S. Katharine Hammond PhD, CIH
 https://publichealth.berkeley.edu/people/s-katharine-hammond/ Comparison of total laparoscopic and abdominal radical hysterectomy for patients with early-stage cervical cancer birth control pills early period 3.03mg yasmin fast delivery. Robotic radical hysterectomy versus total laparoscopic radical hysterectomy with pelvic lymphadenectomy for treatment of early cervical cancer birth control pills directions discount yasmin 3.03 mg without prescription. Laparoscopic total radical hysterectomy by the Pune technique: our experience of 248 cases birth control killeen tx effective yasmin 3.03mg. A case matched analysis of robotic radical hysterectomy with lymphadenectomy compared with laparoscopy and laparotomy birth control 3 weeks buy discount yasmin on-line. Robotic approach for cervical cancer: comparison with laparotomy: a case control study. Robotic radical parametrectomy and pelvic lymphadenectomy in patients with invasive cervical cancer. Total laparoscopic radical trachelectomy with intraoperative sentinel node identification for early cervical stump cancer. Safety and feasibility of robotic radical trachelectomy in patients with early-stage cervical cancer. Extraperitoneal laparoscopic lymph node staging: the University of Southern California experience. Usefulness of extraperitoneal laparoscopic paraaortic lymphadenectomy for lymph node recurrence in gynecologic malignancy. Transperitoneal laparoscopic pelvic and paraaortic lymphadenectomy in gynecologic cancers. Is there a benefit of pretreatment laparoscopic transperitoneal surgical staging in patients with advanced cervical cancer Extraperitoneal endosurgical aortic and common iliac dissection in the staging of bulky or advanced cervical carcinomas. Safety, feasibility, and costs of outpatient laparoscopic extraperitoneal aortic nodal dissection for locally advanced cervical carcinoma. Robotic radical hysterectomy with pelvic lymphadenectomy for cervical carcinoma: a pilot study. Robotic retroperitoneal lower para-aortic lymphadenectomy in cervical carcinoma: first report on the technique used in 5 patients. Robotically-assisted laparoscopic anterior pelvic exenteration for recurrent cervical cancer: report of three first cases. Preliminary experience with robot-assisted laparoscopic staging of gynecologic malignancies. Robotic-assisted laparoscopic cytoreductive surgery for lobular carcinoma of the breast metastatic to the ovaries. Physiology of Micturition the bladder is a complex organ that has a relatively simple function: to store urine effortlessly, painlessly, and without leakage and to discharge urine voluntarily, effortlessly, completely, and painlessly. To meet these demands, the bladder must have normal anatomic support and normal neurophysiologic function. Normal Urethral Closure Normal urethral closure is maintained by a combination of intrinsic and extrinsic factors. The extrinsic factors include the levator ani muscles, the endopelvic fascia, and their attachments to the pelvic sidewalls and the urethra. This structure forms a hammock beneath the urethra that responds to increases in intra-abdominal pressure by tensing, allowing the urethra to be closed against the posterior supporting shelf (Fig. For many women, this loss of support is severe enough to cause loss of closure during periods of increased intra-abdominal pressure, resulting in stress incontinence. Note how the urethra is compressed against the underlying supportive tissues by the downward force (arrow) generated by a cough or sneeze. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Effective urethral closure is maintained by the interaction of extrinsic urethral support and intrinsic urethral integrity, each of which is influenced by several factors (muscle tone and strength, innervation, fascial integrity, urethral elasticity, coaptation of urothelial folds, urethral vascularity). In the clinical setting, damaged urethral support is manifested clinically by urethral hypermobility, which often results in incompetent urethral closure during physical activity and presents as stress urinary incontinence. Intrinsic urethral functioning is more complicated and is not understood nearly as well as incontinence related to loss of urethral support (2). Clinical appreciation of the importance of extrinsic support and intrinsic urethral function led to the separation of stress incontinence into two broad types: Incontinence caused by anatomic hypermobility of the urethra Incontinence caused by intrinsic sphincteric weakness or deficiency Surgical approaches are based on this arbitrary distinction, with a pubovaginal sling recommended for women with intrinsic sphincter deficiency and a colposuspension (also known as retropubic urethropexy) for those with hypermobility. This rationale was based initially on a small study in which women younger than age 50 years with urethral closure pressure less than 20 cm H O had a higher failure rate after a Burch colposuspension2 than did women with a closure pressure greater than 20 cm H O (2 3). This dichotomy was called into question, based on the observation that all women with stress incontinence have some degree of sphincter weakness, regardless of whether they have hypermobility. Minimally invasive synthetic midurethral slings have largely replaced pubovaginal slings and retropubic urethropexy as the most commonly performed surgical procedures for stress urinary incontinence. The use of midurethral slings would seem to lessen the impact of a poorly functioning urethra; however, a similar debate is ongoing about the impact of poor urethral function with both retropubic and transobturator slings. It appears that women with poor urethral function are more likely to experience treatment failure irrespective of the type of procedure performed (4). The Bladder the bladder is a bag of smooth muscle that stores urine and contracts to expel urine under voluntary control. It is a low-pressure system that expands to accommodate increasing volumes of urine without an appreciable rise in pressure. The bladder muscle (the detrusor) should remain inactive during bladder filling, without involuntary contractions. When the bladder has filled to a certain volume, fullness is registered by tension-stretch receptors, which signal the brain to initiate a micturition reflex. Normal voiding is accomplished by voluntary relaxation of the pelvic floor and urethra, accompanied by sustained contraction of the detrusor muscle, leading to complete bladder emptying. Innervation the lower urinary tract receives its innervation from three sources: (i) the sympathetic and (ii) parasympathetic divisions of the autonomic nervous system, and (iii) the neurons of the somatic nervous system (external urethral sphincter). The autonomic nervous system consists of all efferent pathways with ganglionic synapses that lie outside the central nervous system. The sympathetic system primarily controls bladder storage, and the parasympathetic nervous system controls bladder emptying. The somatic nervous system plays only a peripheral role in neurologic control of the lower urinary tract through its innervation of the pelvic floor and external urethral sphincter. The sympathetic nervous system originates in the thoracolumbar spinal cord, principally T11 through L2 or L3 (see Chapter 6). The ganglia of the sympathetic nervous system are located close to the spinal cord and use acetylcholine as the preganglionic neurotransmitter. The postganglionic neurotransmitter in the sympathetic nervous system is norepinephrine, and it acts on two types of receptors: receptors, located principally in the urethra and bladder neck, and receptors, located principally in the bladder body. Stimulation of receptors increases urethral tone and thus promotes closure, whereas adrenergic receptor blockers have the opposite effect. The parasympathetic nervous system originates in the sacral spinal cord, primarily in S2 to S4, as does the somatic innervation of the pelvic floor, urethra, and external anal sphincter. Sensation in the perineum is also controlled by sensory fibers that connect with the spinal cord at this level. For this reason, examination of perineal sensation, pelvic muscle reflexes, and pelvic muscle or anal sphincter tone is relevant to clinical evaluation of the lower urinary tract. The parasympathetic neurons have long preganglionic neurons and short postganglionic neurons, which are located in the end organ. Both the preganglionic and postganglionic synapses use acetylcholine as their neurotransmitter, acting on muscarinic receptors. Because acetylcholine is the main neurotransmitter used in bladder muscle contraction, virtually all drugs used to control detrusor muscle overactivity have anticholinergic properties. Bladder storage and bladder emptying involve the interplay of the sympathetic and parasympathetic nervous systems.
Social work support from the commissioning organisation throughout the entire process birth control pills during menopause buy yasmin 3.03mg line. Each group to discuss their hopes and fears about becoming a carer birth control pills 1974 purchase 3.03mg yasmin otc, however large or small birth control 28 days cycle order 3.03mg yasmin otc. Ask them to list hopes on one sheet and fears on another sheet (give them 10 minutes) birth control pills 3 month cycle brands cheap 3.03 mg yasmin mastercard. Assure all that everything raised will be dealt with in the coming weeks and that if asked that natural families would have very similar concerns. This experience proved so positive for both Tom and his family that it was felt important to continue his placement with Home Sharing on a monthly basis. He does not relate to people and is very involved in his own world and spends hours looking at books. Deirdre: Deirdre is a 10-year-old girl who lives in the countryside with her Mammy and Daddy. Deirdre Loves watching Barney and Postman Pat, going for spins in the car, going swimming and lots of hugs. She does not have speech but communicates through laughing, crying, head and leg movements. These assumptions and prejudices discriminate against the person engulfing them in a situation that can be very hard to break free from. To introduce and highlight the effects of labelling on the person and their family. To consider what the person needs to reach their potential as responsible and valued adults. Exercise: Lee Tell the story-This is Lee, I think he/she is about 10 but I am not sure. We see Lee in the shopping centre and he/she is lying on the ground screaming while a parent/carer tries to placate her but to no avail, (add more detail of possible behaviour as required). Invite your group to write down on the labels two things people might think of someone like Lee. Ask each member of the group to come one by one sticking their labels on Lee whilst saying the words out loud. This is Lee, he is 10, has a lovely smile, is the eldest of 3, is great fun, is afraid of large crowds, etc. All rights reserved I am often asked to describe the experience of raising a child with a disability, to try to help people who have not shared that unique experience to understand it, to imagine how it would feel. Ask each group member for one word to describe the previous session, include group facilitators if necessary. Either all in one group or split into sub groups use the flipchart and invite the group members to highlight what they feel they would need to know as a Home Sharing family. What Home Sharing families may need to know about the guest and the placement plan may be some of the following: How do I make my environment safe Special diets 276 Routines especially around bedtime Fears Guest may have Mannerisms Likes and dislikes Behavioural problems Medical conditions Back up: What to do in the case of an emergency Again either all in one group or split into sub groups, use the flipchart and invite the group members to highlight what they feel a child needs to grow/develop/progress in life. Again either all in one group or split into sub groups, use the flipchart & invite the group members to highlight what they feel an adult needs to grow/develop/progress in life. Acknowledge that many of the supports outlined in the previous exercise may be the same and ask them to consider the additional supports that an adult may require. Other electrical equipment, especially kettle and flex which often sits near the edge of the work surface. What to do to make the person settle in Natural family visit Home Sharing families Home. Scenarios/Pen Pictures: In this section, group members are given pen pictures (either those shown in Week 1 or those below) of potential guests. Split the group into sub-groups and give each group a number of pen pictures and ask them in each case to consider that their first guest is coming to stay with them. Ask them to look at the pen picture and decide what would help each person to settle in to their Home She is very curious and loves to touch, but has no concentration and darts from objects to object. He is easily disturbed by loud noises and sudden actions, and cries if he does not understand his surroundings. She has Down syndrome, can do many things for herself and likes the company of other teenagers. What type of behaviour they would expect of a person with intellectual Disability List their responses on a flipchart and remind them when finished that everything that had been listed out (which may be licking, slapping, repetitive movements etc) that they are also capable of and may do if someone pushes your buttons. Remind them that often behaviour such as lashing out is a response to something else. Ask the group for their opinion Tiredness, anxiety, distress, fear, pain, hunger, medication Movement, sensory issues, worry, not getting own way, out of comfort zone st New environment (remember the 1 thing most do on holidays is to check out the hotel room. Bathroom etc and see where everything is and become familiar with the environment) It has a direct response to either environmental or internal signs. Environment includes people-staff behaviour is important Because it services a function It has consequences It makes us comfortable Be aware that your tolerance for behaviours will change throughout the day, give example of problems occurring early in the day, how they make you late etc and how they effects how you react to other behaviours. Remind all that everyone exhibits some behaviour that others find difficult to deal with and that conflict due to behaviour problems could actually be your behaviour problems causing it. G of negatives that we display+ negative reinforcement Why do we stop behaving / What helps Quite environment, less stimulation Seen the cause of the behaviour and have tried to address it. The behaviour does not have the same function anymore 282 1: the behaviour no longer has any positive consequences 2:It no longer makes us comfortable 3:The environment has changed i. A commonplace observation is that it is difficult to reason with an individual who does not wish to be reasoned with. We recommend the following interpersonal rules to promote a positive engagement approach to managing any incident: Appear calm We know that trying to stay calm in a tense situation can be difficult.
However birth control pills levora order yasmin with a visa, data indicate that fewer than 5 percent of married access birth control non hormonal cheap yasmin 3.03 mg visa, or lack of awareness birth control icd 10 cheap yasmin 3.03 mg on line. In 19 countries only 0 to 2 percent of women with an alleged unmet need for contraception had no knowledge of contraception birth control pills refill 3.03mg yasmin amex, with 524 numbers only reaching 10 to 15 percent in countries where this reason was most prevalent. For unmarried women with unmet need, these were also not prominent reasons for 525 contraceptive nonuse. The infrequency of access, cost, and awareness reasons for not using contraception indicates the reality that increasing funding for and provision of contraceptives 521 For an excellent overview of the problem with the concept of unmet need, see Lant Pritchett, No Need for Unmet Need, Presentation at the Johns Hopkins School of Hygiene and Public Health Population Center Seminar Series (Feb. The reasons most often given by married women for not using contraception were side effects, health concerns, and inconvenience, with numbers at 20 to 50 527 percent of women in 26 of 36 countries surveyed. Fear of side effects is not limited to physical complications but also includes lost time and financial resources in dealing with the side effects, possible loss of work productivity, and possible interference with spousal sexual 528 relations. These women, by definition, do not have an unmet need for contraception, so it is disingenuous to include them in the calculation. The emphasis on including family planning in the post-2015 sustainable 544 development framework will divert attention from real development solutions if it focuses on unmet need. Further, results-oriented family planning programs that set targets for new contraceptive users and increased contraceptive uptake may be tempted to use coercive or unduly influential tactics to meet these targets if women are resistant to participate, which highlights a potential human rights abuse consequence of the 545 incorrect unmet need approach. Women experiencing irregular cycles, depression, weight gain, and other common symptoms relating to hormonal imbalances require health care that treats the underlying health problems and not just the symptoms. Women desiring to avoid pregnancy deserve more than just an offering of artificial contraceptive methods that have mechanisms of action that interrupt the healthy functioning of the body and that may cause side effects. It violates their rights to have to make family planning decisions with incorrect or insufficient information. This knowledge allows each woman to understand how methods of family planning work and which method is best for her. With this knowledge and information, she can become an active participant in her health care and health decisions, and can work with her health care provider to achieve long-term health care outcomes. Policies and funding must reflect the needs and desires of women and what will actually work to meet them. This article builds on concepts previously presented, which include the abandonment of long-used, ill-de ned, and confusing English-language terms of Latin and Greek origin, such as menorrhagia and metrorrhagia. The terminologies and de nitions described here have been comprehensively reviewed and have received wide acceptance as a basis both for routine clinical practice and for comparative research studies. It is anticipated that these terminologies and de nitions will be reviewed again on a regular basis through the International Federation of Gynecology and Obstetrics Menstrual Disorders Working Group. This situation has led to rately, primarily because of dif culties in de ning the 5, 6 dif culties in interpreting the scienti c and clinical study populations using current terminologies. Indeed, two phase 3 clinical trials on management which primarily addressed the most obvious and con of heavy menstrual bleeding with a novel estradiol-based fusing of issues around terminologies, de nitions, and oral contraceptive, using identical protocols, have just classi cations of abnormal uterine bleeding but also been completed on opposite sides of the Atlantic. It was strongly If these recommendations continue to meet with recommended that poorly de ned and confusing ter wide approval, it is hoped they will be steadily incorpo minologies such as menorrhagia, metrorrhagia, anddys rated into daily professional and community use and be 2, 3 functional uterine bleeding be abandoned. Journal editors will be place should be substituted clear and simple terms encouraged to offer guidelines for the use of these that women and men in the general community could terminologies and de nitions in submitted articles. These terminologies partic World Congress of Gynecology and Obstetrics in Cape ularly include several English-language terms with Latin Town in October 2009 and reviewed a series of recom and Greek origins: mendations, which are described here. These audience responses are addressed in recommended to be abandoned as listed in Table 1. It has the methodology behind the recommendations pre mostly been used as a diagnosis of exclusion where the 2, 3, 7 sented here has been described in detail elsewhere. Subsequently Metrorrhagia these recommendations were published (with simulta Hypermenorrhea neous publication in Fertility and Sterility and Human 2, 3 Hypomenorrhea Reproduction), and they were also tested in presenta Menometrorrhagia tions at international meetings. This Working Group also assisted in design Epimenorrhagia ing questions to test the acceptability of the recom Metropathica hemorrhagica mended terminologies, de nitions, and classi cations Uterine hemorrhage with a large multicultural audience in the Congress on Dysfunctional uterine bleeding Abnormal Uterine Bleeding Symposium using the 8 Functional uterine bleeding Audience Responder System. Hence it is now recommended lished data from several population studies (2, 3) gives a that the diagnoses encompassed within dysfunctional de nition of >20 days in individual cycle lengths over a 11 uterine bleeding can be classi ed under three de nable period of 1 year, which is the de nition we prefer. The key characteristics are regularity, that the term oligomenorrhea be abolished. Several abbreviations for these terminolo frequent menstruation and not erratic intermenstrual gies are established or becoming established by increas bleeding; it is very uncommon). The term was understands when a menstrual cycle is irregular, but rst used in New Zealand National Guidelines on Figure 1 the relationships of different types of symptoms and signs of abnormal uterine bleeding using recommended terminologies. These cycles illustrate the characteristics of each type of common pattern in the context of the new recommended terminologies. Women with usually light in volume and is uncommonly associated surface lesions of the genital tract may typically experi with serious pathology (such as intrauterine adhesions ence bleeding during or immediately after sexual inter and endometrial tuberculosis). The term acyclic bleeding is rarely used but encompasses those few women who present with totally erratic bleeding, with no discernable Irregular Nonmenstrual Bleeding cyclic pattern, usually associated with fairly advanced Nonmenstrual bleeding is common and usually consists cervical or endometrial cancer. Premenstrual and post of the occasional episode of intermenstrual or postcoital menstrual spotting (or staining) are descriptions of very bleeding associated with minor surface lesions of the light bleeding that may occur regularly for! Inter symptoms may be indicative of endometriosis or endo menstrual bleeding is de ned as irregular episodes of metrial polyps or other structural lesions of the genital bleeding, often light and short, occurring between oth tract. This bleeding may occasionally be prolonged or heavy, and it may occur on a regular basis around ovulation as a Bleeding Outside Reproductive Age Precocious menstruation (occurring before 9 years of age) is uncommon and usually associated with other Table 2 Acceptable Abbreviations Describing Menstrual Symptoms Established by Popular Usage signs of precocious puberty. The stages of the menopause transition and had to be devised to de ne these new patterns. Twenty-eight or 30-day reference periods may still be used for monthly 8 Acute or Chronic Abnormal Uterine Bleeding hormone systems. Heaviness of ow is dif cult to assess with vention to prevent further blood loss. These analyses led bleeding pattern over the days of one menstrual period, to attempts to de ne clinically important bleeding pat this aspect of the menstrual bleeding experience of terns, derived initially from World Health Organization 13 individual women is very poorly understood. Only one phase 3 clinical contraceptive trials and subsequently 21 article has tried to de ne it in different populations. It modi ed after analysis of menstrual data from 1000 24 is greatly in need of future research in both normal and normal women (Table 4). In general, in the normal cycle, it is recognized that $90% of the total menstrual ow is lost within the rst 3 days of menstruation, with Change in Menstrual Pattern day 1 or 2 the heaviest and day 4 and 5 very light (Fig. At times these patterns may become abnormal, and this change needs to be recognized as part of the presenting clinical problem. Review of the confusion in current and historical terminology and de nitions for disturbances of menstrual ance by doctors from many cultures. Effective treatment of heavy and/or prolonged Clinical Guideline 44; Heavy menstrual bleeding. Available menstrual bleeding with an oral contraceptive containing at.
In the United Kingdom xanax and birth control pills interaction buy cheap yasmin 3.03mg on line, Home Sharing is regarded by parents as a critical service in supporting families within their community birth control 4th week purchase yasmin 3.03mg visa. Families receiving Home Sharing place more of an emphasis on the relation of trust birth control pills tri order yasmin mastercard, rapport with the person with disability birth control pills quarterly periods discount yasmin online american express, when a match works and when it stops looking like a service and starts to feel like a life. The values underpinning Home Sharing provision are delivered in a person centred way, reflect the broad principles outlined within International Charters of Human Rights, the Government Health Strategy, Disability Strategy and the Health Service Executives Corporate Plan, among others. Home Sharing as a model of respite and full time care provision to people with intellectual disability has been found to be most beneficial for all the stakeholders especially for the person with intellectual disability. There is no doubt that Home Sharing as a model is certainly suitable for the vast majority of people with intellectual disability. She is Sonia is a young lady who was requiring a independent in many ways and is very home with a Home Sharing family. She capable with many household chores and has a moderate level of intellectual activities of daily living. She is very sociable, loves chatting She is an outdoors type of person she loves and having a bit of banter with people she going for walks in the woods. She Background: might request to have the door open but For Sonia, living in a group home was she is probably better off with it closed as stressful, she became more obsessed with she is a light sleeper and as soon as she hears the lives and behaviours of her peers and any activity she will get up. She loves through behaviours of concern and verbally music, cinema, dancing, going to Mass and that she wanted to live with a family and shopping. When Sonia was living in the group home It is essential to set boundaries from the and when on her own with one to one outset so Sonia is aware of what the staffing her true self would shine. She has great great sense of humour and she responded understanding of what is acceptable and well to one to one attention. She would talk what is not but she can be challenging and quite openly about what kind of very wilful at times. Behavioural incidents were recorded on a daily basis and she often She likes nothing better that to relax in a absconded from the group home. There bubble bath, she needs some supervision to were regular incidents of physical and ensure shampoo is rinsed out properly and verbal abuse from Sonia towards her peers that she has brushed her teeth properly. It was evident that she could not She loves to relax in front of the fire and cope well in a group living arrangement. These were mainly in the early days usually when there was some change Sonia started Home Sharing on a part time or upset in her life and over the past year basis for one weekend per month with her they have completely diminished making a first Home Sharing family. A the zoo in Dublin, visits to see my family, specific advertisement was created where a walks in the park and to the beach. They were trained, loves visiting family and friends and will assessed and vetted over a number of often request to go see my Mum. She loves When the opportunity came to live with a baking and is very competent at it. She Home Sharing family, Sonia grasped it with loves a relaxing bath at night time and will huge enthusiasm. She Sonia is a bright, fun loving person and she approached the opportunity with a nervous brings a life to our home. In her heart she in this regard and would let you do knew this was the right move for her, with a everything for her if let away with it. We have she began to build confidence and bridges had our challenges in getting to where we with her Home Sharing family. The Home are now but Sonia is well settled living with Sharing family were also supported by their us and she is part of our family. She also Key worker to ensure that as much support receives respite one weekend per month was available as required. She has more regular and positive contact with Perspective of the Home Sharing family: her mother and siblings who meet up with She settled into our home very quickly, at her on a weekly basis. She has become one of the There are little or no incidents of behaviours family and my extended family have of concern. There has mood is stable and she is very involved in been a huge reduction in her old behaviours her new local community. Challenges the National Expert Group acknowledges that there are a significant number of challenges to the optimum running of the Home Sharing service. Equally, where an adult with intellectual disability is placed in Home Sharing there is no legal or regulatory basis underpinning this arrangement. Where adults with intellectual disability are placed in full time care arrangements under Home Sharing some of these people contribute significant amounts of their monies to the Home Sharing families in some schemes. The State was found to be acting illegally in allowing people in care situations to be funding their own care arrangements (Finance Act, 2005). National Standards provide a governance framework for best practice for all these placement types. When children (who are not in care under the above legislation) or adults with intellectual disability are placed in Home Sharing arrangements, whether it is for very short and irregular breaks or longer and more frequent breaks, they are not protected by any specific legislation in relation to their care under Home Sharing, or by any consistent standards to be applied. Some Children with intellectual disability are taken into care for welfare and protection reasons under this legal framework; however evidence would suggest that this is not the 38 case for all children with intellectual disability where there are welfare and protection issues. Case examples from service providers working with children with intellectual disability would demonstrate that Services have experienced welfare and protection cases that were not addressed under Children First and service providers providing services to children with intellectual disability have on occasions placed children in disability arrangements without any legal framework. This practice is of great concern to disability service providers as these children are not under the legal protection of a care order. Home Sharing as a model of service provision is becoming increasingly popular with natural families and Home Sharing families both nationally and internationally. Service providers in the disability sector in Ireland have been developing Home Sharing as a much needed model of support for people with intellectual disability since the 1980s. They are however, conscious that they are doing so in a legislative and regulatory vacuum. The lack of regulation and legislation has been demonstrated in recent cases whereby there were no legal safeguards in place to protect vulnerable people with significant intellectual disability from potential abuse. This also highlights the existence of challenges pertaining to people with intellectual disability who are in Foster Care and after reaching eighteen (18) years of age have no legal framework to protect them when they remain with these Foster Care families. The legislation should include the process for the selection of Home Sharing families, training assessment, vetting and matching the person with intellectual disability with the family. The relationship with the person with intellectual disability, their family and the Home Sharing family. The relationship with the Home Sharing family and the natural family of the person. The relationship between the Home Sharing family and any other people providing support services to the individual. The provision of equipment including training and maintenance/servicing of equipment in accordance with manufacturers recommendations. In order for the Home Sharing model of support to continue and develop the National Expert Group have drafted proposed legislation and regulations (see appendix I) for consideration and approval at Government level. At present, people with intellectual disability are experiencing an inequity as these Home Sharing arrangements do not have the same protections as that of those providing Foster Care. The Finance Act (2005) Section 192 (b) acknowledges the role of Foster Carers and provides them with exemptions from income tax from allowances within the Foster Care placements. A further anomaly within this is whereby a Foster Care family in receipt of a foster allowance for a child with intellectual disability upon reaching eighteen (18) years of age is exempt if the now adult remains living with the same family. If the person with intellectual disability upon reaching eighteen (18) years of age moves to live within a Home Sharing shared living arrangement it is not clear that the Home Sharing family is exempt from tax. While many agencies involved in Home Sharing have developed their own guidelines of selection, training, supervision and monitoring there is no consistency nationally and in the absence of legislation and regulation all participants in the process, including the staff who operate Home Sharing are vulnerable in relation to the monitoring and safeguarding of people in these arrangements. Lack of legislation in particular leads to challenges for service providers to ensure governance that is appropriate and nationally consistent. There is an urgent need for legislation that is specific to this model and for the development of national guidelines that will eventually lead to regulation and inspection. While legislation and consistency are required, by its very nature this model also requires flexibility, so any future legislation and regulation will require recognition of this, and not be so rigid as to prohibit the ability to respond to individual need, or to deter future Home Sharing families from participating 41 in such a model.
Teacher awareness is crucial to the success of dyslexic learners since many of them report high levels of stress when teachers lack understanding and compassion (Karande et al birth control pills 3 month pack purchase 3.03mg yasmin mastercard. Last birth control pills planned parenthood generic 3.03 mg yasmin with mastercard, and probably the main reason for lack of teacher awareness birth control for women martial arts yasmin 3.03 mg otc, is the lack of teacher training in the field of dyslexia birth control pills quitting side effects generic yasmin 3.03 mg with amex. It is clear that successful implementation of inclusion policies needs highly trained teachers in regular and special needs education (Hay, Smit & Paulsen, 2001). The same can be said for the field of learning disabilities in general and dyslexia particularly. It is no secret that teachers across the globe are inadequately trained to identify and manage children with learning disabilities, and the need for training programmes is enormous (Lovett et al. South African teachers are even worse off as there is a severe shortage of properly trained regular teachers let alone teachers trained in the field of special education (Nkabinde, 1993). One reason proposed for lack of teacher training is teacher attitudes (Carroll et al. It has been found that teachers generally have negative attitudes towards inclusion (for example, some teachers may not believe that children experience learning disabilities) and therefore might not choose relevant electives during pre-service training or sign up for workshops as part of their in-service training. In fact, research shows that teachers, who had taken courses in special needs education during their pre-service years, had more positive attitudes to learners with disabilities (Chong et al. However, studies also revealed that this optimism and enthusiasm can quickly wane if new recruits find themselves in schools where they are not provided with opportunities for continued professional development in this area (Gwernan-Jones & Burden, 2009). Therefore if the positive attitudes of pre-service teachers can be harnessed and cultivated once they become full-time teachers, learners with special needs would benefit from their knowledge and expertise. It was found that female teachers generally had more sympathy and less fear than male teachers. In addition, they found that teachers who had a family member with a disability were more comfortable managing learners who displayed cognitive and behavioural difficulties (Chong et al. However, Subban (2005) argues that there is no disparity between the attitudes of males and females towards special needs education. She contends that studies revealing positive female attitudes towards special needs education must be seen in the context in which the study was conducted. For example, in some cultures only females are assigned to care for people with disabilities and thus would seemingly exhibit more positive attitudes. It has been found that special needs education training in different countries occurs at many different levels. Some countries have general teacher training and separate training for special education teachers, others offer electives or courses within the regular training programme for those who are interested in this area, and yet others offer no training whatsoever. In South Africa, pre-1994 special needs training as part of, or separate from, regular teacher training was considered a luxury in light of the fact that so many teachers in mainstream education were inadequately trained (Nkabinde, 1993). This may account for the large numbers of black teachers who are inadequately trained in the area of special needs education. Those who have been trained are probably those who attended previously whites only universities or took it upon themselves to be trained since it was an area in which they had a vested interest. Many of our teacher training institutions presently offer electives in special needs education or include a compulsory module in their regular teacher training course. The importance of offering appropriate special needs training to all mainstream teachers cannot be over-emphasised. This training could be provided by universities, other teacher training institutions or non-governmental organisations. Teacher Awareness of Dyslexia in South Africa A fair amount of research has been conducted in other countries with regard to assessing teacher levels of awareness of dyslexia (Hayes, 2000; Wadlington et al. However, the researcher found no similar literature in pertaining to the South African context. Since teacher awareness of dyslexia internationally is still low, it is believed that this study will corroborate such findings in a South African context. Governments worldwide have introduced policies that grant and protect the rights of all its citizens to basic education. However, the practicalities of implementing these policies have still to be realised in many developing nations, as finances often act as a barrier to such achievement. Creation of new policies often means a change in attitude and training for those assigned the task of such implementation. Teachers have been thrust into a world of new terminology with the onset of inclusive education. Since inclusive education requires all children to be taught in mainstream schools, such teachers find themselves in the position where they need to be equipped with the skills to effectively teach children with special educational needs. Research studies indicate that while teachers are becoming more aware of learning disabilities, they are not necessarily adequately trained to teach children who experience such barriers. This is also likely to be true in mainstream high schools in a South African context. This chapter includes, among others, specifics regarding the ethical considerations, the nature of the questionnaire and the pilot study. Based on the research objectives and the background literature, this study achieved this framework by electing to use a quantitative research design. Quantitative research is, in its simplest form, concerned with numbers and anything measurable. In this study nominal and ordinal data were obtained from the responses to items in the questionnaire (see Appendix C). Quantitative research is also concerned with establishing a relationship between two or more variables (correlational) (Hopkins, 2000). Correlational research aims to establish the relationships or associations between variables, unlike experimental research that seeks causality. Correlational research also aims to determine the strength and direction of the relationship between variables. For example, a relationship was sought between the training institutions at which teachers received their qualifications and their ability to identify dyslexic characteristics. In quantitative research, the survey (non-experimental design) is an appropriate measuring instrument used to elicit this kind of information. According to Mulumba (2008), it can be used to collect data from large numbers of participants over a relatively short period of time. According to De Vos, Strydom, Fouche & Delport (2005) the purpose of the questionnaire is to obtain facts and opinions from people who are generally informed about a particular phenomenon (in this case, awareness of dyslexia). A questionnaire is deemed as the most appropriate measuring instrument since it assures anonymity and asks the same questions of all participants. When completing the questionnaire, participants are free of pressure that might arise when completing the questionnaire in the presence of a researcher. A criticism by many researchers is that a questionnaire with mostly closed questions limits the depth of responses provided by participants and the level of honesty of responses (De Vos et al. The strengths of quantitative research include: Precise, numerical data is provided; data analysis (using statistical software) is generally less time consuming compared to qualitative data analysis and results of quantitative research are generally independent of the researcher. For example, results produced in this study may not be applicable to educational districts or particular schools in other provinces in South Africa. These scales are commonly used to measure attitudes, where respondents specify their degree of agreement with each item (De Vos et al. It is an ordered scale that usually contains five response options: Strongly Agree, Agree, Unsure, Disagree and Strongly Disagree. The Likert scale is also referred to as summative scale, as the result of a questionnaire is usually achieved by summing numerical responses (De Vos et al. The key advantage of the Likert scale is that the odd number of options allows people to take a neutral stance if they genuinely do not have an opinion on the topic. Cheap yasmin amex. Birth Control Pills Day in Iniyavai Indru - 18/08/2015 I Puthuyugam TV. |
