A close reading of Life is a dream by Pedro Calderon De La Barca Essay

A close reading of Life is a dream by Pedro Calderon De La Barca - Essay Example II. Spanish Society Spanish society, in the Golden Age, was concerned about what was real and what was false. At a time when politics were unstable in Spain, De La Barca sought to capitalize on this national anomaly of sorts. As Clotaldo, the jailer of Segismund said in the play, â€Å"Dreams are rough copies of the waking soul.†1 Therefore, what people dreamed about was not necessarily in vain. They were having dreams for a reason. With the idea that life was a dream, De La Barca was playing with notions of whether the consciousness present in life actually existed in Golden Age Spain. De La Barca, in his play, predicted that Segismund would one day grow up to revolt against his father the King. In chaining Segismund to the floor in a prison, he thought that he could keep his son sequestered, far enough away so that he could not hurt the King. However, this sense of fatalism that the King had felt in terms of his son growing up in the future to one day kill him, scared the Ki ng so much that he decided to do something about it (by chaining up his son). However, as one shall see, the idea of fatalism is a key Spanish value that we shall examine in the next portion which we will be reading. III. Spanish Values Spanish values included an unshakeable sense of fatalism, as Segismund speaks about the illusion and reality present in life—a dualism, if one will. He also speaks of the inevitable end of the world with precocious wit, intimating with a fatalistic sense that his suffering is only temporary. â€Å"Whether wake or dreaming, this I know, How dream-wise human glories come and go; Whose momentary tenure not to break, Walking as one who knows he soon may wake, fairly carry the full cup, so well Disorder'd insolence and passion quell, That there be nothing after to upbraid Dreamer or doer in the part he play'd, Whether To-morrow's dawn shall break the spell, Or the Last Trumpet of the eternal Day, When Dreaming with the Night shall pass away.†2 The Spanish people also believed very much in destiny (â€Å"el destino†) and how it related to their outlooks on life. Believing in destiny, many people in Spanish culture had the specific idea that one was supposed to be somewhere at a specific time in order to fulfill their destinies. As Segismund describes in this soliloquy, â€Å"Once more, you savage heavens, I ask of you— I, looking up to those relentless eyes That, now the greater lamp is gone below, Begin to muster in the listening skies; In all the shining circuits you have gone About this theatre of human woe, What greater sorrow have you gazed upon Than down this narrow chink you witness still; And which, did you yourselves not fore-devise, You registered for others to fulfil!†3 With the idea that values were important in Golden Age Spain—as well can one imagine—also important was the idea of having social mores. These were prescriptive ideals which were vanguards of the values of th e people, which will now be discussed at length. IV. Spanish Social Mores Spanish social mores in the Golden Age were very strict. That is why the King warned Segismund once he approached the kingdom with rage and anger after having been chained up for so many years: â€Å"Beware! Beware! Subdue the kindled Tiger in your eye!†4 The Golden Age was an era of restriction and prudence. If ladies wanted to visit with their beaus, they had to be accompanied by chaperones—

Compare and Contrast the aims, strategies and personalities of Charles Essay

Compare and Contrast the aims, strategies and personalities of Charles Stewart Parnell and Daniel OConnell - Essay Example The greatest and common mission of the two personalities was to agitate for liberation of Ireland that they ended not achieving. The two personalities used various strategies in advancing their views. Some strategies were similar while others were different. Following are similarities and differences in terms of personalities, aims and strategies of the two Irish icons with relations to their political and social life. One of the similarities is that both Charles Parnell and Daniel O’Connell were children of Ireland born in Ireland. Both attained university education and were reliable members of their respective societies in the advancement of the rights and needs of their people. Daniel and Parnell had similar feelings about Ireland and wanted to see their country freed from British anarchy and enabled to practice self-rule. Despite being Catholics, the family of Daniel O’Connell also owned land, as did the Parnell family. Daniel O’Connell entered politics in 1828 as the British Member of Parliament for County of Clare1. This happened after he spent a lot of time in activism, which was contrary to Charles Parnell who entered politics short time after graduation. Same to Charles Parnell, Daniel O’Connell used the poor peasants and farmers to agitate for the advancement of his views. Charles Stewart Parnell was a remarkable Irish nationalist born on 27th June 1846 in the County of Wicklow. Parnell was the third son and seventh offspring of an Anglo-Irish father John Parnell Henry and American mother Delia Stewart Tudor. Charles Stewart Parnell gained higher education from Cambridge University. Historical records also show that Charles Parnell attained most of his education in England. In 1875 after completing his studies, Charles secured election into the parliament where he served as collaborate of the Irish

International development project analysis Essay Example for Free

International development project analysis Essay Introduction: †¢ New science, technologies and ideas are crucial for the achievement of the goals, but global research investments are insufficient to match needs and do not focus on the priorities of the poor. †¢ Many technological and policy innovations require an international scale of research effort. †¢ DFID’s (Department for International Development) Central Research Department (CRD) commissions research to help fill this gap, aiming to ensure tangible outcomes on the livelihoods of the poor. †¢ CRD seeks to influence the international and UK research agendas, putting poverty reduction and the needs of the poor at the forefront of global research efforts. †¢ CRD manages long-term research initiatives that cut across individual countries or regions, and only funds activities if there are clear opportunities and mechanisms for the research to have a significant impact on poverty. †¢ CRD works closely with DFID’s Chief Scientific Adviser to maintain external links, particularly with UK Science, Whitehall and political stakeholders, to promote DFID’s agenda. †¢ DFID is seeking views to help it develop a new research strategy 2008-2013. Your chance to get involved When developing policies, it is recognized that consulting with a wide range of interested groups helps to ensure that the impact of its proposals on different sectors of society is taken into account. Public consultations are carried out wherever possible as recommended in the Code of Practice on Consultations by the Cabinet Office in January 2004. The Code aims to increase the involvement of individuals and groups in public consultations, minimizing the burden it imposes on them, and giving them enough time to respond. This guidance is used in conjunction with the compact between the government and the voluntary and community sector which includes a specific code of good practice on ‘Consultation and Policy Appraisal’. If you would like to take part in DFID public consultations, information will be posted on these pages. . . . Page-2 Page-2 Consultation The Cabinet Office is conducting a review of Consultation Policy to see how Government consultations can be improved and is keen to hear your views. As the centre–piece of this review, Hilary Armstrong MP, Minister for the Cabinet Office and Social Exclusion, has launched a paper entitled â€Å"Effective Consultation† to seek evidence on Government consultations. The consultation is aimed at anyone with an interest in responding to government consultation exercises, from those who regularly respond to the Governments consultations to those who might be interested in doing so. These might include business organizations, voluntary and charitable sector organizations, campaigning bodies, trades unions, citizens, etc. The Better Regulation Executive is keen to meet with people who have experience of Government consultations and to discuss with them how Government consultations can be improved. The BRE is therefore organizing a series of events with Government Offices including two, larger, public seminars on the subject. †¢ Annual Reports: Assessment of performance on government consultations. †¢ Code of Practice: The Cabinet Office Code of Practice on Consultation sets out the basic principles for conducting effective Government consultations. †¢ Consultation Guidance: Guidance for running consultations in government. †¢ Current Cabinet Office Consultations: A list of current Cabinet Office consultations with links for more information. †¢ Government Consultations: Links to departmental consultation websites. †¢ Effective Consultation Events: Further details on the Better Regulation Executives program of Consultation events. The following eight Millennium Development Goals (MDGs) were agreed at the United Nations Millennium Summit in September 2000 and nearly 190 countries have subsequently signed up to them. The eight Millennium Development Goals: 1. Eradicate extreme poverty and hunger. 2. Achieve universal primary education. 3. Promote gender equality and empower women. 4. Reduce child mortality. 5. Improve maternal health. 6. Combat HIV and AIDS, malaria and other diseases. 7. Ensure environmental sustainability. 8. Develop a global partnership for development. . . . Page-3 Page-3 REPORTS AND FORMATS Annual Report Format for DFID-contracted Research Programmes Front cover with Title of Research Programme, Reference Number and the Period Covered by the report. Include a table of contents, annexes, etc. , as necessary. 1. Background Information Title of Research Programme: Reference Number: Period covered by report: Name of lead institution and Director: Key partners: Countries covered by research: Planned Actual Start Date: End Date: Total programme budget: 2. One page summary (A narrative focussing on two main questions: (i) How far have intended outputs as listed in the logframe been achieved? And (ii) What is the impact of the research programme so far? ) 3. Key Themes Progress towards outputs and impact What are the research outputs? Outputs OVIs Progress Recommendations/Comments Where are the research impacts? Purpose OVIs Progress Recommendations/Comments 4. Lessons learnt †¢ Working with Partners †¢ Good Practice/Innovation †¢ Project/programme Management †¢ Communication 5. Programme Management Annual Report Summary sheet for R4D 1. Background Information Title of research programme: Reference Number: Period covered by report: Name of lead institution and Director: Key partners: Countries covered by research: Start Date for research programme: End Date for research programme: 2. One page summary 3. Products and Publications Inception Phase Report Format Front cover with Title of Research Programme, Reference Number and the Period Covered by the report. Include a table of contents, annexes, etc. , as necessary. 1. Background Information Title of research programme: Reference Number: Period covered by report: Name of lead institution and Director: Key partners: Countries to be covered by research: 2. A document of overall plans to complement your research proposal and setting out: †¢ Themes. †¢ Planned activities. †¢ Areas for development during life of the research program. †¢ Where appropriate, a response to referees comments on the original research proposal and/or any comments or note of endorsement from the CAG/CARG. 3. Finalized log frame 4. Plans for capacity development 5. The Management structure for the research program 6. Ongoing monitoring arrangements for the research program 7. Communication strategy 8. Annual activity plan 9. Detailed financial plan.

Metastatic Cancer: Types and Causes

Metastatic Cancer: Types and Causes Introduction Cancer is something that many people face or is affected by in some way. Cancer is a problem that is global and always growing affecting more people as the world’s population increases. The 2012 statistics show that were about 3.45 million new cases of cancer and 1.75 million deaths as a result of cancer worldwide in the year 2012. The main cancer site being breast contributing 464,000 cases [Ferlay, Foucher, Tieulent, Et.al, 2013]. Thanks to a better understanding and better treatment of cancer like chemotherapy and cancer based drugs, there has been a decrease in death from cancer and so better survival rates for both males and females affect by cancer [Jemal, Simard, Dorell, Et.al, 2012]. The fact cancer is so prevalent worldwide is due to the many features and ways that cancer affects people. One of these features is that some cancer cells are not static. The cancer cells are able to alter and change in order to form into another cancer that is in another part of the body therefore affecting a different organ site. This ability for cancer cells to move or migrate to different parts of the body is known as Metastasis [Yachida, Jones, Bozic, Et.al, 2010] [Fokas, Cabillic, Et.al, 2007]. The fact that cancer cells are able to migrate to other sites of the body is not just random. Where the cells migrate to, is dependent on where the cancer cells was originally was before the migration. What dictates where the cancer cells go, are specific stimuli or environment within the body so that the cells are able to grow into tumours. The stimuli or environment may consist of specific receptors or chemokines that are shared or common between the two sites [Baruch, 2009]. When cancer has metastasised to a different area the site that the cancer had originated in is known as the primary cancer and the site at which the cancer cells moved to is known as metastatic cancer. A common type of metastasis is from breast to brain, with breast being the primary cancer and br ain being the metastatic cancer. Breast cancer is often found to metastase to the brain, the chances of this occurring are increased when patients have HER2 over expression [Gupta, Adkins, Et.al, 2013]. HER2 comes from the human epidermal growth factor receptor family that controls response such as cell growth and cell differentiation, therefore it can be easily predicted that over expression of HER2 leads to uncontrollable cell growth a feature that is in all cancers [Rubin Yarden, 2001]. The metastasises of cancer within patients does not affect them straight away, as it often takes years for the metastatic cancer to be detected and to affect the person. When the primary tumour has grown, only then will the tumour cells migrate and invade to another part of the body and grow at the site. When the tumour cells are at the new site then they the process of cell growth occurs at the site. But it has been shown that the tumour cells at the new site have been dormant which accounts for the time between the detection of the primary cancer and the metastatic cancer [Rà ¶cken, 2010]. The way the metastatic cancer cells move from their primary site to their metastatic site can be many ways depending on ultimately were the tumour formation will be formed in. Examples of the movement or migration are 1) local tissue invasion which is movement of the tumour cells through the tissue, 2) hematogenous spread which is the movement through the blood; 3) lymphatic spread which similar to the blood by uses the lymph nodes and finally 4) spreading through surfaces and cavities [Pepper, 2001]. There are many sites of metastatasis, below is a summary table of the sites and where they originated from [Nguyen, Bos, Massaguà ©, 2009]. Table 1: A brief summary list that shows the sites of metastasis from primary tumours [Nguyen, Bos, Massaguà ©, 2009]. A metastatic cancer that is particularly important and of interest is metastatic cancer that is able to migrate to the brain. From the table above it can be seen that sites of metastasis for the brain is only in 3 types of tumours, these being breast, lung adenocarcinoma and skin melanoma. Out of these three types’ lung and breast tumours usually metastases to the brain making up 60% of brain metastasises [Nguyen, DeAngelis, 2004]. The reason why brain metastasis is of particular interest is because of how the metastatic cancer is able to pass through the blood brain barrier (BBB). In order to understand the movement of the blood brain barrier it structure must first be looked at. The blood brain barrier is made up of 4 main sections or parts that are of important to it function. These 4 parts are 1) tight junctions, 2) adherens junctions, 3) astrocytes, and 4) pericytes, each section has its own function as well. The tight junctions are made up of claudin, occludin, and junct ion adhesion molecules these are transmembrane proteins which are involved in cell-to-cell adhesion. Adheren junctions are responsible for paracellular permeability. Astrocytes are for structural supports and also for guiding of neurons and finally the pericytes are for mechanical support for cell attachment. [Lawther, Kumar, Krovvidi, 2011] [Hawkins, OKane, Simpson, Et.al 2006]. Figure 1: Image showing the main parts of the BBB and the overall structure of the BBB. Image was extracted from [Lawther, Kumar, Krovvidi, 2011]. Now that the structure of the blood brain barrier can be seen more clearly, a better understanding of how metastatic brain tumours form and how the cells pass through the blood brain barrier. More specifically primary breast cancer that produces metastatic brain tumour can be looked at. The tumour cells that are being metastasised are able to express vascular endothelial growth factor (VGEF). The expression of the vascular endothelial growth factor by the tumour cells is able to disrupt the blood brain barriers permeability which allows the cells to pass through and into the brain [Gerstner, Fine, 2007]. Another way to metastasise to the brain is by the tumour breast cells attaching or invading the brain microvascular endothelial cells and then passes through the blood brain barrier [Arshad, Wang, Sy. Et.al, 2011]. The survival rates of patients that have a metastatic brain tumour in unfortunately not very high. Those patients that have had primary breast cancer and then later gaine d a metastatic brain tumour have between 30-40% chance of death due to the metastatic brain tumour [Wadasadawala, Gupta, Bagul, 2007] [Jaboin, Ferraro, DeWees, Et.al, 2013]. There are treatments available that help fight against metastatic brain tumours the main one and most effective being radiotherapy. However the effectiveness of radiotherapy is dependent of where the tumour cells had originated from i.e. which primary cancer the patient had first. Those that had primary lung or breast cancer are more sensitive to the radiotherapy treatment. Other types of treatments include Craniotomy, Postoperative radiotherapy, and Stereotactic radiosurgery. The treatment that is craniotomy is not used often as it is stressful for the patients. Postoperative radiotherapy is also an effective treatment that improves the life of the person, however there are side effects or conditions that can occur as well like disorder of the nervous system or dementia. The final treatment stated is Stereotact ic radiosurgery which involves using gamma radiation on the site of the tumour [Shibui, 1999]. With the use of radiation is the fear of persevering the nearby cells and tissues. With the advancement of science and technology the treatment of using radiotherapy has become better. The use of radiotherapy is still the main treatment but with better radiotherapy processes and technique the preservation of the cells and tissue from radiation has greatly improved [Owonikoko, Arbiser, Zelnak, Et.al, 2014]. Epithelial–mesenchymal transition (EMT) Epithelial–mesenchymal transition (EMT) is defined as a biological process that occurs within polarised epithelial cells which interact with the basement membrane. The polarised epithelial cells undergo many biological changes that brings about a mesenchymal cell phenotype, these changes include an increased ability of migration, invasion and develop a resistance to the process of apoptosis [Kalluri Weinberg, 2009]. There are keys differences between the epithelial cells and the mesenchymal cells. Epithelial cells are cells that form layers, which are tightly packed by membrane structure such as tight junctions, gap junctions’ adherens junctions and desosomes. These cells do possess an ability of motility, however under normal condition they remain they do not move. In comparison the mesenchymal cells are not organised into layers like epithelial cells. The main difference between the two is that mesenchymal cells are very motile whereas epithelial are not normally [Th iery Sleeman, 2006].The whole process of epithelial–mesenchymal transition plays a role in normal development. These normal developments include gastrulation which is an early phase in embryonic development and heart morphogenesis which need and take advantage of the transition between the epithelial cells into mesenchymal cells. Another key role of the EMT is that it is for the down regulation of E-cadherin [Larue Bellacosa, 2005]. E-cadherin is a tumour suppressor that is encoded by the Cadherin-1 (CDH1) gene that is key for the suppression of carcinoma progression. It has been found and seen that the loss of the Cadherin-1 at EMT sites are linked to the formation, development of cancer. The reason for this is due to the fact that the loss of the E-cadherin increases the ability of invasion in cells [Wang Shang, 2013]. As with any biological process there are transcription factors that cause and regulate the transition. The transcription factors that mediate the processes are SNAI1 which down regulates E-cadherin, Zinc finger E-box (ZEB) and also basic helix–loop–helix transcription factors [Lamouille, Xu, Derynck, 2014]. There are features and properties of the mesenchymal cells that can be linked to cancer if not regulated properly. The mesenchymal cells are able to produce and secrete chemokines and growth factors that stimulate cell growth and angiogenesis. Another key feature of the mesenchymal cells is that they have anti apoptotic properties that can stop or save cells from undergoing apoptosis [Murphy, Moncivais, Caplan, 2013]. Just from seeing the features of the mesenchymal cells it can easily be seen that if the regulation of the process, mutation or changes in expression occur the consequences can be predicted and linked to the formation of cancer. The final aspect of epit helial–mesenchymal transition is how it is linked to the formation of cancer and more specifically metastatic cancers. As stated epithelial–mesenchymal transition is regulated by many growth factors and proteins such as Epidermal growth factor, Hepatocyte growth factor and Transforming growth factor beta, all of which if changed by mutation or expression can ultimately contribute to the hallmarks of metastatic cancer like uncontrollable cell growth and invasion into other tissues and organs in the body which is the main feature of metastatic cancer [Gos, MiÅ‚oszewska, Przybyszewska, 2009]. Below is a diagram that summarises and shows the process of how epithelial–mesenchymal transition can promote the formation of metastatic cancer [Kongemail, Liemail, Wangemail, Et.al, 2011]. Figure 2: A summary of how epithelial–mesenchymal transition can be linked to metastatic cancer. EMT is the process of epithelial–mesenchymal transition and MET is the process of Mesenchymal–Epithelial Transition. Image taken from [Kongemail, Liemail, Wangemail, Et.al, 2011]. The image above shows the transition of a primary tumour into a metastatic tumour and reason for this to happen. Red arrows show aspects that may be gone wrong due mutation or change in expression through methylation. Epigenetics Epigenetics is the genetic control by using factors that does not include a person’s DNA sequence [Simmons, 2008]. Epigenetic control or regulation is the process whereby genes are activated or deactivated within a cell [Mitsuyoshi Nakao, 2001]. Essentially the concept of epigenetics is the change in gene expression that can be caused by certain mechanisms such as DNA Methylation or Histone modification. These changes in gene expression whereby expression of a gene is switched on or off can be inherited and passed on. The idea of epigenetics and its mechanism is needed for maintenance of genes that are specific to tissues. Changes in the process of epigenetics, like DNA Methylation or Histone modification causes disruptions in a genes function, which alters its expression and is one of the hallmarks of how cancer begins [Sharma, Kelly, Jones, 2010]. As stated there two ways that can causes changes, histone modification and DNA methylation which will be the main focus of this p aper. The process of histone modification to a certan extent is reversible depending on the type of modification. The process of DNA methylation is more long term creating long-term repression [Cedar Bergman, 2009]. DNA methylation is the common mechanism in which genes are activated or deactivated by the addition of a methyl group to cytosine or adenine bases, making it an epigenetic signal tool. Changes in the process of DNA methylation can result in a gene being constantly activated or deactivated which can lead to brain tumours or other tumours in the body [Phillips, 2008]. The process of DNA methylation is catalysed by the family of enzymes known as DNA methyltransferases. DNA methyltransferases is an important enzyme in epigenetic silencing of transcription. As this is a family of enzyme there are many types of DNA methyltransferases which are DNMT 1, DNMT 2, and DNMT 3 each one having their own function [Simmons, 2008] [Fakhr, Hagh, 2013]. There are two types of DNA methylat ion these are 1) Hypermethylation and 2) Hypomethylation. Hypermethylation stops transcription in the promoter region of suppressor genes which ultimately lead to gene silencing [Das Singal, 2004]. The location at which hypermethylation occurs at are known as CpG sites, these are sites were cytosine is next to guanine. It is the cytosine in these CpG sites that are usually methylated and therefore switched off [Esteller, 2002]. Hypomethylation is the loss of methylation at regions or sites that are normally heavily methylated, for example satellites like SAT 2. The loss of the methylation at SAT 2 can lead to instability and oncogene activation (Jin, Li Robertson, 2011). Oncogenes when activated increases protein expression which in turn leads to increase in cell division, decreases in cell differentiation and the inhibition of cell death [Chial, 2008]. It is the mutation of a proto-oncogene by hypomethylation that makes an oncogene which is the cause of increase in cell division and therefore the cause of an abnormal growth of cells that leads to tumours and cancer. A proto-oncogene is the normal, non-mutated gene that regulates cell division making it controllable by balancing cell growth and death. There many types of proto-oncogenes these include WNT, RAS and ERK [Chial, 2008] [Torry, Cooper, 1991]. To summarise the idea of Epigenetics is the control of gene expression using DNA methylation or Histone modification. If any of these two processes are damaged or mutated this then means the control of gene expression can no long be controlled and so this leads to increase in cell growth and therefore tumours and cancer. Methylation of Promoter Region The DNA methylation of the promoter region within genes is as stated an epigenetic event that is linked to transcriptional silencing in cancer. This means that DNA methylation in this region is for the control of gene expression [Yang Park, 2012]. The promoter region of gene is a region that starts or causes the initiation of transcription [Gordon, Chervonenkis, Gammerman, 2003]. The process of methylation in the promoter region causes the expression of genes to reduce or in the in case of cancers cause the silencing of the gene altogether. There are two ways that this happens in the promoter region. One of the ways it can occur is the inhibition of sequence-specific transcription factors which contain CpG sites. The second way is by the use of methyl-CpG binding proteins which can compete for binding sites of methylated DNA [Robertson Jones, 2000]. E-cadherin was introduced to have a key role in epithelial–mesenchymal transition. If there is methylation more specifically hy permethylation in the promoter region of the E-cadherin then this can cause the silencing of the gene which has been linked to many types of gastric cancer also known as stomach cancer [Tamura, Yin, Wang, 2000]. Another gene that is important and methylation of it has been shown and linked to astrocytic brain tumour is the Methylguanine-DNA methyltransferase (MGMT). Methylguanine-DNA methyltransferase’s function is as a repair protein that can remove promutagenic alkyl groups’ guanine in DNA. DNA methylation in the CpG Island of the Methylguanine-DNA methyltransferase means that its function in order to remove promutagenic alkyl groups is decreased [Nakamura, Watanabe, Yonekawa, Et.al, 2001].

Alternate Possibilities and Moral Responsibility by Harry Frankfurt Ess

In â€Å"Alternate Possibilities and Moral Responsibility†, Harry Frankfurt attempts to falsify the Principle of Alternate Possibilities. The Principle of Alternate Possibilities is the principle where a person is morally responsible for what he has done only if he could have done otherwise. A person would be morally responsible for their own actions if done by themselves. If someone else had forced that person to do the action, then the person doing the action is not morally responsible. Frankfurt does not believe this to be true and that the person doing the action is morally responsible. Frankfurt’s objections towards the Principle of Alternate Possibilities shows the refutation of natural intuition and places moral responsibility upon those who deserve it. Frankfurt’s â€Å"Black and Jones† example is an appropriate explanation for how the Principle of Alternative Possibilities works. Black put a gun on Jones’ head and tells him to do action A. According to the Principle of Alternate Possibilities, this will play out in three ways. If Jones was not a reasonable man and was â€Å"gung-ho†, not caring about any consequences or cost, then he is not to be morally responsible for that action. If Jones was afraid of what Black will do with the gun and decides to change his decision from doing any other action to action A, then he is only morally responsible for the decision that he made earlier and not for the action. If Jones isn’t affected by Black’s actions, but he considers those actions in planning to make his next move yet still follows his original decision, then he is morally responsible for all actions and decisions.(Frankfurt; Watson, 169-170) What Frankfurt is considering to be a counter-e xample to the Principle of Alternate Possibil... ...ow moral responsibility. One needs to will other alternate possibilities, knowing that there is no moral responsibility for them, to show that the original will has moral responsibility. It is like placing a white stone on a pile of black stones to emphasize the fact that that one stone is a white stone. This shows the need for alternate possibilities and strengthens Frankfurt’s argument. In conclusion, Frankfurt’s argument against the Principle of Alternate Possibilities showed that people under coercion had moral responsibility for their own actions. Copp placed the value of moral responsibility to the ability of being able to do one’s will and Pereboom supports Frankfurt’s argument by placing the robustness condition on alternate possibilities. This shows that there is still a need to put more thought and brainstorming into who has the moral responsibility.

Effects of Living in a Foreign Country Essay -- essays research papers

Living away from your country can be a really interesting and unforgettable experience, but at the same time it has very important effects on one's life. The purpose of this essay is to discuss the three main effects that living in another country can produce in your personal life. The major effect, and also a very common one, is that once you start a regular life away from home, you miss everything. This fact doesn't mean that you are unhappy but that you are aware of being on your own. Missing your family and the attention they all paid to you is a very usual thing to do. Little details like sitting on a Sunday morning watching TV alone instead of helping your dad organizing his things or having a nice chat with your mom makes you realize how valuable your family really is. It is also...

Alzheimer’s Disease

Alzheimer's Disease does not kill instantly; it destroys the individual bit by bit, tearing away at their person-hood and self-identity. Most victims suffer for 9 to 15 years after onset of the illness. It is the most common type of dementia in the United States and Canada and after age 40, the risk of developing it doubles with aging every 5.1 years during adults' life. A form of dementia, the DSM-IV-R's (Diagnostic and Statistical Manual) criteria for diagnosing dementia include: impairment in short- and long-term memory, at least one of the following: impairment in abstract thinking, impaired judgement, other disturbances of higher cortical functioning, personality change, significant interference with work, social activities, or relationships, in addition, symptoms do not occur exclusively during the course of delirium; and specific etiologic organic factor is evidenced or can be presumed. For an individual with this terrible disease, living with memory loss and its associated disabilities are very frightening. Alzheimer's includes behavioral characteristics that extend beyond its cognitive explanations. These behaviors require study because of the influence on both the patient and caregiver. Treatment often looks to drugs for relief of symptoms and to slow the course of progressive decline, rather than on assisting the individual with coping mechanisms. It has been termed a â€Å"family disease†, not only because of possible genetic relation between victims, but because family members provide 80 percent or more of the care giving. Chronic and progressive mental and physical deterioration decrease the victim's capacity for independence and increase the need for support from family members caring for the victim at home. The victim attempts to make sense of a seemingly new and hostile world, and this leads to dubious and uncharacteristic changes in behavior, personality, decision-making, function, and mood. Certain symptoms that are often associated with depression may be observed in patients who are cognitively impaired but not depressed. Professionals must be aware of all the symptoms the patient is experiencing, and reports from family members must also be taken into account. The patient usually reports fewer negative feelings or mood problems than are identified by caregivers. Patients often attempt to cover up their disease by modifying the behaviors of others, rather than identifying their own inevitable retrogression. Fears of the unknown, fears of abandonment, lowered frustration tolerance, and loss of impulse control may result in problematic behavior. Also, appropriate behavior may simply be forgotten, and faces of family members and friends unfamiliar. However, the victim of Alzheimer's often denies these symptoms. More obvious, even to themselves are the expression of emotions such as panic and deprivation. Experiences such as early retirement and anticipated changes in the responsibilities of daily life are never realized. The inability to drive a car is especially painful and frustrating for some. Self-esteem and sense of worth plummet. Individuals with Alzheimer's lose their capability to plan, postpone, wait, or predict the outcomes of their actions. Family members very often fail to attribute losses similar to those previously mentioned to a d isease. They tend to deny the existence of the disease. Family members may go through a period of denial in which they make excuses for the patient, attributing the problems they encounter to normal aging, stress, etc. Alzheimer's disease creates new demands on the family, who have to adopt numerous roles. The parent, once the primary caregiver to their children, is now like a child receiving care. Each family member defines the situation differently, but display common management behaviors that will be discussed further. Within these similar stages of management, reflection of individual attitudes is obvious due to unique interpretations of the stages. The spouse is usually the primary caregiver of the patient, but when unable to provide the care necessary, an adult child is the most likely candidate. These adult children fear that the disease terrorizing their family and destroying a loved one will be hereditary. Negative behavior changes that are undergone by the victim have major effects on the caregiver. Mental health and life satisfaction of the caregiver seem to decrease rapidly, but according to Lisa Gwyther (1994), the key to minimizing these effects is to strategically change responses by the human and physical environment. Changing the responses of the outside world, rather than attempting to change the responses of the individual with the disease helps to organize difficult changes. Experienced spouses and wise families learn to distract the patient rather than confront them on their shortcomings. They should learn to enrich the victims' pleasure in each moment, spurring preserved memories and skills to maintain the victims' positive feelings of competence, belonging, productivity, and self-esteem. Consistent reassurance and unconditional love are vital to peace and harmony within the family. The patient experiences degeneration of short-term memory, which often results in misplacement of objects and forgetting the names of familiar people. They have irrational or imaginary fears that make them suspicious of those closest to them, and they may accuse others of theft and/or infidelity. This is a source of increased frustration, confusion, distress, and irritability on the part of both the patient and the family. As a result, those involved may rely on alcohol and drugs to alleviate the stresses of coming to terms with the disease. Many families of victims either fail to seek, or do not receive a correct medical diagnosis. They tend to become over-involved and angry, stages necessary in the process of adjustment. The family members attempt to counterweigh the losses experienced by the patient, because the deterioration is beginning to become obvious. Their anger, not necessarily with the patient, stems from the burden, embarrassment, and frustrations caused by the patient's behavior. Burden is reported to be highest in this phase of mild dementia. When the spouse is the primary caregiver (in comparison with adult children or others), care is more complete, and less stress, conflict, and ambivalence are observed. Spouses tend to look for activities, or ways of interpreting the patients behavior, that allow for a continuing adult relationship, rather than a parent- child one, which may belittle the patient. Psychological stress results from conflict between resentment, anger, ambivalence, and guilt, self-blame, and the pain of watching a loved one deteriorate. Caregivers also report physical fatigue from providing care to their regressing loved one. Of all of these, the most difficult is performing the basic daily activities for the patient, and coping with upsetting behavior. Proactive approaches towards treatment of the disease involve the conscious decision that success is possible, both for the patient and family- unfortunately this is something that most afflicted individuals realize too late. In addition, the victims of Alzheimer's may or may not respond to certain types of intervention. A patient may react to one type of treatment one minute and not the next. Immediate, observable changes in patient and family behavior, function, and mood were noted when caregivers learned to separate the resolution of the problem from the intention of the patient. For example, rather than confronting a patient or assigning blame when an object is lost, the caregiver replaces the item the patient claimed â€Å"stolen†. In this way, unnecessary stress and tension are eliminated for both patient and caregiver. Each family member experiences a similar process of coming to terms with the changes. This process includes three stages: describing how the victim is the same, and/or different, prior to disease onset, rewriting the individuality of the victim, and redefining the relationship with the victim. During the first stage, family members look for behaviors that still represent the victims' â€Å"true† self, and those that the person with Alzheimer's no longer has. In the second stage, the disease and individual with the disease must be seen as two in one. Part of the struggle in this stage is to maintain the adult identity of the victim while managing their child-like needs. Still, in the third stage of the adapting process, major problems continue to present themselves. These may include: family and social disruptions, increased marital conflicts, and employment-related difficulties. Family members are usually not aware of one-another's viewpoints; they do not understand that they are not all seeing the victim the same way. Due to the fact that they are not all having the same type of relationship with the victim, paths towards the common goal of attaining highest level of function for the victim may be divided. As a result, the more effort individual family members put into achieving this goal, the more conflict is created. However, it individuals voice their different perspectives and encourage discussion, this may allow the family to function as a complete whole. Understanding between family members can be coupled with social support groups' ideas about the disease. A social network may be effective in protecting individuals with terminal diseases from some of the negative effects. An active organization, The Alzheimer's Disease and Related Disorders Association (ADRDA) established a network of individuals and families affected with dementia. The speed at which this network is growing is clear evidence of the need for more groups like it. Information sharing, encouragement, and provision of social support are among the top objectives of such groups. A committee at the St. Louis Chapter of the Alzheimer's Association developed Project Esteem to provide emotional intervention for people with Alzheimer's in the Forgetful phase. Its purpose is to provide opportunities to share thoughts and feelings with peers and professionals, and to have some fun. It came about as two separate groups, one being individuals with Alzheimer's and the other, caregivers. Reported feelings related to dementia from both groups include: anger, anxiety, stress, acceptance, and frustration. The number of individuals who report negative feelings greatly outweigh those of acceptance. At initial meetings, bonding is established through the sharing of early memory experiences. Gradually, comfort comes from knowing that the victims are not alone; there are others with the same limitations. The realization that the victims are ordinary people with a chronic illness, rather than an uncontrollable mental illness, is comforting. Overall, the most effective coping occurs when the individual recognizes their own mental change, realizes the diagnosis, and deals with the unexpected attitudes of others. Benefits of group support in this early stage of Alzheimer's are considerable. Individuals sharing similar situations gain insight and encouragement through verbal exchange; when real world suggestions were needed, and non- verbally; when words were simply not accessible. However, as word comprehension and creation becomes increasingly difficult, the individual enters a new stage of disease development. Short-term memory, orientation, and concentration are now severely impaired. Throughout this stage, remote memory, intellectual functioning, comprehension, and judgement decline steadily. Ability to care for one's self also declines, and sleep patterns are altered; this is a severe blow to the patient's independence and self-esteem. The patient then becomes suspicious and paranoid, even of those closest to them. Likelihood of involvement in accidents at home and abuse of medication increase. Behaviors may include night wandering, night shouting, and nocturnal micturition (night- time urination). Obviously, traditional family behaviors and interactive patterns realize drastic alteration. Family members begin to feel guilty for their impatience and intolerance of the patient, even though many of the demands of the patient are unrealistic and illogical. A major problem for those closest to the patient is readjusting expectations of the patient and themselves. Changes and problematic behavior become a source of stress during this phase, but overall limitation and conflict is reported to decrease, which may simply be the result of institutionalization of the victim. Use of drugs is found to be twice as high in care-givers as in community subjects, and care-givers often let their own health deteriorate. Particularly for the spouse's caregivers, social isolation becomes an issue of psychological well being. Lack of time, energy, and interest in social activities becomes prominent as the deterioration of the patient increases. In one study, spouses of patients exhibited higher levels of stress, in comparison to adult children caregivers; but husbands, in comparison to wives, report fewer burdens, and are more willing to admit the difficulty of the tasks at hand and seek out professional help. Adult male children are as likely as women are to assist their parents, but the men appeared to have the ability to distance themselves from the aging parent. This physical and emotional separation seemed to lower the amount of guilt felt by the men. Possibly because of these differing abilities to deal with the disease, there is often conflict between family members as to how to care for the victim. Two broad coping techniques of family members of Alzheimer victims are: (1) Distancing techniques and (2) Enmeshing techniques. Distancing techniques (as discussed earlier) involve establishing distance between the patient and caregiver both emotionally and physically. Enmeshing techniques involve the intensification of the relationship, and often the exclusion of others. This option is usually observed in cases where the spouse is the primary caregiver. Apparently, it is very difficult for spouses who use the Enmeshing technique to become involved in social support groups. Social support is a proven mediator and alleviator of family stress and patient dejection. Adult day care programs provide respite for family members, and allow the patient to interact with individuals with similar conditions. Generally, the patients see the support group as being most helpful in the areas of information sharing and peer support. This information and assistance may help determine the strength of the individual in last stages of the disease. This phase is the final stage of Alzheimer's disease. Mental deterioration is complete; many patients are completely unaware of, or unable to respond to their surroundings. The patients are totally dependent on others for all aspects of daily living. The patient will, most likely, not identify family and friends, and may not communicate at all. Paranoia, agitation, and combativeness increase significantly, if the patient is able to display these emotions at all. He/she eventually becomes extremely weak, incontinent, non-ambulatory and bedridden. It has been hypothesized that at least some of the premorbid changes in strength and weakness may be predicted from changes observed in the earlier stages. Descriptions by caregivers of premorbid personality traits of the victim are similar to symptoms of depression, hallucinations, and delusions. It is during this stage that most victims are admitted to an institution for professional care. Several behavioral problems such as aggression and wandering appear to increase as individuals are moved from the community to nursing homes. Acceptance of this disturbing disease comes very slowly to the family members. The disease's sly onset and the original appearance by the victim of retention of regular physical vigor make acceptance increasingly difficult. As the disease progresses further and further, the changes that occur for the victim become increasingly obvious and family members tend to define the situation more similarly than in previous, seemingly inconspicuous stages. The grieving process is lengthy, because the death of the person is long before the death of the physical body. Although the loved one is long gone, their shell lives on. At some point during this stage, the spouse must undergo the final challenge of marital evaluation. Because the patient does not recognize anyone, the spouse is totally alone, but not single. Obtaining a divorce often creates many difficult legal issues. Many caregivers need assistance coping with the guilt of â€Å"abandoning† their spouse when placing them in a nursing home. Thus, financial problems come into the picture. Paying for nursing home services is difficult, as all effort in previous years has been put into caring for the patient. Relatives of deceased victims can be compared to those whose family member is still living. Wives and husbands display similar feelings of burden, but the husbands report more social limitations. On the contrary, sons and daughters are different in their descriptions of burden. Sons report less social limitations than daughters do, and less affective limitation when the demented parents had died. The sons of the deceased elderly also report less conflict with others than the daughters do. The need for individual support for the caregiver and family of the deceased is important, especially at this stage of sorrow. There may also be a sense of relief and release, as the extensive suffering of a loved one has finally ended. The empty body, which once contained a loved one, can finally be put to rest. Help and support from the staff at institutions with dealing with the grief of the final loss of a loved one is valuable and most definitely appreciated. Alzheimer's Disease is a ceaseless debilitating disease without known cause or cure. Deterioration of mental and physical processes is inevitable, but varies between individuals- the cause for this variance has only been looked at hypothetically. It is a terrifying disease for the victim, who is constantly aware of the losses that are occurring, but can do nothing to prevent the disease from proceeding on its deadly course. Family members respond to the disease within certain guidelines, but the attitude towards the different stages differs for all involved. Social support systems have proven extremely effective for both the victim and caregiver in the Forgetful phase of the illness. From that point on, influence on patients decreases significantly, but personal gain for caregivers continues. There is an evident need for publicly funded support for Alzheimer's disease victims and their families. The obvious lack of information concerning the symptoms and results of the disease show the necessity for incorporation of education and support into intervention strategies for caregivers. Evaluation of a patient with possible dementia requires a complete medical history, neurologic evaluation, and physical examination. At the present time, no diagnostic tests for Alzheimer's are available in laboratories. It is simply a diagnosis based on elimination of other diseases. There is great need for a biological marker that would confirm the diagnosis of Alzheimer's in a living patient. Rapid progress has been made in identifying a potential genetic marker that could be used to diagnose the disease without autopsy, biopsy, or extended evaluations. Potential disadvantages of this approach would be the reluctance of both patients and physicians to have lumbar punctures done, and the potential overlap of normal patients and Alzheimer sufferers. These potential markers are a glimpse of light at the end of a dark tunnel. Metaphorically, Alzheimer's can be seen as a house that is constantly being eaten by termites, from the inside out. Although the house may look the same on the outside, the very foundation of the house, the part that makes it a home, deteriorates. Attempts to stop the decay are futile and, at best, temporary. Eventually, one will not feel comfortable at home, and will most likely leave the home- possibly for someone else to deal with. This relief is also temporary. The eating away of the house continues, until it eventually topples into an unrecognizable heap of what used to be a home. This feeling was best described by one individual in the middle stages of the disease: â€Å"†¦(J)ust a wild lost world. I'm here but I don't know where I am†. Alzheimer’s disease Alzheimer's disease is one of most prevalent medical conditions that affect the older sector of society. More and more people continue to suffer from this disease, but at present, there is still no cure available. So what causes Alzheimer's disease? What are its effects, and are there any possible solutions for this condition? This essay would delve into the aforementioned details of Alzheimer's disease. Before the nature of Alzheimer's disease can be discussed, it is important to first define what dementia is.This is because Alzheimer's disease is identified as the most general cause behind the dementia not only in America but also throughout the world. Dementia refers to a syndrome which generally damages a person's daily functioning. This is because the memory is impaired, as well as other thinking capabilities, such as reasoning and thought organization. Even the capacity for language and sight is also affected. Due to the memory decline, simple activities become difficult and pa tients need assistance from others since they cannot take care of themselves anymore.Consequently, Alzheimer's disease is a medical condition which affects the brain; it is a disease that slowly develops, damaging one's memory and other mental processes. These include â€Å"reasoning, planning, language, and perception. † It is believed that the disease is caused by the overproduction or amassment of the protein called beta-amyloid; this protein is believed to result in the demise of nerve cells. The condition worsens as time goes by and can lead to death.The possibility of acquiring Alzheimer's disease increases as one ages, especially when one reaches the age of 70. Those who are beyond 85 years of age are most likely to be affected. However, it is important to point out that though memory loss is a normal part of aging, something as severe as Alzheimer's disease is not part of it. Alzheimer's disease was first discovered in 1906 by a German doctor named Alois Alzheimer; in 1910, the disease was officially named after him. Five years prior, Dr.Alzheimer had 51-year-old patient named Frau Auguste D. ; the symptoms of her condition include problems of speech, memory and understanding. She even began doubting her husband's loyalty for no reason at all. Her condition became worse and eventually, she died. When Dr. Alzheimer performed an autopsy, he found that the size of the brain had decreased. The most notable finding was that the cortex had significantly shrunk; the cortex is responsible for memory and speech, among other vital mental functions.When her brain was viewed in the microscope, Dr. Alzheimer discovered brain cells which are either dead or in the process of dying. There were also fat and other deposits found in the blood vessels and brain cells. The brain is composed of neurons, which are nerve cells. These neurons produce signals which are chemical and electrical in nature. The signals are transferred from one neuron to another, enabling the person to think and recall. The transmission between neurons is made possible by neurotransmitters.Those who suffer from Alzheimer's disease experience the demise of neurons; eventually, neurotransmitters are also affected, and the brain functions are completely interrupted. The autopsy that Dr. Alzheimer performed on Auguste D. revealed that the brain tissues were characterized by â€Å"clumps† and â€Å"knots† of brain cells. At present, the former is recognized as plaques, while the latter is now identified as tangles. Both are acknowledged markers of Alzheimer's disease. These two are also possible contributors in causing the brain disorder.On one hand, plaques are composed of the aforementioned beta-amyloid protein. There is still no determined reason for the death of neurons, but the said protein is believed to be responsible for it. There are three genetic mutations that are recognized as responsible for a small percentage of the early-onset type of the disease . These three are as follows: â€Å"amyloid precursor protein, presenilin 1 protein (PS1) and presenilin 2 (PS2). † The said mutations create plaques of amyloid. All three mutations are known to cause at least ten percent of all cases of Alzheimer's disease. Alzheimer’s Disease Alzheimer's Disease does not kill instantly; it destroys the individual bit by bit, tearing away at their person-hood and self-identity. Most victims suffer for 9 to 15 years after onset of the illness. It is the most common type of dementia in the United States and Canada and after age 40, the risk of developing it doubles with aging every 5.1 years during adults' life. A form of dementia, the DSM-IV-R's (Diagnostic and Statistical Manual) criteria for diagnosing dementia include: impairment in short- and long-term memory, at least one of the following: impairment in abstract thinking, impaired judgement, other disturbances of higher cortical functioning, personality change, significant interference with work, social activities, or relationships, in addition, symptoms do not occur exclusively during the course of delirium; and specific etiologic organic factor is evidenced or can be presumed. For an individual with this terrible disease, living with memory loss and its associated disabilities are very frightening. Alzheimer's includes behavioral characteristics that extend beyond its cognitive explanations. These behaviors require study because of the influence on both the patient and caregiver. Treatment often looks to drugs for relief of symptoms and to slow the course of progressive decline, rather than on assisting the individual with coping mechanisms. It has been termed a â€Å"family disease†, not only because of possible genetic relation between victims, but because family members provide 80 percent or more of the care giving. Chronic and progressive mental and physical deterioration decrease the victim's capacity for independence and increase the need for support from family members caring for the victim at home. The victim attempts to make sense of a seemingly new and hostile world, and this leads to dubious and uncharacteristic changes in behavior, personality, decision-making, function, and mood. Certain symptoms that are often associated with depression may be observed in patients who are cognitively impaired but not depressed. Professionals must be aware of all the symptoms the patient is experiencing, and reports from family members must also be taken into account. The patient usually reports fewer negative feelings or mood problems than are identified by caregivers. Patients often attempt to cover up their disease by modifying the behaviors of others, rather than identifying their own inevitable retrogression. Fears of the unknown, fears of abandonment, lowered frustration tolerance, and loss of impulse control may result in problematic behavior. Also, appropriate behavior may simply be forgotten, and faces of family members and friends unfamiliar. However, the victim of Alzheimer's often denies these symptoms. More obvious, even to themselves are the expression of emotions such as panic and deprivation. Experiences such as early retirement and anticipated changes in the responsibilities of daily life are never realized. The inability to drive a car is especially painful and frustrating for some. Self-esteem and sense of worth plummet. Individuals with Alzheimer's lose their capability to plan, postpone, wait, or predict the outcomes of their actions. Family members very often fail to attribute losses similar to those previously mentioned to a d isease. They tend to deny the existence of the disease. Family members may go through a period of denial in which they make excuses for the patient, attributing the problems they encounter to normal aging, stress, etc. Alzheimer's disease creates new demands on the family, who have to adopt numerous roles. The parent, once the primary caregiver to their children, is now like a child receiving care. Each family member defines the situation differently, but display common management behaviors that will be discussed further. Within these similar stages of management, reflection of individual attitudes is obvious due to unique interpretations of the stages. The spouse is usually the primary caregiver of the patient, but when unable to provide the care necessary, an adult child is the most likely candidate. These adult children fear that the disease terrorizing their family and destroying a loved one will be hereditary. Negative behavior changes that are undergone by the victim have major effects on the caregiver. Mental health and life satisfaction of the caregiver seem to decrease rapidly, but according to Lisa Gwyther (1994), the key to minimizing these effects is to strategically change responses by the human and physical environment. Changing the responses of the outside world, rather than attempting to change the responses of the individual with the disease helps to organize difficult changes. Experienced spouses and wise families learn to distract the patient rather than confront them on their shortcomings. They should learn to enrich the victims' pleasure in each moment, spurring preserved memories and skills to maintain the victims' positive feelings of competence, belonging, productivity, and self-esteem. Consistent reassurance and unconditional love are vital to peace and harmony within the family. The patient experiences degeneration of short-term memory, which often results in misplacement of objects and forgetting the names of familiar people. They have irrational or imaginary fears that make them suspicious of those closest to them, and they may accuse others of theft and/or infidelity. This is a source of increased frustration, confusion, distress, and irritability on the part of both the patient and the family. As a result, those involved may rely on alcohol and drugs to alleviate the stresses of coming to terms with the disease. Many families of victims either fail to seek, or do not receive a correct medical diagnosis. They tend to become over-involved and angry, stages necessary in the process of adjustment. The family members attempt to counterweigh the losses experienced by the patient, because the deterioration is beginning to become obvious. Their anger, not necessarily with the patient, stems from the burden, embarrassment, and frustrations caused by the patient's behavior. Burden is reported to be highest in this phase of mild dementia. When the spouse is the primary caregiver (in comparison with adult children or others), care is more complete, and less stress, conflict, and ambivalence are observed. Spouses tend to look for activities, or ways of interpreting the patients behavior, that allow for a continuing adult relationship, rather than a parent- child one, which may belittle the patient. Psychological stress results from conflict between resentment, anger, ambivalence, and guilt, self-blame, and the pain of watching a loved one deteriorate. Caregivers also report physical fatigue from providing care to their regressing loved one. Of all of these, the most difficult is performing the basic daily activities for the patient, and coping with upsetting behavior. Proactive approaches towards treatment of the disease involve the conscious decision that success is possible, both for the patient and family- unfortunately this is something that most afflicted individuals realize too late. In addition, the victims of Alzheimer's may or may not respond to certain types of intervention. A patient may react to one type of treatment one minute and not the next. Immediate, observable changes in patient and family behavior, function, and mood were noted when caregivers learned to separate the resolution of the problem from the intention of the patient. For example, rather than confronting a patient or assigning blame when an object is lost, the caregiver replaces the item the patient claimed â€Å"stolen†. In this way, unnecessary stress and tension are eliminated for both patient and caregiver. Each family member experiences a similar process of coming to terms with the changes. This process includes three stages: describing how the victim is the same, and/or different, prior to disease onset, rewriting the individuality of the victim, and redefining the relationship with the victim. During the first stage, family members look for behaviors that still represent the victims' â€Å"true† self, and those that the person with Alzheimer's no longer has. In the second stage, the disease and individual with the disease must be seen as two in one. Part of the struggle in this stage is to maintain the adult identity of the victim while managing their child-like needs. Still, in the third stage of the adapting process, major problems continue to present themselves. These may include: family and social disruptions, increased marital conflicts, and employment-related difficulties. Family members are usually not aware of one-another's viewpoints; they do not understand that they are not all seeing the victim the same way. Due to the fact that they are not all having the same type of relationship with the victim, paths towards the common goal of attaining highest level of function for the victim may be divided. As a result, the more effort individual family members put into achieving this goal, the more conflict is created. However, it individuals voice their different perspectives and encourage discussion, this may allow the family to function as a complete whole. Understanding between family members can be coupled with social support groups' ideas about the disease. A social network may be effective in protecting individuals with terminal diseases from some of the negative effects. An active organization, The Alzheimer's Disease and Related Disorders Association (ADRDA) established a network of individuals and families affected with dementia. The speed at which this network is growing is clear evidence of the need for more groups like it. Information sharing, encouragement, and provision of social support are among the top objectives of such groups. A committee at the St. Louis Chapter of the Alzheimer's Association developed Project Esteem to provide emotional intervention for people with Alzheimer's in the Forgetful phase. Its purpose is to provide opportunities to share thoughts and feelings with peers and professionals, and to have some fun. It came about as two separate groups, one being individuals with Alzheimer's and the other, caregivers. Reported feelings related to dementia from both groups include: anger, anxiety, stress, acceptance, and frustration. The number of individuals who report negative feelings greatly outweigh those of acceptance. At initial meetings, bonding is established through the sharing of early memory experiences. Gradually, comfort comes from knowing that the victims are not alone; there are others with the same limitations. The realization that the victims are ordinary people with a chronic illness, rather than an uncontrollable mental illness, is comforting. Overall, the most effective coping occurs when the individual recognizes their own mental change, realizes the diagnosis, and deals with the unexpected attitudes of others. Benefits of group support in this early stage of Alzheimer's are considerable. Individuals sharing similar situations gain insight and encouragement through verbal exchange; when real world suggestions were needed, and non- verbally; when words were simply not accessible. However, as word comprehension and creation becomes increasingly difficult, the individual enters a new stage of disease development. Short-term memory, orientation, and concentration are now severely impaired. Throughout this stage, remote memory, intellectual functioning, comprehension, and judgement decline steadily. Ability to care for one's self also declines, and sleep patterns are altered; this is a severe blow to the patient's independence and self-esteem. The patient then becomes suspicious and paranoid, even of those closest to them. Likelihood of involvement in accidents at home and abuse of medication increase. Behaviors may include night wandering, night shouting, and nocturnal micturition (night- time urination). Obviously, traditional family behaviors and interactive patterns realize drastic alteration. Family members begin to feel guilty for their impatience and intolerance of the patient, even though many of the demands of the patient are unrealistic and illogical. A major problem for those closest to the patient is readjusting expectations of the patient and themselves. Changes and problematic behavior become a source of stress during this phase, but overall limitation and conflict is reported to decrease, which may simply be the result of institutionalization of the victim. Use of drugs is found to be twice as high in care-givers as in community subjects, and care-givers often let their own health deteriorate. Particularly for the spouse's caregivers, social isolation becomes an issue of psychological well being. Lack of time, energy, and interest in social activities becomes prominent as the deterioration of the patient increases. In one study, spouses of patients exhibited higher levels of stress, in comparison to adult children caregivers; but husbands, in comparison to wives, report fewer burdens, and are more willing to admit the difficulty of the tasks at hand and seek out professional help. Adult male children are as likely as women are to assist their parents, but the men appeared to have the ability to distance themselves from the aging parent. This physical and emotional separation seemed to lower the amount of guilt felt by the men. Possibly because of these differing abilities to deal with the disease, there is often conflict between family members as to how to care for the victim. Two broad coping techniques of family members of Alzheimer victims are: (1) Distancing techniques and (2) Enmeshing techniques. Distancing techniques (as discussed earlier) involve establishing distance between the patient and caregiver both emotionally and physically. Enmeshing techniques involve the intensification of the relationship, and often the exclusion of others. This option is usually observed in cases where the spouse is the primary caregiver. Apparently, it is very difficult for spouses who use the Enmeshing technique to become involved in social support groups. Social support is a proven mediator and alleviator of family stress and patient dejection. Adult day care programs provide respite for family members, and allow the patient to interact with individuals with similar conditions. Generally, the patients see the support group as being most helpful in the areas of information sharing and peer support. This information and assistance may help determine the strength of the individual in last stages of the disease. This phase is the final stage of Alzheimer's disease. Mental deterioration is complete; many patients are completely unaware of, or unable to respond to their surroundings. The patients are totally dependent on others for all aspects of daily living. The patient will, most likely, not identify family and friends, and may not communicate at all. Paranoia, agitation, and combativeness increase significantly, if the patient is able to display these emotions at all. He/she eventually becomes extremely weak, incontinent, non-ambulatory and bedridden. It has been hypothesized that at least some of the premorbid changes in strength and weakness may be predicted from changes observed in the earlier stages. Descriptions by caregivers of premorbid personality traits of the victim are similar to symptoms of depression, hallucinations, and delusions. It is during this stage that most victims are admitted to an institution for professional care. Several behavioral problems such as aggression and wandering appear to increase as individuals are moved from the community to nursing homes. Acceptance of this disturbing disease comes very slowly to the family members. The disease's sly onset and the original appearance by the victim of retention of regular physical vigor make acceptance increasingly difficult. As the disease progresses further and further, the changes that occur for the victim become increasingly obvious and family members tend to define the situation more similarly than in previous, seemingly inconspicuous stages. The grieving process is lengthy, because the death of the person is long before the death of the physical body. Although the loved one is long gone, their shell lives on. At some point during this stage, the spouse must undergo the final challenge of marital evaluation. Because the patient does not recognize anyone, the spouse is totally alone, but not single. Obtaining a divorce often creates many difficult legal issues. Many caregivers need assistance coping with the guilt of â€Å"abandoning† their spouse when placing them in a nursing home. Thus, financial problems come into the picture. Paying for nursing home services is difficult, as all effort in previous years has been put into caring for the patient. Relatives of deceased victims can be compared to those whose family member is still living. Wives and husbands display similar feelings of burden, but the husbands report more social limitations. On the contrary, sons and daughters are different in their descriptions of burden. Sons report less social limitations than daughters do, and less affective limitation when the demented parents had died. The sons of the deceased elderly also report less conflict with others than the daughters do. The need for individual support for the caregiver and family of the deceased is important, especially at this stage of sorrow. There may also be a sense of relief and release, as the extensive suffering of a loved one has finally ended. The empty body, which once contained a loved one, can finally be put to rest. Help and support from the staff at institutions with dealing with the grief of the final loss of a loved one is valuable and most definitely appreciated. Alzheimer's Disease is a ceaseless debilitating disease without known cause or cure. Deterioration of mental and physical processes is inevitable, but varies between individuals- the cause for this variance has only been looked at hypothetically. It is a terrifying disease for the victim, who is constantly aware of the losses that are occurring, but can do nothing to prevent the disease from proceeding on its deadly course. Family members respond to the disease within certain guidelines, but the attitude towards the different stages differs for all involved. Social support systems have proven extremely effective for both the victim and caregiver in the Forgetful phase of the illness. From that point on, influence on patients decreases significantly, but personal gain for caregivers continues. There is an evident need for publicly funded support for Alzheimer's disease victims and their families. The obvious lack of information concerning the symptoms and results of the disease show the necessity for incorporation of education and support into intervention strategies for caregivers. Evaluation of a patient with possible dementia requires a complete medical history, neurologic evaluation, and physical examination. At the present time, no diagnostic tests for Alzheimer's are available in laboratories. It is simply a diagnosis based on elimination of other diseases. There is great need for a biological marker that would confirm the diagnosis of Alzheimer's in a living patient. Rapid progress has been made in identifying a potential genetic marker that could be used to diagnose the disease without autopsy, biopsy, or extended evaluations. Potential disadvantages of this approach would be the reluctance of both patients and physicians to have lumbar punctures done, and the potential overlap of normal patients and Alzheimer sufferers. These potential markers are a glimpse of light at the end of a dark tunnel. Metaphorically, Alzheimer's can be seen as a house that is constantly being eaten by termites, from the inside out. Although the house may look the same on the outside, the very foundation of the house, the part that makes it a home, deteriorates. Attempts to stop the decay are futile and, at best, temporary. Eventually, one will not feel comfortable at home, and will most likely leave the home- possibly for someone else to deal with. This relief is also temporary. The eating away of the house continues, until it eventually topples into an unrecognizable heap of what used to be a home. This feeling was best described by one individual in the middle stages of the disease: â€Å"†¦(J)ust a wild lost world. I'm here but I don't know where I am†.