What Atlanta has to offer the tourist Essay Example | Topics and Well Written Essays - 250 words - 1

What Atlanta has to offer the tourist - Essay Example Some of the extremely incredible visitors’ attractions and tourists destinations in Atlanta are as follows: Centennial Olympic Park in Atlanta is one of the most frequently visited parks by tourists in Atlanta. It is equipped with many amphitheatres. The Park derives its name from the 1996 Olympic Games which were organized in Atlanta. The CNN Studios happens to be just across the Centennial Olympic Park. Here, the tourists get to learn the way news are organized off the screen and the way they are broadcasted. Then there is the King Center, which honors the life of Martin Luther King, Jr. Life of the activists who have struggled to attain civil rights is presented in a video. Tourists get to gain an in-depth understanding of the civil rights evolution. Next is the famous Ebenezer Baptist Church quite near the King Center, which tourists frequently feel drawn towards. There are many other attractions for tourists in Atlanta. It is undoubtedly, one of the best places for a tourist to

Jose Rizal Epic Poem Essay Example for Free

Jose Rizal Epic Poem Essay A natural hero was born on 1861 His name was Jose Rizal A gifted child who studied foreign languages This great hero was the founder of La Liga Filipina. During his lifetime there was a war The Philippines was shattered to the ground.. Many uprisings were fought against the Spaniards! All of it failed until the Noble Jose Rizal came. His divine weapon was not a sword nor a gun But a small pen. A pen so great it united the Filipinos. His words inspired the hearts of all It spread all over the country like a wild fire The Spaniards heard it just like a wind whispering to them They locked Jose Rizal in a dark tiny chamber in a basement They tortured him.. Oh poor sir Jose Rizal.. Yet his hated grows and burns within his soul The Filipinos planned to free him They had worked so hard.. and it succeeded! Jose sighed.. What a beautiful sight But he said â€Å" Ill stay here to represent our nation† Andres Bonifacio another great hero said.. Are you sure Jose? And Jose replied with all my heart yes I am.. The Spaniards came with an army so great They have to leave Jose Rizal to the hands of the Evil Spaniards They confine him with a great heavy chains Tormented his life for trying to escape And one day the government ordered his death His death day was on December 30, 1896 There he was standing alone under the heavy rain Behind him a hundred gunman to shoot him dead. The leader shouted Fire! and then a gun echoed in the area, the Heroic Jose Rizal was shot in the back.. his eye sight blurred for the last time He felt the pain starts to erupt up to his spine he breathe for the very last time He looked up into the misty sky collapsing facing the gunman There he was lying dead on the bloody ground The Clouds weeps for his death All the Filipinos who watched him get shot screamed No! His death inflamed the hearts of the Filipinos

Successful Management of a Diverse Workforce Essay -- Workforce Employ

Successful Management of a Diverse Workforce Successful management of a diverse workforce poses many challenges in the confusing aspects of diversity that exist in today’s workplace. Equal employment opportunity is an attempt to pay retribution for past errors and many say it was a good beginning but more is needed. We commonly read and hear the increasingly popular term diversity training. The new catchphrase to be found gaining popularity in the workforce is inclusion. With all these confusing concepts, just how can management develop a successful strategy to manage a diverse workforce? The term diversity needs to be defined, as it is applicable in the workplace. Equal Employment Opportunity focused primarily on gender and race. Diversity, though, is filled with many more criteria than just gender and race. Diversity is defined in one article (â€Å"Value of Cultural Diversity,â€Å" 1997) as â€Å"not part of the mainstream, popular culture. In this nation, our popular culture, or ideal business success, is white, young, heterosexual, Christian, and male.† This description, while blunt, may indeed reflect what diversity in the workforce represents. Anyone in the workforce who does not meet the criteria stated in the article would be an example of diversity. When we add age, marital or family status, sexual orientation, religious beliefs, and disabilities the pool of a diverse workforce outside of gender and race gets rather deep indeed. Management strategies must adapt to be effective in managing this expanded diverse workforce. Management in America has historically always dealt with a diverse workforce. During the days under British colonialism a majority of the workforce were religious minorities, political dissidents, minor criminals, and indentured servants from Britain. Further diversifying the workforce was the practice of importing African slaves. After the American Independence, the American workforce began seeing many German and Irish immigrants who were Roman Catholic, which increased as the nineteenth century progressed. Actually, according to Hatton and Williamson (1998), during the second half of the nineteenth century, â€Å" the rate of Irish emigration was more than double that of any other European country, with as many as 13 per thousand emigrating each year†. While the Irish were flooding the workforce from Europe, the Chinese were also flowing into... ...r of the skin we're born with but we can control what we put in our noses.† When does inclusion become intrusion on the dominant culture? How far must the dominant culture bend over to accommodate the multitude of differences found in today’s society? As a nation of diversity, haven’t we already adapted enough without making special concessions for every person with a difference? Recognizing both the differences and the commonalities among the various individuals comprising one’s workplace and instituting fair and balanced strategies are the keys to successful management of a diverse workforce. References Beck, B. E. (1999, July). Style and modern writing [Special issue]. Prose Magazine, 126, 96-134. Gode, S. M., Orman, T. P., & Carey, R. (1967). Writers and writing. New York: Lucerne Publishing. MacDonald, S. E. (1993). Words. In The new encyclopedia Britannica (vol. 38, pp. 745-758). Chicago: Forty-One Publishing. Wilson, J. C. (2001). Scientific research papers. In Stewart, J. H. (Ed.), Research papers that work (pp. 123-256). New York: Lucerne Publishing. Xenon, R. M. (2002). Birth order and romantic attachment style. Journal of Research in Personality, 22, 236-252.

The Last Dalai Lama? Essay -- Tibet History Dalai Lama Essays

The Last Dalai Lama? The twentieth century is rife with examples of countries being torn apart or experiencing great upheaval. Multi-ethnic Yugoslavia broke apart into several nation states with loose foundations. The Soviet Union collapsed, transforming the area into the Commonwealth of Independent States. Germany split in half as a result of World War II and then reunited over forty years later. One country that has experienced tremendous crisis and upheaval on a scale even greater than these European nations, yet often goes unnoticed, is Tibet. Tibet enjoyed peace and autonomy until 1949 when Chinese Communists invaded the country under the guise of the "Peaceful Liberation." Coveting Tibet’s vast natural resources and strategic location in Central Asia, they sent off innocent civilians and peaceful protesters into prisons and concentration camps, subverted their economic and agricultural system, and ravaged Tibetan culture. As a result of the Chinese invasion, Tenzin Gyatso, the Fourteenth Dalai Lama of Tibet has undertaken roles and responsibilities that no other previous Dalai Lama has attempted. Determined to salvage Tibetan life and culture he fled his palace in Lhasa and instituted the Tibetan Government in Exile in Dharamsala, India. Since his flee into exile Tenzin Gyatso has diligently worked to negotiate peacefully with China and other nations to reclaim his country, institute a working democratic government in India, and promote the survival of Tibetan culture through the establishment of schools, monasteries, and cultural centers. Therefore as a result of the Communist invasion of Tibet and Tenzin Gyatso’s subsequent response to it, the role of the Dalai Lama has irrevocably changed. He has gone from an iso... ...e past half-century. His actions and success as a ruler provide a true example of the application of religion towards politics, and that faith can and does overcome. Works Cited Avedon, John. In Exile in the Land from Snows. New York: Harper Perennial, 1997. Goldstein, Melvyn. "The Dalai Lama’s Dilemma." Foreign Affairs, 77 no. 1, 1998, p. 83 – 98. Mullin, Glenn H. The Fourteen Dalai Lamas: A Sacred Legacy of Reincarnation. Santa Fe: Clear Light Publishers, 2001. Pedersen, Kusumita P. "Tibet: Liberation as Oppression." Cross Currents 38, no.1, 1988, p. 100-102. Pilburn, Sidney, ed. The Dalai Lama: A Policy of Kindness. New York: Snow Lion Publications, 1993. Verhaegen, Ardy. The Dalai Lamas: The Institution and Its History. New Delhi: D.K. Printworld, 2002. Wen, Wang. "Tibet: Change and Development." Beijing Review 44, no. 19, p. 12 – 15.

Maya Angelou Essay Essay

An inspirational woman is that who embraces her times of turmoil and converts them to a learning lesson. She does not fear smiling in order to cheer up another person even if inside she is hurting. This woman does not allow gender, age, or race to hinder her from exploring life just like other people who are more privileged compared to her. This inspirational woman is remembered for her encouraging words that no one should live life with a catcher’s mitt on both hands; however, one should be able to throw some things back. Drawing from her wise, honest, and persevering attitude, Maya Angelou is a phenomenon woman who is my inspiration. Maya Angelou endured sexual abuse, racial discrimination, and other impediments but she remained humbled around cultural, family, and community values. Maya Angelou was one of the most successful author, poet, and civil rights activist who were admired universally by many. She was famously known for her teachings using poetry and spoken word, wh ich highlighted the experiences of being an African-American woman leaving in the United States. Most of her works were also inspirational which helped to shape the modern-day prose and poetry (Haigh 1). The same kind of zeal and motivation that Maya exemplifies has helped me to handle any kind of challenge that I encounter and make it work for me, but not against me. When I saw Maya Angelou’s painting at the Charles H. Wright Museum, I began pondering whether Maya ever knew she would end up on exhibits, television shows, Broadway stages, traveling the world and being able to speak five languages fluently. It dawned on me that Maya being a proud woman helped her to become a motivator, but not her being a motivator that made her a proud woman. This character and charisma expressed by Maya inspired me to embrace where I have come from since it would have an impact on where I want to go (Haigh 2). Maya encouraged and inspired generations through her works and she brings out the meaning of the fact that age is just a number. Read more: Who do you admire essay Maya’s inspirational lessons remain an intrinsic part of the American culture even after her death in 2014 at the age of 86. Maya’s most inspiring poem, And Still I Rise, had a very significant passage that said, â€Å"You may shoot me with your words, you may cut me with your eyes, you may kill me with your hatefulness, but still, like air, I’ll rise† (Angelou 21). This passage inspired me to always endure every hardship and  obstacle in my quest of achieving my ambitions since everyone else also experiences setbacks that help them grow. Most people usually perceive that in order to have a motivator in one’s life you have to know the person personally; however, that is not the case. I believe that if a person inspires you without even having met the person in your life, it is an unparalleled gift. Angelou is a significant motivator among women and inspires them to always live their lives open-heartedly and be able to learn, and retain as much as they can and make a difference in someone else’s life. This is because â€Å"people will forget what you said, people will forget what you did, but people will never forget how you made them feel† (Angelou 24). Works Cited Angelou, Maya. â€Å"Phenomenal Woman by Maya Angelou.† 3 January 2003.Thousands of Poems and Poets. Web. 4 February 2015. Haigh, Chris. 12 Inspiring Life Lessons From Maya Angelou. 6 April 2009. Web. 4 Februay 2015.

The Great Depression and a Changing America essays

The Great Depression and a Changing America essays The Great Depression was the longest and worst period of high unemployment and low business activity. It began in October 1929 when thousands of stockholders lost large sums of money. Banks, factories, and stores closed, leaving millions of Americans without a job. The Great Depression affected almost every nation and caused some nations to change their leaders. This led to the rise of the German dictator Adolph Hitler and the Japanese invasion of China. Many causes contributed to the Great Depression. During the 1920s, prices of farm products fell about 40 percent. Some farmers lost so much money that they could not pay the mortgage for their farm. About nine thousand banks went out of business because farmers experienced such poor conditions. Industrial production increased by about 50 percent, but the wages of the workers in coal, railroad, and textile industries rose much slower. As a result, these workers could not buy goods as fast as the industries produced them, which led to a decrease in money circulation, which made the business even worse. From 1925-1929, stock values rose rapidly, which encouraged people to buy stocks in the hope of making large profits. But on October 29th the stock prices fell rapidly. Thousands of people, as well as banks and businesses, lost huge sums of money. After the Great Crash came to the Great Depression, which lasted for ten years. In 1933, Gross National Product (total production of the eco nomy) was nearly a third less than in 1929. Many died of disease from the lack of food during the Depression. Thousands lost their homes because they could not pay mortgages. Hundreds of thousands of people wandered through the country seeking food, clothing, shelter, and a job. Farm families were wiped out because of severe droughts and dust storms. A fire in the state of Washington that lasted all summer and fall was caused by unemployed timber workers and bankrupt farmers in an attempt to earn a few...

It Isnt About Luck

It Isnt About Luck You were lucky to have FundsforWriters to sell your books. I dont have that luxury. I hear this so much, in one version or another. First of all, there is no serious luck in this business. Its a matter of constantly putting yourself out there in terms of writing, publishing, appearing, working social media, fighting to be current, taking chances. There is no one right way or best way, only the way that happens to work for you at that moment in time. Frankly, I started FundsforWriters because I could NOT sell my mysteries. I wanted to be a writer and make an income from writing, so I figured any sort of reputable recognition could only help me in becoming a professional writer. As someone who loved stringing words, I walked through whatever door opened for me, wrote whatever might help me take one step further in my career. However, I had my conditions and parameters in who I wrote for and what I wrote and how I proceeded: 1) Markets had to pay. Even as a beginner, I recognized that being paid mattered not only in my pocketbook but also in the eyes of editors I pitched. They knew who paid and who didnt, and that mattered in their judgment of me. I wrote a column once for nothing, hoping to aid my resume, but after several issues, when the editor still could not afford to pay, I stepped away. And I learned that nobody cared that Id written that column. 2) I had to build and retain a following. I couldnt just write and build up credits. I had to have someplace to flaunt those credits (website, then social media) and some means to retain those people who read my work and liked it (newsletter). 3) Repetition matters. I wanted to become Google-able, which meant frequent and reputable appearances. If I wasnt on the first page of a Google search for my name, I strived to submit to enough magazines, websites, newsletters, and blogs to improve my search ranking. A book a year wasnt going to work. 4) Quality matters. Its a given that your writing quality matters, but be careful where you make your appearances. I wish I knew way back when what I know now about that. I wouldve been a tad more selective in some instances as to whom I wrote for. You might be new. You might be a struggling mid-lister. You might be seasoned and coming back into the fold, trying to remain pertinent. Fight to present yourself as strong, diligent, and reliable. Keep putting yourself out there, but dont give it away. People will respect you so much more.

Free Cover Letter Sample for Marketing Job

Free Cover Letter Sample for Marketing Job SAT / ACT Prep Online Guides and Tips The writer of this cover letter works in marketing, so hopefully he's able to market for himself with a strong cover letter! As you'll see below, the applicantuses a list format to presenthis professional skills and draw direct connections with the job's requirements. Read on to see how the applicant describeshis experiences,and then continue on to an analysis of what this sample cover letter does well. Cover Letter Sample for Marketing Manager Position Bran Starkman5 Tree LaneSnowtown, CO 80001 May 1, 2016 Cecily LannisterDirector of MarketingKing Co.10 Landing St.Sunnyvale, CA 94085 Dear Ms. Lannister, I’m writing to express my strong interest in joining King Co.’s team as Marketing Manager, an opportunity I discovered on Monster.com. King Co. takes such an innovative approach to itsmarketing, and I would love to contribute toits progressive vision.With my five years of experience in marketing management, I havethe skills and knowledge to excel in this role. Please allow me to highlight my qualifications as they related to your stated requirements. Your Requirements My Experience Marketing degree, 3 years exp. Obtained my BA in Marketing Communication in 20 and have three years of experience as an SEO Content Marketing Manager Skilled with content strategy development and implementation Developed and executed SEO strategy that achieved top 3 rankings on Google for key product search terms; led team that expanded unique visitors from 10k/month to 2 million/month in one year Social media guru Maintained editorial calendar across social media platforms; oversaw 30% increase in Facebook and Twitter shares; synchronized social media posts with content publication Professional, personable, and passionate 3 years of successful content team management while maintaining strong interpersonal relationships; devoted to fostering open communication and supporting growth of team members I’ve attached my resume to flesh out my professional background as Marketing Manager, along with two letters of recommendation. I’m very excited about this opportunity with King Co. and look forward to speaking with you soon. Please don’t hesitate to contact me at 508-508-5080 or bran.starkman@gmail.com. Thank you for your consideration. Sincerely, Bran Starkman Bran Starkman508-508-5080 bran.starkman@gmail.com Bran says he's skilled with content; did this skill come through in his cover letter? Marketing Manager Cover Letter: The Breakdown Bran took a bullet point approach to his cover letter, using a list to match the position’s stated requirements with his own qualifications in a form that’s sometimes referred to as an executive briefing. Visually, this format makes his letter easy to read and understand. He showed an understanding of the position by explicitly listing its requirements, and he provided specific examples of his professional accomplishments with data. Bran's measured approach seems to work well for the position of marketing manager, which also requires a high degree of organization and the use of metrics to measure impact. Bran’s cover letter hits the four key features described in our cover letter guide - it’s customized to the job at hand, it uses specific examples, it communicates enthusiasm, and it’s highly readable. Bran includes his and the hiring manager's contact information at the top, so presumably he's sending his cover letter as a hard copy or Word document attachment. Hopefully, his cover letterwill land Bran an interview with King Co. Before you check out more cover letter samples, consider the followingimportant note on format. A Note on Format Before addressing the hiring manager, Bran provided a header with his name and contact information at the top of his cover letter. He also added the date and contact details of Ms. Lannister. This kind of formatting is traditional for cover letters, and it still works well if you're sending your letter by hard copy or as a Word attachment. Many jobs, though, expect you to paste your cover letter in the body of an email or in a text box on their application portal. If you're sending your letter this way, then you can usually leave off these headers. They're more applicable if you can format your letter with a certain look. If you're going the plain text body of email or text box approach, then you can just start right in with the salutation. As you finalize the look of your cover letter, consider how you're sending it, along with any application instructions. Then let that method guide your cover letter's final look! What's Next? Are you ready to read another cover letter? Check out this sample cover letter for the job of Editorial Assistant with a publishing company. Would you like tolearn more about cover letters? Our full guide has great tips on writing cover letters, along with five more samples! Are you wondering how to structure your letter? Our cover letter template guides you through the writing process, step by step.

Sustainability and Innovation Paper Assignment Example | Topics and Well Written Essays - 2000 words

Sustainability and Innovation Paper - Assignment Example There are different sources of innovation depending on the area where the innovations are to occur. The main innovation source is change in structure where things in an organization or company will be organized and formulated in a new way. Innovations can also arise from experimentations (Rolf, 2008, p.21). This involves some empirical processes that are crucial for designing the innovation. Innovation occurs in different sectors and one of the crucial ones where it has and will continue to take place is in the construction industry. There are different types of innovations that have occurred in the construction industry ranging from the materials used to do the innovations to the methods used to do the same. In the past the topic had been ignored but from some years ago people have realized the roles that the sector plays and why changes have to be made accordingly. This is a topic that has been taken with much weight by engineers from different corners of the world. The innovations are mainly done for various reasons; (i) To reduce hazards and risks in the construction sites during the process and after the process. (ii) To reduce expenses that are incurred in coming up with complete constructions. This will mean innovating in new materials to be used in the construction processes. ... The main one that is a threat to the present generations and future generations is global warming (Elzen, Geels and Green, 2004, p.18). This is changing the environment at an alarming rate and some scientists have predicted that the situation in some areas is likely to be beyond control unless necessary measures are put in place promptly to rescue such. In United Kingdom the matter has been taken with much weight since they have recognized that the different personnel that are involved in the construction activities have slowed and even ignored preserving the environment through the different activities they undertake (Horbach, 2005, p.41). This is more in the construction industry with much force been on the small contractors. For innovations to be said to be successful, they must satisfy the needs of all stakeholders. The innovation involves a process that is arranged in a sequential manner. The first one is research that is carried out by experts in that field. After research ther e is discovery that results from the research carried out. After discovery there is development followed by patenting & approval. This is then followed by production, marketing and then lastly adoption (Fisk 2010, p.39). Innovations can be stimulated or caused by external forces or internal forces in an organization. The external forces that are likely to pressurize innovations are globalization of markets, social change, government deregulation, fragmentation of markets, and emergence of new technologies. Internal forces that can pressurize innovations in an organization are profitability, core competencies, and high-quality employees (Heinelt & Smith, 2003, p.43). Sustainable development Sustainable development is a wide concept that is minimized in definition to mean

Determination of nitrogen dioxide content of the atmosphere Lab Report

Determination of nitrogen dioxide content of the atmosphere - Lab Report Example Apparatus include sampling probe, absorber, gas drying tube, air-metering device, thermometer, manometer, air pump, spectrophotometer, and stopwatch. Reagent grade chemicals have been used. Water free from nitrite and deionized according to specification D 1193 for type I or II reagent water has been used. Anhydrous sulfanilic acid has been used as the absorbing reagent, N-(1-Naphthyl)-Ethylenediamine Dihydrochloride stock solution (0.1 percent), Sodium Nitrite standard solution (0.0246 g/L) and NO2 permeation device were reagents and materials that were used in the experiment. 5.0012 g of anhydrous sulfanilic acid was dissolved in 1 L of water containing 140 mL glacial acetic acid. The process was gently heated to speed up the process. 20 mL of the of N-(1-naphthyl)-ethylenediamine dihydrochloride 0.1 % stock solution and 10 mL acetone were added, and diluted to 1 L. 0.1 g of the reagent was dissolved in 100 mL water.Calibration and StandardizationThe flowmeter was calibrated using practice D 3195. The gas meter was calibrated using test method D 1071. Standardization was based on observation. 0.82 mol of NaNO2 produced the same color as 1 mol NO2. 1 mL working standard solution contains 24.6 Â µg NaNO2. The amount of NO2 given by (24.6/69.1)x(46.0/0.82), which is 20 Â µg NO2. Standard conditions of 101 kPa and 25C were taken, and the molar gas volume was 24.47L (ASTM International 3). Graduated amounts of NaNO2 solution were added to a series of 25mL volumetric flasks up to 1 mL.

Should the UK withdraw from the European Convention on human rights Essay

Should the UK withdraw from the European Convention on human rights - Essay Example Sovereignty of the parliament dictates that the parliament has the sole discretion to make and amend laws in the UK. No person or body is recognized by the UK legislation to overrule the law made by the parliament. In this spirit the parliament is seen to be competent to make any laws. Laws that deprive the citizens of their right to property, liberty, voting, and life among others should be seen as valid so long as they have been passed by the parliament. This is done in faith that the parliament can exercise self restraint and only pass laws that are at par with the moral standards. However, this has not been the case always because some politicians have normally put their own selfish interests at the cost of national interests. The ECHR being an international body helps to regulate such offensive or repugnant laws. The citizens of Britain should advocate against their government withdrawal from the convention. This is for the benefit of regulation of the laws that the parliament may pass. The Human Rights Act of 1998 and its Problems The human rights act of 1998 was drafted on the principle of protection of human rights but reconciled with the sovereignty of the state (UK Government, 2012). Under this act, the parliament may make legislations and the courts may not necessarily quash them on the grounds of inconsistency with the European Convention on human rights. In fact, it is only the higher courts that should interpret the legislations and determine their inconsistency. The higher courts may only declare incompatibility where it is very clear. This act was put forward in order to ensure parliamentary sovereignty. ... an Rights Act of 1998 and its Problems The human rights act of 1998 was drafted on the principle of protection of human rights but reconciled with the sovereignty of the state (UK Government, 2012). Under this act, the parliament may make legislations and the courts may not necessarily quash them on the grounds of inconsistency with the European Convention on human rights. In fact, it is only the higher courts that should interpret the legislations and determine their inconsistency. The higher courts may only declare incompatibility where it is very clear. This act was put forward in order to ensure parliamentary sovereignty. However, the enactment of the act has transformed the constitutional environment in which the parliament’s legislative power exists; the legislative powers have been altered. Three features of the act pose problems to its enactment and goes against the ECHR. The first problem is that the act places the power to interpret whether the acts are consistent wi th convention rights in the hands of the judiciary. This greatly alters the process of interpretation of the legislation. This has two implications; it is rare for legislation properly interpreted to go against the human rights norms. The parliament will always use a clearer and precise language if it wishes to abrogate human rights. The use of clear language draws the attention of public and the parliament. The government may put a strong justification of the legislation to win the public support. This legislation may be infringing on the rights of the people but it may escape the eyes of the judiciary which has been given the ultimate power to determine its compatibility with the rights convention (Elliot, 2002). The second problem is that the minister in-charge of the bill should make a

Alternative fules-----history Assignment Example | Topics and Well Written Essays - 750 words

Alternative fules-----history - Assignment Example e early 19th century petroleum, became an alternative option to whale oil that was initially used by people in lighting lamps and it led to the death of large number of whales in the oceans. The dawn of the 20th century was marked by the appearance of ethanol as the alternative to gasoline. The rise in the alternative fuel sources came due to the ever increasing demand for more environmental friendly fuels. The traditional fuels were mainly from natural resources such as those from fossil fuels that included oil, gas and coal and they were diminishing at a very high rate. This led to the constant increase in the price level of fuels as well as increased dependency by the world’s leading economies. The negative impacts of the continued use of non-renewable energy sources has been witnessed in the world by the occurrence of global warming, depletion of the ozone layer due to the increased emission of greenhouse gases emitted in the process of burning fossil fuels. Increased air pollution as well as soil erosion have been attributed to the use of fossil fuels. These factors triggered the need for alternative sources of fuel so as to reduce environmental degradation. Human beings have increasingly realized their mistakes as far as energy is concerned and they have b egun to come up with alternative fuels that are friendly to the environment. Examples of alternative fuels that have been introduced in the recent past include wind and solar energy that are not depleted and their continued use does not cause harm to either human beings or other living things. The use of fossil fuels have been an ongoing process and has been an essential source of energy since humans first discovered coal. From Neolithic times to the eighteenth century, humans made only minor improvements to coal and wood-burning technology. The steam engines that were invented in the 1700s were the first machines to use fossil fuels to power mechanical processes. By the year 1802, many cities in the

The Benefits of the Universitys Agricultural Patents Article

The Benefits of the Universitys Agricultural Patents - Article Example The cell line defends stops the growth of mycotoxins. Within the global food environment, Mycotoxin-infected agricultural products precipitate economic losses (DAR, 2006). University of Illinois (2013) offers Agriculture-based courses for farm enthusiasts and entrepreneurs. With the ARS and-University of Illinois patent partnership, the outcome is the improvement of our nation’s agriculture product outputs. The partnership ensures there is abundantly safe top quality food on the American people’s tables. The service helps its citizens, communities, and entities generate economic gains from agriculture transactions. The service scientifically conducts research to solve the nation’s agricultural problems. Solving includes protecting the agricultural products from identified pests (DAR, 2006). The purpose of the patent is to improve the nations’ agricultural food product scene. The improvement includes reducing the economic loss from infected agricultural food products. The research finds ways to reduce or eliminate the harmful effects a certain aflatoxin strain. Aflatoxin reduces the agricultural food products’ quality (DAR, 2006). Further, the ARS partners with University of Illinois to create anti-toxin defenses. Certain fungi produce mycotoxins. The mycotoxins crop up and develop on certain plant types. The plant types include barley, corn, wheat. Aflatoxin is one type of mycotoxin, a toxin (having ill effects) substance (DAR, 2006). The patent has many future applications. The patent will ensure an increase in farm plant outputs. With the anti-toxin patent, the University of Illinois and the United States Governments Agricultural Research Service increases the supply of plant food. With more food, the U.S. Governments hunger statistics is reduced. More food supply contributes to the reduction of farm food prices.  

Alternative fules-----history Assignment Example | Topics and Well Written Essays - 750 words

Alternative fules-----history - Assignment Example e early 19th century petroleum, became an alternative option to whale oil that was initially used by people in lighting lamps and it led to the death of large number of whales in the oceans. The dawn of the 20th century was marked by the appearance of ethanol as the alternative to gasoline. The rise in the alternative fuel sources came due to the ever increasing demand for more environmental friendly fuels. The traditional fuels were mainly from natural resources such as those from fossil fuels that included oil, gas and coal and they were diminishing at a very high rate. This led to the constant increase in the price level of fuels as well as increased dependency by the world’s leading economies. The negative impacts of the continued use of non-renewable energy sources has been witnessed in the world by the occurrence of global warming, depletion of the ozone layer due to the increased emission of greenhouse gases emitted in the process of burning fossil fuels. Increased air pollution as well as soil erosion have been attributed to the use of fossil fuels. These factors triggered the need for alternative sources of fuel so as to reduce environmental degradation. Human beings have increasingly realized their mistakes as far as energy is concerned and they have b egun to come up with alternative fuels that are friendly to the environment. Examples of alternative fuels that have been introduced in the recent past include wind and solar energy that are not depleted and their continued use does not cause harm to either human beings or other living things. The use of fossil fuels have been an ongoing process and has been an essential source of energy since humans first discovered coal. From Neolithic times to the eighteenth century, humans made only minor improvements to coal and wood-burning technology. The steam engines that were invented in the 1700s were the first machines to use fossil fuels to power mechanical processes. By the year 1802, many cities in the

Impact of Gender on Academic Performance Essay Example | Topics and Well Written Essays - 1500 words

Impact of Gender on Academic Performance - Essay Example Studies of gender differences in general academic performance are less conclusive. The results vary from no gender differences found. While conducting research there will be some ethical considerations. Before conducting the research the permission will be taken from the school management. Researcher’s personal biases and opinions should not get in the way of the research.Participants can be with draw any time if they want to quit. The results of the experiment will be kept confidential and researchers will use results with students’ permission for research purposes. Students should feel free to ask any question about the research and they will be provided with the outcome of the research. In this research the aim of the study is to analyse the difference in the academic performance of male and female students. Underlying the purpose and research question of the study conducted, the research design that was selected for the study is an exploratory correlational research design. The implementation of a correlational research design has permitted the researcher to explore and discover relationships amongst a large number of variables within a study. In correlational research, according Zechmeister et. al., the main purpose is to establish whether two variables are related, and if so, establish the direction of the observed relationship. In this research study we are going to analyse following research hypothesis: Null Hypothesis: There is no significant difference in the academic performance of girls and boys.

Domestic Violence Essay Essay Example for Free

Domestic Violence Essay Essay Domestic violence is defined as acts of physical and/or psychological violence committed by one partner or on to another. Though committed by both sexes, men commit the majority of domestic violence acts. While efforts have been made to prevent men from engaging in domestic violence, these efforts have yet to make a major effect on the rates of violence against women. This is because these efforts often involve reversing long-held cultural and societal beliefs. Given this situation, violence against women will likely continue despite best efforts to decrease women’s vulnerability to such acts unless male risk factors and protective factors are addressed. While general risk factors exist, such as age and familiarity with the person, the majority of perpetrators have adopted behaviors, either learned behaviors or societal beliefs that increase their likelihood of committing domestic violence. Previous acts of violence against women is often the biggest predictor of whether or not a man will commit an act of violence. For example, men who commit rape are likely to have done so multiple times. That’s why individuals with a history of physical violence are more likely to commit future acts. Men who hold traditional gender role beliefs, (men as breadwinners; women should stay at home) and adapt to masculine norms (men need to be self-reliant; have power over women) are more likely to commit violence against women. Men who commit acts of domestic violence are likely to have experienced acts of violence against themselves, so they redirect their abuse to another. A large portion of these men also experienced abuse as a child, so they grow up thinking this behavior is acceptable. On the other hand, there are protective factors that can reduce the chance of men committing domestic violence. There are not many ways of decreasing the chance of domestic violence, but there are some. Some of the most common would be: changing social norms that turn away from or support violence against women (either through community intervention or public education), and/or by creating more stability in low-income communities, since there is a connection between violence and social problems (poverty, substance abuse, etc. )

Dementias Effect on the Visual System

Dementias Effect on the Visual System Abstract Recent evidence indicates that memory impairment and visual dysfunction are clearly linked in dementia, and that special testing for visual dysfunction can improve the early diagnosis and treatment of dementia. Visual function is divided in terms of anatomic, functional and cognitive areas respectively. Under normal circumstances these functions perform seamlessly together to produce a visual reality of what we call the external world. Alzheimers disease is the most common form of dementia and past research into this area has shown that sufferers show visual deficits in several key areas. Namely contrast sensitivity, motion, colour, depth perception as well as visual hallucinations. Thus by approaching the patient in a appropriate manor with regards to dementia, clinical professionals can detect visual dysfunction and memory impairment whilst also providing a vital role in secondary and tertiary preventative measures. Furthermore clinical professionals can provide aid in the treatmen t of dementia linked visual disorders. With current demographic trends, dementia is becoming increasingly prevalent due in the ageing population. Consequently there is an increased need for practitioners to have a sound knowledge of such dementia conditions. Improving the sufferers quality of life should be the practitioners main concern. By providing thorough treatments and suggestions on patient tailored environmental modifications this can be achieved. (1) Introduction Dementia is a loss of mental function in two or more areas such as language, memory, visual and spatial abilities, or judgment severe enough to interfere with daily life1. Dementia is not a disease itself, sufferers show a broader set of symptoms that accompany certain diseases or physical conditions1. Well known diseases that cause dementia include Alzheimers disease, Creutzfeldt-Jakob disease and multi-infarct dementia1. Dementia is an acquired and progressive problem that affects cognitive functions, behavior, thinking processes and the ability to carry out normal activities. Vision is one of the most important primary senses, therefore serious or complete sight loss has a major impact on a individuals ability to communicate effectively and function independently. Individuals who suffer from both dementia and serious vision loss will inevitably be subject to profound emotional, practical, psychological and financial problems. These factors will also influence others around the sufferer and will extend to the family and the greater society. As we get older both dementia and visual problems inevitably become much more prevalent. Current demographic trends show the increase of the number of very old in our population. Therefore it is inevitable that dementia and serious sight loss either alone or together, will have important consequences for all of us1. The vast majority of people are aware that dementia affects the memory. However it is the impact it has on the ability to carry out daily tasks and problems with behavior that cause particular problems, and in severe cases can lead to institutionalization. In the primary stages of dementia, the patient can be helped by friends and family through ‘reminders. As progression occurs the individual will loose the skills needed for everyday tasks and may eventually fail to recognize family members, a condition known as prospagnosia. The result of such progression is that the individual becomes totally dependent on others. Dementia not only affects the lives of the individual, but also the family2. Dementia can present itself in varying forms. The most common form of dementia in the old is Alzheimers disease, affecting millions of people. It is a degenerative condition that attacks the brain. Progression is gradual and at a variable rate. Symptoms of Alzheimers disease are impaired memory, thinking and changes in behaviour. Dementia with Lewy bodies and dementias linked to Parkinsons disease are responsible for around 10-20% of all dementias. Dementia with Lewy bodies is of particular interest as individuals3 with this condition not only present confusion and varying cognition, but also present symptoms of visual hallucinations2. Another common condition that causes dementia is multi-infarct dementia, also known as vascular dementia. It is the second most common form of dementia after Alzheimers disease in the elderly. Multi infarct dementia is caused by multiple strokes in the brain. These series of strokes can affect some intellectual abilities, impair motor skills and also c ause individuals to experience visual hallucinations. Individuals with multi infarct dementia are prone to risk factors for stroke, such as high BP, heart disease and diabetes. Multi infarct dementia cannot be treated, once nerve cells die they cannot be replaced1. In most cases the symptoms of dementia and serious sight loss develop independently. However some conditions can cause both visual and cognitive impairments, for example Down syndrome, Multiple sclerosis and diabetes. Dementia is most prevalent in the elderly, as is sight loss. Therefore it is inevitable that a number of people will present dementia together with serious sight loss. There have been many studies into the prevalence of dementia in the UK. An estimate for the prevalence of dementia in people over 75 years of age is 15% of the population2. The Alzheimers society suggest that 775,200 people in the UK suffer from dementia (figures taken 2001). The Alzheimers society also calculates that the prevalence of dementia in the 65-75 years age group is 1 in 50, for 70-80 years 1 in 20 and for over 80 years of age 1 in 5. Estimates suggest that by 2010 approximately 840,000 people will become dementia sufferers in the UK. Estimates suggest that around 40% of dementia sufferers are in residential institutions. One study from 1996 showed that dementia sufferers are 30 times more likely to live in an institution than people without dementia. At 65 years of age men are 3 times more likely than women to live in an institution and at 86 men and women are equally likely to be institutionalized4. Visual impairments are not associated general diagnostic features of dementia. However recent research has shown the change in visual function and visual processing may be relevant. Alzheimers disease patients often present problems with visual acuity, contrast sensitivity, stereo-acuity and color vision. These problems are believed to be more true of cognitive dysfunction rather than any specific problems in the eye or optic nerve9. Early diagnosis is essential to both dementia and sight loss patients, as drug treatments are becoming more and more available. Therefore maximizing the treatment and care for the individual. On the other hand early diagnosis of visual conditions is also essential, so that progression is slowed and treatment is commenced, therefore further progression is prevented if plausible2. The Mini-Mental State examination MMSE, is the most commonly used cognitive test for the diagnosis of dementia. It involves the patient to undertake tests of memory and cognition. It takes the form of a series of questions/answers and uses written, verbal and visual material. Poor vision or blindness is the most common cause of poor performance on this test other than dementia itself2. Visual deterioration can occur simultaneously with memory loss in most dementia sufferers. Therefore early recognition of dementia through vision tests has become of importance. Table 1 shows few possible tests that might be useful for such purpose Table 1 : Vision tests for possible early detection and monitoring of Alzheimers disease Use Benton visual retention test Might be able to predict risk for AD 10-15 years before the onset of the disease Tests visual memory Contrast sensitivity AD patients have selectively reduced CS for distinguishing large objects and faces Useful field of view Tests processing speed, divided attention and selective attention Facilitates detection of â€Å"attentional dysfunction†; patients suffering from this problem complain of poor vision and inability to identify someone in a group or an object on a patterned background Could be useful to assess fitness to drive Facial recognition AD patients do not recognize faces with large features and low contrast AD patients do not recognize familiar faces (due to impaired memory) Tests that use facial expressions with progressively diminished degree of contrast The aim of this paper is to provide information about current knowledge on the topic of visual function dementia. With regards to Alzheimers disease, there will be an inclination to several main foci of research. Namely anatomical/structural changes, functional visual changes, cognitive brain changes and other changes such as the effects of diagnostic drugs on Alzheimers disease patients. (2) Alzheimers disease Alzheimers disease is the most common cause of dementia amongst older adults. The Alzheimers research trust estimates that 700,000 individuals in the UK currently are afflicted. This number will inevitably increase exponentially in the near future with the trend of an increasingly aging UK population. Therefore it must be of the utmost of importance worldwide to have an understanding all behavioral, anatomical and physiological aspects of this disease. Alzheimers disease is a degenerative disease that attacks the brain, it begins gradually and progresses at a variable rate. Common signs are impaired thinking, memory and behavior. Health professionals and care givers agree that the memory deficit is usually the initial sign of the disease. However researchers have long known that Alzheimers disease is characterized by impairments of several additional domains, including visual function5. However these findings have not yet appeared in the diagnostic guides consulted by healthcare professionals, for example the most recent addition of the Diagnostic Statistical manual of mental disorders states that few sensory signs occur in early Alzheimers disease2. Therefore we still have a limited understanding of the true extent to which visual impairments affect Alzheimers disease sufferers. The current web site of the Alzheimers association1 and National Institute of Aging6 make no mention of the topic of sensory changes in Alzheimers disease. It has even been said that patients with Alzheimers disease report visual problems to their healthcare professionals less frequently than do healthy elderly individuals7. Nevertheless visual function is impaired in Alzheimers disease8. In terms of cognitive changes, the neuropathology of this disorder affects several other brain areas which are dedicated to processing low level visual functions, as well as higher level visual cognition and attention5.These neuropathological cognitive changes are more dominant however in the visual variant of Alzheimers disease known as posterior cortical atrophy. However visual problems are also present in the more common Alzheimers disease. Alzheimers disease begins when there are deposits of abnormal proteins outside nerve cells located in the brain in the form of amyloid. These are known as diffuse plaques, and the amyloid also forms the central part of further structured plaques known as senile or neurotic plaques1. Buildup of anomalous filaments of protein inside nerve cells in the brain can also take place. This protein accumulates as masses of filaments known as neurofibril tangles. Atrophy of the affected areas of the brain can also occur as well as the enlargement of the ventricles1. There is also a loss of the neuro transmitter Serotonin, Acetylcholine, Norepinephrine and Somatostatin. Attempts have been made to try to slow the development of the disease by replacing the neurotransmitters with cholinesterase inhibitors, such as donepezil (Aricept), rivastigmine (excelon), galantamine (Reminyl) and memantine (Namenda)1. These drugs work by increasing the levels of transmitters between cells, which otherwise beco me lacking in Alzheimers disease. The National Institute for Clinical Excellence NICE conducted a review of these drugs in March 2005 and concluded that none of these drugs provided sufficient enough advantages to the patient in order to justify their cost. They recommended against the use of such drugs in the Nhs, though the Department of Health later overturned this ruling. (3) Visual Changes in Alzheimers Patients Loss of vision is a key healthcare dilemma amongst the elderly. By the age of 65 approximately one in three people have a vision reducing eye disease. Dementia, Alzheimers disease patients and elderly patients, consequently have many visual conditions in common. Alzheimers disease impairs visual function early in the course of the disease and functional losses correlate with cognitive losses. There are several common visual functional deficits that are frequently identified in Alzheimers disease. There is evidence for deficits in Motion perception9,10 contrast sensitivity11 colour discrimination of blue short wavelength hues34 and performance on backward masking tests31.In Alzheimers disease the secondary point of damage is usually the visual association cortex and other higher cortical areas, as well as the primary visual cortex 13,14. (3.1) Some of the main changes that occur in the eye with aging include: The crystalline lens increases in thickness, therefore decreasing its transparency and elasticity; therefore there is a tendency for cataracts to appear. The conjunctiva can become thicker and wrinkled, therefore is subject to deposits such as pinguecela. The iris can atrophy, therefore pupils become constricted and their response to light becomes sluggish. The eyes ability to dark/light adapt is affected. Refractive index of the cornea decreases and it becomes less transparent. Arcus senilis can appear. The ocular globe and eyelids can shrink leading to conditions such as entropian, ectropian and trichiasis. Also while the lachrymal production is reduced the puncta lachrymalis can become stenosed and provide less drainage which gives rise to chronic watering of the eyes Anterior chamber usually becomes more shallow and the sclera more rigid, increasing the prospects of glaucoma. (3.2) Visual changes due to Alzheimers disease reported in literature are outlined below: (3.2) Anatomic Abnormal nerve fiber layer and retinal ganglion cells (Blanks et al, 1989); (Tsai et al, 1991); (Hedges et al, 1996 Imaging of the nerve fibre layer can be conducted via three techniques. These include Optical coherence topography (OCT), Scanning laser polarimetry and Confocal laser topography. Parisi et al16 conducted research upon the optic nerve fibre layer thickness using OCT. 17 Alzheimers disease individuals and 14 age matched healthy individuals were used. The findings of this study showed a definite relationship between the thickness of the nerve fiber layer and the prevalence of Alzheimers disease. There was a significant decrease in the nerve fiber layer thickness in Alzheimers individuals when compared to healthy age matched particpants. Macular cell loss (Blanks et al, 1990) Research has shown a definite decrease of the number of retinal ganglion cells located in the maculae of Alzheimers disease sufferers in comparison to age matched control individuals. It was found that the loss of retinal ganglion cells varied with eccentricity from the central macula17. Results obtained by Blanks et al, 1990 showed a 28% loss of neurons from retinal ganglion cells at 0-0.5mm from the foveola, 24% loss at 0.5-1.0mm and 47% loss at 1.0mm to1.5mm from the foveola. These losses of retinal ganglion cells were constantly greater than those seen in age matched healthy individuals. Supranuclear cataract (Goldstein et al, 2003) Cataract removal could improve not only the visual acuity but may be an important tool in helping those patients suffering from visual hallucinations (Chapman et al, 1999); however, no prospective study has been carried out to prove the role of vision improvement through cataract surgery on the well-being of patients suffering from AD; Exfoliation (Janciauskien and Krakau, 2001) Abnormal pupillary innervation [109-113] Glaucomatous optic nerve cupping (Bayer et al, 2002) (3.3) Functional Decreased visual acuity (Holroyd and Shepherd, 2001) Rapid loss of visual field in patients with AD and glaucoma (Bayer and Ferrari, 2002) Visual field loss (inferior) (Trick et al, 1995) Reduced contrast sensitivity (Holroyd and Shepherd, 2001) Abnormal colour discrimination (blue, short-wavelength hues) (Cronin-Golomb et al, 1991) Abnormal flash visual evoked potentials (VEPs) (Holroyd and Shepherd, 2001) Delayed saccadic eye movements (Holroyd and Shepherd, 2001) (3.4) Cognitive Abnormal visual sustained/divided/selective attention and visual processing speed (Rizzo et al, 2000) Inability to recognize depth (Holroyd and Shepherd, 2001) Impaired face recognition (van Rhijin et al, 2004) (3.5) Other Excessive pharmacological mydriasis/miosis [109-113] These changes summed together not only diminish the quality of vision, but many of them also make the examination of the eye much more complicated. In conjunction with the general visual symptoms of aging, Alzheimers patients can also experience visual disturbances caused by the brain rather than the visual system alone. This means that they can have problems and difficulties perceiving what they see rather than how clearly they see it3. Difficulties are usually experienced in the areas mentioned earlier, namely depth, motion, color, and contrast sensitivity. Visual hallucinations are also a common problem linked to loss of vision in Alzheimers disease patients18. Another common disorder linked to patients with Alzheimers disease is a variant of motion blindness. The patient can appear to be confused and lost; the individual will see the world as a series of still frames19. Visual changes in Alzheimers disease may also be dependent upon which brain hemisphere is more severely damaged; this factor can often be overlooked. An individual with Alzheimers disease could have damage to a greater extent on their left brain hemisphere from plaques and tangles. This would therefore cause subsequent retinal changes in only the left hemi-retinas of each eye i.e. the right visual fields. The right eye visual field would be affected in the temporal side (right) and the left eye visual field would be affected nasally (right)20. When only half the retina is impacted, smaller regions of the optic nerve and nerve fiber layer show losses. The left eye with affected temporal retina would show optic nerve damage in differing regions of the nerve than the right eye with nasal retinal damage20. Alzheimers patients commonly show selective degeneration of large ganglion cell axons located in the optic nerves. This suggests that there would be impairment of broadband channel visual function. Conversely studies have shown that broadband visual capabilities are not selectively impaired in Alzheimers disease. The magnocellular and parvocellular neurons are greatly affected in Alzheimers patients, this has been proved by studies of the dorsal Lateral geniculate nucleus(LGN)1. The geniculostirate projection system is split both functionally and anatomically into two sections. They include the parvocellular layers of the Lateral geniculate body and also incorporates the magnocellular layers. These systems are mainly divided in the primary visual cortex and go through further segregation in the visual association cortex. They conclude in the temporal and paritetal lobes1. The parvocellular layers contain smaller, centrally located receptive fields that account for high spatial frequencies (acuity), they also respond well to color. On the other hand these cells do not respond well to rapid motion or high flicker rates. The magnocellular cells have larger receptive fields and respond superiorly to motion and flicker. They are however comparatively insensitive to color differences. The magnocellular neurons generally show poor spatial resolution, although they seem to respond better at low luminance contrasts. To summarize the parvocellular system is superior at detecting small, slow moving, colored targets placed in the centre of the visual field. Meanwhile the magnocellular system has the ability to process rapidly moving and optically degraded stimuli across larger areas of the visual field1. The parvocellular system projects ventrally to the inferior temporal areas, which are involved in visual research, pattern recognition and visual object memory. The magnocellular system projects dorsally to the posterior parietal and superior temporal areas. These are specialized for motion information processing. The cerebral cortical areas to which the parvocelluar system projects receives virtually no vestibular afferents. Alternatively the cerebral areas to which the magnocelullar system projects receives significant vestibular and other sensory inputs. These are believed to be involved in maintaining spatial orientation. Research shows shows that the magnocellular system is more involved in Alzheimers disease1 Oddly, many individuals experience difficulties at low spatial frequencies instead of high frequencies as in old age. This suggests that areas controlling the low spatial frequency processing in the primary visual cortex would be affected more than those for higher frequencies processing21 After neuropathilogical studies in 1997 by Hof et al were carried out on brains with visual impairments they concluded that cortical atrophy dominated on the posterior parietal cortex and occipital lobe22. Glaucoma is also a neurodegenerative disease that has similar effects on the visual system. Lower spatial frequencies in the contrast sensitivity, deficits in the blue short wavelength color range as well as reductions in motion perception are all linked to glaucomatous patients23. When patients diagnosed with Alzheimers disease also have glaucoma, the deterioration of vision related to glaucoma is much more rapid and progression is more aggressive than in people with glaucoma solely and not Alzheimers disease as well24.Glaucoma is different from Alzheimers disease in that it affects the visual function at the early sites of neural activity, namely, the retinal ganglion cells. Glaucoma destroys the afferent axons at the nerve fiber layer in the retina. This loss of axons ultimately leads to added atrophy further up the visual pathway due to decreased neuronal input. Alternatively Alzheimers disease impacts the cells that are located terminally or intermediary in the visual pathway of the brain. The result is again reduced neuronal input due to loss of nerve fibre connections and atrophy along the visual pathway. When the two diseases exist in the same individual together it can be seen that there is likely to be a greater disruption to the visual system25. One key difference between the two diseases is that they affect the visual pathway at different points. Glaucoma is a degenerative disease starting at the beginning of the visual pathway, whereas Alzheimers disease is a degenerative process starting relatively late in the visual pathway. When the two diseases coexist then the neuronal and functional losses of vision are cumulative. (4) Optometric examination of dementia patients Dementia patients present special problems for optometrists. A standard eye test can be an audile to even the best of us. The patient is placed in an unfamiliar environment surrounded by unusual equipment, machinery and is subjected to probing questions about their medical history which will without doubt tax their already flawed memory. Dementia patients are most likely to be from the elderly. Therefore several difficulties are presented while conducting an ocular examination. The patient is required to sustain a position and has to maintain concentration throughout the testing procedures, which can be very difficult. Subjective examination requires responses from the patient, they are expected to remember and follow complex instructions given to them by the optometrist as well as make many precise discriminatory judgments in a short space of time. The multiple tasks required to be completed during the examination are often beyond dementia patients as they are limited by the disease . Therefore it is common that patients with even a minor degree of dementia fail to provide valid answers, provide unpredictable responses to the subjective examination and retreat into an apathetic state1,2. During the visual examination of Alzheimers disease patients, several key visual problems can be detected. Moderate dementia patients will often experience problems such as topographic agnosia, alexia without agraphia, visual agnosia and prospagnosia1. Such patients often cannot describe individual components of photos and routinely fail to recognize family members. The degree to which such problems are experienced is consistent with the level of cytochrome oxidase deficits in the associated cortical area. In conjunction with these problems dementia patients often have problems with texture discrimination and blue violet discrimination1. Throughout the examination of the elderly dementia patients there are two contradictory requirements, firstly is ‘assurance. The patients responses will be delayed and the patient may feel anxious in such an unfamiliar situation. Thus constant reassurance is required and they cannot be rushed. Alternatively time constraints are important, a dementia/elderly patient is likely to have a short attention span. Consequently the two factors above much be considered and balanced. The examination must be thorough yet carried out as quickly as possible. Often when examining a dementia patient a family member of the carer must be present in order to aid the communication between optometrist and patient, for example difficulties are likely to occur when recording history and symptoms without a carer present. All factors need to be considered such as family history, medication, eye treatment and knowledge of any medical conditions and if so how long they have suffered from them. In terms of an external examination firstly, gross observations should be recorded for example does the patient have an abnormal head position or is there any lid tosis. Many external observations can also be detected with the aid of pupil reflexes. Upon carrying out the external examination the optometrist must be carful to explain exactly what each procedure will involve so as not to intimidate the patient. (4.1) Internal ocular health examination Internal examination of an elderly patient often presents many problems. Older patients tend to have constricted pupils and often opacities in the media such as cataract. All of which make opthalmoscopy a much more complex task for the optometrist. Patients with dementia also show poor fixation as well as lack of concentration. Pupil dilation is often used to aid external examination however many older patients can have a poor response to the insertion of mydriatic eye drops. fddfdffdg There have been many studies into the affects of diagnostic mydriatic and miotic drugs. Many studies have shown excessive mydriatic pupil response to trompicamide (a pupil dilating drug) in patients with Alzheimers disease when compared to control individuals26-30. On the other hand studies into the use of Miotic drops, particularly Pilocarpine have shown an increased response of pupil constriction in Alzheimers disease patients upon comparison to normal control patients. These findings suggest a defect in pupillary innervation with Alzheimers disease individuals. Studies of post mortem individuals with exaggerated mydriatic pupil responses to Tropicamide found a definte disruption to the Edinger-Westphal nucleus. The Edinger-Westphal nucleus is one of the key structures of the brain involved in the autonomic nervous system, it mediates the sympathetic and para-sympathetic pupil responses. Research by Scinto et al found amyloid plaques and neurofibrillary tangles in all individuals t ested with excessive mydriatic pupil responses. The conclusion was that the Edinger-Westphal nucleus is targeted early in the progression of Alzheimers disease. In terms of intraocular pressures use of the goldman an Perkins tonometers will be limited for the elderly dementia patients, due to health and safety reasons. Sudden movements whilst carrying out pressure tests on such equipment may be dangerous. Therefore this can be overcome to a degree by the use of handheld instruments such as the pulseair. However even with the pulseair problems can still be faced with uncooperative patients. (4.2) Objective Refraction examination With uncooperative and awkward patients objective refraction through retinosopy may be difficult. Factors such as opacified media, miotic pupils, and poor fixation will influence the accuracy of the refraction. The recent introduction of hand held optometers has contributed to somewhat overcoming such problems. Instruments such as thee Nikon Retinomax are excellent for obtaining an objective refraction of the elderly patient with miotic pupils and cloudy media. When presenting the Snellen chart to a patient, the quality of their response will inevitably depend upon the degree of their dementia. Depending on which stage of dementia they are suff Dementias Effect on the Visual System Dementias Effect on the Visual System Abstract Recent evidence indicates that memory impairment and visual dysfunction are clearly linked in dementia, and that special testing for visual dysfunction can improve the early diagnosis and treatment of dementia. Visual function is divided in terms of anatomic, functional and cognitive areas respectively. Under normal circumstances these functions perform seamlessly together to produce a visual reality of what we call the external world. Alzheimers disease is the most common form of dementia and past research into this area has shown that sufferers show visual deficits in several key areas. Namely contrast sensitivity, motion, colour, depth perception as well as visual hallucinations. Thus by approaching the patient in a appropriate manor with regards to dementia, clinical professionals can detect visual dysfunction and memory impairment whilst also providing a vital role in secondary and tertiary preventative measures. Furthermore clinical professionals can provide aid in the treatmen t of dementia linked visual disorders. With current demographic trends, dementia is becoming increasingly prevalent due in the ageing population. Consequently there is an increased need for practitioners to have a sound knowledge of such dementia conditions. Improving the sufferers quality of life should be the practitioners main concern. By providing thorough treatments and suggestions on patient tailored environmental modifications this can be achieved. (1) Introduction Dementia is a loss of mental function in two or more areas such as language, memory, visual and spatial abilities, or judgment severe enough to interfere with daily life1. Dementia is not a disease itself, sufferers show a broader set of symptoms that accompany certain diseases or physical conditions1. Well known diseases that cause dementia include Alzheimers disease, Creutzfeldt-Jakob disease and multi-infarct dementia1. Dementia is an acquired and progressive problem that affects cognitive functions, behavior, thinking processes and the ability to carry out normal activities. Vision is one of the most important primary senses, therefore serious or complete sight loss has a major impact on a individuals ability to communicate effectively and function independently. Individuals who suffer from both dementia and serious vision loss will inevitably be subject to profound emotional, practical, psychological and financial problems. These factors will also influence others around the sufferer and will extend to the family and the greater society. As we get older both dementia and visual problems inevitably become much more prevalent. Current demographic trends show the increase of the number of very old in our population. Therefore it is inevitable that dementia and serious sight loss either alone or together, will have important consequences for all of us1. The vast majority of people are aware that dementia affects the memory. However it is the impact it has on the ability to carry out daily tasks and problems with behavior that cause particular problems, and in severe cases can lead to institutionalization. In the primary stages of dementia, the patient can be helped by friends and family through ‘reminders. As progression occurs the individual will loose the skills needed for everyday tasks and may eventually fail to recognize family members, a condition known as prospagnosia. The result of such progression is that the individual becomes totally dependent on others. Dementia not only affects the lives of the individual, but also the family2. Dementia can present itself in varying forms. The most common form of dementia in the old is Alzheimers disease, affecting millions of people. It is a degenerative condition that attacks the brain. Progression is gradual and at a variable rate. Symptoms of Alzheimers disease are impaired memory, thinking and changes in behaviour. Dementia with Lewy bodies and dementias linked to Parkinsons disease are responsible for around 10-20% of all dementias. Dementia with Lewy bodies is of particular interest as individuals3 with this condition not only present confusion and varying cognition, but also present symptoms of visual hallucinations2. Another common condition that causes dementia is multi-infarct dementia, also known as vascular dementia. It is the second most common form of dementia after Alzheimers disease in the elderly. Multi infarct dementia is caused by multiple strokes in the brain. These series of strokes can affect some intellectual abilities, impair motor skills and also c ause individuals to experience visual hallucinations. Individuals with multi infarct dementia are prone to risk factors for stroke, such as high BP, heart disease and diabetes. Multi infarct dementia cannot be treated, once nerve cells die they cannot be replaced1. In most cases the symptoms of dementia and serious sight loss develop independently. However some conditions can cause both visual and cognitive impairments, for example Down syndrome, Multiple sclerosis and diabetes. Dementia is most prevalent in the elderly, as is sight loss. Therefore it is inevitable that a number of people will present dementia together with serious sight loss. There have been many studies into the prevalence of dementia in the UK. An estimate for the prevalence of dementia in people over 75 years of age is 15% of the population2. The Alzheimers society suggest that 775,200 people in the UK suffer from dementia (figures taken 2001). The Alzheimers society also calculates that the prevalence of dementia in the 65-75 years age group is 1 in 50, for 70-80 years 1 in 20 and for over 80 years of age 1 in 5. Estimates suggest that by 2010 approximately 840,000 people will become dementia sufferers in the UK. Estimates suggest that around 40% of dementia sufferers are in residential institutions. One study from 1996 showed that dementia sufferers are 30 times more likely to live in an institution than people without dementia. At 65 years of age men are 3 times more likely than women to live in an institution and at 86 men and women are equally likely to be institutionalized4. Visual impairments are not associated general diagnostic features of dementia. However recent research has shown the change in visual function and visual processing may be relevant. Alzheimers disease patients often present problems with visual acuity, contrast sensitivity, stereo-acuity and color vision. These problems are believed to be more true of cognitive dysfunction rather than any specific problems in the eye or optic nerve9. Early diagnosis is essential to both dementia and sight loss patients, as drug treatments are becoming more and more available. Therefore maximizing the treatment and care for the individual. On the other hand early diagnosis of visual conditions is also essential, so that progression is slowed and treatment is commenced, therefore further progression is prevented if plausible2. The Mini-Mental State examination MMSE, is the most commonly used cognitive test for the diagnosis of dementia. It involves the patient to undertake tests of memory and cognition. It takes the form of a series of questions/answers and uses written, verbal and visual material. Poor vision or blindness is the most common cause of poor performance on this test other than dementia itself2. Visual deterioration can occur simultaneously with memory loss in most dementia sufferers. Therefore early recognition of dementia through vision tests has become of importance. Table 1 shows few possible tests that might be useful for such purpose Table 1 : Vision tests for possible early detection and monitoring of Alzheimers disease Use Benton visual retention test Might be able to predict risk for AD 10-15 years before the onset of the disease Tests visual memory Contrast sensitivity AD patients have selectively reduced CS for distinguishing large objects and faces Useful field of view Tests processing speed, divided attention and selective attention Facilitates detection of â€Å"attentional dysfunction†; patients suffering from this problem complain of poor vision and inability to identify someone in a group or an object on a patterned background Could be useful to assess fitness to drive Facial recognition AD patients do not recognize faces with large features and low contrast AD patients do not recognize familiar faces (due to impaired memory) Tests that use facial expressions with progressively diminished degree of contrast The aim of this paper is to provide information about current knowledge on the topic of visual function dementia. With regards to Alzheimers disease, there will be an inclination to several main foci of research. Namely anatomical/structural changes, functional visual changes, cognitive brain changes and other changes such as the effects of diagnostic drugs on Alzheimers disease patients. (2) Alzheimers disease Alzheimers disease is the most common cause of dementia amongst older adults. The Alzheimers research trust estimates that 700,000 individuals in the UK currently are afflicted. This number will inevitably increase exponentially in the near future with the trend of an increasingly aging UK population. Therefore it must be of the utmost of importance worldwide to have an understanding all behavioral, anatomical and physiological aspects of this disease. Alzheimers disease is a degenerative disease that attacks the brain, it begins gradually and progresses at a variable rate. Common signs are impaired thinking, memory and behavior. Health professionals and care givers agree that the memory deficit is usually the initial sign of the disease. However researchers have long known that Alzheimers disease is characterized by impairments of several additional domains, including visual function5. However these findings have not yet appeared in the diagnostic guides consulted by healthcare professionals, for example the most recent addition of the Diagnostic Statistical manual of mental disorders states that few sensory signs occur in early Alzheimers disease2. Therefore we still have a limited understanding of the true extent to which visual impairments affect Alzheimers disease sufferers. The current web site of the Alzheimers association1 and National Institute of Aging6 make no mention of the topic of sensory changes in Alzheimers disease. It has even been said that patients with Alzheimers disease report visual problems to their healthcare professionals less frequently than do healthy elderly individuals7. Nevertheless visual function is impaired in Alzheimers disease8. In terms of cognitive changes, the neuropathology of this disorder affects several other brain areas which are dedicated to processing low level visual functions, as well as higher level visual cognition and attention5.These neuropathological cognitive changes are more dominant however in the visual variant of Alzheimers disease known as posterior cortical atrophy. However visual problems are also present in the more common Alzheimers disease. Alzheimers disease begins when there are deposits of abnormal proteins outside nerve cells located in the brain in the form of amyloid. These are known as diffuse plaques, and the amyloid also forms the central part of further structured plaques known as senile or neurotic plaques1. Buildup of anomalous filaments of protein inside nerve cells in the brain can also take place. This protein accumulates as masses of filaments known as neurofibril tangles. Atrophy of the affected areas of the brain can also occur as well as the enlargement of the ventricles1. There is also a loss of the neuro transmitter Serotonin, Acetylcholine, Norepinephrine and Somatostatin. Attempts have been made to try to slow the development of the disease by replacing the neurotransmitters with cholinesterase inhibitors, such as donepezil (Aricept), rivastigmine (excelon), galantamine (Reminyl) and memantine (Namenda)1. These drugs work by increasing the levels of transmitters between cells, which otherwise beco me lacking in Alzheimers disease. The National Institute for Clinical Excellence NICE conducted a review of these drugs in March 2005 and concluded that none of these drugs provided sufficient enough advantages to the patient in order to justify their cost. They recommended against the use of such drugs in the Nhs, though the Department of Health later overturned this ruling. (3) Visual Changes in Alzheimers Patients Loss of vision is a key healthcare dilemma amongst the elderly. By the age of 65 approximately one in three people have a vision reducing eye disease. Dementia, Alzheimers disease patients and elderly patients, consequently have many visual conditions in common. Alzheimers disease impairs visual function early in the course of the disease and functional losses correlate with cognitive losses. There are several common visual functional deficits that are frequently identified in Alzheimers disease. There is evidence for deficits in Motion perception9,10 contrast sensitivity11 colour discrimination of blue short wavelength hues34 and performance on backward masking tests31.In Alzheimers disease the secondary point of damage is usually the visual association cortex and other higher cortical areas, as well as the primary visual cortex 13,14. (3.1) Some of the main changes that occur in the eye with aging include: The crystalline lens increases in thickness, therefore decreasing its transparency and elasticity; therefore there is a tendency for cataracts to appear. The conjunctiva can become thicker and wrinkled, therefore is subject to deposits such as pinguecela. The iris can atrophy, therefore pupils become constricted and their response to light becomes sluggish. The eyes ability to dark/light adapt is affected. Refractive index of the cornea decreases and it becomes less transparent. Arcus senilis can appear. The ocular globe and eyelids can shrink leading to conditions such as entropian, ectropian and trichiasis. Also while the lachrymal production is reduced the puncta lachrymalis can become stenosed and provide less drainage which gives rise to chronic watering of the eyes Anterior chamber usually becomes more shallow and the sclera more rigid, increasing the prospects of glaucoma. (3.2) Visual changes due to Alzheimers disease reported in literature are outlined below: (3.2) Anatomic Abnormal nerve fiber layer and retinal ganglion cells (Blanks et al, 1989); (Tsai et al, 1991); (Hedges et al, 1996 Imaging of the nerve fibre layer can be conducted via three techniques. These include Optical coherence topography (OCT), Scanning laser polarimetry and Confocal laser topography. Parisi et al16 conducted research upon the optic nerve fibre layer thickness using OCT. 17 Alzheimers disease individuals and 14 age matched healthy individuals were used. The findings of this study showed a definite relationship between the thickness of the nerve fiber layer and the prevalence of Alzheimers disease. There was a significant decrease in the nerve fiber layer thickness in Alzheimers individuals when compared to healthy age matched particpants. Macular cell loss (Blanks et al, 1990) Research has shown a definite decrease of the number of retinal ganglion cells located in the maculae of Alzheimers disease sufferers in comparison to age matched control individuals. It was found that the loss of retinal ganglion cells varied with eccentricity from the central macula17. Results obtained by Blanks et al, 1990 showed a 28% loss of neurons from retinal ganglion cells at 0-0.5mm from the foveola, 24% loss at 0.5-1.0mm and 47% loss at 1.0mm to1.5mm from the foveola. These losses of retinal ganglion cells were constantly greater than those seen in age matched healthy individuals. Supranuclear cataract (Goldstein et al, 2003) Cataract removal could improve not only the visual acuity but may be an important tool in helping those patients suffering from visual hallucinations (Chapman et al, 1999); however, no prospective study has been carried out to prove the role of vision improvement through cataract surgery on the well-being of patients suffering from AD; Exfoliation (Janciauskien and Krakau, 2001) Abnormal pupillary innervation [109-113] Glaucomatous optic nerve cupping (Bayer et al, 2002) (3.3) Functional Decreased visual acuity (Holroyd and Shepherd, 2001) Rapid loss of visual field in patients with AD and glaucoma (Bayer and Ferrari, 2002) Visual field loss (inferior) (Trick et al, 1995) Reduced contrast sensitivity (Holroyd and Shepherd, 2001) Abnormal colour discrimination (blue, short-wavelength hues) (Cronin-Golomb et al, 1991) Abnormal flash visual evoked potentials (VEPs) (Holroyd and Shepherd, 2001) Delayed saccadic eye movements (Holroyd and Shepherd, 2001) (3.4) Cognitive Abnormal visual sustained/divided/selective attention and visual processing speed (Rizzo et al, 2000) Inability to recognize depth (Holroyd and Shepherd, 2001) Impaired face recognition (van Rhijin et al, 2004) (3.5) Other Excessive pharmacological mydriasis/miosis [109-113] These changes summed together not only diminish the quality of vision, but many of them also make the examination of the eye much more complicated. In conjunction with the general visual symptoms of aging, Alzheimers patients can also experience visual disturbances caused by the brain rather than the visual system alone. This means that they can have problems and difficulties perceiving what they see rather than how clearly they see it3. Difficulties are usually experienced in the areas mentioned earlier, namely depth, motion, color, and contrast sensitivity. Visual hallucinations are also a common problem linked to loss of vision in Alzheimers disease patients18. Another common disorder linked to patients with Alzheimers disease is a variant of motion blindness. The patient can appear to be confused and lost; the individual will see the world as a series of still frames19. Visual changes in Alzheimers disease may also be dependent upon which brain hemisphere is more severely damaged; this factor can often be overlooked. An individual with Alzheimers disease could have damage to a greater extent on their left brain hemisphere from plaques and tangles. This would therefore cause subsequent retinal changes in only the left hemi-retinas of each eye i.e. the right visual fields. The right eye visual field would be affected in the temporal side (right) and the left eye visual field would be affected nasally (right)20. When only half the retina is impacted, smaller regions of the optic nerve and nerve fiber layer show losses. The left eye with affected temporal retina would show optic nerve damage in differing regions of the nerve than the right eye with nasal retinal damage20. Alzheimers patients commonly show selective degeneration of large ganglion cell axons located in the optic nerves. This suggests that there would be impairment of broadband channel visual function. Conversely studies have shown that broadband visual capabilities are not selectively impaired in Alzheimers disease. The magnocellular and parvocellular neurons are greatly affected in Alzheimers patients, this has been proved by studies of the dorsal Lateral geniculate nucleus(LGN)1. The geniculostirate projection system is split both functionally and anatomically into two sections. They include the parvocellular layers of the Lateral geniculate body and also incorporates the magnocellular layers. These systems are mainly divided in the primary visual cortex and go through further segregation in the visual association cortex. They conclude in the temporal and paritetal lobes1. The parvocellular layers contain smaller, centrally located receptive fields that account for high spatial frequencies (acuity), they also respond well to color. On the other hand these cells do not respond well to rapid motion or high flicker rates. The magnocellular cells have larger receptive fields and respond superiorly to motion and flicker. They are however comparatively insensitive to color differences. The magnocellular neurons generally show poor spatial resolution, although they seem to respond better at low luminance contrasts. To summarize the parvocellular system is superior at detecting small, slow moving, colored targets placed in the centre of the visual field. Meanwhile the magnocellular system has the ability to process rapidly moving and optically degraded stimuli across larger areas of the visual field1. The parvocellular system projects ventrally to the inferior temporal areas, which are involved in visual research, pattern recognition and visual object memory. The magnocellular system projects dorsally to the posterior parietal and superior temporal areas. These are specialized for motion information processing. The cerebral cortical areas to which the parvocelluar system projects receives virtually no vestibular afferents. Alternatively the cerebral areas to which the magnocelullar system projects receives significant vestibular and other sensory inputs. These are believed to be involved in maintaining spatial orientation. Research shows shows that the magnocellular system is more involved in Alzheimers disease1 Oddly, many individuals experience difficulties at low spatial frequencies instead of high frequencies as in old age. This suggests that areas controlling the low spatial frequency processing in the primary visual cortex would be affected more than those for higher frequencies processing21 After neuropathilogical studies in 1997 by Hof et al were carried out on brains with visual impairments they concluded that cortical atrophy dominated on the posterior parietal cortex and occipital lobe22. Glaucoma is also a neurodegenerative disease that has similar effects on the visual system. Lower spatial frequencies in the contrast sensitivity, deficits in the blue short wavelength color range as well as reductions in motion perception are all linked to glaucomatous patients23. When patients diagnosed with Alzheimers disease also have glaucoma, the deterioration of vision related to glaucoma is much more rapid and progression is more aggressive than in people with glaucoma solely and not Alzheimers disease as well24.Glaucoma is different from Alzheimers disease in that it affects the visual function at the early sites of neural activity, namely, the retinal ganglion cells. Glaucoma destroys the afferent axons at the nerve fiber layer in the retina. This loss of axons ultimately leads to added atrophy further up the visual pathway due to decreased neuronal input. Alternatively Alzheimers disease impacts the cells that are located terminally or intermediary in the visual pathway of the brain. The result is again reduced neuronal input due to loss of nerve fibre connections and atrophy along the visual pathway. When the two diseases exist in the same individual together it can be seen that there is likely to be a greater disruption to the visual system25. One key difference between the two diseases is that they affect the visual pathway at different points. Glaucoma is a degenerative disease starting at the beginning of the visual pathway, whereas Alzheimers disease is a degenerative process starting relatively late in the visual pathway. When the two diseases coexist then the neuronal and functional losses of vision are cumulative. (4) Optometric examination of dementia patients Dementia patients present special problems for optometrists. A standard eye test can be an audile to even the best of us. The patient is placed in an unfamiliar environment surrounded by unusual equipment, machinery and is subjected to probing questions about their medical history which will without doubt tax their already flawed memory. Dementia patients are most likely to be from the elderly. Therefore several difficulties are presented while conducting an ocular examination. The patient is required to sustain a position and has to maintain concentration throughout the testing procedures, which can be very difficult. Subjective examination requires responses from the patient, they are expected to remember and follow complex instructions given to them by the optometrist as well as make many precise discriminatory judgments in a short space of time. The multiple tasks required to be completed during the examination are often beyond dementia patients as they are limited by the disease . Therefore it is common that patients with even a minor degree of dementia fail to provide valid answers, provide unpredictable responses to the subjective examination and retreat into an apathetic state1,2. During the visual examination of Alzheimers disease patients, several key visual problems can be detected. Moderate dementia patients will often experience problems such as topographic agnosia, alexia without agraphia, visual agnosia and prospagnosia1. Such patients often cannot describe individual components of photos and routinely fail to recognize family members. The degree to which such problems are experienced is consistent with the level of cytochrome oxidase deficits in the associated cortical area. In conjunction with these problems dementia patients often have problems with texture discrimination and blue violet discrimination1. Throughout the examination of the elderly dementia patients there are two contradictory requirements, firstly is ‘assurance. The patients responses will be delayed and the patient may feel anxious in such an unfamiliar situation. Thus constant reassurance is required and they cannot be rushed. Alternatively time constraints are important, a dementia/elderly patient is likely to have a short attention span. Consequently the two factors above much be considered and balanced. The examination must be thorough yet carried out as quickly as possible. Often when examining a dementia patient a family member of the carer must be present in order to aid the communication between optometrist and patient, for example difficulties are likely to occur when recording history and symptoms without a carer present. All factors need to be considered such as family history, medication, eye treatment and knowledge of any medical conditions and if so how long they have suffered from them. In terms of an external examination firstly, gross observations should be recorded for example does the patient have an abnormal head position or is there any lid tosis. Many external observations can also be detected with the aid of pupil reflexes. Upon carrying out the external examination the optometrist must be carful to explain exactly what each procedure will involve so as not to intimidate the patient. (4.1) Internal ocular health examination Internal examination of an elderly patient often presents many problems. Older patients tend to have constricted pupils and often opacities in the media such as cataract. All of which make opthalmoscopy a much more complex task for the optometrist. Patients with dementia also show poor fixation as well as lack of concentration. Pupil dilation is often used to aid external examination however many older patients can have a poor response to the insertion of mydriatic eye drops. fddfdffdg There have been many studies into the affects of diagnostic mydriatic and miotic drugs. Many studies have shown excessive mydriatic pupil response to trompicamide (a pupil dilating drug) in patients with Alzheimers disease when compared to control individuals26-30. On the other hand studies into the use of Miotic drops, particularly Pilocarpine have shown an increased response of pupil constriction in Alzheimers disease patients upon comparison to normal control patients. These findings suggest a defect in pupillary innervation with Alzheimers disease individuals. Studies of post mortem individuals with exaggerated mydriatic pupil responses to Tropicamide found a definte disruption to the Edinger-Westphal nucleus. The Edinger-Westphal nucleus is one of the key structures of the brain involved in the autonomic nervous system, it mediates the sympathetic and para-sympathetic pupil responses. Research by Scinto et al found amyloid plaques and neurofibrillary tangles in all individuals t ested with excessive mydriatic pupil responses. The conclusion was that the Edinger-Westphal nucleus is targeted early in the progression of Alzheimers disease. In terms of intraocular pressures use of the goldman an Perkins tonometers will be limited for the elderly dementia patients, due to health and safety reasons. Sudden movements whilst carrying out pressure tests on such equipment may be dangerous. Therefore this can be overcome to a degree by the use of handheld instruments such as the pulseair. However even with the pulseair problems can still be faced with uncooperative patients. (4.2) Objective Refraction examination With uncooperative and awkward patients objective refraction through retinosopy may be difficult. Factors such as opacified media, miotic pupils, and poor fixation will influence the accuracy of the refraction. The recent introduction of hand held optometers has contributed to somewhat overcoming such problems. Instruments such as thee Nikon Retinomax are excellent for obtaining an objective refraction of the elderly patient with miotic pupils and cloudy media. When presenting the Snellen chart to a patient, the quality of their response will inevitably depend upon the degree of their dementia. Depending on which stage of dementia they are suff