Body Fat and Eating Disorders Paper Essay Example | Topics and Well Written Essays - 500 words

Body Fat and Eating Disorders Paper - Essay Example t disease, high blood pressure, stroke, high cholesterol, diabetes, back pain, respiratory problems, kidney disorders, gallbladder problems, osteoarthritis, excess fatigue, sleep apnea, metabolic syndromes and urinary incontinence. There are various factors that could lead to obesity or an accumulation of body fat which occurs due to an imbalance in the calories consumed and burnt by the body. Other contributing factors include a lack of physical activity, increased consumption of fat, sugar, alcohol intake, overeating, chronic use of corticosteroids, hormonal imbalances and other related metabolic problems (Body composition and Health, 2002). Eating disorders such as anorexia nervosa, bulimia nervosa and binge eating have serious effects on the physical and mental health of individuals and in extreme cases can also lead to life-threatening problems. This is mainly because such disorders do not exist for a particular period of time; rather they have the potential to become lifelong disorders in cases where they are not treated. In such cases they could affect the mental, emotional and physical well-being of individuals and also put tremendous strain on their relationships with other people. In the case of anorexia nervosa, in which individuals starve themselves the body becomes severely depleted of vital nutrients and hence there is a slowdown of metabolic process in order to conserve energy. As a result a number of medical problems arise some of which warrant immediate medical attention. The health consequences of anorexia nervosa includes an abnormal decrease in heart rate and blood pressure which increases the risk of heart failure, bone density reduction, loss and weakening of muscles, severe body dehydration increasing the risk of kidney failure, increased fatigue and general body weakness, dryness of skin and hair with hair loss and growth of lanugo all the body in an effort to maintain body temperature (Health Consequences of Eating Disorders, n.d; Eating

Journal Research Paper Example | Topics and Well Written Essays - 500 words - 3

Journal - Research Paper Example The first one, â€Å"Boys and Girls†, lets the reader know that Nenny is still too young to be a friend to her sister and yet, the unnamed older sister is already looking forward to the time when Nenny will be old enough to be her friend and enjoy each others company. The sense of sibling love is quite strong in this story because she feels protective of her younger sister and looks out for her because not all the kids in their neighborhood are nice children and she does not want her sister exposed to any bad influences. The end of the story makes one wonder what might have become of the sisters after some years had passed. That is why it was nice to see the relationship progression in the second story â€Å"Our Good Day†. In â€Å"Our Good Day†, the readers learn that Nenny is no longer a little child. She is already old enough to be the friend of her sister and that the relationship between them is one filled with trust and care. It also shows that the older sister keeps her younger sibling in mind and is very happy to be able to share any good fortune that she might come into in life with her. However, the story that shows us the greatest development in the relationship of the sisters can be seen in the story â€Å"Laughter†. Look at that house, I said, it looks like Mexico. Rachel and Lucy look at me like I am crazy, but before they can let out a laugh, Nenny says yes: Yes, thats Mexico all right. Thats what I was thinking exactly. This shows that the sisters have reached a point in their sibling-ship where they know each other so well that they trust that the other will know what the one is trying to say. Even more impressive, is that the sisters already think alike. Which is a sign that the siblings are quite in-tune with one another and share more than just a superficial relationship. I guess that is why I enjoyed reading about these stories so much. The short stories give a sense of character development and

Cirque Du Soleil Essay Example for Free

Cirque Du Soleil Essay Cirque du Soleil began in Quebec with two street performers (Guy Lalibert and Daniel Gauthier) back in 1982 and called their small group of young street performers ‘The High Heels club’ and decided to put on a small festival for the audience. By 1984 Cirque du Soleil was born, the name meaning ‘Circus of the sun’ in French. The main philosophy or aim of Cirque du Soleil is creativity and innovation of the circus to redefine the entertainment landscape, and thrill audiences around the world. Since its inception, Cirque du Soleil has created a lot of shows with incredibly different themes and issues. The most popular of these shows are: Saltimbanco- explores the urban experience in all its myriad forms, Alegria-explores power and the handing down of power over time, the evolution from ancient monarchies to modern democracies, old age, youth. Quidam-it could be anyone, anybody. Someone coming, going, living in our anonymous society. A member of the crowd, one of the silent majority. Dralion- Dralion derives much of its inspiration from Eastern philosophy with its perpetual quest for harmony between humankind and nature. Varekai- production pays tribute to the nomadic soul, to the spirit and art of the circus tradition, and to the infinite passion of those whose quest takes them along the path that leads to Varekai. Cirque du Soleil captures many dramatic forms including acts from contortionists, jugglers, feats of strength, clowning, dance, mime, light climates, puppeteers, stage maneuvers, comedy, interaction with public, acrobats and trapeze artists. An example of your typical act, is a man in a mouse wheel, being spun around in 360Â ° circles, doing tricks that amaze the audience because of the manipulation of gravity. Also, Cirque du Soleil does not make use of any such animals. Traditionally, Cirque du Soleil shows do not use pre-recorded music, with exceptions; all music is played live and in many circumstances sung live by singers with magnificent voices. The costumes used in the show are always very elaborate, or if flexibility is needed the costumes can be plain but are usually colourful and creative, matching the theme of the show. The sets for the shows are typically amazing again always matching the culture being performed on stage. Cirque Du Soleil has a vast range of characters in the huge number of performances and the company itself has over 4000 employees and 1000 artists. Characters in the performance are always bright, colourful and extremely skillful and always are doing amazing tricks that depict the theme of the show or that can lighten and entertain the audience. As the performance goes on most of the time you enter the life of some of the characters as they tell their life story (normally the host) and interact more and more with the audience.

Feature extraction using crossing number (cn) and ridge tracking technique

Feature extraction using crossing number (cn) and ridge tracking technique PROPOSED ALGORITHM: FEATURE EXTRACTION USING CROSSING NUMBER (CN) AND RIDGE TRACKING TECHNIQUE The various steps involved in feature extraction are as given below: 3.2.1 ADAPTIVE BINARIZATION The enhanced greyscale image is converted to a binary image using adaptive binarization [1]. Global thresholding is not used for binarization because of possibilities of non-uniform illumination on the surface of scanner. Thus using adaptive binarization with a window size of 91 x 91 (This size was finalised after a number of trial and errors). The algorithm can be outlined as follows: Algorithm: Adaptive binarization Input: Enhanced greyscale image e(x,y). Output: Binarized image bin(x,y). For each pixel (i) of e(x,y) Compute local mean (ml) in the 91 x 91 neighborhood of the pixel. If ml > e(xi,yi) then, bin(xi,yi) = white. Else bin(xi,yi)= black. End For. - 3.2.2. THINNING The binarised image is skeletonised using medial axis transformation (MAT)[1] to obtain a single pixel thin ridge structure. The thinning algorithm can be outlined as follows: Assumptions: Region points are assumed to have value 1(white) and background points to have value 0(black). Notations: 1. The 8 neighbour notation of a centre pixel p1 is as shown. p9 p2 p3 p8 p1 p4 p7 p6 p5 2. n (p1) is the number of non zero neighbours of p1. I.e. n (p1) = p2 + p3 + †¦. + p9. 3. t (p1) is the number of 0-1 transitions in the ordered sequence p2, p3,†¦p9,p2. Algorithm : Thinning Input: Binarized image bin(x,y). Output: One pixel thinned image th(x,y). Steps: 1. W.r.t the neighborhood notation a pixel p1 in bin(x,y). is flagged for deletion if the following conditions are satisfied; 2 ≠¤ n(p1) ≠¤ 6 . t(p1)=1. p2 V p4 V p6 = 0 p4 V p6 V p8 = 0 2. Delete all the flagged pixels from bin(x,y). 3. W.r.t the neighborhood notation a pixel p1 in bin(x,y) is flagged for deletion if the following conditions are satisfied; 2 ≠¤ n(p1) ≠¤ 6 . t(p1)=1. p2 V p4 V p8 = 0 p2 V p6 V p8 = 0 4. Delete all the flagged pixel from bin(x,y). 5. Go to step 1 if bin(x, y) is not same as the previous bin(x, y) (indicating that single pixel thickness is yet not obtained) 6. Assign the image bin(x, y) obtained from step 4. to th(x, y). Thus one iteration of the thinning algorithm consists of applying step 1 to flag border points for deletion deleting the flagged points; applying step 3 to flag the remaining border points for deletion; and deleting the flagged points. The basic procedure is applied iteratively until no further points are deleted, at which time the algorithm terminates, yielding the skeleton of the region. 3.2.3 ESTIMATING SPATIAL CO-ORDINATES DIRECTION OF MINUTIAE POINTS. Minutiae representation is by far, the most widely used method of fingerprint representation. Minutia or small details mark the regions of local discontinuity within a fingerprint image. These are locations where the the ridge comes to an end(type: ridge ending) or branches into two (type: bifurcation). Other forms of the minutiae includes a very short ridge (type: ridge dot), or a closed loop (type: enclosure). The different types of minutiae are illustrated Figure 1. There are more than 18 different types of minutiae [2] among which ridge bifurcations and endings are the most widely used. Other minutiae type may simply be expressed as multiple ridge endings of bifurcations. For instance, a ridge dot may be represented by two opposing ridge endings placed at either extremities. Even this simplification is redundant since many matching algorithms do not even distinguish between ridge ending and bifurcations since their types can get flipped. The template simply consists of a list of minutiae location and their orientations. The feature extractor takes as input a gray scale image I(x,y) and produces a unordered set of tuples- M = {m1,m2,m3mN}. Each tuple mi corresponds to a single minutia and represents its properties. The properties extracted by most algorithms include its position and orientation. Thus, each tuple mi is usually represented as a triplet {xi, yi, ÃŽ ¸i}. The crossing number (CN) method is used to perform extraction of the spatial coordinates of the minutiae points. This method extracts the bifurcations from the skeleton image by examining the local neighborhood of each ridge pixel using a 33 window. The CN of a ridge pixel ‘p is given as follows CN=0.5 { i=18pi-pi+1 } p(9) =p(1) . For a pixel ‘p if CN= 3 it is a bifurcation point. For each extracted minutia along with its x and y coordinates the orientation of the associated ridge segment is also recorded. The minutia direction is found out using a ridge tracking technique. With reference to figure 3.3 once the x and y coordinates of the bifurcation point are known, we can track the three directions from that point. Each direction is tracked upto 10 pixel length. Once tracked we construct a triangle from these three points. The midpoint of the smallest side of the triangle is then connected to the bifurcation point and the angle of the resulting line segment is found which is the minutia direction. Assumptions: Ridges are assumed to have value 0 (black) and background points to have value 1(white). Notations: The 8 neighbor notation of a center pixel p1 is as previously shown. The algorithm for extracting the minutiae using the crossing number technique can be outlined as follows: Algorithm: Crossing number Input: Thinned image th(x,y). Output: Image with (x,y) coordinates and orientation thita of each minutia. Steps: 1. For every pixel p in th(x,y) compute the crossing number (CN) ; CN=0.5 { i=18pi-pi+1 } p(9) =p(1) . 2. If CN= 3, the pixel p is declared as a bifurcation point and its x and y coordinates, i.e. p.x and p.y are recorded. 3. The orientation at the bifurcation points p.ÃŽ ¸ is calculated using tracking algorithm. Fingerprint matching Process:- Each minutiae may be described by a number of attributes such as its position (x,y), its orientation ÃŽ ¸, its quality etc. However, most algorithms consider only its position and orientation information. Given a pair of fingerprints and their corresponding minutiae features to be matched, features may be represented as an unordered set given by I1 = {m1,m2.mM} where mi = (xi, yi, ÃŽ ¸i) I2 = {m1,m2.mN} where mi = (xi, yi , ÃŽ ¸i ) Here the objective is to find a point mj in I2 that exclusively corresponds to each point mi in I1. Usually points in I2 is related to points in I1 through a geometric transformation T( ). Therefore, the technique used by most minutiae matching algorithms is to recover the transformation function T( ) that maps the two point sets . The resulting point set I2 is given by: I2 = T(I1) = {m†1,m† 2,m† 3.m†M} m†1 = T(m1) m† N = T(mN) The minutiae pair mi and m†j are considered to be a match only if (xi-xj)2+(yi-yj)2≠¤r0 min( |ÃŽ ¸i − ÃŽ ¸Ã¢â‚¬  j | , 360 − |ÃŽ ¸i − ÃŽ ¸Ã¢â‚¬ j | ) Here r0 and ÃŽ ¸0 denote the tolerance window. The matcher can make on of the following assumptions on the nature of the transformation T Rigid Transformation: Here it is assumed that one point set is rotated and shifted version of the other. Affine Transformation: Affine transformations are generalization of Euclidean transform. Shape and angle are not preserved during transformation. Non-linear Transformation: Here the transformation may be due to any arbitrary and complex transformation function T(x,y). The problem of matching minutiae can be treated as an instance of generalized point pattern matching problem. In its most general form, point pattern matching consists of matching two unordered set of points of possibly different cardinalities and each point. It is assumed that the two pointsets are related by some geometrical relationship. In most situations, some of the point correspondences are already known (e.g. control points in an image registration problem [5,4,6,7])andthe problem reduces to finding the most optimal geometrical transformation that relates these two sets. However, in fingerprints, the point correspondences themselves are unknown and therefore the points have to be matched with no prior assumption making it a very challenging combinatorial problem. There have been several prior approaches where general point pattern techniques havebeen applied. Some of these have been discussed here. Ranade and Rosenfield [8] proposed an iterative approach for obtaining point correspondences. In this approach, for each point pair mi, mj they assign pij , the likelihood of the point correspondence and c(i, j, h, k), a cost function that captures the correspondence of other pairs(mh,m_k) as a result of matching mi with mj. In each iteration pij is incremented if it increases the compatibility of other points and is decremented if it does not. At the point of convergence, each point mi is assigned to the point argmaxk(pik). While this is a fairly accurate approach and is robust to non-linearities, the iterative nature of the algorithm makes it unsuitable for most applications. The hough transform [9] approach or the transformation clustering approach reduces the problemof point pattern matching to detecting the most probable transformation in a transformation search space. Ratha et al [10] proposed a fingerprint matching algorithm based on this approach. In this technique, the search space consists of all the possible parameter under the assumed distortionmodel. For instance, if we assume a rigid transformation, then the search space consists of all possible combinations of all translations (Δx,Δy) , scales s and rotations and ÃŽ ¸. However, to avoid computation complexity the search space is usually discretized into small cells. Therefore the possible transformations form a finite set with Δx ÃŽ µ {Δ1x,Δ2x . . .ΔIx} Δy ÃŽ µ {Δ1y,Δ2y . . .ΔJy} ÃŽ ¸ ÃŽ µ {ÃŽ ¸1, ÃŽ ¸2 . . . ÃŽ ¸K} s ÃŽ µ {s1, s2 . . . sL} A four dimensional accumulator of size (I Ãâ€"J Ãâ€"K Ãâ€"L) is maintained. Each cell A(i, j, k, l) indicatesthe likelihood of the transformation parameters (Δix,Δjy, ÃŽ ¸k, sl). To determine the optimal transformation, every possible transformation is tried on each pair of points. The algorithm used is summarized below for each point mi in fingerprint T . for each point m_j in fingerprint I for each ÃŽ ¸k ÃŽ µ {ÃŽ ¸1, ÃŽ ¸2 . . . ÃŽ ¸K} for each sl ÃŽ µ {s1, s2 . . . sL} compute the translations Δx,Δy Explicit alignment: An illustration of the relative alignment using ridges associated with minutiae mi and mj ∆x∆y=∆xi∆yi-s1cosÃŽ ¸k -sinÃŽ ¸ksinÃŽ ¸k cosÃŽ ¸kxjyj †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦(1) d Let (Δix,Δjy) be the quantized versions of (Δx,Δy) respectively. e If T{mi} matches with m_j increase the evidence for the cell A[Δix,Δjy, ÃŽ ¸k, sl] A[Δix,Δjy, ÃŽ ¸k, sl] = A[Δix,Δjy, ÃŽ ¸k, sl]+1 3.The optimal transformation parameters are obtained using (Δ*x,Δ*y, ÃŽ ¸*, s*) = argmax(i,j,k,l) A[Δix,Δjy, ÃŽ ¸k, sl] References: Gonzalez, Woods, and Eddins. Digital Image Processing using matlab. Prentice Hall, 2004. D. Maltoni, D. Maio, A.K. Jain, S. Prabhakar, Handbook of Fingerprint Recognition, Springer, 2003, ISBN 0-387-95431-7. R.Thai, Fingerprint image enhancement and feature extraction. Australia. Anil Jain, Salil Prabhakar, Lin Hong, and Sharath Pankanti. Filterbank-based fingerprint matching. In Transactions on Image Processing, volume 9, pages 846-859, May 2000. Anil Jain, Arun Ross, and Salil Prabhakar. Fingerprint matching using minutiae texture features.In International Conference on Image Processing, pages 282-285, october 2001. L. Hong, Y. Wang, and A. K. Jain. Fingerprint image enhancement: Algorithm and performanceevaluation. Transactions on PAMI, 21(4):777-789, August 1998. L. Brown. A survey of image registration techniques. ACM Computing Surveys, 1992. A. Ranade and A. Rosenfeld. Point pattern matching by relaxation. Pattern Recognition, 12(2):269-275, 1993. R. O. Duda and P. E. Hart. Use of the hough transformation to detect lines and curves in pictures. Communications of the ACM, 15(1), 1972. N. K. Ratha, K. Karu, S. Chen, and A. K. Jain. A real-time matching system for large fingerprint databases. Transactions on Pattern Analysis and Machine Intelligence, 18(8):799-813, 1996.

Effectiveness of the Citroen C4 Robot and Ice Television Advertisements

Citroà «n spend millions on their advertising campaigns, like any other company. The demographic and psychographic for Citroà «n has changed over recent years. They were first designed to appeal to older drivers and now they are appealing to an entirely new and different audience. Using music, colour and special effects they are trying to attract a younger market. Though both of the advertisements are appealing to slightly different audiences, they both have a fun feel and look about them. The music used in the C4 ?Robot? advert plays as soon as the advert starts. It is very funky, modern, and up-to-date to attract and appeal to younger drivers looking to buy their fist, maybe second, car. The music also fits in well with the modern futuristic background of the advertisement and design of the car. Most young people want the latest technology, as we are a technology era, and so I would say that the music reflects about the car quite well. The music is non-digetic, as you cannot see the source (where it is coming from). The director plays this. The ?Robot? dances to the music with 90?s style moves, and the people who would appreciate them are in their 20?s. The dancing also relates to a night club. This again is targeting the generation of younger car drivers. The music that is used in the ?Ice? advert is slightly different to that used in the ?Robot? advert. It is still quite up-beat but not as much as the music used in the ?Robot? advert, as the advert is aimed at a slightly older audience, people maybe with families and more responsibility as the emphasis is on safety. As in the ?Robot? advertisement, the music is again non-digetic. Instead of dancing to the music, the robot skates on ice and the music isn?t the... ...s down at us, the viewers, as it finishes ice skating. He looks menacing suggesting that the car is in control and when you are driving the car you feel powerful and dominate, feline like a jaguar is an aggressive animal. After reviewing the two advertisements, and analysing the effects on the targeted audiences, I think the ?Robot? advert is the most effective in appealing to its target audience, first time car buyers, because all of the devices and techniques used attract the audience very well. The advertisement showed the car to be something that most first time car buyers are looking for, a sleek, nifty, small but spacious, funky and modern and also technological car. The most effective devices used were sound and special effects. This is because the sound catches the attention of the viewers but the special effects make the viewers watch and want the car.

The Act of Valor

The Act of Valor Today’s society consists of a diverse human race that shares a common goal, to live life to its fullest potential. In the film, The Lord of the Rings: The Fellowship of the Rings, the main character, Frodo, is set out on a quest to destroy the ring that has long acquired the presence of evil. On his quest to destroy the ring, he encounters many challenges. His challenges consists of keeping the ring safe from the evil ones who want it back, making sure the ring gets to the destination, and keeping his life safe from harm.Along his journey, he is joined by a couple of his friends, all of which he must learn to trust, in order to destroy the rings that possesses evil. They are faced with the challenges to keep safe from Saruman and his orcs, the black riders, and Sauron’s soul. Throughout his journey, his qualities of a hero show. He owns the qualities of resilience, determination, courage, trust, and heroism. Without the qualities he possesses, it would have been an impossible task to complete. Frodo faces many challenges as he tries to destroy the ring.Those who seek to retrieve the ring are out to murder him. Without the help of his friends and those who care for him, he would not have stayed alive. Through his courage and determination, he shows that he can be trusted to be the one that destroys the ring. He is equipped with many qualities that help him complete the task. His optimism brought the strength he needed to succeed. As individuals in today’s society, we face many challenges in our lives. Yes, challenges can bring us down, but it also makes us stronger.Some of us are faced with challenges such as being able to survive, fighting cancer, being the first to go to college, being able to pay for bills, etc. Nevertheless, each of us encounters challenges that help shape and develop our lives. Challenges are not meant to kill anyone, but instead they are meant for people to reach their full potential in being able to f ind the answers and strength to be able to overcome the challenges we face. Each of us is born for a reason. It is impossible to tell what out fate is, but as time goes by, we start to find out just what our mission on Earth is.Frodo possesses the qualities of a Hero Archetype. Being a determined, resilient, trustworthy, and courageous individual, he is one that pleases everybody. Frodo never quit with being able to destroy the ring. Although he faced many challenges along the way, he managed to stay strong. He witnessed Gandalf’s death, he was nearly dead, and he had to leave his home to complete the task, but despite all that he encountered along the way, he managed to be determined. There were many negative effects on Frodo, but he maintained his composure and stayed optimistic until the end.Each of us has been knocked down multiple times by school, work, or simply the stress that we all face. Being knocked down is for us to realize what we need to do to get back up. Deter mination is the key to withstanding any negative effects on life. If we have a positive outlook on life and how our future will be, we can start to be heroes of our own lives. Frodo’s goal was to destroy the ring. Facing the challenges that follows as he is on his journey may impact him. By being determined, his goal to protecting the ring from the evil is reached.In our lives, we have many goals in life that we want to reach. We make mistakes here and there, but we learn from them and grow stronger. By being determined and positive, we can make sure our goals are reached. During Frodo’s journey, his friends and individuals who help protect him from those that want to retrieve the ring from him accompany him. They guide him in his journey to find his way safely. They are there to protect him from the evil that surrounds him. During our lives, we befriend many individuals who help us with our future.These friends of ours, are people we trust, turn to when they are in ne ed, or simply to have a sense of security. Just like Fordo being accompanied by his friends, we have friends we turn to when we need them. Frodo’s task is to protect the ring from the evil black riders that want it back. As he is on his journey, he makes many decisions that help him and his friends stay alive. The critical decision making that he makes throughout the film are vital in order to keep the ring in his possession, as well as stay alive.We are faced with making decisions that are crucial to our future. Without making the best decision, we cannot be successful in our lives. Frodo’s decision making made it possible for him to succeed. The Lord of the Rings: The Fellowship of the Rings, is not just a film, but it also shows its comparison to today’s society. Frodo faces many challenges while he is set out on his quest to destroy the ring. Each of us, face challenges in our life that make it difficult for us to succeed, but by working extra hard, we can m anage to overcome any challenge.Also, Frodo makes vital decisions that help with the safety and survival of Frodo and the group of followers. We face many points in our lives that consist of valuable decision-making. Those who want to protect him, as well as his friends accompany Frodo. During our lifetime, we befriend many people who become treasures to our hearts. Being able to have people we can turn to and trust is truly amazing. The film shows many relations between reality and how the movie is portrayed. As Frodo is on his journey to destroying the ring, he shows great heroism that is noticed by many.

End of Life Care Essay

When a loved one is dying, conversations about the end of life can be uncomfortable and difficult. Still, discussing end-of-life care is important. Depending on the circumstances, you might be able to help your loved one make important end-of-life decisions — such as whether to remain at home, move to a nursing home or other facility, or seek hospice care. Also, you can work with your loved one’s health care team to make sure your loved one remains comfortable at the end of life. Pain, anxiety and other end-of-life symptoms can often be treated. Even at the end of life, you can continue to support and nurture your relationship with your loved one. Simply being there can be an important source of strength and comfort for everyone. Grief When a loved one dies, grief can feel like a dagger in your heart. Often, grief triggers raw, intense emotions. You might wonder how you’ll ever pick up the pieces and heal your wounds — yet not feel as if you’re betraying your loved one’s memory. There are no quick fixes for the grief and anguish that follow a loved one’s death. As you face your grief, acknowledge the pain and know that it’s part of the healing process. Take good care of yourself, and seek support from friends and loved ones. Although your life will never be quite the same, the searing pain of grief will eventually become less intense. Accepting your new â€Å"normal† can help you reconcile your losses and move on with your life. Hospice Care Also called: End-of-life care Hospice care is end-of-life care provided by health professionals and volunteers. They give medical, psychological and spiritual support. The goal of the care is to help people who are dying have peace, comfort and dignity. The caregivers try to control pain and other symptoms so a person can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient’s family. Usually, a hospice patient is expected to live 6 months or less. Hospice care can take place * At home * At a hospice center * In a hospital * In a skilled nursing facility ————————————————- What is the role of the family? Family members often make sacrifices to care for relatives. Families provide care, pain management, and protect the patient. Although they may lack knowledge, caregivers gain satisfaction and pride from providing care, but are also at risk for depression and health problems related to caregiver stress (Haley & Bailey, 1999: Haley et al., 2001; Weitzner, Haley, & Chen, 2000). Some cultures may believe caring is the community’s duty and obligation. Caregivers benefit from social support, maintaining social activities and roles, and psychological interventions that teach coping skills. Most people want their family to be given choices about treatment and few wanted the physician to decide alone (Bradley, 1998). End of life: Caring for a dying loved one Whether you bring a dying loved one home or keep vigil at the hospital, you can take measures to provide comfort and relief at the end of life. Caring for a dying loved one isn’t easy. Even when you know the end of life is approaching, you might not feel prepared. Understanding what to expect — and what you can do to increase your loved one’s comfort — can help. * Choosing where to die Your loved one may have various choices for end-of-life care. Options may include: * Home care. Many people choose to die at home or in the home of a family member. You can assume the role of caregiver or hire home care services for support. Hospice care — services that help ensure the highest quality of life for whatever time remains — can be provided at home as well. * Inpatient care. Some people may prefer round-the-clock care at a nursing home, hospital or dedicated inpatient hospice facility. Hospice and palliative care — a holistic treatment approach intended to ease symptoms, relieve pain, and address spiritual and psychological concerns — can be provided in any of these environments. When you discuss the options with your loved one, consider his or her preferences as well as special physical, emotional and psychosocial needs. Evaluate how much support can be provided by family members and friends. For help determining the best option, talk with your loved one’s health care team or a social worker. You might ask for a referral to palliative or hospice care specialists — health care providers trained in specific care for people nearing the end of life. * Spirituality at the end of life As your loved one approaches the end of life, he or she may talk about spirituality or the meaning of life. Don’t force the subject — but if it comes up, encourage your loved one to explore and address his or her feelings. You might ask your loved one open-ended questions about his or her beliefs and experiences or most meaningful moments. You may want to invite a spiritual leader to visit your loved one as well. * Saying goodbye You can help your loved one communicate his or her final wishes for family and friends. Encourage your loved one to share his or her feelings, including thanks or forgiveness, and give others a chance to say goodbye. This may stimulate discussion about important, unsaid thoughts, which can be meaningful for everyone. Your loved one might also find it comforting to leave a legacy — such as creating a recording about his or her life or writing letters to loved ones, especially concerning important future events. * Recognizing when death is near It’s difficult to predict exactly when someone will die. As death approaches, however, your loved one may show various signs and symptoms indicating that the end of life is near. Look for: * Restlessness and agitation. Your loved one may frequently change positions. * Withdrawal. Your loved one may no longer want to participate in social events or other favorite activities. * Drowsiness. Your loved one may spend most of his or her time asleep. * Loss of appetite. Your loved one may eat and drink less than usual. * Pauses or other changes in breathing. This may happen when your loved one is asleep or awake. Providing comfort The active phase of dying usually begins several days before death. Although you can’t change what’s happening to your loved one, you can help him or her feel as comfortable as possible — ideally with the support of palliative or hospice care specialists. Your loved one also may experience a brief, final surge of energy. Though it can be confusing to see your loved one with renewed vitality, remember that this is a normal part of dying. If it happens, take advantage of the opportunity to enjoy your loved one and say your final goodbyes. * Keeping vigil For many families, keeping vigil near a dying loved one’s bed is a way to show support and love. If you decide to keep vigil, continue talking to your loved one. If you think your loved one would want to share this time with others, invite family members or close friends to show their support as well. Express your love, but also let your loved one know that it’s all right to let go. What is working? Mental health providers with palliative expertise can improve communication and resources. Mental health experts help providers understand the patient’s concerns and culture. They explain confusing medical terms and clarify CPR, pain management, and other treatments and encourage collaboration. Mental health providers also help relieve the common emotional distress and grief resulting from a terminal illness or care giving. COPING WITH BEREAVEMENT â€Å"IN OUR HEARTS, WE ALL KNOW THAT DEATH IS A PART OF LIFE. IN FACT, DEATH GIVES MEANING TO OUR EXISTENCE BECAUSE IT REMINDS US HOW PRECIOUS LIFE IS.† * Coping With Loss The loss of a loved one is life’s most stressful event and can cause a major emotional crisis. After the death of someone you love, you experience bereavement, which literally means â€Å"to be deprived by death.† Remember — It takes time to fully absorb the impact of a major loss. You never stop missing your loved one, but the pain eases after time and allows you to go on with your life. * Knowing What to Expect When a death takes place, you may experience a wide range of emotions, even when the death is expected. Many people report feeling an initial stage of numbness after first learning of a death, but there is no real order to the grieving process. Some emotions you may experience include: * Denial * Disbelief * Confusion * Shock * Sadness * Yearning * Anger * Humiliation * Despair * Guilt These feelings are normal and common reactions to loss. You may not be prepared for the intensity and duration of your emotions or how swiftly your moods may change. You may even begin to doubt the stability of your mental health. But be assured that these feelings are healthy and appropriate and will help you come to terms with your loss. * Mourning A Loved One It is not easy to cope after a loved one dies. You will mourn and grieve. Mourning is the natural process you go through to accept a major loss. Mourning may include religious traditions honoring the dead or gathering with friends and family to share your loss. Mourning is personal and may last months or years. Grieving is the outward expression of your loss. Your grief is likely to be expressed physically, emotionally, and psychologically. For instance, crying is a physical expression, while depression is a psychological expression. It is very important to allow yourself to express these feelings. Often, death is a subject that is avoided, ignored or denied. At first it may seem helpful to separate yourself from the pain, but you cannot avoid grieving forever. Someday those feelings will need to be resolved or they may cause physical or emotional illness. Many people report physical symptoms that accompany grief. Stomach pain, loss of appetite, intestinal upsets, sleep disturbances and loss of energy are all common symptoms of acute grief. Of all life’s stresses, mourning can seriously test your natural defense systems. Existing illnesses may worsen or new conditions may develop. Profound emotional reactions may occur. These reactions include anxiety attacks, chronic fatigue, depression and thoughts of suicide. An obsession with the deceased is also a common reaction to death. * Dealing with a Major Loss The death of a loved one is always difficult. Your reactions are influenced by the circumstances of a death, particularly when it is sudden or accidental. Your reactions are also influenced by your relationship with the person who died. A child’s death arouses an overwhelming sense of injustice — for lost potential, unfulfilled dreams and senseless suffering. Parents may feel responsible for the child’s death, no matter how irrational that may seem. Parents may also feel that they have lost a vital part of their own identity. A spouse’s death is very traumatic. In addition to the severe emotional shock, the death may cause a potential financial crisis if the spouse was the family’s main income source. The death may necessitate major social adjustments requiring the surviving spouse to parent alone, adjust to single life and maybe even return to work. Elderly people may be especially vulnerable when they lose a spouse because it means losing a lifetime of shared experiences. At this time, feelings of loneliness may be compounded by the death of close friends. A loss due to suicide can be among the most difficult losses to bear. They may leave the survivors with a tremendous burden of guilt, anger and shame. Survivors may even feel responsible for the death. Seeking counseling during the first weeks after the suicide is particularly beneficial and advisable. Living with Grief Coping with death is vital to your mental health. It is only natural to experience grief when a loved one dies. The best thing you can do is allow yourself to grieve. There are many ways to cope effectively with your pain. * Seek out caring people. Find relatives and friends who can understand your feelings of loss. Join support groups with others who are experiencing similar losses. * Express your feelings. Tell others how you are feeling; it will help you to work through the grieving process. * Take care of your health. Maintain regular contact with your family physician and be sure to eat well and get plenty of rest. Be aware of the danger of developing a dependence on medication or alcohol to deal with your grief. * Accept that life is for the living. It takes effort to begin to live again in the present and not dwell on the past. * Postpone major life changes. Try to hold off on making any major changes, such as moving, remarrying, changing jobs or having another child. You should give yourself time to adjust to your loss. * Be patient. It can take months or even years to absorb a major loss and accept your changed life. * Seek outside help when necessary. If your grief seems like it is too much to bear, seek professional assistance to help work through your grief. It’s a sign of strength, not weakness, to seek help.