Monday, November 29, 2010

Limitations for Advance Care Planning for Alzheimer's Patient

AHRQ Study for Advance Care Planning

Agency of Healthcare Research and Quality (AHRQ) performed a detailed research on the current state of the effectiveness of the Advance Care Planning for the patients with chronic illnesses. The research finding indicates that most patients have not participated in advance care planning, yet many are willing to discuss end-of-life care. One way to determine patients' preferences for end-of-life care is to discuss hypothetical situations and find out their opinions on certain treatment patterns. These opinions can help clarify and predict the preferences they would be likely to have it if they should become incapacitated and unable to make their own decisions.

Studies funded by AHRQ indicate that many patients have not participated in effective advance care planning. The Patient Self-Determination Act guarantees patients the right to accept or refuse treatment and to complete advance medical directives. However, despite patients' rights to determine their future care, AHRQ research reveals that:
  • Less than 50 percent of the severely or terminally ill patients studied had an advance directive in their medical record.
  • Only 12 percent of patients with an advance directive had received input from their physician in its development.
  • Between 65 and 76 percent of physicians whose patients had an advance directive were not aware that it existed.
  • Having an advance directive did not increase documentation in the medical chart regarding patient preferences.
  • Advance directives helped make end-of-life decisions in less than half of the cases where a directive existed.
  • Advance directives usually were not applicable until the patient became incapacitated and "absolutely, hopelessly ill."
  • Providers and patient surrogates had difficulty knowing when to stop treatment and often waited until the patient had crossed a threshold over to actively dying before the advance directive was invoked.
  • Language in advance directives was usually too nonspecific and general to provide clear instruction.
  • Surrogates named in the advance directive often were not present to make decisions or were too emotionally overwrought to offer guidance.
  • Physicians were only about 65 percent accurate in predicting patient preferences and tended to make errors of undertreatment, even after reviewing the patient's advance directive.
  • Surrogates who were family members tended to make prediction errors of overtreatment, even if they had reviewed or discussed the advance directive with the patient or assisted in its development.
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Why Advance Care Planning is Needed?

Advance care planning describes a patient expressing how other people should manage future medical problems when the patient is no longer able to make decisions about his or her care. A patient can document these plans as witnessed legal documents. Such a document is called a living will.  It describes the kinds of treatments the person would or would not want to receive.  A durable power of attorney  for health  care describes  the  person  who  should  serve as  surrogate  and  speak  on  behalf  of  the  patient. Alternatively, a patient can choose not to execute these legal documents but instead have informal guides for care that are kept in a chart note or remembered conversation.

In  general,  the  process  of  advance  care  planning benefits  patients:  decreasing  depression,  enhancing  a sense of being in control and settling treatment preferences.   It  may  be  particularly  useful  in  the  case  of patients  who  are  at  risk  of  problems  with  surrogate decision-making.   Specifically,   the   patient   may   be estranged from their spouse, though not divorced, and living with a partner.  Or  the  patient  may  not  have  a partner but several children who are not in close contact  with  each  other.  There  are,  of  course,  multiple permutations  upon  these  kinds  of  family  situations.

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Advance Care Planning Limitations

The  general  point  is  that  they  present  the  risk  that there  may  be  disagreements  among  people  over  who has the authority to speak on behalf of the person and what is the proper way to care for them. A useful strategy  to  avoid  such  a  situation  is  to  ask  a  patient 'Suppose your Alzheimer's disease gets worse so that you can't talk with me the way you are right now and instead I have to talk with someone else about how to take care of  you. Who should I talk to? Who do you trust? Is there anyone in the family I should not talk to?' However, as potentially valuable as advance care planning is, clinicians need to address three limitations to assure that advance care plans create an understanding and appreciation of the patient's future, and identify values that should help to shape that future.  The first limitation is the nature of the specificity of the directive.  Living  wills  may  seem  to  assure  the strictest  adherence  to  a  patient's  self-determination, for example, 'I do not want a feeding tube'. However, a  directive  applies  to  specific  conditions,  the  most common  of  which  is  the  condition  of  a  terminal  illness.  In other words, the directive to withhold an enteral feeding tube would only apply in the event the person is not competent and also in a terminal state.

Such conditions limit the scope of the directive. And yet,  the  future  health  states  that  typically  motivate people to make a living will are cases of a persistent vegetative state or severe dementia, both of which do not clearly describe a person who is terminal and may in fact live for at least a year or more. A clinician can address this limitation by fostering advance care planning  conversations  that  focus  on  the  patient's  goals, values and personal concepts of best interests, and are amended  to  include  conditions  such  as  persistent vegetative state or severe dementia.

A second limitation of advance directives is that many people do not see them as a means to determine precisely the course of future events. Specifically, people  may  not  want  to  make  specific  plans  for  their future care in the same manner that they use a will to instruct  people  to  manage  their  property.  Instead, people may use an advance directive to entrust others to act in their best interests. Whereas a will for property typically states instructions such as 'My sister gets the car and my son gets the boat', a person may not want their living will to have the same degree of specificity.  Instead  of  stating  the  decision  specific  'In  the event I have severe stage dementia, I do not want an enteral feeding tube', their directive would state 'In the event  I  have  severe  stage  dementia,  I  leave  it  to  my trusted  husband  to  decide  whether  I  should  have  an enteral feeding tube'. The clinician or whoever is helping the person complete their advance care plan then needs  to  ask  the  person  what  kinds  of  factors  the trusted husband should or should not think about.

To  guide  this  discussion  of   factors,  a  clinician should assess how much freedom or leeway a person would  grant  their  trusted  proxy  over  their  advance care  preferences  and  if  they  would  grant  them  freedom,  what  factors  should  guide  it.  For  example,  a patient  may  say  'If  I  reach  the  point  where  I  cannot recognize my family, then I don't want to be kept alive. If I get pneumonia or something, let me go. Period'. A useful probe to this statement is how much leeway or freedom the patient would give to their proxy over this decision to do the opposite.  For  example,  this  same patient may say 'Well, if  I'm happy and laughing and enjoying life, it's worth taking some chances, but that's really  the  key  �  how  much  I  am  enjoying  life'.  This example illustrates how the person modified their initial strong preference against treatment under certain clinical circumstances to include factors that their proxy should take into consideration.

A  third  limitation  is  that  a  dementia  patient's impairments   in   abstract   reasoning,   planning   and insight  may  hinder  their  decision-making  abilities  to the  degree  that  they  lack  the  capacity  to  execute  an advance directive.  A useful strategy for the clinician is to present a patient with a description of a person in the profound stage of dementia and asks the patient 'Suppose that you were in this condition. How would you want to be cared for?'  The patient's answer is then  a  starting  point  both  to  assess  their  ability  to make  decisions  about  their  future  care  and  for  a discussion about their goals and values of care.

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Sources and Additional Information:
Clinical Diagnosis and Management for Alzheimer's Disease by Serge Gautheir


Basic Employment Approaches after Retirement

For either financial or personal reasons you think you might want to work past the traditional retirement age of 65. What are your real options to find a job, offering certain income?

In spite of the reality that older people are generally have more obstacles to get employed, than younger potential employees, there are still multiple options available and they seem to be growing.

When embarking on a career or job search in retirement, there are many questions you will want to evaluate, including:
  • What is motivating you to find a retirement job? Money? Boredom? Both?
  • How much money do you need to earn?
  • What do you want to spend your time on?
  • What kind of work would you find fulfilling?
  • How much time do you want to spend on the job?
  • How much responsibility do you want?
  • How much flexibility do you want?
  • Would you consider working for yourself?
  • What hours would you like to work?
  • What kind of activities would you like to engage in at work?
  • What kind of retraining are you willing to engage in?
From staying in your lifelong job to pursuing something totally different, explore the following ideas for retirement careers.

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Stay in Your Current Job

While some employers encourage retirement at or even before 65, many other employers wish to retain their employees for as long as possible. There is no rule that says you must retire at any age. If you enjoy your current job and/or the benefits of your job (financial, social, or other) then there is really no reason to voluntarily leave.

In fact, the only real reason to voluntarily leave a job is because you have defined something better to do. If you wish to stay in your current job past retirement age, but feel that you are being forced out by your employer, please consult information about age discrimination.

According to a study by Cornell University:
  • 3 out of 4 companies would permit older employees to reduce their hours rather than take full retirement, but not many employers list retirement job option as part of their formal employment policies.
  • 26 percent of employers that would allow older employees to reduce their hours prior to retirement would not change the employees' health benefits.
  • 40 percent would allow employees to draw pension benefits even though they're working part-time at retirement jobs.
Phased Retirement

Phased retirement is when you retain your current job with your current employer, but reduce or change the hours you spend at the job and, in some cases, your responsibilities. Working part-time or on a more flexible schedule at your current job is a great way to ease into retirement. You can benefit from increased leisure while keeping an income and � in many cases � the benefits (medical and other) from your job.

Phased retirement offers huge benefits to the employee as well as the employer. Many employers will learn that they actually need baby boomers to continue working. If baby boomers retire at or before the age of 65, the United States may experience huge labor shortages. Not all employers offer phased retirement. If your employer does not, you might be able to help them design a program to meet your needs.

New Part-Time Retirement Jobs

There are numerous employers, who are interested in hiring seniors for business reasons, and some are even setting up special recruiting programs for retirement jobs to attract older workers. Everyone from McDonalds to New York Life Insurance wants to employ older Americans.

The AARP has developed a program called the AARP's Featured Employer's Program. For this program, AARP partnered with employers who want the experience and leadership of older Americans.

In addition, many other organizations help to connect prospective employers and interested older workers, such as the National Council on Aging.

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Consultant Jobs

Use the expertise you developed during your working years to offer short-term consulting or freelance services to companies that prefer to contract for temporary on certain projects. Generally, you will need to get a business license, keep records, and file taxes as a business on the income you earn, however these expenses are not significant, and even the minimum income will be able to cover them easily.

Work at Home Jobs

Finding a work-at-home occupation is probably of the most popular retiree jobs. Working from the comfort of your own home, without having to commute to the office each day, wear a suit, or deal with the same old office politics, gossip and plain pointless conversations; there are certainly many advantages to working from home.

Companies are seeking ways to reduce their overheads. With this come opportunities for part-time, stay-at-home work.

Some of the most popular jobs you can do at your kitchen table include writing, proofreading, editing and researching. If we just look at the category of writing, there is a unbelievable variety of related jobs, such as ghost-writing, resume writing, technical writing, blogging, travel writing. I have even seen jobs advertised for people to simply cut and paste internet research findings into a word document.

You can find many opportunities like this at freelance websites such as elance.com, odesk.com and freelancer.com.

Other work-at-home jobs include data entry, crossword creation, recipe testing and writing, graphics design and computer programming.

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Temporary Employment

The largest employer in the U.S. is not a major corporation like Boeing or Microsoft; it's Manpower Inc., a temp agency based in Milwaukee.

Temporary employees ("temps") are used by many businesses to supplement full-time staff or to help out with special projects. Temps often earn as much as permanent workers. Hourly rates range from $10 to $30, depending on the type of work being performed and where you're located. In addition, about 30 percent of temp jobs turn into full-time positions.

Government and Community Programs

Federal and state governments have set up a variety of programs to provide job training and employment services to seniors, and so have many local communities.

One of the best government programs is the Senior Community Service Employment Program (SCSEP), a program administered by the U.S. Department of Labor that helps low-income people 55 and older prepare for a variety of community service jobs.

Notable community programs include the Career One-Stop Centers and America's Job Bank. Check with your state Employment Security Department, Department of Labor, or Department of Aging for other senior employment programs in your area.

This post just offers basic approaches to stay busy and earn certain additional income during your retirement. We will review some of the most promising ideas in the further publications.


Sources and Additional Information:


http://tinyurl.com/29yzcz7

Thursday, November 25, 2010

Portable Freeware Media Viewer and Editor - FreeVimager



FreeVimager is am image viewer and editor. It can as well play AVI video files and some type of audio files.

�View & Edit graphics file of type: JPEG, BMP, GIF, TIFF (multi-page), PNG, PCX and EMF.
�Save As PDF command
�Jpeg lossless rotate and crop
�Works with all Windows versions from 95 up to Windows 7
�Multi-monitor support: switch form one monitor to another through context menu or TAB key
�The executable only version stores the settings to a INI file
�Preview Display with transparency (useful when working with two or more monitors)
�Unicode support: Open, Edit, Batch Process or Batch Rename your files named in Russian, Indian, Chinese, Japanese...
�EXIF is displayed and all data are kept when editing and saving images
�EXIF date / time adjustment in batch mode
�IPTC & XMP single file / batch editing support for JPEG and TIFF files
�Batch Processing and CD / DVD Slideshow creation
�Print Preview with image positioning by dragging
�Size optimized Email sending of images and AVI files
�Well known editing features like: rotate, crop, resize, brightness, contrast, sharpen, ...
�Live configurable Redeye removal tool
�Live Ansel Adams Zone System Histogram under Brightness, Contrast, …
�Twain Scan multiple pages to tiff and PDF (possibility to Email directly)
�AVIvideo player with snapshot functionality and draggable borders in full-screen mode
�Audio and CD player
�Zip extraction (context menu entry available)

Direct Download (portable, no installation needed): http://ping.fm/TQAOg

Screenshots (Click to Enlarge):



Thanksgiving Quotes for your Celebration

Here are some wonderful Thanksgiving quotes that show you how to count your blessings. How often do we remember to express our gratitude to our friends, family, and God? If you wish to express your deepest gratitude, these thanksgiving quotes will be helpful.

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Henry Van Dyke 
Gratitude is the inward feeling of kindness received. Thankfulness is the natural impulse to express that feeling. Thanksgiving is the following of that impulse.

Johannes A. Gaertner
To speak gratitude is courteous and pleasant, to enact gratitude is generous and noble, but to live gratitude is to touch Heaven.

William Law
Would you know who is the greatest saint in the world: It is not he who prays most or fasts most, it is not he who gives most alms or is most eminent for temperance, chastity or justice; but it is he who is always thankful to God, who wills everything that God wills, who receives everything as an instance of God's goodness and has a heart always ready to praise God for it.

Melody Beattie
Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos to order, confusion to clarity. It can turn a meal into a feast, a house into a home, a stranger into a friend. Gratitude makes sense of our past, brings peace for today, and creates a vision for tomorrow.


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Frank A. Clark

If a fellow isn't thankful for what he's got, he isn't likely to be thankful for what he's going to get.

Fred De Witt Van Amburgh
None is more impoverished than the one who has no gratitude. Gratitude is a currency that we can mint for ourselves, and spend without fear of bankruptcy.

John Fitzgerald Kennedy
As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them.

Estonian Proverb
Who does not thank for little will not thank for much.

Ethel Watts Mumford
God gave us our relatives; thank God we can choose our friends.

H. U. Westermayer
The Pilgrims made seven times more graves than huts. No Americans have been more impoverished than these who, nevertheless, set aside a day of thanksgiving.


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Meister Eckhart
If the only prayer you said in your whole life was, 'thank you,' that would suffice.

Galatians 6:9
Do not get tired of doing what is good. Don't get discouraged and give up, for we will reap a harvest of blessing at the appropriate time.

Thomas Aquinas
It would seem that the ingratitude, whereby a subsequent sin causes the return of sins previously forgiven, is a special sin. For, the giving of thanks belongs to counter passion, which is a necessary condition of justice. But justice is a special virtue. Therefore this ingratitude is a special sin. Thanksgiving is a special virtue. But ingratitude is opposed to thanksgiving. Therefore ingratitude is a special sin.

Albert Barnes
We can always find something to be thankful for, and there may be reasons why we ought to be thankful for even those dispensations which appear dark and frowning.

Henry Ward Beecher
The unthankful heart... discovers no mercies; but let the thankful heart sweep through the day and, as the magnet finds the iron, so it will find, in every hour, some heavenly blessings!

William Faulkner
Gratitude is a quality similar to electricity: it must be produced and discharged and used up in order to exist at all.

George Herbert
Thou that has given so much to me,
Give one thing more -- a grateful heart;
Not thankful when it pleases me,
As if Thy blessings had spare days;
But such a heart, whose pulse may be
Thy praise.

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J.A. Shedd
He who thanks but with the lips
Thanks but in part;
The full, the true Thanksgiving
Comes from the heart.

Edward Sandford Martin
Thanksgiving Day comes, by statute, once a year; to the honest man it comes as frequently as the heart of gratitude will allow.

Ralph Waldo Emerson
For flowers that bloom about our feet;
For tender grass, so fresh, so sweet;
For song of bird, and hum of bee;
For all things fair we hear or see,
Father in heaven, we thank Thee!

Henry Ward Beecher
The unthankful heart... discovers no mercies; but let the thankful heart sweep through the day and, as the magnet finds the iron, so it will find, in every hour, some heavenly blessings!

Henry Jacobsen
Praise God even when you don't understand what He is doing.

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Gerald Good
"If you want to turn your life around, try thankfulness. It will change your life mightily."

Robert Burns
Some hae meat and canna eat, -
And some wad eat that want it;
But we hae meat, and we can eat,
Sae let the Lord be thankit.

O. Henry
There is one day that is ours.  There is one day when all we Americans who are not self-made go back to the old home to eat saleratus biscuits and marvel how much nearer to the porch the old pump looks than it used to.  Thanksgiving Day is the one day that is purely American.

Ellen Orleans
I have strong doubts that the first Thanksgiving even remotely resembled the "history" I was told in second grade.  But considering that (when it comes to holidays) mainstream America's traditions tend to be over-eating, shopping, or getting drunk, I suppose it's a miracle that the concept of giving thanks even surfaces at all.

Jon Stewart 
I celebrated Thanksgiving in an old-fashioned way. I invited everyone in my neighborhood to my house, we had an enormous feast, and then I killed them and took their land. 


Sources and Additional Information:

Tuesday, November 23, 2010

Enrich your Gmail experience with Rapportive

I love how Rapportive "just works" out of the box.
Rapportive is telling me so much I didn't know.
I do not know how I ever survived Gmail without Rapportive.
Can't believe I waited this long to install.
From Twitter Buzz


Rapportive is a free browser plugin (available as both a Firefox add-on and as a Chrome extension), replacing the adverts in Gmail's sidebar (which you would like probably to get rid of anyway) with useful information about your contacts: a photo, bio and links to social media accounts (Twitter, LinkedIn, Flickr, etc).

You can immediately see what people look like, where they're based, and what they do. You can establish rapport by mentioning shared interests. You can grow your network by connecting on LinkedIn, Twitter, Facebook and more. And you can record thoughts for later by leaving notes.

Installation is simple and takes no more than couple of minutes. You have to give it access to a minimum of information to get started (as your name and email address, via your Google account). The service pulls contact information from the Rapleaf database, so the amount of biographical information and links to social media accounts that are returned will depend on how well Rapleaf has managed to tie that contact's email address to the various social media services.

Install plugin for free: http://rapportive.com/

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4 common types of political risks for International Markets operations


For multinational corporations, the meaning of political risk covers the potential threat that a host country will make political decisions, planned or sporadic, that will prove to have unfavorable effects on the corporation profits and goals, causing investors to lose some or all of the value of their invested assets. Undesirable political actions or events might be in wide range from completely disastrous, such as widespread destruction due to revolution or riots, to those of a more financial nature, such as creation of laws that prevent free movement of the capital (Investopedia, 2006).

The common types of political risks are as follows: systemic, procedural, distributive, and catastrophic political risks (Daniels, Radebaugh, & Sullivan, 2001). Let's review each type in more details.

Systemic Political Risks

Company investing in the international business sector, might be a subject of the inherited political risks initiated from substantial changes in the business policies of the host government. The regulations shifts might be directed to the general market structure, or it might be focused on the particular business sector, or even on a small operational niche. The possible reasons for the policies changes might be related to the new government establishment, shifts in the strategic views on the economic sector, or even personnel changes among top government officials, responsible for the country economic course.

Some of the systemic political risks sources might be even beyond the national government abilities to control and regulate economy, if they come from the global international business events and processes. Regional economic and financial crisis will eventually influence the economic outputs of the corporate division, located in the zone, affected by such an economic downturn.

Example: Enactment of capital and currency controls in Malaysia in 1998 was perceived absolutely negatively by international investors, causing capital to be withdrawn from the country. However, further currency stabilization, falling interest rates, and rising stock prices proved the point of the investors, who believed in the strengthening of country economy (Devadason).

Procedural Political Risk

Procedural risk reflects the potential cost and its deviation to perform the whole range of operational activities in the host country, including smooth movements of the final products, raw materials, finances, human resources, and any other components essential for successful business operations. Government and authorities' corruption, unsettled labor disputes, high level of bureaucracy, ineffective business decision-making, preferential treatment for certain businesses might lead to the low business efficiency and transaction costs increase.

Example: A former executive of Houston-based Global Engineering, Construction and Services Company, Albert Stanley, has pleaded guilty to bribing Nigerian officials in order to secure contracts to build liquefied natural gas facilities in the country. He claimed that the government officials insisted on the certain amount of kickback in exchange for the artificially delayed case approval (Ikokwu, 2008).

Distributive Political Risk

Any country, striving for the economic prosperity, is interested deeply in foreign investments in its economy. However, as foreign corporations are starting to get significant profits from its business ventures in the host country, local government might decide to reevaluate its guidelines on the fair wealth distribution between the foreign corporation and the local government needs. At this stage, national government might perform certain revision of their tax codes, regulatory structures, and monetary policy to capture greater benefits from foreign companies, decreasing the return on invested capital to the shareholders (Daniels, Radebaugh, & Sullivan, 2001).

Example: Following the reelection of President Hugo Chavez, and after announcing certain nationalization plans (mainly in telecommunications and electricity), the Venezuelan government has intensified its rhetoric against foreign oil and gas companies (Grenome & Socanos, 2007). The whole atmosphere of the foreign investment to the country, especially in the affected industries, strengthened the distributive political risk for all foreign corporations. Moody's Investors Service immediately changed the risk rating outlook to on the oil sector in the country to negative from stable (Hess & O'Shaughnessy, 2007).

Catastrophic Political Risk

Catastrophic political risk includes unanticipated political changes that largely affect all business operations in the country, but can be especially dangerous for local operations of the foreign companies. That includes military conflicts, racial and ethnic clashes, civil war, terrorism, etc. (Daniels, Radebaugh, & Sullivan, 2001).

Example: From 2002, Kenyan economy was considered as one of the most promising developments in Africa with annual growth of 2.8% in 2003, 4.3% in 2004, 5.8% in 2005, 6.1% in 2006, and 7.0% in 2007. However, the violence that broke out after the December 27, 2007 general election paralyzed the economy completely in January and early February 2008. And even now, while country shows some signs of recovery, events in the political arena still pose the greatest risk to the Kenyan economy (Makau, 2008).

References

Daniels, J.D., Radebaugh, L.H., & Sullivan, D.P. (2001). Globalization and Business. New York: Prentice Hall. Ch. 10, pp. 239-243.

Devadason, R. (n.d.). Investment Risk - Political Risk. Retrieved September 4, 2008, from http://www.freecoolarticles.com/FP15.14.htm

Grenome, L., & Tsokanos, B. (2007, February 14). S&P: Ongoing political risk in Venezuela still poses challenges for foreign oil and gas companies. Retrieved September 8, 2008, from http://www.bnamericas.com/research_detalle.jsp?documento=79414&idioma=I

Hess, W.L., & O'Shaughnessy, J. (2007, February 13). Moody's changes outlook on Venezuelan heavy crude oil projects to negative. Retrieved September 8, 2008, from http://bnamericas.com/research_detalle.jsp?documento=79034&idioma=I

Ikokwu, C. (2008, September 5). Nigeria: LNG � American admits bribing Nigerian officials. Retrieved September 5, 2008, from http://allafrica.com/stories/200809050001.html

Investopedia (2006). What is political risk and what can a multinational company do to minimize exposure? Retrieved September 4, 2008, from http://www.investopedia.com/ask/answers/06/politicalrisk.asp

Makau, J. (2008, July 3). Kenya: Political risks and threat to economy. Retrieved September 8, 2008, from http://allafrica.com/stories/200807031022.html


Google PageRank Explained


Everybody using internet is aware of the power of Google. Google is everywhere whether its search engine, email, social networking, online marketing, blogging etc.

But most important of all these is it's search engine which share approximately 60% of all searches made all over the world.This explains the importance of rank SERP (Search Engine Results Page) fo Google.The higher the ranking on SERP the more free visitors you will get from Google.

While displaying the results for a particular query Google takes into consideration a lot of factors.

Two most impotant factors being (source - Google's Corporate Information) -
  • PageRank Technology
  • Hypertext-Matching Analysis.
Now here comes the importance of Google PageRank.

What is Google PageRank?

According to Google - PageRank is Google's view of importance of a webpage. Pagerank is given out of 10.

Thus a webpage with a higher pagerank will be more important in view of Google as compared to the one with lower pagerank. Hence, a webpage with a better pagerank will get higher position in the SERP.
e.g. A webpage with Google PageRank of 5/10 will be more important and hence placed higher in Google SERP than the webpage with Google PageRank of 3/10.

How does Google determines a PageRank for any webpage ?

Lets see what Google says -

PageRank relies on the uniquely democratic nature of the web by using its vast link structure as an indicator of an individual page's value. In essence, Google interprets a link from page A to page B as a vote, by page A, for page B. But, Google looks at more than the sheer volume of votes, or links a page receives; it also analyzes the page that casts the vote. Votes cast by pages that are themselves "important" weigh more heavily and help to make other pages "important".

So Google takes into account the backlinks each webpage gets from different other webpages. Each backlink a webpage gets is considered as a vote by Google in the favour that webpage. But at the same time Google also analyzes the webpage from which a baclink is given.

Let's examine the following figure for some better understanding -

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In the above figure A,B,C,D,E and F are different webpages. Here you can see that page C has got a higher pagerank than page E, even though it have fewer links as compared to page E. It's because of the importance of the page from which page C is receiving a link and also the number of outbound links from that page. In the above case as you can see page B has got most importance and is having only one outbound link to page C, so up to 90% of its PageRank is carried to page C.

In the essence, a page with higher baklinks from quality pages (those with higher pagerank) will have a better pagerank.

Thus, improving your Google PageRank helps you by getting you more visitors through search engines and ultimately can result into better revenue from your website/blog.

Source: Blogger-Help


Monday, November 22, 2010

Agitated Depressive Disorder

Agitated Depression a state of clinical depression in which the person exhibits irritability and restlessness. This term is applied to depressive disorders in which agitation is prominent. Agitation occurs in many severe depressive disorders but in agitated depression, it is particularly severe. Agitated depression is seen more commonly among the middle aged and elderly than among younger patients. However, there is no reason to suppose that agitated depression differs in other impotent ways from the other depressive disorders.



Definition of Agitated Depression

A major depression with agitation that may be driven by hypomania.
Although many people experience symptoms such as feeling slowed down and lethargic when they are depressed, others may experience just the opposite. They may feel anger, agitation and irritability. This is what "agitated depression" refers to.

Agitated depression was once called melancholia agitata. It is now also known as mixed mania.

Agitation occurs in many severe depressive disorders, but in agitated depression it is particularly severe. There is no reason to suppose that agitated depression differs in other important respects from other depressive disorders.

Diagnostic Criteria for Agitated Depression

  • Major Depressive Episode
  • At least two of the following symptoms:
    • Motor agitation
    • Psychic agitation or intense inner tension
    • Racing or crowded thoughts
Agitated depression meets the criteria for major depressive episode but not those of a mixed bipolar disorder according to the DSM-III-R.



Agitated Major Depressive Disorder Symptoms

It is not tough to identify the symptoms of agitated depression. People that suffer from this type of depression are not able to sit still and keep on restlessly moving here and there all the time. It is due to the outburst of emotional energy caused because of agitated depression. Those that suffer from this type of depression tend to complain a lot and develop the feelings of being misunderstood by others. At least 2 of the following manifestations of psychomotor retardation (not more subjective anxiety) are required for several days during the current episode:
  • Tearing of cloths
  • Motor agitation
  • Intense inner tension
  • Racing thoughts
  • Never ending baseless thoughts
  • Continuous talking
  • Hand wringing
  • Pacing
  • Pulling or rubbing on hair, skin, or clothing
  • Outbursts of complaining or shouting
  • Difficulty in explaining problem

Agitated depression in bipolar I disorder

The occurrence of agitated depression in bipolar I disorder is not rare and has significant prognostic and therapeutic implications. Whether the co-occurrence of a major depressive syndrome with one or two of these symptomatic clusters makes up a "mixed state" remains unclear.

Clinical Forms of Agitated Depression

  1. Psychotic agitated depression
    Proposed name: Melancholia
  2. Non-psychotic agitated depression
    Meets the RDC criteria
  3. Excites anxious depression
    Provisional name: Psychic agitation and racing or crowded thoughts.


Complications for Agitated depression

The complications that have been mentioned in various sources for Agitated depression includes getting involved in risky activities, dysfunction in family and work, and even suicide or homicide.

Treatment

Agitated depression can be difficult to treat because the behavior patterns associated with this form of depression lend to the inability to consistently take medication. It is important to get properly diagnosed by a mental health care professional who can supervise your treatment closely. Psychotherapy is also useful in treating agitated depression. It is usually necessary to have long term treatment as a combination drug and psychotherapy. The drug therapy has to be fine tuned to your specific needs. This can take up to a month to see results and a cessation of side effects in most people but it is highly effective.

The common treatment approaches are:
  1. Medicines - Antidepressants and anticonvulsant like divalproex, aripiprazole, clozapine or olanzapine is largely used in treatment of agitated depression.
  2. Psychotherapy - In most of the cases psychotherapy is preferred to treat agitated depression.
  3. Combination of medicines and psychotherapy - When drug therapy and psychotherapy is used in combination then effect is much better for curing agitated depression.
  4. Electroconvulsive therapy - Electricity is passed to the brain through electrodes to overcome from agitated depression.


Sources and Additional Information:

Namenda Treatment for Moderate to Severe Alzheimer's

About Namenda

A medication known as Namenda (memantine), an N-methyl D-aspartate (NMDA) antagonist, is prescribed to treat moderate to severe Alzheimer's disease. This drug's main effect is to delay progression of some of the symptoms of moderate to severe Alzheimer's. It may allow patients to maintain certain daily functions a little longer than they would without the medication. For example, Namenda may help a patient in the later stages of the disease maintain his or her ability to use the bathroom independently for several more months, a benefit for both patients and caregivers.

Namenda is believed to work by regulating glutamate, an important brain chemical. When produced in excessive amounts, glutamate may lead to brain cell death. Because NMDA antagonists work very differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination.

Namenda was approved in October 2003 by the Food and Drug Administration for the treatment of moderate to severe Alzheimer's disease. The approval was based partly on a rigorous 28-week study of 252 people who were randomly chosen to receive the drug or a placebo. The results, published in the prestigious New England Journal of Medicine in the spring of 2003, showed that the drug could slow the downward spiral of the disease.

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Therapeutic Effect

Namenda is proven to help treat the symptoms of moderate to severe Alzheimer's disease. That is important because the longer symptoms are treated, the more quality time you may have to spend with the person with Alzheimer's disease who you are caring for.

In a 28-week study, mentioned earlier, published in the New England Journal of Medicine patients suffering from moderate to severe Alzheimer's disease received either 20 mg of Namenda per day or a placebo (sugar pill). The study found that compared to patients taking placebo:
  • Patients taking Namenda experienced a slower rate of decline in thinking over time.
  • Namenda treated patients had significantly greater ability to perform daily activities, including doing household tasks such as taking out the garbage or clearing the table after dinner, as well as conversing.
Namenda in combination with donepezil may do more to treat the symptoms of moderate to severe Alzheimer's disease then donepezil alone.

Since so far there is no cure for Alzheimer's disease, the goal of treatment with Namenda, as with all Alzheimer's disease medications, is to treat the symptoms of Alzheimer's disease. Once treatment is started, you may wonder how long it will take for Namenda to have an effect. Some patients have seen an improvement within twelve weeks of starting therapy, although individual results may vary.

Please keep in mind that either no change in Alzheimer's disease symptoms or a slower rate of progression of symptoms are positive results compared to the more rapid decline a person with Alzheimer's disease might experience without treatment. It is important to understand that every day symptom progression is delayed may allow the person with Alzheimer's disease to spend more quality time with his or her loved ones.

How it works?

Namenda works in a unique way and is different from other prescription medications approved to treat Alzheimer's disease. As the only NMDA receptor antagonist, Namenda targets a brain chemical known as glutamate. Nerve cells rely on a variety of chemical messengers to transmit messages from one cell to the next. One of those chemical messengers is glutamate.

Glutamate is a chemical in the brain that has been associated with learning and memory. Abnormal glutamatergic activity in the brain may lead to Alzheimer's disease symptoms. Namenda may help block abnormal glutamatergic activity to improve symptoms.

Other Alzheimer's disease medications, known as AChEIs (acetylcholinesterase inhibitors), such as Aricept (donepezil), work by targeting a different brain chemical called acetylcholine. When there is too little acetylcholine in the brain of a person with Alzheimer's disease, memory and learning can be affected. AChEIs work by addressing that problem.

Taking Namenda alone or in combination with donepezil may help improve quality of life for people with Alzheimer's disease and their caregivers. There is no evidence that Namenda prevents or slows neurodegeneration in patients with Alzheimer's disease.

Taking Namenda

Getting Started
Therapy begins at a low dose (5 mg per day) and is gradually increased until the recommended target dose (10 mg, twice daily) is reached. A common dosing schedule for beginning Namenda therapy is provided below:
Recommended Namenda dosing schedule

  1. Week 1: Start on Day 1
Take one 5 mg tablet in the morning, each day.

  1. Week 2: Start on Day 8
Take one 5 mg tablet in the morning and one 5 mg tablet at night, each day.

  1. Week 3: Start on Day 15
Take one 10 mg tablet in the morning and one 5 mg tablet at night, each day.

  1. Week 4: Start on Day 22
Take one 10 mg tablet in the morning and one 10 mg tablet at night, each day.

  1. Once the recommended target dose (10 mg, twice daily) has been reached, people taking Namenda can continue with that daily regimen unless instructed otherwise by their doctors (For patients with severe renal impairment, 5 mg twice daily is the recommended dose).
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Side Effects

Although generally well-tolerated, the most common side effects are dizziness, headache, constipation, and confusion. Unlike cholinesterase inhibitors such as Aricept, Exelon, and Razadyne, those taking Namenda have a low risk of gastrointestinal side effects.

Potential Interactions

Namenda has a low potential for drug interactions. However, other NMDA antagonist medications, which include some cold and flu medications (like dextromethorphan), should be used with caution while taking Namenda. Sometimes, doctors prescribe Namenda along with a cholinesterase inhibitor to treat moderate Alzheimer's disease, as some studies have shown additional benefit from combining these medications.


Sources and Additional Information:



Sunday, November 21, 2010

Working in Retirement - Overview

Once upon a time "retirement" meant dropping out of the workforce entirely to pursue leisure or rest. In fact, the dictionary defines the word "retire" as "1.) To withdraw, as for rest or seclusion, 2) To go to bed, 3) To withdraw from one's occupation, business, or office; stop working. 4) To fall back or retreat, as from battle. 5) To move back or away; recede."

However, work and retirement are no longer mutually exclusive ideas. The current generation of retirees is redefining what it means to be retired � both out of necessity and choice. Many recent surveys show that 60 � 90 percent of retirees will work after their retirement.

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Why are People Working in Retirement?

Necessity: There are numerous advantages of continuing to work � the main one being that you can continue to build retirement assets while delaying your need to utilize those assets.

Rising healthcare costs, lack of adequate retirement assets, reduction of pension and retiree health benefits, increasing longevity and rising living expenses mean that many people need to work in retirement.

Desire: Many retirees want to work in retirement. This group feels like they wish to contribute to and engage with society through work.

The desire to stay mentally active plays a major role in people's decision to work in retirement. But so do financial concerns. The AARP asked 2,001 individuals between 50 and 70 years old who work full- or part-time why they do it. The need for money was the primary response.

What is surprising, says AARP research director Jeff Love, is how much longer people plan to work. In 1997, AARP started asking people at what age they planned to retire, and the response was mid- to late 60s. In the latest survey, almost half the respondents said they plan to work into their 70s or beyond. Although the need for money is a driving force, some people would continue to work even if they didn't need the money, Love says.

Baby boomers -- in their 50s now -- will have a harder time letting go of their jobs for the leisure of retirement because their identities are tied to what they do professionally, Love says. "Their jobs mean a lot to them." And they'll be physically able to work longer thanks to advances in medicine and healthier lifestyles that are extending life expectancies.

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The Pros

Whether you need money, want to stay mentally active or just like working and never plan to retire, there are pros and cons you should consider when deciding whether to work past the traditional retirement age of 65.

Money. If you delay retirement, think of it as another year you won't have to tap your nest egg and more time to rebuild a 401(k) or qualified retirement plan wrecked by the recent bear market. The extra money Terry makes pays for leisure activities, such as traveling. The couple haven't had to tap their retirement savings yet, so it continues to accrue interest for their later years. They pay their bills with their Social Security income.

Health insurance. The good thing about working is that your new employer might provide group health coverage. It can be difficult to find a part-time job in retirement that offers health benefits, so be aware that you may have to work longer hours to qualify.

Mental activity. Working during what traditionally are seen as retirement years offers people a chance to continue their mental development, learn new things and contribute to society.

Community. Many people say their workplace is like their family away from home. Working in retirement allows individuals to be around other people and feel like they are part of a community.

Social security benefits. Because Social Security benefit payments are based on your top 35 earning years, you could rack up bigger monthly checks by staying on the job longer. And thanks to changes in the law, workers age 65 or older can claim full benefits even if they continue to work full-time.

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Cons

Age discrimination. It still exists, and a 40% rise in claims from 1999 to 2002 proves it. Furthermore, 30% of respondents in the AARP study say age discrimination will be a barrier. Some employers may be biased about older Americans' ability to get up to speed if they have been out of the workforce for a while, says Deborah Russell, an AARP expert on aging workforce issues. That's why it is imperative for older people to keep their work skills up to date.

Pension problems. Returning to work after retiring could affect your pension, Russell says. Be sure to check with your former employer to make sure you won't be hit with any penalties or have any problems accessing your pension fund if you return to work, especially if you go back to your old employer. If you had chosen a lump-sum pension payment when you left your job, don't worry, your funds would not be affected.

Taxes on Social Security benefits. By working and increasing your income, there's a greater chance that a larger percentage -- up to 85% -- of your Social Security benefits will be subject to income taxes.

Less leisure time. Retirement traditionally is viewed as a time to stop working and start relaxing. If you had planned to spend time with friends and family, pursue other interests, travel or volunteer, you'll have less time to do these things if you work in retirement.

IRA withdrawals. If you have a traditional IRA and are working in retirement, you still will have to take required minimum distributions at 70. These withdrawals count as income, which could mean more of your social security benefits would be taxed. If you did not retire, and just continue working, you may be able to get around this rule.


Sources and Additional Information:


http://tinyurl.com/38m8j5s

Bart - freeware file and folder backup tool

Bart is a file and folder backup tool, which transfers changes from multiple source directory trees to destination trees. When run, it will copy any files which have changed since the last run, bringing the destination up to date with the source in an efficient way, copying only files required.

Bart can read from a list of source directories, so not only can it keep your My Documents folder backed up, but also any other data stored on your drive in other locations. Direct the target of each of these folders at a network drive on another machine, a second hard drive in the same machine, or removable media such as a USB pen drive. When first run, all the files will be copied, and then on subsequent runs only the files which have altered will be updated, new files copied, and deleted ones removed.

Bart keeps the target completely in line with the source. It does not perform two-way synchronization. If a file in the target was changed, on next run of Bart, it would be replaced with the file from the source.

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Source

The source can be either a single file, or a directory. If a directory is used, then a checkbox controls whether all subdirectories are also copied. Multiple source directories can be chosen, so that all your data areas can be backed up at once.

Destination

The destination folder is kept synchronized with the source. Any changes which are made to the destination would be overwritten the next time Bart is run - to this end do not edit files in the destination, or save anything new! The synchronization is one-way, and is complete.

Exclusions

An exclusion list can be set for each task, so that certain files can be ignored. To back up a photos directory, but leave out thumbnail files, the pattern "thumbs*" would be added. Multiple file specifications can be made, such as "*obj;*pdb;*aps;*.sbr;*.pch;*.idb;*.res", and full paths can be excluded by specifying them. "d:photos2004;thumbs*;00_index*;*gif" would omit the 2004 folder, and also skip over any file starting with "thumbs" or "00_index" and any ending with "gif".

Exclude directories by specifying the whole directory, eg "c:program filesfirewall".

Exclude files by specifying the filename, eg "persfw.conf", not the whole path "c:program filesfirewallpersfw.conf"

Command line

The following can be specified on the command line:
  • -runall - Bart will run all enabled jobs, show the balloon summary and quit
  • -show - When used with -runall, the main dialog is displayed while the jobs are running
  • -stay - Bart will stick around once it's finished running the jobs. Clicking any buttons in the interface if -show is specified will also cause it to remain
  • -shutdown - the computer is shut down once the jobs have been run with no errors reported
  • -ignoreerrors - if -shutdown has been specified and errors were found, shut down anyway
  • -datelog - save detailed logs to different files, named as the date they were generated
  • -logexclusions - also write files which are skipped to the detailed log file
  • -file - open the specified job file
eg:
c:program filesbartbart.exe -runall -show -shutdown

This will start Bart, run all the jobs, and at completion the computer will be shut down.

Logging

Bart writes an HTML-based log file (log.html) of its operations, a CSV with details of each run (summary.log), and pops up a task-tray balloon when the tasks are complete.


Direct Download: http://ping.fm/71PyJ


Learning Curve for Stock Trading

How long does it take to become good at stock trading?  No trader's journey to learning and succeeding in the markets is the same, but here are some basic guidelines and time frames to becoming a competent stock trader:

The First Year

Your beginning months should be spent researching and developing your stock trading plan.  No one should ever begin trading in the stock market without a plan of action.  Will you be a day trader? Long term investor?  What rules and guidelines will you establish and follow for making trades?  Without this information, you'll rarely succeed and never be able to duplicate success you do obtain through luck.

Attend seminars and workshops designed for stock trading.  Don't fall for the ones that claim to share "secrets of stock trading" as there are no secrets!  Look for seminars and workshops which teach you to read charts, discuss the psychology of trading, creating trading plans and guidelines, or basic money management courses for investors.

Purchase and begin using charting software.  Observe the changes in the market, and look for patterns and trends.  Don't make any decisions now; this is just an observation stage.




Read books about stock trading.  Don't read them the way you would a novel � really analyze what the author is saying, see if you can put the information into real-life context, and watch how the information is reflected in the market.

At the end of the first year of learning and studying stock trading, you should have a stock trading technique chosen and a plan for your own trading in place.  You may have decided stock trading is not for you in which case you've just saved yourself a whole lot of money!

Year Two

Now that you've put in the research and planning time, your second year should begin your initial attempts at making trades.  Open an account with an amount of money you can afford to lose, and consider it your educational expense into the world of stock trading.

Before making any purchases, test out your planned strategy through "back testing".  Look at various stocks and see how you would have done if you had purchased a certain number of stocks during a particular time period. Would you have made a profit or lost money?  Once you see how it works, decide on your first purchases.

Continue observing trading charts, attending seminars and workshops and studying books.  Continue making trades and monitoring your progress.  Adjust your stock trading plan according to the results you're obtaining.  You're looking to create a plan that profits more than it loses, so that you can put the strategy you've chosen into place and stick with it.

Year Three and Four

By now, you should have a plan you're comfortable with.  You should be making small gains in the market.  Keep to the plan and maintain discipline � each time you make a trade that is outside your stock trading plan, you risk losing more than you can gain.

Becoming competent in stock trading is a lot like obtaining a college degree � it takes you three to four years of studying and applying what you've learned to become successful.






Saturday, November 20, 2010

View all installed USB devices on your system

USBDeview is a small utility that lists all USB devices that currently connected to your computer, as well as all USB devices that you previously used.

For each USB device, extended information is displayed: Device name/description, device type, serial number (for mass storage devices), the date/time that device was added, VendorID, ProductID, and more...

USBDeview also allows you to uninstall USB devices that you previously used, disconnect USB devices that are currently connected to your computer, as well as to disable and enable USB devices.
You can also use USBDeview on a remote computer, as long as you login to that computer with admin user.

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License
This utility is released as freeware.

System Requirement
This utility works on Windows 2000, Windows XP, Windows 2003, Windows Vista, Windows Server 2008, and Windows 7.

Under Windows Vista/7/2008 with UAC turned on, you should right click on USBDeview and choose 'Run as Administrator'. In order to disable/enable USB items on x64 systems, you must use the x64 version of USBDeview.

Developers' website: http://ping.fm/jSH2e

Download (32-bit OS): http://ping.fm/02A7p

Download (64-bit OS): http://ping.fm/NYGqk


Friday, November 19, 2010

Speed up your Technical Writing with PhraseExpert



If you are writing a lot of professional or technical documentation, and you would like to speed-up a process, you may find a freeware PhraseExpress quite useful.After a while you may avoid typing the most common phrases again and again. Instead, the program will perform educated guess and will input the string automatically. �

How PhraseExpert may help you?

  • Organize frequently used text snippets.
Text snippets allow you to reply instantly to common questions. A snippet can be anything from a short phrase like "Kind regards" to a complete contract draft. When you are replying to an email, you simply type a text shortcut ("Autotext"), press a hotkey or select the desired phrase from a selection menu, and the snippet will be inserted for you automatically.

  • Expand abbreviations as you type.
PhraseExpress expands text abbreviations into full phrases for you. E.g. typing 'sig' could insert your signature into any program. �It provides this known MS Office Autotext feature in any Windows program, e.g. Internet Explorer, Excel, Database Front Ends, etc.

  • Auto-Complete
PhraseExpress silently monitors your individual text input and analyzes repetitive phrases. The text prediction algorithm is completely different from tedious Auto-Complete functions that are using just static dictionaries or web based contents. PhraseExpress rather adapts to your individual writing style. It learns what you type, it learns which suggestions you like and which you didn't. It automatically dumps rarely used words and assesses frequently word combinations based on your preference usage and frequency.

  • Spell Checking
PhraseExpress includes a system-wide spell checker in seven languages in any program. PhraseExpress supports Unicode for multi-language phrases and also offers you to switch the keyboard language layout automatically during keyboard input. This enables multi-language users to use different language within a single phrase with correct display of the characters. Or you can highlight any text and let PhraseExpress change the language scheme on demand.

  • Clipboard Manager
While the standard Windows Clipboard keeps only the�last�copied data, the PhraseExpress Clipboard Manager�stores recently copied clipboard contents for instant pasting into any application.

  • Program Launcher
Launch programs�simply by entering a text shortcut. For example, type 'word' to launch Microsoft Word or 'exc' to open a spreadsheet. You can define whether the program shall launch instantly or optionally after pressing a customizable confirmation key.

  • Correct spelling mistakes in any application.
PhraseExpress Standard Edition is free-of-charge to all personal users:

  • Fully featured
  • No trial expiration
  • No Spyware
  • No Adware
  • No strings attached&33;



Screenshots (Click to Enlarge):