History and Physical Examination Essay Example for Free

History and Physical Examination Essay Admitting Diagnosis: Stomatitis possibly methotrexate related. Chief Complaint: Swelling of lips causing difficulty swallowing. HISTORY OF PRESENT ILLNESS: This patient is a 57-year-old Cuban woman with a long history of rheumatoid arthritis. She has received methotrexate on a weekly basis as an outpatient for many years. Approximately two weeks ago she developed a respiratory infection for which she received antibiotics and completed that course of antibiotics. She developed some ulcerations of her mouth and was instructed to discontinue the methotrexate approximately 10 days ago. She showed some initial improvement but over the last 3 to 5 days has had malaise, a low grade fever and severe oral ulcerations with difficulty in swallowing. Although she can drink liquids with less difficulty. Patient denies any other problems at this point except for a flare of arthritis since discontinuing the methotrexate. She has rather diffuse pain involving both small and large joints. This has caused her some anxiety. MEDICATIONS: 1. Prednisone 7.5 mg p.o. daily. 2. Estradiol 0.5 mg p.o. q.a.m. 3. Mobic 7.5 mg p.o. daily, recently discontinued because of questionable allergic reaction. 4. HCTZ 35 mg p.o. every other day and oral calcium supplements. 5. In the past she has been on penicillamine, azathioprine, and hydroxychloroquine but she has not had Azulfidine, cyclophosphamide or chlorambucil. ALLERGIES: None by history. FAMILY/SOCIAL HISTORY: None contributory. PHYSICAL EXAMINATION: This is a chronically ill appearing female alert oriented and cooperative. She moved with great difficulty because of fatigue and malaise. VITAL SIGNS: Blood pressure 107/80. Heart rate 100 and regular. Respirations 22. HEENT: Normocephalic, no scalp lesions, dry eyes with conjunctival injection, mild exophthalmos, dry nasal mucosa, marked  cracking and bleeding of her lips with erosions of the mucosa. She has a large ulceration of the mucosa at the bite margin on the left. She has some scattered ulcerations on her hard and soft palate. She has difficulty opening her mouth because of pain. Tonsils not enlarged. No visible exudate. SKIN: She has some mild ecchymosis on her skin and some erythema. She has patches but no obvious skin breakdown. She has some fissuring in thebuttocks crease. PULMONARY: Clear to percussion and auscultation bilaterally. CARDIOVASCULAR: No murmurs or gallops noted. ABDOMIN: Soft, non-tender, protuberant, no organomegaly and positive bowel sounds. NEUROLOGIC: Cranial nerves 2 through 12 are grossly intact. Diffuse hyporeflexia. MUSCULOSKELETAL: Corrosive destructive changes in the elbows, wrists and hands consistent with rheumatoid arthritis. Has bilateral total knee replacements with stove pipe legs and perimalleolar pitting edema 1+. I feel no pulses distally in either leg. PHYCIATRIC: Patient is a little anxious about these new symptoms and theyre significance. We discussed her situation and I offered her psychological services. She refused for now. PROBLEMS: 1. Swelling of lips and dysphasia with questionable early Stevens-Johnson syndrome. 2. Rheumatoid arthritis class 3, stage 4. 3. Flare of arthritis after discontinuing methotrexate. 4. Osteoporosis with compression fracture. 5. Mild dehydration. 6. Nephrolithiasis 7. Anxiety PLAN: 1. Admit patient for IV hydration and treatment of oral ulcerations. 2. Obtain a dermatology consult.  3. IV leucovorin will be started and the patient will be put on high dose corticosteroids. 4. Considering patients anxiety perhaps obtain services of Stella Rose Dickinson PHD phycology at a later date.

Journal of JFK assasination :: essays research papers

November 22, 1963 The cheers and cries of the crowd were roaring and still escalating as he approached. The 1961 Lincoln Continental peered over the corner. The flap of hands in the air blocked the lens momentarily. Two security motorcycles made the turn on Elm Street and I felt excitement circulate my entire body as I knew any second the 35th President of the United States, John F. Kennedy, would appear. My legs trembled as I felt the breeze of the motorcade approach me. I was perched on a stone on Elm Street grasping my 8mm Bell and Howell camera. To Kennedy’s request his automobile would be without a top. Kennedy was now focused on my camera. I attentively filmed the hands of the President waving to the crowds of spectators; but if they had only known they were about to be spectators of a ghastly tragedy. And right then and there, on a clear November 22, 1963, John Fitzgerald Kennedy was assassinated. The laudation of the motorcade instantly turned into an outcry of thousands. An ineffable b lanket of terror covered me; yet I stood concretely filming the bomb of blood explode in my front of my eyes until the vehicle violently swerved and disappeared into an overpass. My heart dropped to the floor. I saw the world, I felt the world enter utter commotion, but my ears were not receptive to sound. A silence domed the scene. BOOM! The unbearable noise rang in my ears. I saw his body jump forward and his head swing back wildly†¦I stared, I tried, but I could no longer be reluctant to the truth. September 5, 1959 The scolding became part of the norm. The drill sergeant loved to yell and torment all of those under his command. I felt compassion especially for a man who seemed to have persistent trouble with the Corps. He was considered an outcast by many. Out in the range he had very poor marksmanship. Drill Sergeant Peters seemed to enjoy decrying this man. If he would become hesitant due to exhaustion from physical training, Sergeant Peters would soon enough get on his case and verbally torture him. I looked into the man’s eyes and saw a subtle expression of fear, anger, and distress cooking up all at once. A mask veiled despondent inside of him. He surely was not an exceptional shooter, or the fittest man there.

Quality of Primary Education in India Essay

Education in India is provided by the public sector as well as the private sector, with control and funding coming from three levels: central,state, and local. Taxila was the earliest recorded centre of higher learning in India from at least 5th century BCE and it is debatable whether it could be regarded a university or not. The Nalanda University was the oldest university-system of education in the world in the modern sense of university. Western education became ingrained into Indian society with the establishment of the British Raj. Education in India falls under the control of both the Union Government and the states, with some responsibilities lying with the Union and the states having autonomy for others. The various articles of the Indian Constitution provide for education as a fundamental right. Most universities in India are controlled by the Union or the State Government. India has made progress in terms of increasing primary education attendance rate and expanding literacy to approximately two thirds of the population. [3] India’s improved education system is often cited as one of the main contributors to the economic rise of India. [4] Much of the progress, especially in higher education and scientific research, has been credited to various public institutions. The private education market in India is merely 5%[ although in terms of value is estimated to be worth $40 billion in 2008 and will increase to $68–70 billion by 2012. However, India continues to face stern challenges. Despite growing investment in education, 25% of its population is still illiterate; only 15% of Indian students reach high school, and just 7% graduate. The quality of education whether at primary or higher education is significantly poor as compared with major developing nations. As of 2008, India’s post-secondary institutions offer only enough seats for 7% of India’s college-age population, 25% of teaching positions nationwide are vacant, and 57% of college professors lack either a master’s or PhD degree As of 2011, there are 1522 degree-granting engineering colleges in India with an annual student intake of 582,000, plus 1,244 polytechnics with an annual intake of 265,000. However, these institutions face shortage of faculty and concerns have been raised over the quality of education. [9] In India education system is not based on pure merit, but its based on caste based reservations. In universities/Colleges/Institutions affiliated to federal government there is minimum 50% of reservations applicable to various castes. At state level it varies. State of Andhra Pradesh has 83. 33% of reservations as on 2012 ,which is highest percentage of reservations in India. So the state is popularly known as the state that killed merit. PRIMARY EDUCATION SYSTEM IN INDIA The Indian government lays emphasis to primary education up to the age of fourteen years (referred to as Elementary Education in India. ) The Indian government has also banned child labour in order to ensure that the children do not enter unsafe working conditions. However, both free education and the ban on child labour are difficult to enforce due to economic disparity and social conditions. 80% of all recognized schools at the Elementary Stage are government run or supported, making it the largest provider of education in the Country. [pic] However, due to shortage of resources and lack of political will, this system suffers from massive gaps including high pupil to teacher ratios, shortage of infrastructure and poor levels of teacher training. Figures released by the Indian government in 2011 show that there were 5,816,673 elementary school teachers in India. As of March 2012 there were 2,127,000 secondary school teachers in India. Education has also been made free] for children for 6 to 14 years of age or up to class VIII under the Right of Children to Free and Compulsory Education Act 2009. There have been several efforts to enhance quality made by the government. The District Education Revitalization Programme (DERP) was launched in 1994 with an aim to universalize primary education in India by reforming and vitalizing the existing primary education system. 85% of the DERP was funded by the central government and the remaining 15 percent was funded by the state The DERP, which had opened 160000 new schools including 84000 alternative education schools delivering alternative education to approximately 3. 5 million children, was also supported by UNICEF and other international programmes. This primary education scheme has also shown a high Gross Enrollment Ratio of 93–95% for the last three years in some states. Significant improvement in staffing and enrollment of girls has also been made as a part of this scheme. The current scheme for universalization of Education for All is the Sarva Shiksha Abhiyan which is one of the largest education initiatives in the world. Enrollment has been enhanced, but the levels of quality remain low. CONCERNS FOR QUALITY EDUCATION As far as the provision of access and coverage is concerned, India today boasts of its educational system being the second largest in the world. It consists of nearly 610 thousand primary and 185 thousand upper primary schools, about a quarter million nonformal education centers, about 1. 87 million teachers and 110 million students study in primary classes in the recognized schools (1997-98). As per 1991 Census estimates there were about 115. 6 million children in primary school going age group in the country2. The latest educational statistics indicate a GER of 89. 7 percent for primary classes (81. 2 percent being for girls and 97. 7 percent for boys). 3 . The number of students in primary  classes in India is larger than the total population of the neighboring Bangladesh THE STATE OF QUALITY OF PRIMARY EDUCATION IN INDIA The key concern about education, in any formal educational system, of all time, has been its quality. Every stake holder, direct or indirect, of education is concerned about its quality. Guardians or parents, irrespective of their socio-economic status, want to educate their children with best quality education which would add better value to the degrees their wards acquire subject to the budget constraints. But what do we mean by ‘quality education? How this quality is being assessed? What is the status of the quality of education in India? This paper seeks to focus on these issues with respect to the quality of primary education in India. There is no universally accepted definition for ‘quality of education’. In education, perception of quality is around students (Mukhopadhyay, 2001). The performance of the students like examination results, learning achievements, ability to apply learned knowledge in practical life– exhibit the quality of an education. For some, â€Å"Quality of education† means value addition in education (Feigenbaum 1951); excellence in education (Peters and Waterman 1982); for others, fitness of education outcomes and experience for use (Juran and Gryna 1988). For a society, â€Å"excellence† and â€Å"value† are most appropriate indicators for quality education. A generally accepted definition of quality education does not exist and different end users adopt different criteria for determining the quality of education. In this study we measure the quality of primary education on the basis of student learning achievement (i. e. , ability of read, write and do mathematics). PRIMARY EDUCATION :UNIVERSILITY VS QUALITY: The universal declaration of human rights (1948) considered primary education as the basic human right of all people. Accordingly, all nations prioritized universal access to education. The developed and developing countries have attained universal or near universal access to primary education. Now the focus is on the quality of student learning. The quality concern is not uniform across the nations. The developing and poor nations are still striving for expansion of educational access. It has been established that access to education and its quality are not sequential  elements. At the sub-regional meeting of South Asian Ministers in Katmandu in April 2001, quality education was unanimously identified as a priority area. All participants were in agreement that there was an urgency to develop the quality of education to meet the intermediate target and education for all by 2015. Because how well pupil are taught and how much they learn can have a crucial impact on how long they stay in school and how regularly they attend. Further whether parents send their children to school at all is likely to depend on the judgment they make about the quality of teaching and learning. Based on this perception parents decide whether attending school is worth the time and cost for their children and for themselves. The World Bank (1997) suggested that ‘the best way to improve access is to improve quality which would make coming to school or staying in school a more attractive option from the perspective of parents as well as children. Moreover, efforts to improve quality will tend to increase the efficiency of the public expenditure and will encourage parents to contribute children education’. In the year 1950, when the Constitution of India was adopted, education was recognized as a basic individual right. Directive Principles of State Policy, Article 45, states that â€Å"the state shall endeavour to provide within a period of ten years from the commencement of this Constitution, for free and compulsory education for all children until they complete the age of fourteen years† (The Constitution of India). In line with the commitment of the country to provide elementary education to all children, educational facilities have got tremendously expanded during the post independence period, especially in primary stage. The number of primary school in India has increased from 2. 2 lakhs in 1950-51 to nearly 7 lakhs in 2004-05. In addition, there are at present nearly 3 lakhs non-formal education centres providing primary level education to out-of-school children in the age group 9 to 14. This expansion has definitely helped in making primary level education more easily accessible to a large section of children. As a result, the illiteracy rate and drop-out rate at school stage have come down. The national literacy rate has increased from 52. 21 per cent in 1991 to 64. 84 per cent in 2001. The drop-out rate has also declined from 64. 9 per cent in 1960-61 to 29 per cent in 2004-2005. Although the literacy  rates for both males and females have increased, the latter still continues to lag behind the former. However, there has been a narrowing of the male-female gap in literacy from 24. 8 percentage point in 1991 to 21. 7 percentage point in 2001(Selected Educational Statistics 2004-05). Primary education is the first stage of formal education. The main objective of quality primary education is to inculcate basic knowledge about reading, writing and arithmetic among the children. It is expected that after the successful completion of the primary level of education, a pupil should be able to read, write, and solve simple arithmetic problem. A study conducted by the Teamlease Services has revealed a very disappointing scenario of primary education in India. The study was conducted in primary schools in all the States of India (excluding Union Territories, Mizoram, Sikkim) to measure the learning achievement (quality) of students in language and mathematics. This study found that in India after completion of primary level education, 11 per cent student were not able to recognize anything, 14. 1 per cent can recognize only letters, 14. 9 per cent can read a word, 17 per cent can read a paragraph of a story and only 42. 8 per cent can read the complete story (Table 1). School Children who can read-standard-wise (IV) (in per cent) |State |Nothing |Letters |Word |One-Para of the |Complete story | | | | | |story | | |Andhra Pradesh |8. 8 |10. 5 |15. 6 |17. 7 |47. 35 | |Arunachal Pradesh |7. 2 |13. 5 |21. 6 |13. 3 |44. 4 | |Assam |10. 8 |15. 5 |20. 2 |21. 2 |32. 3 | |Bihar |14. 9 |15. 2 |12. 8 |14. 8 |42. 3 | |Goa |6 |6. 1 |12. 9 |24. 2 |56. 2 | |Gujarat |7. 2 |12. 4 |18. 9 |18. 6 |42. 9 | |Haryana |8. 5 |12. 1 |12. 7 |16. 1 |50. 7 | |Himachal Pradesh |3. 5 |14. 9 |11. 8 |14. 5 |55. 35 | |Jammu & Kashmir |3. 4 |10. 2 |26. 5 |20. 8 |39. 1 | |Karnataka |5. 4 |12. 1 |17. 7 |19. 0 |45. 9 | |Kerala |3. 2 |3. 7 |10. 7 |11. 3 |71. 1 | |Madhya Pradesh |15. 7 |15. 3 |15. 5 |17. 1 |36. 5 | |Maharashtra |7 |12. 1 |13. 0 |17. 4 |50. 45 | |Manipur |10. 6 |10. 7 |18. 7 |15. 7 |44. 4 | |Meghalaya |9 |8. 9 |22. 0 |8. 9 |59. 5 | |Nagaland |3. 1 |16. 5 |21. 7 |255. 6 |33. 2 | |Orissa |12. 4 |15. 0 |13. 5 |15. 05 |44. 2 | |Punjab |8. 9 |15. 3 |15. 1 |17. 85 |42. 8 | |Rajasthan |15. 8 |13. 2 |12. 7 |14. 95 |43. 6 | |Tamil Nadu |10. 3 |11. 4 |17. 5 |17. 3 |43. 6 | |Tripura |1. 0 |7. 3 |11. 7 |16. 8 |63. 4 | |Utter Pradesh |16. 8 |19. 2 |14. 6 |14. 8 |34. 6 | |West Bengal |4. 3 |12. 3 |13. 8 |24. 6 |44. 9 | |Chhattisgarh |7. 3 |16. 0 |15. 0 |15. 5 |46. 4 | |Jharkhand |13. 8 |16. 9 |15. 5 |15. 4 |38. 5 | |Uttaranchal |6. 8 |13. 0 |11. 2 |13. 3 |55. 7 | |All India |11. 0 |14. 1 |14. 9 |17. 0 |42. 8 | Source: India Labour Report 2007 The condition of students learning achievement (quality) is extremely poor in mathematics compare to language. This study found that after the successful completion of the primary level education, 18. 6 per cent children could not recognize the numbers, 26. 7 per cent children can recognize the numbers but not able to do addition or subtraction, 23. 9 per cent children only can do subtraction, and only 30. 7 per cent children can do addition, subtraction as well as division. Table 2 contains data relating to mathematical learning achievement (quality) in all Indian states. IMPROVING QUALITY OF PRIMARY EDUCATION For improving quality, the concerned authorities need to emphasis on the following issues,Early childhood education is extremely important and must be universalized. Aelevant curriculum. Accurate assessment of learning outcomes. Participatory management of education system. Engaging local communities,. Using ICT in teaching learning process Training of teachers and administrators of ICT. ,District Institute of Education and Training (DIETs) and State Council of Educational Research and Training (SCERT) need to be more strengthened and undergo structural changes. ,Establishment of a National Primary Education Assessment system like National Assessment and Accreditation Council (NAAC) for Higher education. ,Strengthening the teacher training institution. Reform in examination system. Proficiency in English is widely perceived as an important avenue for employment and upward knowledge, which also greatly facilitates the pursuit of higher education. English should be incorporated into the curriculum of primary schools as a language subject. CONCLUSION It appears from the empirical study that quality of primary education has been compromised for its universality in India. Operation Black Board, District Primary Education Project, National Literacy Programme, Sarvha Shiksha Abhiyan—all aim at universalizing. It is time that the nation pays heed to the quality dimension. As it has already been pointed out, quality indirectly helps in making the quantity. As a result, quality improvement programmes need to be devised for all levels—national, state and district.

The Nature Of The Gettysburg Address By Abraham Lincoln

â€Å"The Gettysburg Address† is a speech by the President of United States, Abraham Lincoln, which is one of the best representations of American history. It was produced by Lincoln during the Civil War, on November 19, 1863, at the commitment of the Soldiers’ National Cemetery in Gettysburg, Pennsylvania. Abraham Lincoln carefully arranges the Address, which was not planned to be as important as other presentations that day; the Gettysburg Address ended up being one of his greatest and most important scripts just over two minutes. Lincoln repeated the equality embraced by the Declaration of Independence, and affirmed the struggle of Civil War fighting over the power from the secession crisis not just for the Union, but also for the principle†¦show more content†¦The South had a larger agriculture than the North by 84%. The southern state had slavery and used them as farm laborers and formed the backbone of the southern economy. In the beginning of the Civil W ar, the northern states had a population of twenty-two million people while the southern states had combined a population of nine million, Union had forces exceeding the Confederates approximately two to one. The railroads were one the most useful tools for the North because they had more tracks on their side, allowing them to transport in a long distance, could load with a lot of cargo, and sent it on a very long way. As such, they became vital for the Army to import supplies of the soldier’s equipment of the Civil War. The North had won the war after four year of conflict. After the South surrendered and the war bankrupted them, the roads, farms, and factories were in ruins, which all but wiped out an entire generation of men. Abraham Lincoln had a dream to make all the troublemakers comes to peace and re-unite with the Union, which would join the nation together again. Abraham Lincoln freed four million slaves and allowed these freed men to join the Union Army, as the war has come to a close. Southern States admitted the Northern States had added the 13th Amendment to abolish slavery, the 14th Amendment the Right of Citizens, the 15thShow MoreRelatedGettysburg Address Rhetorical Analysis Essay examples889 Words   |  4 PagesFour and a half months after the Union defeated the Confederacy at the Battle of Gettysburg, Abraham Lincoln delivered the Gettysburg Address on November 19, 1863. He gave the Union soldiers a new perspective on the war and a reason to fight in the Civil War. Before the address, the Civil War was based on states’ rights. Lincoln’s speech has the essence of America and the ideals that were instilled in the Declaration of Independence by the Founders. The sixteenth president of the United States wasRead MoreAnalysis Of Edward Everett s Gettysburg Address1433 Words   |  6 PagesEdward Everett’s Gettysburg Address Gettysburg Final Draft May 4, 2016 Abraham Lincoln is arguably one of the United States greatest presidents and is well-known for writing one of the most iconic literary pieces in American history, the Gettysburg Address. Lincoln’s Gettysburg Address is an outstanding 272-word oration, meant to have been a â€Å"few appropriate remarks† (Wills), yet it is considered to be one of the greatest speeches ever written, and rightly so. However, Lincoln was not the onlyRead MoreRhetorical Analysis of The Gettysburg Address Essay776 Words   |  4 Pages Four and a half months after the Union defeated the Confederacy at the Battle of Gettysburg, Abraham Lincoln delivered the Gettysburg Address on November 19, 1863. He gave the Union soldiers a new perspective on the war and something to fight for. 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