, Harrison, and Montage are the ones who managed to overcome the government to make a statement and ultimately find who they really are and make themselves happy. The next pitfall of the quest for equality is the inability to be creative. When the government takes away the society’s individuality In Fahrenheit 451 , their ability to have creative thoughts and actions Is taken away a. â€Å"Stuff your It’s more fantastic than any dream made or paid for in factories. † This quote by Montage is basically stating that people should live how they want with no regrets. It goes along with the idea of creativity because your own wonders and dreams are ways of thinking creatively. Since that is not allowed in their society, it is considered a risk, so if they are living life as if they were to die in ten seconds, it would be better to have creativity in that time instead of sitting around and watching TV and being anti- social. In addition to that example, in the book Anthem, when Equality is in the Home of the Infants, he explains how everything was plain and boring. â€Å"The sleeping halls were white and clean and bare of all things, save one-hundred beds. peg. 2)† This quote shows the reader how their society wants the children to grow up; plain and bare of all things. They do not want the wall painted colors, or the children to have toys because then they will start asking questions and that is not a part of their society. Creativity is an individual trait, and the collectivism in that book does not allow individuality. The final example o f a society that inhibits creativity is in the movie, The Hunger Games by Gary Ross, based on the book by Suzanne Collins. In the movie, Catkins Evergreen is a very creative girl, which makes her stronger than the there and therefore she is frowned upon by her opponents and the government. At the end of the movie, Catkins and her partner, PETA, are the only contestants left, but only one person can win. She uses her creativity and finds a way out of the government’s rules and makes sure they don’t get their way. Catkins pulls out poisonous berries and they were to either eat them, and have no winner, or Just threaten to eat them, so they could both win. This ties in to the pitfall because in her quest for equality, she found a loophole in the restrictions on creativity, but she will eater be punished for her actions. These examples show how the lack of creativity is a major set-back in a society. The final pitfall in the quest for equality is the lack of intelligence. In Fahrenheit 451, Mildred is a good example of how uneducated someone could be, in a society with collectivism. Mildred is completely under the spell that the government has cast over the society and she constantly is forgetting things. Education and individual intelligence is not a priority in their society; therefore everyone relies on their technology. Maybe you took two pills and then forgot and took two more, and forgot again, and were so dopey you kept right on until you had thirty of forty of them in you. (peg. 17)† This quote shows how Mildred can be senseless to the point where she can’t recognize when she is putting her life in danger. This is an issue because in order to find equality, one must have the brains and be able to rely on their own instincts. Also, in Anthem, intelligence is allowed to some people but not to others. Equality wants to be in the Home of the Scholars, but because he is so smart, the nuncio makes him a street sweeper which involves no intelligence at all. â€Å"We would accept of life mandate, and we would work for our brothers, gladly and willingly, and we would erase our sin against them, which they did not know, but we did. (peg. 25)† When Equality says that, he shows that he is accepting the Job that the council has given him, but he is not necessarily happy about it. He wants to expand his intelligence but he can’t because the government no longer allows him to do studies. When he said, â€Å"erase our sin against them†, he is talking about the fact that he was society. The last example of how the government causes their society to lack intelligence comes from the movie Wall-E. In the movie, the move all of the people into space because the earth is no longer able to sustain human life. The captain, who is like the government but only for the spaceship, does not give the people on the ship information about earth. They are completely oblivious to the fact that Earth has been destroyed. This ties along to the other books because of how the influence of the government can make people so clueless. Hunger Games, and Wall-E, the collectivism that is enforced by the government intros and brainwashes the society. The three major pitfalls while looking for equivalence and equality are the lack of individuality, inability to be creative, and lack of intelligence. Without individuality, you cannot be creative. When you do not have creativity, you have no way of being truly intelligent. These three pitfalls cause a domino effect because without one, you cannot have the other. This is why the societies in the stories are not functioning the way they should, and is also why people are chose to disobey the government. How to cite Collectivism Enforced by the Government, Papers

Economics problems free essay sample

What is the effect on the equilibrium price and equilibrium quantity of orange juice if the price of apple juice decreases and the wage rate paid to orange grove workers increases? Apple juice and orange juice are substitutes for consumers, so the fall in the price of apple juice decreases the demand for orange juice. The demand curve for orange juice shifts leftward. The increase in the wage rate paid to orange grove workers raises the cost of producing orange juice. The supply of orange juice decreases and the supply curve of orange juice shifts leftward. The net effect of these events decreases the equilibrium quantity but has an undetermined effect on equilibrium price. If supply decreases by more than the demand, the shift in the supply curve is greater than the shift in the demand curve and the equilibrium price rises. If demand decreases more than the supply, the shift in the demand curve is greater than the shift in the supply curve and the equilibrium price falls. We will write a custom essay sample on Economics problems or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page 3. What is the effect on the equilibrium in the orange juice market if orange juice becomes more popular and a cheaper robot is used to pick oranges? Because orange juice becomes more popular, demand increases and the demand curve for orange juice shifts rightward. The cheaper picking robot lowers the production costs of orange juice, so the supply of orange juice increases and the supply curve of orange juice shifts rightward. The equilibrium quantity increases. But the effect on the equilibrium price is ambiguous. If the change in supply is greater than the change in demand, the shift in the supply curve is greater than the shift in the demand curve and the equilibrium price falls. If the change in demand is greater than the change in supply, the shift in the demand curve is greater than the shift in the supply curve and the equilibrium price rises. The table shows the demand and supply schedules for greeting cards. Use the table to answer exercises 4 and 5. 4. If the price of a greeting card is $7. 00, describe the situation in the market. Explain how market equilibrium is restored. At the price of $5. 00, the quantity supplied equals the quantity demanded. At a price of $7. 00, the quantity demanded is 120 greeting cards and the quantity supplied is 160 greeting cards. There is a surplus of 40 greeting cards a week and the price falls. As the falls, the quantity demanded increases, the quantity supplied decreases, and the surplus decreases. The price falls until the surplus disappears. The market equilibrium occurs at a price of $5. 00 and 140 cards a week so the price falls to $5. 00 a greeting card. 5. If new audio greeting message (sent via cell phone) becomes popular and at the same time the cost of producing greeting cards falls, set out the three-step process of analysis and show on a graph the adjustment process. How does the price and quantity of greeting cards change? The new audio greeting message affects the demand for greeting cards. The demand for greeting cards decreases because greeting cards and audio greeting cards are substitutes. The demand curve for greeting cards pads shifts leftward, from D0 to D1 in Figure 4. 6. Simultaneously the fall in the cost of producing a greeting card affects the supply. The fall in the cost of producing greeting cards increases the supply and the supply curve shifts rightward, from S0 to S1 in Figure 4. 6. At the initial price of a greeting card, $5.  00 in Figure 4. 6, there is a surplus of 60 greeting cards per week. The surplus forces the price lower, so the equilibrium price of a greeting card falls, to $2. 00 in the figure. The effect on the quantity of greeting cards, however, is ambiguous. If the magnitude of the decrease in demand exceeds that of the increase in supply, the quantity of greeting cards decreases. If the magnitude of the increa se in supply exceeds that of the decrease in demand, the quantity increases. And, if the magnitudes of the changes are the same, as in Figure 4. 6, the quantity of greeting cards does not change.

Multi Layered Psychosocial Care Package †MyAssignmenthelp.com

Question: Discuss about the Multi Layered Psychosocial Care Package. Answer: Introduction Different but related readings were selected and their nature and purposes explored. The authors and intended audience of all the readings were also identified. The analysis of the main themes was also don in relation to personal experiences and interests. Strengths and possible gaps of the literatures provided were also explored in relation to the issue at hand. Practice driven evaluation of a multi-layered psychosocial care package for children This is a research paper that portrays an evaluation of four conflict affected countries that are hit by a multi-layered psychosocial and mental health care delivery framework. This is achieved through various levels involving multiple filters to the arrival of the last stage(Sommers-Flanagan, J., Sommers-Flanagan, R., 2014). The different levels include; Level 1- the population that I affected by violence Level 2- children who go to school and are exposed to the consequential risk at hand Level 3- children with severe psychosocial problems being divided into sub groups Level 4- training paraprofessional to take care of the affected children by administering the desired treatment to them. Level 5- treating children with disorders This was a technique that was used to select the children with mental and psychosocial disorders and help them out(Alisic, E., Conroy, R., Magyar, J., Babl, F. E., O'Donnell, M. L., 2014). This is a project report. This is due to its nature and the fact that its a reportshowing the implementation of a given proposal that was insinuated to enhance the improvement of that particular situation ofchildren who were exposed to mental and psychosocial disorders due to violence in their countries. The author is the project manager who ensured the implementation of the project. The donor-in this case it is the PLAN Netherlands since they made funds available for the implementation of the project. The governments of the recipient four countries; where the project was implemented because they had to get a copy of the report afterthe implementation. Themes Utilization and evaluation of care package This care package encompasses of five different levels that were used to care for children with mental and psychosocial disorders in the four countries affected by conflicts. Selection and admittance to varying levels of care The concerned children who are put in sub groups are examined, and the hugely affected ones are put under the necessary therapy and given the best care until they get better(Hotham, S., Hamilton-West, K. E., Hutton, E., King, A., 2014). Treatment related criteria This includes the result of the treatment, perception of the treatment outcome and the treatment burden. Questionnaires and interviews are conducted for this purpose to come out with a desirable outcome(Okun, B., Kantrowitz, R., 2014). Strengths/gaps The main strength of this reading is that the authors have portrayed the kind of help and service that should be given to children with various disabilities and disorders. They discuss the types of initiatives that should be taken into consideration to ensure that the parties involved get all the care they need. Counseling psychology quarterly This is a case study in counseling psychology that tends to improve the informal and embedded ways counseling by the non-qualified practitioners like the nurses, teachers and the social workers. This is brought about by the ability of the service users to open up quickly to them. Research has proved that it is the most significant form of counseling that people receive and so critical resources should be executed so as to enhance the quality of counseling sessions by the practitioners in other fields like education, social work and other professions so as to contribute effectively in the health and well-being of the service providers(Chui, H., Ziemer, K. S., Palma, B., Hill, C. E. . , 2014). This is an article that has been published by counseling professionals with vast experience in counseling. It contains counseling skills and knowledge that is relevant to both the service providers and the service users(Hill, C. E., Kline, K., Bauman, V., Brent, T., Breslin, C., Calderon, M., ... Kuo, P. , 2015).The author of this article is John McLeod and Julia McLeod. John McLeod is a psychology professor who is the author of many books and articles in psychotherapy and counseling. Julia McLeod is a counseling lecturer and is co-author of counseling skills. The intended audience of this article is the psychology practitioners, trainers and researchers. The article provides important counseling skills that enhance the quality of counseling sessions and highlighting the challenges to be encountered by the service providers(Chan, F., Thomas, K. R. (Eds.). , 2015). Themes: Scope and extent of embedded counseling Survey research has shown that many people seek emotional support from the non-qualified counseling practitioners like the clergy, nurses and teachers hence they deal with a broad range of emotional problems like marriage problems, stress and inability to perform tasks. Practitioners perspectives on the experience of using counseling skills The practitioners are normally faced with a variety of challenges in the course of counseling since they deal with a wide range of difficult clients. Furthermore, some clients have difficulty in controlling their tempers and emotions. For this reason it is crucial to possess the counseling skills and the need to be empathetic. Issues associated with the challenge of responding to expression of emotions The practitioners find difficulty in responding to the emotional communication of the service users and do not know when exactly to distract. It requires the practitioner to provide a response that will be memorable to the service user and in as much as it will be of help(Greenberg, L. S. . , 2017). Qualities of helpful and unhelpful embedded counseling conversations Embedded counseling has been of great importance in portraying the difference between helpful and unhelpful counseling conversations. It is determined by the effectiveness of the counseling session and how useful the client finds the conversation meaningful and helpful in the long run (Wang, 2015). Strengths/gaps The reading portrays a major strength of the uses of numerous counseling skills provided by the non-qualified professionals like the teachers, nurses and members of the clergy. The study emphasizes that the public identifies more with the non-qualified staff as they can help them cope with social and emotional issues hence reducing stress. Journal of applied research in intellectual disabilities This is a journal article that was generated as a result of a study involving staff members on working with people with intellectual disabilities before and after bereavement. This was arrived at due to the increased mortality rates and the ageing population. It was therefore realized that their reaction was not any special from those of others and that they did not only suffer the loss of death(Heller, T., Fisher, D., Marks, B., Hsieh, K. , , 2014). Consequently staff had positive attitude grieving with people who had intellectual disabilities just like other people. It was still acknowledged that they experienced different post death behavior as well. This is a journal article that focuses on supporting adults with intellectual disorders during experiences of loss and bereavement through suggestions from staff and training activities. The author of this journal is John McEvoy. The audience includes the adults with intellectual disability as it show them how to deal with bereavements. The staffs of given organizations so that they can be able to go through the training needs and implement them when dealing with people with intellectually disabilities are also an appropriate audience. Themes: Factors affecting post bereavement adjustment This encompasses the type of relationship if was so close or not, the type of disability involved and the post death involvement and the pre death involvement which affects the party involved so much if at all there was either of the two. Family This involves the role that the family has to play as a result of the loss like communicating to friends and other family members who may not be around, honoring the wishes of the dead if there was any and most importantly the ability to work hand in hand as a team and avoiding unnecessary conflicts that may arise(Beadle?Brown, J., Mansell, J., Ashman, B., Ockenden, J., Iles, R., Whelton, B., 2014). Role of staff in supporting the bereaved Put aside the personal and professional conflicts in time of death so as to help the bereaved overcome the situation with ease and less stress. Engage the individual so that he or she can understand what has happened and give the colleaguemore support. Strengths/gaps They have portrayed how the service users find it easy to confide in other practitioners due to their day to day interactions like a teacher and a student or a nurse and a patient other than seeking professional counseling(Barker, C., Pistrang, N. , 2015). Some gaps can also be identified in cases of non-professional counseling whereby the practitioner is not in real sense but advising. The practitioner finding themselves sympathizing other than empathizing with the service users hence may end up being carried away with emotions especially during communication hence reducing chances of professional support. Conclusion I agree with the authors of the above readings since they have done a significant work in the field of psychosocial counseling impacting positively on the service users at no cost and providing relevant information to the service users on how to deal with some special cases in that field. They have also given a basis of counseling skills and relevant trainings that are applicable in different mental disorders and psychosocial disabilities. Bibliography Alisic, E., Conroy, R., Magyar, J., Babl, F. E., ODonnell, M. L. . (2014). Psychosocial care for seriously injured children and their families: A qualitative study among Emergency Department nurses and physicians. . Injury,, 45(9), 1452-1458. Barker, C., Pistrang, N. . (2015). Research methods in clinical psychology: An introduction for students and practitioners. . Beadle?Brown, J., Mansell, J., Ashman, B., Ockenden, J., Iles, R., Whelton, B. (2014). . Practice leadership and active support in residential services for people with intellectual disabilities: an exploratory study. Journal of intellectual disability reserach, 58(9), 838-850. Chan, F., Thomas, K. R. (Eds.). . (2015). Counseling theories and techniques for rehabilitation and mental health professionals. .Springer Publishing Company. Chui, H., Ziemer, K. S., Palma, B., Hill, C. E. . . (2014). Peer relationships in counseling psychology training.,. Counselling Psychology Quarterly, 27(2), 127-153. Greenberg, L. S. . . (2017). Emotion-focused therapy of depression. . Person-Centered Experiential Psychotherapies, , 1-12. Heller, T., Fisher, D., Marks, B., Hsieh, K. , . (2014). . Interventions to promote health: crossing networks of intellectual and developmental disabilities and aging. . Disability and health journal, 7(1), S24-S32. Hill, C. E., Kline, K., Bauman, V., Brent, T., Breslin, C., Calderon, M., ... Kuo, P. . (2015). Whats it all about? A qualitative study of meaning in life for counseling psychology doctoral students. Counselling Psychology Quarterly,, 28(1), 1-26. Hotham, S., Hamilton-West, K. E., Hutton, E., King, A. . (2014). An evaluation of a postural care training package: Improving self-efficacy in parents and teachers who care for a physically disabled child. Okun, B., Kantrowitz, R. . (2014). Effective helping: Interviewing and counseling techniques. . Nelson Education. Sommers-Flanagan, J., Sommers-Flanagan, R. . (2014). Tough kids, cool counseling: User-friendly approaches with challenging youth. . John Wiley Sons. Wang, K. T. (2015). Research design in counseling. . Nelson Education.