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Myself, am a 48 year old man with a wife and three sons
Topic: Introduction Essay
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I am a 48 year old man with a wife and three sons. Already a retired accountant, I still fell that I have not achieved all that I dreamt of. I feel motivated that I can still pursue another profession since am still energetic and have all support from my wonderful and caring family. I was working as an accountant before I retired. Currently I am at home with my wife and children though I have a feeling that I have a lot to do for the world even at my age.
Apart from work I also like sports and specifically soccer. I not only watch but also play in local clubs. The game makes me keep fit and also relax from many hustles of life. I now wish to become a nurse as I believe that I have all it takes to achieve that dream. I have always wanted to become one and I believe that this is the right time. I also received little income which did not correlate with the services that I gave to the institution I was working for. Having three sons to take care of, I feel that I need better and satisfying remunerations in order to meet all the expenses.
I have always wanted to get involved in a profession where I get to pass my services direct to the clients and assisting the community to live healthily. That is that reason I decided to retire as an accountant since I did not get the satisfaction I longed for as far as giving back to the community is concerned. Pursuing nursing and later on taking a degree will be my dream come true.
The fact that my family is in support of the decision I have already made makes me confident that I can achieve this dream. My wife has agreed to support my course through taking care of the young sons while am doing my studies. The other factor is that this is an informed personal decision I am making after thinking over for sometime. Therefore I understand all the repercussions of making such a decision.
The only fear I have is that getting a job by the time I graduate could be a problem. This is bearing in mind that the market is flooded with young, energetic and qualified personnel whom I will be competing with. The other factor is the notions that people have on the older generation, that executing services would become troublesome. There are many responsibilities that the older people have including the family issues. Most people have the misconception that due to such responsibilities, those affected like me can not work properly as they carry with them the domestic issues to the working environment. The other factor I fear is related to the policies that several colleges have concerning the age limit students should have when pursuing certain professions. However, I am confident that I will be received well and offered the necessary support so as to achieve my goal.
After graduating as a nurse I would like to pursue Bachelor of Science degree. This is owing to the competitive environment out there. I know that unless I take such an action I might be rendered irrelevant in the job market or end up landing into unsatisfying related activities.
myotonic dystrophy
Introduction
Myotonic dystrophy refers to an inherited muscle wasting and weakness disorder that is characterized by unrelenting involuntary muscle contractions. The involuntary contractions come as a response to the voluntary use of muscle or the muscle percussion. Clinically, the condition is classified under muscular dystrophy although the mechanism of the disease is unique and distinct from the mechanism of other muscular dystrophies. One distinct feature of myotonic dystrophy is that it has widespread effects all over the systems of the body. Myotonic dystrophy is caused by defective genes. This form of muscle dystrophy distinct is also followed by myotonia (a delayed muscle relaxation after contraction), as well as a number of abnormalities apart from those of the muscle. This makes myotonic dystrophy different from all other types of dystrophies. The condition exhibits an early muscle wasting pattern unique among the key muscular dystrophies. Unlike other muscular dystrophies, the condition first affects muscles in the feet, forearms, hands, neck and face, rather than the shoulder and hip muscles. This condition is also known as multisystemic since its effects are not limited to the voluntary muscle systems.
Causes
As stated earlier, myotonic dystrophy is an inherited condition. It is linked to defective genes for proteins that manage the charged particle’s flow within muscle cells. The gene defect is known as triple retreat, implying that it incorporates extra DNA code triplets. There exists a possibility that the mutation also affects the nearby genes. It is also possible that the prevalent symptoms of the condition result from numerous genetic disruptions.
Diagnosis of Myotonic Dystrophy (Chronic and End Stage OF disease)
The case presented involves a 47-years old man suffering from end-stage myotonic dystrophy. Varied methods of diagnosis may be used in determining the ailment from which he is suffering. Since the disease in this man is at the end-stage, a neurological examination cannot be used. Neurological examination is used in the initial stages since the principal diagnostic feature of the condition is a significant, transient increased in the muscle tone, brought about by the use or percussion of the muscle. Other features of the condition of the disease include muscle weakness, male testicular atrophy, muscle atrophy and haggard faces. In addition, the involvement of the distal muscle precedes that of the proximal muscle. However, in the late stages as in this man’s case, the prominence of the increased tone reduces in which case the diagnosis cannot be done on the basis of neurological exam alone. Nevertheless, various diagnosis methods may be used including the following.
1. Electromyography (EMG) – this method of diagnosing the condition is crucial in confirming the diagnosis. It indicates a typical myotonic discharge that has a waning and waxing quality. The predictable variability in the frequency and amplitude of the myotonic muscle action potential differentiates it from that of the Complex Repetitive Discharge (CRD) which exhibits a continuous amplitude and frequency.
2. Genetic testing- Individuals who have myotonic dystrophy have a different DNA from the normal population in that a component of Chromosome 19 is expanded. This expansion can be readily detected by the use of standardized genetic material tests.
How Myotonic Dystrophy Affects The Respiratory System
Newsom1 states that, while myotonic dystrophy affects numerous systems in the body, the respiratory system is the most affected and the most likely to cause an individual’s death. This is because of the weakness of the diaphragm, which is the sheet of muscles situated at the top of one’s abdomen and carries out the key job of coughing and breathing. The weakness of the diaphragm results in a reduction of stamina and energy, as well as an increased lung infection due to the inability to cough in the right manner. In essence, the old man will have to be provided with mechanical ventilation assistance, as well as an appropriate respiratory hygiene.
Rehabilitation programs for the condition
Given the advanced stage of the condition in this case, the condition cannot be treated using medication. In essence, any rehabilitation programs offered to the man will only be meant to ease the pain and enhance his life. Wolf, Shochina and Ferber3 state that, the treatment is mainly aimed at preventing complications that come with weaknesses including decreased dexterity and mobility, scoliosis, contractures, respiratory insufficiency and heart defects. The appropriate programs would be the following.
1.Physical therapy
Physical therapy is used to sustain the affected muscle’s range of motion, as well as delay or prevent contracture. Strenuous exercises, however, would not be recommended as they may increase the damage. During these exercises, braces are used on the feet, as well as ankles to prevent equinus. In addition, full-leg braces would be used to lengthen the period of independent walking. It may, however, not be possible to strengthen other muscles since the condition in this case is in the last stages.
2.Surgery
Tenotomy surgery is performed when the contracture are increasingly pronounced. During the surgery, the contracted muscle’s tendon is cut and the limb braced in its usual resting position as the tendon regrows. When any surgery is being carried out on individuals with muscular dystrophy, it is imperative that anesthesia is carefully selected. This is because individuals with the condition are vulnerable to a severe reaction called hypothermia, when a halothane anesthetic is administered.
3.Nutrition
Good nutrition assists in promoting general health in all muscular dystrophies including myotonic dystrophy. Brown and Mendell4 assert that no supplement or uncommon diets have been shown to uplift any of the dystrophies. Nevertheless, the weakness of the throat muscles may make it necessary for a gastronomy tube to be used. This tube would be inserted into one’s stomach to provide the nutrition directly.
4.Occupational therapy
Occupational therapy incorporates tools and techniques to compensate for the loss of dexterity and strength. The strategies used in this case include changes in the man’s home, dressing aids, adaptive utensils, wheelchair accessories, communication aids, as well as compensatory positioning and movement.
5.Cardiac care
Antiarrhythmia medications such as nifedipine and mexiletine may be used to treat the arrhythmias that come with the condition. In addition, doctors may implant a pacemaker if the drugs do not offer sufficient control. However, the age of the man and the advanced nature of the condition would limit the need to install heart transplants.
6.Respiratory care
Since the man has a weak diaphragm and other ventilatory muscles, it is imperative that a mechanical ventilator is installed to ensure that he continues breathing deeply enough. A tracheostomy tube may be used to administer air through a mouthpiece or nasal mask. The tube is inserted via a surgical incision in the neck and to the windpipe. However, supplementary oxygen would not be necessary. Emery2 states that, it is imperative that proper hygiene of the lungs is maintained for the long-term survival and health of the individual. In addition, assisted cough machines may be used to clear the secretions present in the airways.
Bibliography
Newsom Davis J. The respiratory system in muscular dystrophy. Br Med Bull 1980
Emery, Alan E. Muscular Dystrophies. Cary, NC: Oxford University Press, 2003.
Wolf E, Shochina M, Ferber I, Phrenic nerve and diaphragmatic involvement in progressive muscular dystrophy. Electromyogr Clin Neurophysiol 1981;
Brown, R H., and Mendell, J R. “Muscular Dystrophies and Other Muscle Diseases. New York: McGraw-Hill, 2001
Barohn, Richard J. “Muscle Diseases.” Philadelphia: Saunders, 2003
Hazard Mitigation and Vulnerability Assessment
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Hazard Mitigation and Vulnerability Assessment
Summary of the Event: Evansville Tornado of 2005
The tornado hit Evansville area of Indiana in the United States on 6th November, 2005 during the wee hours of the day. Notably, this was the first tornado that occurred in the month of November. It is seemingly one of the deadliest that had been experienced in the region as it culminated in up to twenty five fatalities (Walker, 2007). Comparatively, it was also the most destructive in Indiana’s history. It prompted the United States to develop better strategies to cushion its population against the adverse effects that stem from relative events. This paper focuses on the mitigation procedures that were in place before the event, the geographic technologies employed in assessing mitigation alternatives, mitigation changes that were made as a result of the event and the relative ‘window of opportunity’ associated with this event. Mitigation procedures that were in place before the event
The National Windstorm Impact Reduction Act was established in 2004. It advocates for improved understanding of tornadoes and other windstorms by all populations, assessment of the impacts of windstorms and reduction of the impact of windstorms.
The National manufactured Housing Construction and Safety Standards Act that was instituted in 2004 requires all forms of constructions to adhere to the set standards regarding protection of the negative impacts associated with tornadoes (Roger, 2008).
The Tornado Shelters Act that was passed by the congress in 2003 authorizes local communities to make use of the available funds provided by the Community Development Block Grant (CDGB). These seek to enable locals constructing shelters in home parks to develop tornado safe shelters. Specifically, it benefits residents of low and moderate income categories.
How geographic technologies were used to assess mitigation alternatives
Weather radio alarms were used by the weather forecasting team to alert the locals of an approaching tornado. This was necessitated by the local weather radio transmitter.
The local television provided vital information that empowered the communities about the causes, effects, mitigation and prevention strategies for tornadoes (Bradford, 2001). Technical terms were simplified to ensure that all facets of the population clearly understood the concept of tornadoes.
Technology used to detect severe weather had been installed by researchers from Severe Storms Research Center (Previdi & Liepert, 2008). The main aim for this was to record and monitor any signs of severe weather conditions. Relative data provided useful insights regarding the severe weather trends (Grazulis, 2001).
Mitigation changes that were made as a result of the event
The CJ’s law was introduced by Republican Phil Hoy. This requires persons or corporations manufacturing mobile homes to install an operational weather radio that has a separate power outlet. This according to Groisman (2001) would be imperative for alerting the locals in of an approaching tornado.
The Warning Decision Support System (WDSS) technology was established in the local institution of higher learning to provide vital information for early detection and warning of the event. Relative technology includes artificial intelligence, neural networks, image processing and a host of other algorithms that employ Doppler radar data. Information derived from this would probably reduce the negative impacts of the incidences by 50% (Gibbons, 2010).
The Vanderburgh County took practical measures by passing the legislation that sought to toughen the safety standards governing mobile home construction. Specifically, this required that the respective homes be securely anchored using additional braces and straps. This according to Walker (2007) was instrumental in preventing future incidences of a tornado.
National legislation regarding land use and zoning was localized. This was in a bid to ensure that the measures undertaken to cushion the society against the effects of the tornado were viable.
The Natural Hazards Risk Reduction Act was instituted in 2011. This provides that research related to hazards and development places emphasis on reducing relative loss of lives as well as destruction of property. Notably, this could be attained by intensifying hazard mitigation measures.
The Home protection Act, 2009 was introduced. This basically amended the provisions of the National Manufactured Housing Construction and Safety Standards that had been initially established in 2004. Essentially, it required all mobile homes to be equipped with an operational weather radio (Gibbons, 2010).How this event was a ‘window of opportunity’
As a natural disaster, this tornado led to significant fatalities that compromised the quality of life of the locals. Besides destroying property of invaluable value, the tornado culminated in loss of lives. However, this also acted as a ‘window of opportunity’ in various ways.
To begin with, it triggered the use of a local telethon to collect funds (Roger, 2008). FEMA believed that no other technology had previously been employed for collecting such amount of funds. The funds were geared towards helping the locals that had been affected by the tornado. Thus besides the society benefiting significantly from this, it discovered the use of a technology that could be handy for future incidences.
The relative experience compelled WEHT, a local television station, to initiate a campaign aimed at providing the event’s victims with weather radios for free. The rest of the population would get the sets at a discounted price. This greatly increased the sales of the sets and undoubtedly, the manufacturers benefited significantly. Over time, this initiative has been replicated by WEHT’s competitors and the program has reportedly spread to various parts of the country (Roger, 2008). In this sense, the tornado was a ‘window of opportunity’.Critique the mitigation approaches
The legislation advocating for education of population about the implications of tornadoes and how the negative effects could be minimized is sustainable. The inherent capacity building empowers the populations about important knowledge and skills to counter the relative negative effects of this natural disaster (Lins & Slack, 1999).
Although the populations had been informed about the tornadoes and how the impacts of these could be reduced, minimal efforts had been made to conduct practical drills of these. The populations would understand better if frequent drills would be undertaken. Also, efforts regarding the enforcement of legislation pertaining to building and zoning standards needed to be put in place. Arguably, the destruction would not have been very massive if the relative legislation was enforced to the later.
Critique the use of geographic technologies
The use of local television to empower the locals about prevention and mitigation strategies is commendable. In this respect, statistical evidence ascertains that a significant 72% of the population relies on the television weather forecasts for making vital decisions (Downton & Pielke, 2005). This was an important technological approach to use for informing and empowering the populations accordingly.
Use of technology to detect incidences of severe weather was also remarkable. Using this, the technicians were able to monitor the movement of the tornado effectively. Although they did not inform populations about this in a timely manner, they were aware of the scenario and attempted to counter the effects accordingly.
Notably, the susceptibility of the populations was enhanced by the failure of the weather radios to sound an alarm. Although the event occurred odd hours, alarms need to have been sounded at least thirty minutes before the tornado. The failure of the radios implies poor preparedness by the relevant stakeholders (Walker, 2007).
How social vulnerability played a role in the creation of the disaster
Lack of access to critical information pertaining to the tornado, relevant technology and inaccessibility to knowledge about its occurrence greatly undermined the ability of the population in this region to respond to this event in a timely and effective manner. As aforementioned, technological faults hindered judicious communication of critical information regarding the approach of the disaster to the locals.
The massive destruction of property and infrastructure is attributable to poor construction practices in addition to laxity in enforcement of important codes and regulations. Intensification of capacity building amongst the population implies that they were not equipped with adequate knowledge and skills to counter the after effects of the tornado. The response of health professional to the event was also inadequate. In this respect, Previdi and Liepert (2008) indicate that two victims of the event died of injuries one month after the event. Lessons learned that could inform disaster risk reduction efforts
Firstly, disasters are emergency events that require prior preparation by all facets of the population. Besides providing effective, relevant and operational technology, the government should ensure that the entire population is well informed about all types of disasters and how to respond to them. This according to Gibbons (2010) is instrumental for reducing the risks associated with the disastrous events. Most importantly, the respective technology should be improved periodically, in line with the technological advancements being experienced currently.
The government should ensure continued monitoring of the disasters. Fundamentally, statistical data is credible and provides a basement upon which objective decisions regarding the events can be made. Using this, weather technicians and forecasters can determine trends and establish viable early warning systems.
Timely response to disaster incidences is important for reducing the relative negative effects. To attain this, all stakeholders should collaborate with each other in providing help to the affected population. Undoubtedly, this calls for effective mobilization of resources. Furthermore, all stakeholders need to be committed to saving lives and property.
Due to the effects of the tornadoes, technological infrastructure including electricity is bound to fail (Previdi & Liepert, 2008). Response and mitigation measures should provide for efficient alternatives to be employed in saving lives and property.
In most instances, tornadoes offer a ‘window of opportunity’. This should be explored to benefit the community in different ways. As it has come out from the study, emergent opportunities have lasting positive impacts on the affected populations. Moreover, they can be effectively used for countering the negative impacts of the disasters. In this regard, the affected populations can use this to perceive the disaster positively. From a psychological point of view, this hastens the process of healing (Parmesan, 2000).
References
Bradford, M. (2001). Scanning the skies: A history of Tornado forecasting. USA: University of Oklahoma Press.
Downton, M. & Pielke, R. (2005). How accurate are disaster loss data? The case of US flood damage. Natural Hazards, Vol. 35, 211-228.
Gibbons, G. (2010). Tornadoes. USA: Holiday House
Grazulis, T. (2001). The tornado: Nature’s ultimate windstorm. OK: University of Oklahoma Press.
Groisman, Y. (2001). Heavy precipitation and high stream flow in the contiguous United States: trends in the 20th century. Bulletin of the American Meteorological Society, Vol. 82, 219-246.
Lins, H. & Slack, J. (1999). Stream flow trends in the United States. Geophysical Research Letters, Vol. 26, 226-230
Parmesan, C. (2000). Impacts of extreme weather and climate on terrestrial biota. Bulleting of the American Meteorological Society, Vol. 83, 443-450.
Previdi, M. & Liepert, B. (2008). Inter-decadal variability of rainfall on a warming planet. Eos, Vol. 89, 21, 193-195.
Roger, P. (2008). Normalized hurricane damages in the United States: 1900-2005. Natural Hazards Review, Vol. 9, 29-42.
Walker, S. (2007). Spatial and temporal analysis of tornado fatalities in the United States: 1880-2—5. Weather and Forecasting, Vol. 22, 1224.