The PEACE Domestic Violence Agency Summary Essay Example for Free

The PEACE Domestic Violence Agency Summary Essay Introduction It was not that long ago that what transpired at home was considered a secretive, a personal matter and was not looked at by the public. Within the last few years, there has been an rise in awareness of the importance of child abuse and negligence, spouse/partner mistreatment, and elder cruelty not only as serious societal problems but also as crimes. The PEACE Domestic Violence Agency was step up to help individuals break through the barriers. Overview of the Program The PEACE Domestic Violence Agency is a non-profit organization that is based out of Portland Oregon. With this program, they will empower survivors, promote recovery through direct services, and reduce victim trauma. They will support the health of their clients. Along with providing help for the young people whom have been in the legal system, and reduce the prevalence of domestic violence through increased service provision, awareness, and education. Assessment Assessments are an important tool for any organization especially for the PEACE agency they are used to expand their abilities to obtain future funding, validate its accountability, fulfill objectives, and enhance its operation. For the PEACE agency, using an empowerment approach will help program staff to understand the effectiveness of the program in which they serve by assessing the clients’ observation of the program activities, identifying the program’s long-term impact, the progresses, success, and by monitoring the activities to validate the program’s accomplishments. An effective project evaluation plan will recapture the program’s purpose and  will guarantee the PEACE Domestic Violence Agency can continue to accomplish its mission by reducing the incidents of domestic violence and help to promote recovery through education and awareness. Needs and Problem Statement The specific aims is one of the many steps the PEACE Agency will need when requesting a grant. This piece includes as subcategories of the needs and problem statement. This is where the PEACE Domestic Violence Agency will express the importance of knowing what they are doing and why they are doing it. They should state how the city of Portland is experiencing increasing reports of spousal and child abuse, assault, and incidents of road rage, domestic and youth violence, and the effects it has on the people. Then they will summarize how their direct services and education will help the target these areas. A needs and problem statement should be something like this, â€Å"It was not that long ago that what happened at home was considered a private, family matter and was excluded from scrutiny by the public. Within the last few decades, there has been an increase in awareness of the seriousness of child abuse and neglect, spouse/partner abuse, and elder abuse not only as critical societal problems but also as crimes.† When it comes to a literature review this is where data is used to fill and rational what is happening. It tells the history and the current views of the problem or need in order to give the reader a better understanding and appreciation of the problem or need. Program Planning According to our reading, program planning is an organized process where a set of coordinated activities or interventions is developed to address and facilitate change in some or all of the identified problems. (Yuen/Terao, 2003) Program planning is something that never stops every organization uses program planning to continually make thing better. Every organization uses program planning to develop their current program and new programs. All programs planning it is important that you have a goal set bases on the needs and the problems that you are trying to work on. Our text also states, â€Å"Program planning not only concerns what will happen, it also involves the assessment of what has happened and what really would have happened. It is by design and by its very nature related to needs assessment and program evaluation. Needs or problems assessment is the necessary and fundamental  step for any successful program planning.† (Yuen/Terao, 2003) â€Å"A program and evaluation of a program are not separate activities. When planned carefully, these two set of activities can be integrated into an organized set of ongoing operations that promote and support each other.† (Mika, 1996, p. 6) Alternative Funding The PEACE Domestic Violence agency needs to look at way to find funding especially when detecting the demanding needs of funding and present unbearable conditions. The PEACE Domestic Violence agency normal gets their funding form grants issued by the National Foundation funding Program. With this funding, the agency will move forward and continue to make an effort when they are trying to reach its objective which is promoting the safety of young men, women and children whose lively-hood not on relies on it, nevertheless they are subjective by domestic violence on a day to day basis. The objective is to lessen the numbers of domestic violence attach through education, heightened awareness, and service requirement. The PEACE Domestic Violence agency will always want to continue submitting applications to their â€Å"Stakeholders Program†. When it comes to a funding course that is set up to supporting many other businesses that are under the same objective within the Supporting F amilies plan this takes about three years and can produce $150,000 yearly. Implementation When someone wants to build a human service organization, they will need the data collected from numerous programs with the initial organization planning. They will need to provide objectives for issues that surround the project and an outline of how to ultimately reach the goal of building this system for an operational organization that is attributed by many stages such as: Phase I: Categorized documentation of instructions for the project Law enforcement cases of any domestic violence statistics for the region, the targeted culture, or ethnicity, age group, and complaint numbers for issue (HHS, 2014). Phase II: Member forms a quantitative research data for the project to commence. Phase III: Gather information for the victims who contributed in the study along with any criticism to decide a cause or constancy. Phase IV: A series of ethnographic inquiries of incidences that will need to be used in future projects that intention to qualitative data  research taken in long-term views to provide the efficiency of the programs. Phase V: Logs of all activity, related documents, meetings, project bids for the quantitative data analysis for its demographic approach. Furthermore, the recovery in the evaluation team, they will look into the damage peace, the internal perspective of a clinician practitioner, and a psychological expert. (HHS, 2014) The PEACE of Domestic Violence agency will make sure the confidentiality of the facts given by the individual in the study, and the supervisor stores all the data on files only for the evaluation team to view. There are legal things that need complying with along with ethics and processes that the state requires. The foundation of the budget report having the monthly expenses being seven thousand dollars that will pay off short-term employees of one manager and six employees, victim resources, and office supplies. There will be a forty percent grant to help the organization of the Stakeholder Program covering an annual seventy one thousand dollars. Regarding the need supporting the assets and the catastrophic, the agency needs the National Foundation for its organization aid. The agency will promotes safety for domestic violence victims and their families and aid each potential avenue that supports the objective. There will be fewer incidences of violence with the implementing of positive education, and precautionary training. The PEACE agency will continue with an investment for the program, by providing support given by separate corporations for the supportable program that will cover three years and roughly one hundred twenty five thousand dollars per year. The PEACE Domestic Violence Agency recommends the grant to cover the costs of servicing, administration, and population parameters. The money for the infrastructure of the organization resources include; operating costs, wage compensation, transportation, and legal assistance (HHS, 2014). Evaluation The evaluation plan for the PEACE Domestic Violence Agency will be a project-wide evaluation using the empowerment methodology. This form of evaluation plan will work seamlessly with the agency’s domestic violence program since it provides structure for the big picture and focuses on the tenacity of the program. As well as it involves program staff in the evaluation development and implementation, this enables them to feel invested in the program. The first phase in developing this type of plan is  to â€Å"identify the answer to the big question†. (Yuen Terao, 2003, p.53) Therefore, in the case of the PEACE agency, it would be finding out whether or not the instances of domestic violence can be reduced and in what way. Another question could be whether educating people about domestic violence plays a key role in stopping it. Our evaluation plan will include both process and outcome evaluation by getting the papers of activities made, and assembly the material from a wide-ranging of sources to allow the agency to indicate â€Å"what benefits were achieved as a result of the services provided† (Yuen Terao, 2003, p.53). PEACE Domestic Violence Agency is going to have to evaluate what programs are helping these families and individuals on monthly bases. If there is part of their program that is not helping or that could us more focus they need to know as soon as possible this way they can focus on other things. An example would be if the there is not a prison they may not need to focus as much on the helping of prisoner families compared to the crime has gone up in the area over domestic violence so they need to focus more on those programs within their organization. Knowing where to focus their strengths in is most agencies battle therefore good planning and evaluations it where you need to really pay close attention to. Conclusion Each year, too many people have been affected and are still being affected by violence, abuse, and rage. According to Rotary Club of Portland, â€Å"more than 1 in 3 women and 1 in 4 men in the U.S. are physically, emotionally, or sexually abused in their lifetime. Domestic violence affects people of all ages, race, ethnicity, socio-economic status, and sexual orientation. You have already met numerous survivors of abuse. They are all around you.† (Designs, 2012) Statistics like these can be found all over the country but ever since the factories shut down, the residents of the city of Portland have experienced a higher increase of such incidents. Ignoring this sudden steady increase of violence, abuse, and rage in the city of Portland will destroy the families that make Portland what it is. The children will grow up witnessing all types of violence and abuse and will increase their likelihood to become abusers themselves. Stepping in now will help teach the community that domestic abuse is not acceptable for any reason. The victims of abuse will have help in recovery and a chance to break the cycle from continuing on to the next generation. There has been some success in  decreasing incidents of abuse through education. Counseling has also been effective in helping victims become survivors. These methods will be successful in Portland as well. The PEACE Domestic Violence Agency intend to add some self-help classes to overcome potential barriers of culture and stress but our most promising intervention will be our shelter. This will provide a way out for the victims who feel trapped. References Designs, E. (2012). Domestic Violence Solutions . Retrieved May 31, 2014, from Rotary Club of Portland: http://rotarypdx.org/outreach/service/domestic-violence-solutions HHS. ( 2014). Retrieved from Department of Health and Human Services of maltreatment child exploitation: http://www.childwelfare.gov/pubs/reslist/rl_dsp.cfm?rs_id=21rate_chno=19-00044 Yuen/Terao. (2003). Practical Grant Writing and Program Evaluation,. Brooks/Cole.

Clinical case scenario assignment

Clinical case scenario assignment The impact of oral conditions on an individuals quality of life can be profound, more so when they are increased risk patients such as the elderly or those with Down syndrome. These individuals experience the same dental problems as the general population; however, poor oral health may add an additional burden, whereas good oral health has benefits in that it can improve general health, social acceptability, self-esteem and quality of life (Fiske, Griffiths, Jamieson, Manger, 2000). When formulating an oral health care plan for higher risk patients, it is valuable to have a general knowledge of how to treat such cases. This assessment will explore two clinical case scenarios and the process through which each treatment plan is developed. Furthermore, the importance of providing a patient with quality care, rather than merely treatment, will be explored. CASE 1 Appointment 1: Complete Initial Assessment Take medical history According to Duggal, Hosy, and Welbury (2005, p.42), taking a comprehensive case history is an â€Å"essential prelude to clinical examination, diagnosis, and treatment planning†, and also plays a role in establishing a relationship with the patient. In this case the patient is a thirteen year old female with Down syndrome, a genetic disorder that ranges in severity with unique characteristics that can influence dental care (Pilcher, 1998). It is associated with physical and medical conditions such as cardiac defects, compromised immune system, and upper respiratory infections (MacDonald Avery, 2000). Dental consideration The history reveals that the patient received surgery for a cardiac abnormality at birth, and does not require antibiotic cover for dental treatment. The National Heart Foundation of New Zealand (2009) state that antibacterial cover is given as a prophylactic measure to prevent endocarditis; a serious and potentially fatal infection that affects the endocardium when bacteria is transported through the blood stream from the mouth because of dental work. Although prophylaxis is not necessary, consultation with the patients physician is crucial to determine any underlying medical conditions that concern her dental treatment. According to Pilcher (1998) the eruption of teeth in persons with Down syndrome is usually delayed, may occur in an unusual order and there is an extremely high rate of missing teeth in both the primary and permanent dentitions. Therefore, it is important to maintain the primary dentition for as long as possible. Additionally, The National Institute of Dental and Craniofacial Research (NIDCR) (2010) state that patients with Down syndrome can experience rapid destructive periodontal disease thought to be a result of their lowered host immune response. Other related factors include abnormal tooth morphology with an increased likelihood of smaller or conical roots, bruxism, malocclusion, and poor oral hygiene (Boyd, Quick, Murray, 2004). Therefore, good homecare is vital to manage periodontal disease and carious lesions. The mental capability of people with Down syndrome can vary widely (NIDCR, 2010), which is why as a health professional it is important to perceive how much information the patient is able to comprehend. Education should be given to the family and caregiver to ensure optimal homecare is provided. Plaque index Taking a plaque score is a quick and useful way for a dental provider to assess oral hygiene by estimating the tooth surface covered with debris and/or calculus (Wilkins, 2009). The patient has plaque deposits along the gingival margins of many tooth surfaces and calculus deposits on the lingual surfaces of the lower anterior teeth indicating poor oral hygiene. Periodontal probing It is described that the patient has red and inflamed gingival tissues with the worst area associated with the upper anterior teeth. This is likely to be a result of mouth breathing which is common in patients with Down syndrome due to a small nasal airway and incompetent lips (Pilcher, 1998). Periodontal charting will determine whether the condition is gingivitis which is reversible or periodontitis. If there are periodontal pocket depths greater than 3mm, bone loss and root surface involvement, a more extensive treatment will be required (Wilkins, 2009). Record examination and dental charting Upper permanent lateral incisors appear to be absent Upper deciduous canines show no mobility permanent canines not visible Mesial marginal ridge of 75 broken down as a result of dental caries and is symptomless Fistula buccal to 74 Permanent incisors and first molars show signs of mild to moderate hypoplasia Radiographs Bitewing radiographs should be taken to check for bone levels, calculus, overhangs of restorations, and carious lesions in the posterior teeth. An orthopantomogram (OPG) will determine the presence and position of permanent teeth and assess growth and development as well as other pathology (Cameron Widmer, 2003). Additionally, a periapical radiograph will be necessary for pre-operative assessment of tooth 74 and 75 to determine the origin of the fistula. Diagnosis Abscessed tooth (74 or 75 depending on radiographs) 75 has dental caries with pulpal involvement Periodontal disease (depending on pocket depth) Differential diagnosis: Severe plaque-induced gingivitis or Chronic periodontitis Mild to moderate molar incisor hypomineralisation hypoplasia Oral health education and instruction The patient has poor plaque control and therefore should be taught brushing and flossing techniques using the tell/show/do method so the dental provider can see how well the patient and parent or caregiver understand what is being instructed. She should be advised to brush at least twice a day and floss daily, as well as brush the tongue and gingiva. The use of an electric toothbrush and floss holders should be recommended as those with Down syndrome often have limited manual dexterity (Sacks Buckley, 2003). Additionally, a high concentration of fluoride such as Neutrofluor 5000 Plus toothpaste is recommended for daily use by patients with high risk of dental caries which Wilkins states will promote remineralisation and help strengthen the teeth (2009). Dietary advice Diet should be discussed with a focus on finding if the patient has a lot of sugar in her diet and educating her on the effects of cariogenic foods, perhaps using Stephans curve to explain depending on her level of understanding. The patient should be encouraged to eat cheese, unsweetened yogurt, milk and other dairy products as they contain calcium, phosphorous and magnesium which helps protect dental health (The Dairy Council Digest, 2000). Moreover, sugary and acidic drinks should be minimised as they can cause enamel erosion. It is vital the parent or caregiver receive this information as they may have a significant influence over her diet and pamphlets taken home to serve as a reference or reminder. Formulate a treatment plan Cameron and Widmer (2003, p. 6) state that treatment should be performed in the following order: (1) Emergency care and relief of pain, (2) preventive care, (3) surgical treatment, (4) restorative treatment, (5) orthodontic treatment, (6) extensive restorative or further surgical management, and (7) recall and review. Once this has been completed it should be discussed with both the patient and her parents or caregiver and informed consent must be given. Appointment 2: The amalgam restoration in the 74 is described as appearing sound but there is a fistula present buccal to the tooth. A fistula is a channel allowing excess exudate to drain from an abscess (Ibsen Phelan, 2004). Although this can be painless, it is considered an emergency and should be dealt with before any dental treatment. It is likely that the fistula is related to the 75 which is broken down due to dental caries. When the marginal ridge of a primary molar is broken down due to dental caries, the pulp is consistently exposed (Cameron Widmer, 2003). Although the 75 is described as symptomless, this may be because the drained exudate is relieving pressure from inside the tooth meaning it is less likely to be painful. If the PA radiograph confirms that the carious lesion on tooth 75 has pulpal involvement, it will be treated with either pulpectomy or extraction. Pulpectomy: If tooth 35 is not present, the 75 should be preserved and a referral to a dentist to perform root canal therapy will be given. It is advised that a stainless steel crown be placed as according to Cameron and Widmer (2003) this is the strongest possible final restoration following pulpectomy and will be necessary to preserve the 75 for as long as possible. Extraction: If 35 is present, the 75 should be extracted. However if 35 is not ready to erupt, a space maintainer is recommended to preserve the gap after extraction of 75 to prevent the adjacent teeth drifting into its space. This will enable the 35 to erupt in the proper position and prevent malocclusion in the future and will require a referral to an orthodontist. The amalgam restoration on tooth 74 appears sound and depending on radiograph results, if there is no abscess on tooth 74 and 34 is present, no treatment is needed on this tooth. If there is abscess on 74, the same treatment for abscessed 75 is indicated. Appointment 3: Reassess oral hygiene: Reinforce good behaviour and make necessary recommendations for continual improvement. Scale and polish: The aim of this is to remove as much bacteria from the oral cavity as possible and have a healthy mouth to perform restorative work in. According to Stefanac and Nesbit (2001), when planning treatment, it is sensible to put the least invasive treatments first when possible so that the patient can familiarise themselves with the dental setting and feel comfortable. (Pilcher, 1998) states that having a patient with Down syndrome that is relaxed and at ease can assists with cooperation in the chair and useful for future appointments. Hypoplasia: The permanent incisors and first molars are described as having mild to moderate hypoplasia. Enamel hypoplasia is a deficiency in quantity of enamel that results in a defect of contour in the surface (Cameron Widmer, 2003). This defect can cause tooth sensitivity, may be unsightly and more susceptible to dental caries. A compromised immune system is a characteristic of most individuals with Down syndrome which contributes to a higher rate of infections (Pilcher, 1998) and it is possible that the hypoplasia is related to the patients condition. Because of the teeth involved, this is likely to be Molar Incisor Hypomineralisation (MIH) which is defined as a hypomineralisation of systemic origin of one to four permanent first molars frequently associated with affected incisors (Weerheijm, 2003). It is important that MIH be treated as soon as identified to minimise the heightened risk of dental caries and prevent the patient from experiencing tooth sensitivity. Treatment options depend on the severity of the hypoplasia and the symptoms associated with it (University of Iowa, n.d.). It should be noted that the worst area of inflamed gingival tissue is associated with the upper anterior teeth which could be a result of the patient avoiding these as they are sensitive or painful to brush. It may be useful to ask the patient about this so that education can be given on the importance of brushing all areas and the problem can be addressed. In this case scenario, the most effective treatment would be the application of a fluoride varnish to the hypoplastic areas followed by resin-based sealants. Alternatively, if ideal moisture control cannot be achieved, glass ionomer sealant can be used. According to Subramaniam, Konde, and Mandanna (2008), the retention of resin sealant is seen to be superior of that of the glass ionomer which should be treated as temporary only. Cameron and Widmer (2003) explain that localised defects may be restored with composite resin and pitting defects may require stain removal with either rotary instruments or some sort of bleaching system. Furthermore, if there is sensitivity, the use of tooth mousse products should be advised to assist with remineralisation and desensitisation of the teeth (Walsh, 2007). Appointment 4: Remove IRM: Although the temporary restoration on tooth 65 is sound, it should be replaced with a permanent filling as Mount and Hume state that zinc oxide eugenol hydrolyses in time and should not be used for over six months (1998). Additionally, composite should not be used because the release of eugenol will inhibit the polymerisation of the composite resin (Mount Hume, 1998). Therefore, an amalgam restoration should be placed on tooth 65 if the radiograph shows tooth 25 is present. If the permanent successor is not present, the temporary restoration should be replaced with a permanent restoration like a stainless steel crown and may require pulpotomy depending on how far the carious lesion has progressed in the tooth. Recall: A three month recall should be arranged as the patient is high risk for caries and periodontal disease. It is essential that optimal oral hygiene is maintained and well monitored by the dental practitioner. CASE 2 The human needs of each older adult must be assessed individually and not based on preconceived stereotypes as the healthcare needs of elderly persons can vary from health to severe illness (Darby Walsh, 2010). According to Fiske et al. (2000) there is a general trend for a reduction in edentulism and an increase in the retention of natural teeth. This attitude leads to more people wanting to understand how to best maintain good oral hygiene and it is the role of the dental provider to assist these individuals with appropriate educational instructions. In this clinical case scenario the patient is an 81 year old man who comes to the clinic for dental hygiene care. Appointment 1: Complete Initial Assessment Take medical history The patient shows early signs of Parkinsons disease; a progressive neurodegenerative disorder of neurons that produce dopamine (Little, Falace, Miller, Rhodus, 2008). Loss of these neurons results in characteristic motor disturbances including a resting tremor, muscular rigidity, bradykinesia and postural instability. It is common for those with Parkinsons disease to also experience xerostomia as a result of polypharmacy and is significant as this increases the risk of periodontal disease and coronal and root surface caries (Wilkins, 2009). It is described that the patient has mild congestive heart failure which The American Heart Association (2011) state is the inability of the heart to supply sufficient blood flow to meet the needs of the body and can be a result of myocardial infarction and other forms of ischemic heart disease, hypertension, valvular heart disease, and cardiomyopathy. As the heart failure is mild, he will not require antibiotic prophylaxis for dental treatment however it is wise to confirm this with his physician. The patient is taking nitroglycerin tablets under the tongue to relieve chest pain several times a week. It is taken sublingually for immediate relief of chest pain by reducing the oxygen need of the heart and may cause dizziness, light-headedness and fainting and may cause xerostomia (Medline Plus, 2011). The patient has stiffness in the fingers of his dominant right hand due to arthritis; an inflammatory or degenerative process which involves the joints (Arthritis Foundation, 2011). Patients with arthritis may experience pain, swelling, limitation of motion and deformity of the joints and may find it difficult to keep an open mouth for long dental procedures. Oral hygiene assessment The patient has poor oral hygiene. It is likely that due to his arthritis which affects the fingers in his right hand, he is not adequately brushing quadrants 2 and 3. It should be noted that there are signs of abrasion lesions on the buccal surfaces of quadrants 1 and 4. Abrasion is the mechanical wearing away of tooth substance by forces other than mastication (Wilkins, 2009, p.272) and this is likely to be a result of the patient vigorously brushing horizontally. Furthermore, he has heavy plaque deposits on the lower lingual and all interproximal which indicate interproximal plaque removal methods must be instructed. Periodontal probing All periodontal pockets measure 1-3 mm except for 26 mesial with a probing depth of 4mm indicating generally good periodontal health. Record exam and dental charting 27 moderately filled teeth present with tooth 25 lost due to a fractured root Gingival recession is present with 1-2 mm areas of root surfaces exposed on most teeth. A couple of theses surfaces present with light brown marks that are soft to touch Tooth 26 shows sign of periodontal bone loss palatally as well as tipping and drifting forward into the space left by 25 Heavy plaque deposits on the buccal surfaces of quadrant 2 and quadrant 3 as well as lower lingual and all interproximal surfaces Very light plaque deposits on the buccal surfaces of quadrant 1 and quadrant 4 Some surfaces with light plaque show signs of abrasion Radiographs To complete the initial assessment, bitewing radiographs and an OPG should be taken. This can give the dental provider information on alveolar bone levels, plaque retention factors, interproximal and secondary caries, furcation defects, subgingival calculus and additional pathology (Tugnail, Clerehugh, Hirschmann, 1999). A periapical radiograph of tooth 26 is taken to examine bone loss and to check for subgingival calculus and root surface caries. Risk assessment The patient is at high risk of developing dental caries and moderate risk for periodontal disease due to his medical history. His lack of manual dexterity associated with Parkinsons disease and arthritis, makes adequate plaque removal difficult to achieve. Moreover, due to medications, he is more likely to have xerostomia which will increase his risk of periodontal disease and dental caries, especially root surface caries (Wilkins, 1999). Diagnosis Moderate plaque-induced gingivitis Localised moderate chronic periodontitis on tooth 26 due to tilting Generalised gingival recession Toothbrush abrasion Areas of root surface caries Oral health education and oral hygiene instruction Perhaps the most important treatment a dental provider can give is that of oral health education, information, promotion and counselling. This enables the patient to maintain good oral hygiene themselves and prevent further disease processes. In this clinical case scenario it is vital to advise the patient on homecare which will address his risks of dental caries and periodontal disease. According to Darby Walsh (2010) caries control and prevention activities must address three interrelated factors: (1) removal of bacterial plaque and biofilm, (2) reduction of refined carbohydrates and snacking in the diet, and (3) use of topical fluoride. The patients oral hygiene activities are compromised due to the arthritis in his right hand and in the future will be further affected by his developing Parkinsons disease. His poor oral hygiene should be addressed firstly by recommending the use of adaptive devices. Using a powered toothbrush and modifications of handle size, width, and grip, will provide assistance for the patient with thorough plaque removal. It should also be suggested that the patient use floss holders to ensure the effective removal of interproximal plaque or alternatively, interproximal brushes can be recommended if the patient is able to use them effectively. Poor dietary practices involving the over consumption of soft, retentive refined carbohydrates and frequent snacking patterns are common among older adults (Darby Walsh, 2010). The dental provider has an obligation to educate the patient on optimum food choices and nutritional patterns to promote oral health. It could also be beneficial to speak with any caregivers regarding the patients diet and make suggestions to prevent further carious lesions. Replacing sweet snacks with cheese and crackers or substituting sugar-free hard candy for mints are examples of two specific dietary interventions that may be more easily and realistically implemented for older adults. Furthermore, the frequent use of topical fluoride products for home use should be encouraged. A high fluoride toothpaste (5,000 ppm) will help to strengthen enamel and aid in the prevention of dental caries and will cause little change in the routine of the patient. For management of xerostomia, the patient is advised to take frequent sips of water and avoid the consumption of alcoholic drinks which will further dry out the oral mucosa. Sugar-free chewing gums will help stimulate the saliva but if the patient experiences difficulty in chewing because of arthritis, this may not be advisable. Additionally, tooth mousse should be recommended to provide lubrication and assist in preventing root surface caries (Walsh, 2007). If the patient is unable to provide adequate home care, alternative solutions should be provided, such as the introduction of the Collis curve toothbrush, assisted brushing, or chlorhexidine rinses (Little et al., 2008) These aids facilitate self-care and hence self-determination for the patient. The patient may suffer from mild dementia and due to his age may have difficulty remembering everything discussed at the initial appointment therefore all instruction should be written down and passed to him or a caregiver. Formulate a treatment plan Appointments should be kept short and scheduled in the morning or early afternoon when patient is less tired or whenever suits his needs best. Once a care plan has been completed it should be discussed with the patient and informed consent must be given. Appointment 2: Re-assess oral hygiene Quadrant scaling is recommended in case a full debridement cannot be completed in one appointment Reinforce good oral hygiene Appointment 3: Re-assess oral hygiene Complete scaling and full mouth polish Reinforce good oral hygiene A referral letter to the patients dentist is to be written and given to him regarding the restorative work required on the root caries present in his mouth. The importance of treatment should be explained to the patient and if necessary his caregivers should also be advised of the work required. As a preventive method, fluoride varnish should be applied to the other receded areas to help remineralise the enamel and reduce any sensitivity the patient may be experiencing (Wilkins, 2009). Recall: Upon completion of treatment for this patient, a three month recall should be arranged as his medical history indicates he may require regular maintenance in the future. This is also a good chance to evaluate the outcome and effectiveness of the previous treatment. According to Stefanac and Nesbit (2001) an oral health care plan is about balancing the ideal with the practical, and emphasis should be placed on the patient and their needs which ought to drive the treatment planning process. There has been a shift in treatment given by dental providers, where the focus is now on not only restoring the problem in the clinic, but educating the patient on how they can best achieve optimal oral health themselves. This assessment has investigated two different clinical case scenarios and discussed oral health care plans for each. In addition, it has examined the importance of treating each patient as an individual with specific needs and the significance of providing them with methods or self-care.

ASDAs Hierarchial Structure :: Papers

ASDA's Hierarchial Structure A hierarchical structure has many levels. Each level is controlled by one person. A hierarchical company tends to be a very big company just like ASDA is. In a hierarchical company, instructions are generally passed down from one person to another until it gets to the bottom. If there was a problem in a hierarchical structure it would move up through the structure again from one person to another until it gets to where it is supported to be. Strengths of a Hierarchical structure In a hierarchical structure there is a close control of workers. Workers in ASDA will know exactly what they have to do so they don’t wait around until they are told what they have to do. There is a small span of control. A span of control is when an amount of people report to one person. Also there is a better chance for promotion. Weaknesses of a Hierarchical structure In a hierarchical structure information is slow moving. There may be poor communication between departments. Also workers may not feel involved in the business and they may not feel motivated to work. The types of communication used in a Hierarchical structure The type of communication used is hierarchical will be more written communication. It will be written communication because the information will have a long way to go before it gets to the person. If it was verbal then when the message gets passed on it will change along the way. Any problems in communication and how I can solve it The problem with communication in hierarchical will be: communication will be slow, might not reach its destination and the information might change. Possible solutions: if the information is slow then maybe you can e-mail the person and then the information will get there faster. If the information might change then it will be a good thing to write it down so it won’t change. An explanation of the type of structure for Castell Engineering: ASDA's Hierarchial Structure :: Papers ASDA's Hierarchial Structure A hierarchical structure has many levels. Each level is controlled by one person. A hierarchical company tends to be a very big company just like ASDA is. In a hierarchical company, instructions are generally passed down from one person to another until it gets to the bottom. If there was a problem in a hierarchical structure it would move up through the structure again from one person to another until it gets to where it is supported to be. Strengths of a Hierarchical structure In a hierarchical structure there is a close control of workers. Workers in ASDA will know exactly what they have to do so they don’t wait around until they are told what they have to do. There is a small span of control. A span of control is when an amount of people report to one person. Also there is a better chance for promotion. Weaknesses of a Hierarchical structure In a hierarchical structure information is slow moving. There may be poor communication between departments. Also workers may not feel involved in the business and they may not feel motivated to work. The types of communication used in a Hierarchical structure The type of communication used is hierarchical will be more written communication. It will be written communication because the information will have a long way to go before it gets to the person. If it was verbal then when the message gets passed on it will change along the way. Any problems in communication and how I can solve it The problem with communication in hierarchical will be: communication will be slow, might not reach its destination and the information might change. Possible solutions: if the information is slow then maybe you can e-mail the person and then the information will get there faster. If the information might change then it will be a good thing to write it down so it won’t change. An explanation of the type of structure for Castell Engineering:

Eating Disorders: A Feminist Issue Essay -- Health Bulimia Anorexia Fe

Eating Disorders: A Feminist Issue What is a feminist approach to understanding eating disorders? Not all feminists have the same understanding of eating disorders. There are many different theories that are prevalent in feminist literature today. This web page will explore some of the different feminist perspectives about the cause of eating disorders in our culture. Power Control and obedience In her book Unbearable Weight, Susan Bordo (1993) makes the argument that the fear of women's fat is actually a fear of women's power. Thus, as women gain power in society, their bodies dwindle and suffer. She states that "female hunger--for public power, for independence, for sexual gratification-- [must] be contained, and the public space that women be allowed to take up be circumscribed, limited... On the body of the anorexic woman such rules are grimly and deeply etched" (Bordo, 171). Naomi Wolf (1991) has a similar explanation of the origin of eating disorders in her bestseller The Beauty Myth. She states: "a cultural fixation on female thinness is not an obsession about female beauty but an obsession about female obedience" (Wolf, 187). Women who remain thin are being obedient; it is another way for patriarchy to control women. "If women cannot eat the same food as men, we cannot experience equal status in the community" (Wolf, 189). Sexuality Sexuality is another issue that feminist Naomi Wolf explores in an effort to understand the prevalence of eating disorders among women. "Fat is sexual in women. . . to ask women to become unnaturally thin is to ask them to relinquish their sexuality" (Wolf, 193). Women who develop eating disorders, especially anorexia, are denying their sexuality and natural female b... ... disordered attitudes and behaviors. Psvchology of Women Quarteriv. 2-0, 2. Goodman, Ellen. (1996). The skeleton look is in fashion. The Tennessean. June 1 1. Mahowald., Mary Betody. (1995). To be or not to be a woman: anorexia nervosa, normative gender roles, and feminism. Nagging Questions. Ed. Dana E. Bushnell. Boston: Rowman Er Littlefield. Martz, D. M., Handley, K. B. Er Eisler, R. M. (1995). The Relationship between feminine gender role stress, body image, and eating disorders. Psychology of Women Quarterly, 19, 4. Morris, B. J. (1985). The phenomena of anorexia nervosa: a feminist perspective. Feminist Issues, 5, 2. Orbach, Susie. (1978) Fat Is A Feminist Issue. New York: Berkeley Press. Swartz, L. (1985). Is thin a feminist issue? Women's Studies International Forum, 8. 5. Wolf, Naomi. (1991). The Beauty Myth. NewYork: Doubleday.

The Dangers of Tattoos Essay -- Body Art

Tattoos are becoming a popular phenomenon that is seen everywhere. Today’s youth are getting permanent tattoos to be cool and trendy, but are not considering the long-term effects. Teenagers should be aware of all that body modification may include, it is not just a pretty picture. Adolescences must consider the dangers and conscientious result of attaining diseases, being underage, and having a permanent mark on their body.   Ã‚  Ã‚  Ã‚  Ã‚  The unsanitary conditions of getting a tattoo tend to go unnoticed by teenagers. The increase popularity in body art has also caused an increase in the incidences of Hepatitis, especially Hepatitis C. Hepatitis C is spread by contact with human blood. Since, the government regulation has not enforced hygiene requirements for tattoo parlors, disease such as Hepatitis C thrive in these environments. Another disease that can be acquired is HIV. The government does not force tattoo parlors to use new needles or to sanitize the old ones. Also, tattoos can get easily infected and leave a scar if not properly taken care of. Sometimes, people die from ink poisoning if too much ink gets into the blood stream. I haven’t even touched on how painful it is to get a tattoo and how painful it will be to obtain a disease. Young adults do not consider the dangers of a tattoo until it is too late.   Ã‚  Ã‚  Ã‚  Ã‚  Another problem with getting a tattoo is being underage. Teenagers have to convince their parents that a tattoo isn’t a foolish decision and they really want ...

Kotak Mahindra

Established in 1984, The Kotak Mahindra Group has long been one of India’s most reputed financial organizations. In Feb 2003, Kotak Mahindra Finance Ltd. , the group’s flagship company was given the license to carry on banking business by the Reserve Bank of India (RBI). This approval creates banking history since Kotak Mahindra Finance Ltd is the first company in India to convert to a bank. The license authorizing the bank to carry on banking business has been obtained from the RBI in tune with Section 22 of the Banking Regulation Act 1949. KMBL was promoted by Mr.Uday. S. Kotak, Kotak and Company Ltd and Mr. Sidney & A. A. Pinto under the name of Kotak Capital Management Finance Ltd on 21st Nov 1985 and obtained a Certificate of Commencement of Business on 11th Feb 1986.Key group companies and their businesses Kotak Mahindra Bank Kotak Mahindra Capital Company Kotak Securities Kotak Mahindra Prime Kotak Mahindra Asset Management Company Kotak Mahindra Old Mutual Life Insurance Limited BOARD OF DIRECTORS * Mr. K. M. Gherda – Executive Chairman * Mr. Uday Kotak –Executive Vice Chairman and Managing Director * Mr.Anand Mahindra –Co Promoter of Kotak Mahindra Bank and Vice Chairman and Managing Director of Mahindra and Mahindra * Mr. Cyril Shroff –Co Promoter * Mr. Pradeep N Kotak –Agri Division of Kotak and Company Limited * Dr. Shanker Acharya * Mr. Shivaji Dam –Managing Director Kotak Mahindra Old Mutual Life Insurance Limited * Mr. C. Jayaram –Executive Director * Mr. Dipak Gupta –Executive Director Product Detail Kotak Mahindra Bank is one of the prominent subsidiaries of Kotak Mahindra group. The activities of the company being parallel to its objective are very wide and cover all the components of a Bank.The Basic area of Operations is the Banking business, other products are meant for the regular revenue generation. Being a Banking house, the company is in regular touch with Banking Acc ounts, Investment Services, Convenience Banking and Other Services. Kotak Mahindra Bank, it's not about selling you many different products — it's about working out a holistic, pragmatic solution that addresses your financial needs. Through their varied products,they commit themselves to becoming â€Å"banker† to the customer rather than being â€Å"asset financier† to our customers.Banking Services by Kotak Mahindra There are three types of banking accounts: * Savings Account * Edge Savings Account: * Pro Savings Account: * Ace Savings Account * Current Account * Edge Current Account * Pro Current account * ACE Current Account * Term Deposit Investment Services * Demat & On Line Trading Account * Initial Public Offers(Ipo’s) Mutual Funds Convenience Banking * Multiple Banking Channels * ATM (Automatic Teller Machine): * Phone Banking * Mobile Banking * SMS Banking OTHER SERVICES * Banking Hours * Best Compliments Card – the perfect giftCOMPETIVE P ROFILE * HDFC Bank * ICICI Bank HDFC BANK Market Strategy Emphasizes The Following: * Increase market share in India’s expanding banking and financial services industry by following a disciplined growth strategy focusing on quality and not on quantity and delivering high quality customer service. * Leverage our technology platform and open scalable systems to deliver more products to more customers and to control operating costs. * Maintain current high standards for asset quality through disciplined credit risk management. Develop innovative products and services that attract the targeted customers and address inefficiencies in the Indian financial sector. * Continue to develop products and services that reduce bank’s cost of funds. * Focus on high earnings growth with low volatility. ICICI BANK MARKETING STRATEGY OF ICICI BANK: * India’s second largest bank * 614 branches and extension counters * 2200 ATM’S * Biggest private sector bank in India * Most valuable bank in India in terms of market capitalization * Described by the competitors and industry expert in one word – â€Å"Aggressive† Strategy of Kotak Mahindra 1.Kotak Mahindra Bank is Leading Bank in the country, it provides a variety of products and services to different segments of customers. 2. The Bank aims to serve customers from teenagers to senior citizens, hence different products designed to suit specific requirements of the above. 3. Aims to serve all classes of the society from the salaried middle class to the high income business class. Customers are categorized and segmented according to their requirements and needs. For Example, the EDGE Saving Account aims to serve middle class customers so minimum balance required to be maintained is Rs. 0000. While the PRO and ACE Saving Accounts are targeted at high income customers, the minimum balance requirement is Rs. 20000 and Rs. 75000.4. Customers who are more profitable to the Bank (High Value Customer s) are provided special facilities. Priority Banking is meant to serve these high value customers. 5. The Bank prides itself with the ability to provide differentiate products in the crowded market of saving accounts. Bank offers the free home baking, special co-branded debit cards (Smart fill Debit Card) which makes its product unique. . The Bank is also involved in marketing activities which serves as a medium of advertisement for the Bank. These are as follows: * Extended happy hours at certain pubs in Delhi for the Bank’s account holders. * Gift Vouchers on making utility payments, such as cell phones, electricity and MTNL bills. * Free Gifts like caps, pens/wallets to its customers. * Free add-on cards for relatives. 7. The Bank wants its customers to transact more through Internet Banking and ATM, Rather than the customers using the branch. 8.The Debit Cards provided by the Bank are Internationally Accepted around the world, hence giving the customers the convenience to transact anytime, anywhere. 9. The Bank has tied up with other Banks so that its customers can use other Bank’s ATM facility for free transactions 10. The Bank also provides DEMAT account and also sells Mutual Funds, this provides the Bank and Government additional revenue. 11. The Bank has been very successful in enlarging its customer base during the last couple of years. 12. The Number One Reason of people choosing Kotak Mahindra Bank is the Brand Name/Reputation of the Bank.Hence it should be careful that the Brand name and Goodwill the Bank has earned is not diluted. 13. The Biggest competitors of the Bank are ICICI Bank and HDFC Bank and STANDRAD CHARTERED. 14. ATM Facility is most popular way to transact with the Bank. 15. Overall the customers appreciate the service and products offered by the Bank and are willing to recommend the Bank to their acquaintances , But more attention has to paid towards: * Increasing the number of ATM machines. * Improving Internet Bankin g Facility.

President Roosevelt and the New Deal

In the 1920's or the ‘Roaring Twenties' as they were then referred to, there was a great deal of money, crime and corruption floating around in the American economy and stock market. A lot of people were buying on credit and getting out loans to invest on the stock market. This was encouraged by President Hoover and his Republican government. The reason for their doing of this was partly to gain a lot of money for themselves and to make America look good for any visitors. It was a time of conservatism, it was a time great social change. From the world of fashion to the world to politics, forces clashed to produce the most explosive decade of the century. In music, the sound of the age was jazz. The Jazz Age came about with artist like Bessie Smith and Duke Ellington. Youth ruled everything. From the young styles of dress to the latest celebrities. If it was young, it was the thing. The new age ladies of this time were young ladies who would go out wearing loose clothing and loads of make up (flappers) and this was unseen before in the States. It was the age of prohibition, it was the age of prosperity, and it was the age of downfall. The Government encouraged the people to buy lots of goods and to invest in the stock market. The poorer people looked at the rich people and thought that they could be as rich as them if they took out a loan, but the bank manager would see these people as unreliable in the terms of the people paying back the money. The bank managers therefore charged the poorer person maybe 15% interest where as if a person with a nice car and a large house came in to take out a loan then the manager would think that they are more likely to pay back the money so they would only put 5% interest on their loan. This in fact put the poorer person in even more debt as they had to pay back a lot more than the richer person. It was also a time of great racism in America with the Ku Klux Klan operating in their most vicious period killing a lot of people and the police hardly took any notice of their actions. Most city officials were owned by the Mafia and they did whatever the Mafia wanted them to do. This greatly increased the rate of crime in most parts of America and because this was the time of prohibition the Mafia brought lots of alcohol into the country. His party was a very relaxed with the economy and with the way it was run and they had adopted a policy of ‘laissez faire'. They said that they would not govern and guide the American economy but they would let it take its way down its own path and see where it ends up. Obviously they did not completely abandon it however they did not keep the right amount of watch on it as they should have done. This irregular regulation the economy led to an major imbalance in the products which America had been selling to their population. The people that bought the large goods that fuelled the American economy, for instance cars, fridges and radios were not going to keep on buying them forever. If a family had a car then unless they were rich they would not invest in another car because there would be no need to. This is the same with fridges and radios because people did not need to buy two or three fridges or radios. Most people could manage with one fridge and again, unless you were quite well-off you were unlikely to buy more than one radio. These major products therefore only had a limited field of marketing before the field was ‘over- farmed' and nobody wanted to buy from that field anymore. This major reduction in sale therefore led to a major reduction in the amount of people employed by a company. For example, Ford motor cars would not have to employ as many people if they are not producing as many cars because they will not have to run as much machinery and the manual jobs will not be as substantial. Because of this many people were made redundant and were forced to go without a job. During President Hoovers presidency there were no unemployment benefits so people who lost their jobs would have to either try and get another job or live on the money that they already had which for most peoples cases that was not a great deal of money. For most this money only lasted a couple of months so people started to sell a lot of their property and people started selling their houses to gain a little extra cash. In these cases most people did not get a lot of money for their houses and soon found themselves living in shanty towns or ‘Hoovervilles' as a lot of Americans called them. Hoover did not really care about the people's situation and his policy was that people should sort out their own problems. These ‘Hoovervilles' housed great quantities of crime (mainly with the Mafia), heavy drugs also supplied by the gangs and they were very dirty and run down. A new president was to be called for to sort out the problems that America had to deal with. These mainly were that the amount of crime had to be brought down and the Great Depression had to be lifted of the people of America. The man to propose these solutions was a man called Franklin Delano Roosevelt. Franklin was a very clever man who had had a good upbringing and who had always had money in his family While at Harvard, Franklin fell in love with Anna Eleanor Roosevelt, his fifth cousin once removed. Eleanor had had a trying childhood. Her mother, a beautiful socialite who gave her little affection, died when Eleanor was eight. Her father, Theodore Roosevelt's brother, was spirited and charming. But he was unstable and alcoholic, and he died when Eleanor was ten. Orphaned, she lived with her maternal grandmother and entered her teens feeling rejected, ugly, and ill at ease in society. When Franklin, a dashing Harvard man two years her senior, paid her attention, she was flattered and receptive. On March 17, 1905, the two Roosevelts were married. Her uncle Theodore, president of the United States, gave her away. The marriage was successful enough on the surface. Within the next 11 years Eleanor delivered five children (a sixth died in infancy): Anna (1906), James (1907), Elliott (1910), Franklin D. , Jr. (1914), and John (1916). Having been born into wealth, the Roosevelts never lacked for money, and Eleanor and Franklin moved easily among the upper classes in New York and Campobello. Eleanor, however, was often unhappy. For much of her married life she had to live near Franklin's widowed and domineering mother. Family duties kept her at home, while Franklin played poker with friends or enjoyed the good life. Later, during World War I, she was staggered to discover that Franklin was having an affair with her social secretary, a pretty young Virginian named Lucy Mercer. Despite these tensions, Eleanor remained a helpful mate throughout the 40 years of her marriage to Franklin. When he contracted polio in 1921, she labored hard to restore his emotional health and to encourage his political ambitions. Thereafter, with Franklin confined to braces and wheelchairs, she served as his eyes and ears. Because she possessed deep sympathy for the underprivileged, she guided his social conscience. Franklin was the man who proposed to the American populace his solutions to get America out of the mess that the country was in. Previously In 1910 Roosevelt was elected to the New York Senate and made the governor of New York. While he was the governor he tried out some of his plans like unemployment benefits and these proved to work well in the recovery of people's lives. He was willing when he came to be elected for President to put these plans into action and the people liked this. The people believed that they could trust Roosevelt because he had put some of his plans into action before and they had worked well in New York. This why he beat Hoover by a landslide vote in the elections in 1932. When he became President he immediately set his plans rolling and the people knew that they had made the right choice in the form of a President and Government that were actually going to do something positive for the country.