Indian & European Relations in the 1600s Essay Example for Free

Indian European Relations in the 1600s EssaySpain in conjugation America1560s Spanish give up search for Indian gold. Focus on defending their empire from English (who were plundering treasure ships and Caribbean ports) and cut Protestants (who began to decide in Florida though the Spanish had already claimed the land). Spanish establish fort at St. Augustine, Florida (1565) to protect route of the treasure fleet. They also massacre French Protestants. Raids by congenital Americans wipe out military outposts and religious missions. 1573 The Comprehensive Order for innovative Discoveries says that missionaries, not conquistadors, have to pacify the land. Franciscan friars set up missions in Nuevo Mxico (New Mexico) and attack Native Americans. Native Americans do forced labor. 1680 Pop leads revolt, kills 400 Spaniards and forces pillowing 1500 to flee to El Paso, and destroys Spanish missions (Pueblo Revolt of 1680). Spaniards return, Native Americans thread a deal that lets them practice their own religion and end forced labor, but they have to help the Spaniards. payoff Spanish fail to convert Native Americans, Santa Fe left vulnerable. In Florida, raids by English leave St. Augustine vulnerable.French in North America1608 First permanent settlement, Quebec, is founded1662 King Louis XIV turns New France into a royal colony, tries to get people to move there. Cannot get enough people. New France becomes an area for trading furs. Rise of the Iroquois French introduce diseases that kill legion(predicate) Indians. Indians get guns from fur trade, which leads to war. The Five Iroquois Nations come out on top, have control of the fur trade in Quebec (with the French) and New Amsterdam (with the Dutch). French Jesuits puree to win Indian converts. They do not exploit the Indians, and they come to understand their culture. They eventually win converts by adapting Christianity to the needs of the Indians. Outcome Despite efforts of the Jesuits, French fur trade causes devastation through disease and loss of Indian culture. Iroquois warriors kill many, though they too are harmed French burned their villages and killed many warriors in 1666 and over again in 1690.Dutch in North AmericaDutch set up a fur-trading post (Fort Orange) along the Hudson River. West India Company has monopoly on the fur. Later, Dutch founded New Amsterdam and made it the capital of New Netherland. Colony didnt thrive small population made it vulnerable. Fort Orange succeeds as a peaceful and successful fur-trading post. Dutch near New Amsterdam are more aggressive towards Indians. 1640 war. After the war, West India Company ignores New Netherland, focuses on knuckle down trade. 1664 Dutch fall under control of the English under the Duke of York 1673 Dutch assault momentarily recaptures the colonyEdmund Andros takes control, in retaliation imposes English law and demands allegiance. Outcome Dutch, who had once been dominant, are now a subject people.Chap ter 6 Making War and Republican Governments (1776-1789)Patriots demand that colonists join Loyalist or Patriot stead cannot stay neutral. Patriots have advantage to get supporters b/c they control local governments. Patriots make army, and Patriots encouraged people to support the army by taking a more active reference in govt. Character of politics changes when common people exert influence democratic army launches age of republican revolution.Americans forced to retreat, Britain pushed back Americans into PA. When winter comes, Britain halts their crusade and Patriots catch them off guard, winning small victories.Armies and StrategiesHowe doesnt want to destroy Americans, just wants them to surrender and compromise. Howe cannot win decisive victory, Washington avoids defeat. Washingtons handicaps Fights only defensively, has unfit recruits, Radical Whig Patriots believe army is threat to liberty.American Victory at SaratogaBritains mark isolate New EnglandNorths colonial se cretary Germains externalise attack Albany from 3 sides. Burgoyne, St. Leger, and Howe will attack. Howes different plan attack Philadelphia (home of Continental Congress), end rebellion w/ single victory. Howe uses his plan slowly. Continental Congress flees to PAs interior. Howes slow attack immediately leads to defeat of Burgoynes army. Burgoynes actions fights, then stalls. Americans led by General Gates slows Burgoynes progress. Burgoynes army stuck in Saratoga, NY. Beaten back maculation trying to raid VT. Has troops w/drawn to help Howe. Meanwhile, Gates forces grow. October 1777 Burgoyne forced to surrender. Turning point of the war.Social and Financial PerilsBritish naval shut off causes disruption in New England fishing industry, and British occupation causes decrease in domestic trade and manufacturing. People move out, decrease in population. Chesapeake colonies break off cuts tobacco exports. Short supply of goods = army starts getting supplies from the people. Wom en and Household ProductionWomen1 Increase output of homespuns2 Participate in farmworkDespite this, goods remain scarce and prices rise. War also created deprivation, displacement, and death. War divides communities b/c of Patriots violence.Financial CrisisState govts are weak, dont create new taxes. Creation of rescript money, Continental Congress and colonies economies crumble.Valley ForgeStarvation and sickness for Americans during the winter in Valley Forge, but Baron von Steuben raises morale. Continental army becomes tougher and better disciplined.The passage to Victory, 1778-17831778 Continental Congress allies w/ France. alignment gives Continental Congress money, supplies, and later troops. Also confronts Britain w/ inter subject field war that challenges domination of Atlantic.The French AllianceAlliance starts w/ secret loan to colonies to avenge Frances loss of Canada to Britain. Later turns into a formal adhesiveness.Negotiating the TreatyAmerican diplomats ensure treaty specifies that French support cannot end until the United States is independent. Alliance revives colonies and Continental Congress.The British ResponseWar is becoming unpopular in Britain. Some British support Americans and campaign for domestic reforms. George III initially committed to crushing rebellion, but after British defeat at Saratoga changes his mind. Tries to prevent American and French alliance (Parliament repeals Tea Act, Prohibitory acts, and renounces right to tax colonies).War in the SouthFrench and Spanish (who joined the war against Britain in 1779) agendas cause British to change over focus of the war to the South.Britains Southern StrategyBritish plan1 Focus on winning tobacco and rice colonies (VA, Carolinas, GA) then affirm on local Loyalists to hold them 2 Exploit racial divisions between slaves and Patriot owners get slaves to flee At first, British are winning. But tide turns. Dutch join fight against British. France dispatches troops to AmericaP artisan Warfare in the CarolinasGeneral Green fights in Carolinas. Fighting goes back and forth. Britain is weakened by this war of attrition, and British decide to give up Carolinas to Greene and focus on VA instead.Benedict Arnold and Conflicting LoyaltiesBenedict Arnold switched from American side to British side. Fights for George III in VA.Britain DefeatedWashington and the French fleet surround Cornwallis and his troops on land. Cornwallis is outnumbered, cannot escape by sea. October 1781 Cornwallis surrenders in YorktownThe Patriot AdvantageWhy the Americans win the war1 Some British mistakes2 Widespread Patriots in America3 Many Americans support war through taxes and joining the militia4 Patriots led by experienced politicians5 George WashingtonAmericans refuse to support British army, refuse to accept occupation by Loyalist forces, and subscribe the inflation caused by the war.Diplomatic TriumphPeace talks begin in 1782, but French and Spanish stall b/c they chill out hope for major naval victory or territorial conquest. Ignoring Treaty of Alliance, Americans sign a separate peace w/ the British. September 1783 Treaty of Paris. bang-up Britain recognizes independence of the colonies.Britain gets1 Canada 2 Rights for merchants to pursue legal claims for prewar debts 3 Americans will encourage state legislatures to return confiscated lieu to Loyalists and grant them citizenship America gets1 Great Lakes and land east of the Mississippi River2 Fishing rights3 Freedom of navigation on the Mississippi4 British cannot seize property like slaves1783 Treaty of Versailles Britain makes peace w/ France and SpainChapter 10 Creating Republican Institutions, 1776 1787The State Constitutions How Much Democracy?Many states had written state constitutions when the Continental Congress urged them to in 1776.The Rise of Popular Politics, 1820-1829Expansion of the franchise = most democratic symbol of the Democratic Revolution. Gives ordinary men more power th an anywhere else in the world.The declivity of the Notables and the Rise of PartiesAmerican Revolution weakened the deferential society, but didnt overthrow it. Wealthy notables still dominated the political system at first. 1810 fence to expand suffrage began. State legislatures grant broader voting rights to diffuse criticism and deter migration to the west. The new voters refused to support politicians that flaunted their high social status. Democratic politics is corrupt.Martin avant-garde Buren1 Created political machine, the Albany Regency. 2 Patronage gives government jobs to ships company members in return for their loyalty. (Spoils system) 3 Insists on party discipline, requires elected officials to follow dictates of the party caucus.The Election of 1824Five candidates, all Republicans, campaigned for presidency. Jackson received most popular votes, but Adams won because ashes made a corrupt bargain with Adams, where Clay would vote Adams into presidency if he would b ecome secretary of state.Presidency of John Quincy Adams the last notable presidentSupports American System (protective tariffs, national bank, subsidized ingrained improvements) Resistance to the American System southerners oppose protective tariffs because they raised the price of manufactures, and smallholders feared powerful banks that could force them into bankruptcy. Politicians oppose American System on constitutional understanding (for example, saying that the national governments income couldnt fund state improvement projects because those projects were the responsibility of the states). Southerners were also angry about the Tariff of 1828, which raised duties on raw materials and textiles. Southerners also dislike Adamss pro-Indian policy.Jacksonian Impact1 Expanded potential authority of President by identifying it with the voice of the people. 2 Upheld national authority by threatening use of military force, laying foundation for Lincolns later defense of the Union. 3 Reinvigorated Jeffersonian impost of limited central government by undermining American System of national banking, protective tariffs, and internal improvements. 4 Undermined constitutional jurisprudence of marshal by appointing Taney as Marshalls successor. Taney partially reversed nationalist and property-rights decisions of Marshall. Example In the case Charles River Bridge Co. v. Warren Bridge Co. (1837), Taney says that a charter doesnt needfully bestow a monopoly, and a legislature could charter competition (in this case, a competing bridge co.) to help the public.This decision directly challenges what Marshall said in the Dartmouth College v. Woodward case, where Marshall stresses the binding nature of a contract by saying that a state cannot invalidate a contract. Other cases that place limits on Marshalls nationalistic interpretations by enhancing role of state governments Mayor of New York v. Miln (1837) New York state can use police power to inspect health of immigrants . Briscoe v. patois of Kentucky (1837) When it issues currency, a bank owned by the Kentucky doesnt violate the provision of the Constitution that prohibits states from issuing bills of credit. As a result of the Taney Courts decisions, the role of state governments in commerce was greatly enhanced. 5 States write new constitutions that extend democracy, many of which introduce classical liberalism (laissez-faire). Laissez-faire says the government role in the economy should be limited.

Competency Goal Functional Areas Essay Example for Free

Competency Goal Functional playing areas EssayTo establish and bear on a safe, healthy learning environment. I keep children healthy by monitoring their health daily. I ask if they have any boo boos and if so how they got them and I put them on a daily health list, I as well do this by c befully observing children, watching for signs of illness, making sealed immunizations are up to date. I as well keep children healthy by keeping the room clean. Children are informed and able to make good decisions on how to stay healthy like washing hands later on going to the bathroom, blowing their nose or coughing into their hands, when we come in from outside and before after lunch. I also keep children safe by creating and environment where children gain the knowledge that allows then to make appropriate choices. I make sure activities are safe and developmentally appropriate. The children are encouraging to make good choices by having discussions, giving lessons, and watching books that talk about safety issues I try to draw a fun and safe environment where children can learn and grow. I provide and age appropriate environment for the children.I do this by preparing a weekly lesson plan, providing activities for children of all developmental levels. I have activities that are for inside the classrooms which are for gross motor skills such as bean bags, musical instruments, trip the light fantastic music, and all sizes of blocks. I also have fine motor activities, such as large and small beads to string, Legos, locking flowers, stencils, scissors, crayon and markers. I also allow time for the children to practice writing skills like their names and letters also to draw beautiful pictures.Competency Goal 1 Functional Area 1 Safe In order to function provide an environment which is safe for the children in my care, I do the following to prevent and reduce injuries I keep all cleaning supplies and chemicals locked up and out of the childrens reach, to avoid po isoning or other injuries. I am also certified in First Aid and CPR which give me the knowledge to handle any injuries or accidents. I am familiar with the classroom and center emergency body waste procedures in case of a fire or other emergency.I maintain an easily accessible and current list of emergency numbers and also all the parent numbers. I inspect all toys and equipment, frequently throughout the day to ensure that they are safe for rehearse. I teach safe use of playground equipment. Functional Area 2 Healthy In order to provide and environment that promotes health, and prevents illness and which teaches children about good nutrition and practices that promotes wellness, I do the following I keep the toys and the rooms clean. I wash my hands and wear gloves before and after handling food.I wear gloves if and when children need help when going to the bathroom, cleaning their noses in order not spread germs. I also teach the children how to wash their hands after using the bathroom, wiping their nose, coming in from outside, while letting them know how important, it is to washing their hands. I also follow centers policies for sick children to prevent other illnesses from spreading throughout the center. I also read books about health care and talk about going to the Doctor and Dentist. I also share the importance of healthy foods like fruits and vegetables.

Effects on Vietnams economy: Hospitality and tourism

Effects on Vietnams economy Hospitality and touristry touristry which plays an fundamental part in the economy of Vietnam creates considers of jobs and export value. Nevertheless, in that respect ar still more a(prenominal) another(prenominal) difficulties that Vietnam has to overcome in order to make our dream becoming one of countries which is famous for touristry come true.Vietnam is one of members of southeast Asia, which has a lot of exciting economic activities in general and tourism in particular. Vietnam has a lot of advantages to develop tourism. Therefore, to make Vietnam an ideal tourism destination, our rude should agree specific strategies for this goal.First, one strategy for Vietnam tourism development is internationalist cooperation. In order to stimulate sustain fitted tourism growth, the Vietnam government should increase the cooperation with many countries around the world, especially Asian ones. For example, many events were held for the friendship an d solidarity of Vietnam and Laos in 2012. To mark the 50-year anniversary of 2 countries diplomatic relations and the 35-year signing of friendship and cooperation treaty, Vietnam organized the triad Vietnam-Laos friendship festival. In addition, Vietnam has cooperated with Japan tourism authority and willing receive 1 million Japanese arrivals to Vietnam in 2015. The 40th day of remembrance of reversible relationship between Viet Nam and Japan in 2013 in culture, sports and tourism activities is an important landmark for the bilateral tourism cooperation. From these examples, we can see that to improve tourist industry, Vietnam should have international tourism cooperation with other countries and international organizations, and links our tourism market with regional and world tourism ones. Moreover, Vietnam should expand bilateral and multilateral cooperation relationship to gain the support of other countries and international organizations, accelerate Vietnams tourism deve lopment and integration, and increase the image and status of Vietnams tourism in the international arena.The secant strategy to improve tourism industry is infrastructure development in line with environmental protection. For a sustainable tourism development, it is extremely necessary that the tourism infrastructure system should be invested appropriately. Vietnam opened its door to the world in 1994. Vietnam has a lot of tourism potentials. Vietnam is changing to make tourism better. Vietnam should pay help to the number of air transport of passengers when the country becomes the favorite destination for international visitors. We should upgrade and expand the system of international airports, increase the well-equipped planes, open new routes to many cities in the world, and increase the quality of the flights to meet the postulate of tourists. For example, Vietnam is planning to build Long Thanh international airport with a large amount of capital investment funds funds to s erve more foreign tourists. In recent years, Vung Tau has been a specific example of developing infrastructure in line with environmental protection. Vung Tau city has measures to prolong the environment. Many hotels in Vung Tau have met criteria on the environmental protection and contributed to saving energy. Furthermore, many tourism areas and hotels in Vietnam should focus attention on investing in standard systems of treating sewage and garbage, clearing beaches, cultivating trees, looking after gardens, and creatingclean environment and beautiful scenery to serve tourists.The next is human resource development for tourism. Vietnam needs to have some plans to develop human resources for tourism industry both in terms of quality and quantity. The tourism human resources in Vietnam should learn occupational skills and knowledge. They are directly influencing services quality, tourists satisfaction and the professionalism of the tourism sector. Schools and universities specializi ng in tourism should develop a network of strong tourism instruct establishments with modern technical and teaching equipment. The purpose of this training is to build the professional tourism labor force having practical skills and experience to please the tourists coming to Vietnam. Vietnam should metamorphose tourism professions that will help to increase the tourism workforce and competition with other countries. Reinforcing foreign language for people who work in tourism is a necessary factor to help Vietnam integrate with the worlds tourism industry. In the past, many tour guides couldnt speak English and other languages, or they only used body language with simple words to express what they wanted to talk about. In a competing environment with other countries, Vietnam should invest in training labor force with ability of communicating with foreigners fluently. Our countries should have many programs about sponsoring the excellent or well-qualified students to study overseas to widen their headspring about tourism, which is very helpful for Vietnam. After they have experience of tourism business from many countries, they will contribute what they learn to the construction of nation.According to the go away recommendation, Vietnam is facing many challenges, fierce competition with countries in the region such as Malaysia, Thailand, Cambodia. On the other hand, the neighbors have very huge trade investment campaigns in order to increase the attractiveness of tourism market, so the ability to attract tourists in Vietnam becomes more difficult. On July 11th 2012, group of international experts came to Vietnam to abet our country make a tourism marketing scheme and a plan for tourism growth in the future. The experts aided the Vietnam National Administration of Tourism (VNAT) to develop advertising schemes in 3 terms short, medium, and long. In addition, they helped VNAT analyze information from 7 important markets. From experts report on trademark conc epts, communication channels, marketing instruments and action strategies. Vietnam acknowledged that advertisement was a key point in developing tourism and increasing the competition in international arena. Vietnams tourism industry should have a strategy and clear developing target for marketing activities, and effectively advertise about the diversity of tourism products offered and main tourism areas, prolong the time of visitors temporary residence to attract tourists back. Moreover, we should have tourism websites introducing destinations, and expand the system of foreign travel offices to make the marketing better. Vietnam pressingly needs to use many new trademarks and contemporary advertising tools to highlight its tourism image.With the coastline of over 3000 km, 2700 small and large islands, many beautiful beaches and famous bays, Vietnam has a lot of opportunities for sea tourism development such as Vung Tau, Da Nang, Nha Trang, Ha Long, Phu Quoc, Phan Thiet From now the n on, Vietnam should push beach-island tourism effectively. Sea tourism is considered as a scheme and a strong point in Vietnam tourism. One of well-known destinations that attracts a large number of international tourists is Ha Long bay be to Quang Ninh province, and widely known by the beautiful landscape of limestone. Besides, Nha Trang and Da Nang are places having charming beaches on the world. The sea tourism industry attracts approximately 70% of international visitors, 50% of domestic tourists annually, and accounts for 70% of turnovers for the whole tourism. Moreover, Vietnam should focus on building many standardized hotels in coastal regions. It is necessary to organize the sea tourism fair at national and international levels to develop brand and affirm position of Viet Nam sea tourism. Organization of the Viet Nam international sea tourism fair will contribute to promotion of sea tourism in Nha Trang Khanh Hoa in particular and Viet Nam in general. The growth of sea t ourism not only helps people dungeon near the beaches have jobs but also stimulates economic development. In addition, sea tourism of Vietnam should connect with national protection, security, and establish marine tourism areas to be able to compete with other countries.In the past, Vietnam was a nation having a long period of time in preventing invasion from strong enemy such as China, French, USA therefore, nowadays, it becomes an interesting places which foreign visitors are curious to discover about its people, custom and culture. This is a good opportunity for Vietnam to develop cultural tourism. We should open many tours to famous destinations that still keep historic landmarks (Cu Chi tunnel, palace of independence) or cities having ancient features ( Hanoi capital, Thang Long citadel, Hue old capital). In addition, many traditional festivals should be encouraged to contribute to introducing the beauty of friendly culture to international friends.In conclusion, it is forecas ted that in the next 10 years, Vietnam tourism industry will stick around to grow rapidly. Nevertheless, to encourage the tourism potential of the country, we should know to take advantage of development chances and make good our shortcomings in coming years, which makes tourism play an important part in the national economy..

Profiling Genome of Tibetan Chicken

Profiling Genome of Tibetan yellow(a)Profiling the genome-wide DNAmethylation pattern of Tibetan whinervictimization w lot genome bisulfite sequencingAbstractBackground Tibetan yelloweds existing at high altitudes show specific adaptations to high-altitude conditions, only when the epibrokertic modification bases of these adaptations havent been characterized.Results We investigated the genome-wide DNA methylation patterns in Tibetan volaille affinity using whole genome bisulfite sequencing (WGBS). Generally, Tibetan chicken exhibited analogous methylation pattern with that of lowland chiken. A total of 3.92% of genomic cytosines were methylcytosines, and 51.22% of cytosines in CG contexts were methylated which was less than those in lowland chicken (55.69%). Moreover, the base next to methylcytosine of mCHG in Tibetan chicken had a preference for T, which was several(predicate) from that in lowland chicken. In Tibetan chicken, the methylation takes in the conjurer were rela tively low, firearm the element body retained hypomethylated. DNA methylation trains in upstream characters of the transcription start site ( toxic shock syndrome) of ingredientshad a negative relationship with the gene manifestation level, and the DNA methylation of gene-body were also negatively think to gene expression.Conclusions We firstly generated the genome-wide DNA methylation patterns in Tibetan chicken, and our results will be helpful for future epigenetic studies in adaptations to high-altitude conditions and provide a new idea for the stripe and treatment of mountain sickness and otherwise hypoxia-related diseases to human.Keywords Epigenetics, DNA methylation, MethylC-Seq, highland chicken, adaptation, extreme environment. BackgroundDNA methylation is a crucial epigenetic modification that plays a vital berth in genomic imprinting 1, transcriptional repression 2, and chromatin activation 3. In recent years, we have gained knowledge on the association of DNA methylation with cellular differentiation, development, and disease, however, little information is on hand(predicate) concerning the DNA methylation modifications under long-term extreme environment.Environmental aspects influence through both genetic and epigenetic tools 4, 5. Several studies have tried to establish the relationship between environmental factors and DNA methylation in humans. It was reported that reduced global DNA methylation in whole communication channel was related to exposure to ambient air contamination at the home addresses of non adults 6. In malignant cells, airborne benzene induce a signifi cannistert decrease in the methylation of LINE-1 and AluI, and increasing airborne benzene levels can cause hypermethylation in p15 and hypomethylation in MAGE-1 7. The ordinary level of methylation in p16 was increased in patients with benzene poisoning compared with control group, while no alternation was observed in the p15 methylation 8. Korea et al. reveale d that most organochlorine (OC) pesticides were inversely and significantly related to the methylation of Alu 9. In the prenatal pregnant women, lead exposure was inversely related to genomic DNA methylation in white blood cells 10. Moreover, base on the epigenetic inheritance mechanisms, adaptive traits that result from the environment can be transferred to the next generation. For instance, environment containing endocrine-disrupting chemicals can affect the germ line and promote disease across offspring via DNA methylation 11.Above researchs shows that environmental conditions could induce DNA methylation alternation to to influence disease, prompting us to explore whether DNA methylation is associated with the unique adaptations of get animals to hypoxia and high-dose ultraviolet radiation in high-altitude environments. The Tibetan chicken which lives in high-altitude environment has smaller body, lour heart rate, higher spleen rate and erythrocyte volum than low-altitude chic ken. antecedent research showed that humans relocating to high-altitudes might undergo acute mountain sickness, high-altitude pulmonary edema, and high-altitude cerebral edema 12. Whereas, the Tibetan chicken is greatly adapted to the low-oxygen and high-altitude environment and displays legal performance in terms of survival and has high reproduction 13. Therefore, investigation the genome-wide DNA methylation of Tibetan chicken, brain the effects of DNA methylation on the plateau adaptability, whitethorn provide a new idea for the prevention and treatment of mountain sickness and other hypoxia-related diseases to human.In this study, we perform whole genome bisulfite sequencing (WGBS) on Tibetan chicken blood to analyze their global DNA methylation patterns. The DNA methylome distribution in the Tibetan chicken genome was shown for the first time. Our results will provided an important resource for exploring low-oxygen adaptation mechanism in high-altitude district.MethodsAnima lsIn this study, ace Tibetan chicken was obtained from Xiangcheng County in the Ganzi Tibetan Autonomous Prefecture with the living place ab show up 3500 meters above sea level. Blood samples were smooth and stored at -20 C for bisulfite sequencing. Total genomic DNA was collected from the blood with the use of a TIANamp Genomic DNA Kit (Tiangen, Beijing, China). All experiments in this study were performed in consonance with relevant guidelines and regulations, and were approved by the Science and Technology Department of Sichuan Province.MethylC-Seq library construction and sequencingDNA was fragmented by sonication with a Sonicator (Sonics Materials) to a mean sizing of approximately 250 bp, followed by blunt ending, 3-end addition of dA, and adapter ligation, in which Illumina methylated adapters were use harmonise to the manufacturers instructions (Illumina). The bisulfite novelty of Tibetan chicken DNA was carried out using ZYMO EZ DNA Methylation-Gold kit (Zymo Research , Irvine, CA, USA) and amplified via PCR with 12 cycles. Ultra-high-throughput pair-end sequencing was performed by the Illumina Genetic Analyzer (GA2) on the basis of manufacturer instructions. Raw GA sequencing data were subroutineed using Illumina base-calling pipeline (SolexaPipeline-1.0).Data FilteringData filtering was performed via the elimination of the adaptor sequences, contamination and low-quality reads from raw reads. Low-quality reads consist of three types including 1) Contain adaptor sequence 2) N base return over 10% 3) The human body of base whose quality less than 20 over 10% was trimmed, and the read which accord with one of them will be removed. barely cleaned data were apply for the downstream analyses.Reads AlignmentOn the forward read of for each one read pair, observed cytosines were replaced with replaced with adenines, and the observed guanines were replaced with adenines on the reverse read of each read pair. The alignment form reads were then mappe d to the alignment form gallus_gallus reference genome by SOAP aligner14. Each hit with a single placement with a minimum number of mismatches and and a clear operation chain was defined as unambiguous alignment (uniquely mapped reads) and was used for ascertainment of methyl-cytosine. The copy numbers of the local region was estimateed by calculating the the uniquely mapped reads.Estimating methylation levelsMethylation level was determined by dividing the number of reads covering each mC by the total reads covering that cytosine, which was also capable the mC/C ratio at each reference cytosine. The function is showed as followingMethylation level = 100 *GO enrichment AnalysisGO annotations of Tibetan chicken genes were downloaded from the Ensembl (ftp//ensembl.org/pub/current/otherdata/Gene_ontology/gallus_gallus_glean_gene.go). GO comparative analyses between interested genes groups were performed using BGI WEGO (http//wego.genomics.org.cn/cgi-bin/wego/index.pl).KEGG road Analy sisDifferent genes usually interact with each other to exercise their biological functions. Kyoto Encyclopedia of Genes and GenomesKEGGis the main public pathway database. Super geometry analyses were conducted to find the KEGG pathways enriched in genes differentially methylated compared to the whole genome. The calculation formula is the comparable as that in GO function analyses, N represents number of genes with pathway annotation For the number, n is the number of differentially expressed genes corresponding N, M represents number of all genes which have a particular pathway annotation m represents numbers of differentially expressed genes which have a particular pathway annotation. Pathway mapped Q value 0.05 defined as the pathway of significant enrichment. Through significant enrichment of the pathway, we can determine the most main in biochemical pathways and signal transduction pathways.Results ball-shaped mathematical function of DNA methylationIn the present study, blood samples from a Tibetan chicken were used to generate three libraries for genome-wide methylation sequencing. All libraries showed nearly complete bisulfite conversion (99.7%). A total of 41.3 Gb raw data were obtained from three blood samples. After data filtering, 151,345,614, 165,745,108 and 141,554,972 clean reads were generated for the three libraries, respectively. Of the total reads, 75.6% were mapped to the reference genome, with 28 X Whole-genome average coverage depth, which could reveal the data quantity of clean data because of the characteristics of bisulfite sequencing (Table 1 and 2).Cytosine patterns have 3 major types (CG, CHG and CHH, H represents non-G base, hereinafter inclusive) according to the sequence context. Therefore, we analyzed the relationships between powerful sequencing depth and genome coverage for different cytosine patterns (Figure S1, S2). Figure S1 reveals that there is a negative correlation between the effective sequencing depth and the percentage of cytosine in genome. The Figure S2 shows that the distribution of genome coverage varies with sequencing depth accord with the Poisson distribution, and the depth of the distributions apex is near to the genome average sequencing depth.In additon, we performed effective coverage analysis base on three different levels chromosome, gene region and genomic feature. The effective coverage of all cytosine in each chromosome ranges from 82.77% to 97.86%, except for 24.96% in chr17 , while the CpG effective coverage of each chromosome ranges from 86.74% to 97.5%, except for 23.58% in chr17 (Table S1). Moreover,coverage of all cytosine in CDS and intron region was 95.94% and 93.66%, respectively and CG coverage in CDS and intron region was 96.04% and 93.45%, respectively (Table S2).DNA methylation patternsIn Tibetan chicken, the methylation level of all genomic C sites was more than 3.9%. Patterns of Cytosine methylation in Tibetan chicken were found to have three major types ( mCG, mCHG and mCHH) according to the sequence context. We discovered overall genome-wide levels of 51.22% CG, 0.4% CHG, and 0.45% CHH methylation in the Tibetan chicken (Table 3). In whole genome, the CG methylation active over 96% of cytosine methylation, which is the primary cytosine methylation pattern. However, the rate of mCHH was only 3% and the rate of mCHG was 1%(Fig. 1A).Methylation status of CG, CHG and CHH differ between species, even varies with different conditions concerning time, space and physiology within a single organism. Figure 1b showed that percentage of the methylation level of methyl-cytosine varies with methylation level. In the tibet chicken blood, more than 75 % of mCG sites were 60-100 % methylated (Fig. 1b). In addition, chromosome1 was used as an instance to illuminate the methyl-cytosine density distribution in chromosome, and the methyl-cytosine density showed large variations throughout the chromosome 1, which was similar to other chromosomes (Fig. 1c)Proximal Sequence Features AnalysisTo discover whether the particular local sequences were markedly enriched as the DNA methylome of Arabidopsis, we analyzed the sequence adjacent to sites of CG and non-CG methylation. The methylation ratios of all potential 9-mer sequences were calculated, and the methylated cytosine was located at the one-fourth position in these sequences (permitting an analysis of three bases upstream of CHG, and CHH methylation). As shown in figure 2, hardly a sequence preference was found in the CG-flanking regions of the hole genome or in the mCG-flanking regions. Moreover, the highest frequency base that next to the CHG cytosine in genome was A, followed by T and C, while the base following the mCHG methylcytosine has a preference for T, followed by A and C. In CHH context, the fifth position that proximal to the sites of cytosine has a preference for C, and the sixth position prefer to T, which is similar to the mCHH(Fig. 2).DNA methylation levels of d ifferent utilitarian regionsDifferent genomic features are associated with distinct regulation functions. To study the DNA methylation profile in different genomic features, the heat map was used to present the distribution of methylation level in the CDS, downstream, Genome, intron and upstream (fig. 3). The comparative analysis of mean DNA methylation levels revealed that different gennome regions showed distinguishing DNA methylation levels. Additionally, we analyzed DNA methylation patterns across the transcriptional units at whole genome level. In Tibet chicken, most of the champion regions have an association with CpG islands and are hypomethylated, which showed a lower CG methylation level than the gene-body and the gene downstream. Moreover, methylation of CG declined sharply before the TSS and increased markedly towards the gene body regions and stayed at a plateau until the 3 end of the gene body, and two obvious peaks were present in the regions of the internol exon and the last exon (Fig. 3). The methylation of CHG had the identical varying tendency with the methylation of CG, but was characterised by mitigatory changes compared to the rapid changes of CG methylation. Furthermore, the methylation peaks of both CG and CHG were presented in the internal and last exons in which the methylation lows of CHH appeared.DNA methylation levels of showman and genebodyMethylation of the promoter suppresses gene expression, but the functional role of gene-body DNA methylation in highly expressed genes has yet to be clarified. To better characterise the methylation of promoter and gene-body, a comprehensive analysis of methylated genes and unmethylated genes in gene-body and upstream2k was performed. In total, 14,018 genes were methylated in both promoter and gene-body, while 505 genes were exclusively methylated in promoter and 409 genes were exclusively methylated in gene-body, and 231 genes unmethylated in both promoter and gene-body (fig. 4A). Gene ontolo gy analysis of methylated and unmethylated genes revealed the top-ranked enriched GO terms were related to the cellular process, metabolic process, and response to stimulus in the biological process (BP) category. The cellular component (CC) category mainly comprised genes involved in cell, cell part, and organelle. Within the molecular function (MF) category, binding, catalytic activity, and transporter activity were highly represent (fig. 4B and 3S). In addition, KEGG analysis showed that genebody methylation genes were clustered in the metabolic pathways, protein processing in endoplasmic reticulum, and calcium signaling pathway, while the genebody unmethylation genes were clustered in metabolic pathways, Fc gamma R-mediated phagocytosis, and endocytosis. Moreover, promoter methylation genes were most involved in ubiquitin mediated proteolysis, oocyte meiosis, and melanoma, while , promoter unmethylation genes were most involved in N-Glycan biosynthesis, Glycosylphosphatidylinos itol(GPI)-anchor biosynthesis, and Fat digestion and absorption (fig. 5).DNA methylation and gene expression levelDNA methylation of promoter generally suppress gene transcription via inducing a compact chromatin structure. We obtained the gene expression profiles of Tibetan chicken from the GEO database. found on expression levels, all genes were divided into ten groups, from the lowest 10% and to the highest 10%. Furthermore, the genomic regions that 2 kb upstream of the TSS were defined as the proximal promoter, and used the mean methylation as the methylation level of each group. The correlation analysis showed that gene expression level was negatively related to the mean DNA methylation level of the promoter regions (fig. 6A r=-0.93, pshowed little difference in these ten groups with different expression level (fig. 6B r=-0.83, pDiscussionGenomics technologies have been extensively used to investigate the adaptations of humans, animals and plants to extreme conditions 15, 16. However, the relationships between the adaptions and the epigenetic modifications that result from extreme environmental exposures remains to be further elucidated. To date, the methylation pattern of Tibetan chicken remains unknown. To improve our understanding of the association between epigenetic modifications andadaptations to hypoxia and high-dose ultraviolet radiation in high-altitude environments, we analyzed whole-genome single-base resolution DNA methylomes by WGBS to provide the genomewide DNA methylation patterns in Tibetan chicken blood and interrogate the potential role of DNA methylation in adaptations to high-altitude environments.Genome-wide DNA methylations of lowland chickens have been researched using MeDIP-seq 17, 18, MBD-Seq 19, and Methyl-MAPS 20, which measure methylation base on immunoprecipitation and restriction enzyme digestion. Compared to WGBS, these technologies generate lower resolution and coverage, and fail to obtain methylation level for CHG and CHH . For example, Only 32 % of CpG coverage was obtained from the study of lowland chicken using Methyl-MAPS 20. In the other lowland chicken study, the CpG coverage ranges from 83.72 to 91.57 % using MethylC-seq 21. In the current study, the CpG effective coverage of each chromosome ranges from 86.74% to 97.5%, except for 23.58% CpG coverage of chr17 in Tibet chicken.In lowland chicken, more than 55.69% of cytosines in CG contexts were methylated which is much higher than those in Tibet chicken (51.22%), while the percentage of mCHG and mCHH in Tibet chicken was higher than those in lowland chicken. In addition, 96.24 %, 0.86 % and 2.89 % of all methylcytosines were present in the CG CHG and CHH context, respectively, while the CG methylation in Tibet chicken occupied only 96% of cytosine methylation. Moreover, the base next to methylcytosine of mCHG in lowland chicken had a preference for A, while that in highland chicken prefer to T. All these indicated that the highland environment s decrease the global CG methylation levels of chicken, and change the sequence context preferences for methylation, suggesting that the methylation involve in the adaptations of chicken to high-altitude environments.In Tibetan chicken genome, the DNA methylation level rapidly down before the TSS and markedly increased towards the gene body regions and stayed at a plateau until the 3 end of the gene body. These methylation features discovered in this study consistently match with those previously reported in bovid placentas 22. Similar to the lowland chickengenome, the Tibetan chicken genome has two CG methylation peaks in the internal and last exons, but the difference is that the lowland chicken genome showed a mitigatory methylation level in the genome regions before the TSS 21, suggesting that the long-term hypoxia and UV radiation under high-altitude conditions cause methylation alternation.The promoter plays a crucial role in the regulation of gene transcription and most of th e promoter regions are hypomethylated 23, while the gene-body DNA methylation is associated with chromatin structure and elongation efficiency, and prevents spurious transcription initiation 24, 25. In present study, we found the promoter is hypomethylated, whereas the methylation level in gene-body is relatively high, a finding that is similar to those from previously reported in human 26 and lowland chicken 17. Hypermethylation of the promoters represses gene transcription 27, and the reduction of methylation at the promoters causes gene overexpression 28. In human embryonic stem cells, Laurent et al. reported that 20% of the most highly expressed genes displayed the lowest methylation levels in promoter. We analyse the relationship between the methylation and the expression inTibetan chicken, using the method reported in previous studies 17. Similar to reports in humans 17, 29, 30 and lowland chicken 5, DNA methylation level in 2 kb upstream of genes is negatively related to the gene expression level in Tibetan chicken, this was further evidence that DNA methylation at the promoters is involved in gene silencing.Methylation in gene-body is more prevalent than in promoter, but the role of gene-body methylation in gene regulation remains unclear. Previous researchs showed that gene-body methylation has an intricate correlation with expression level. roughly researchers believed that the methylation of gene-body is positively correlated with gene expression 26, 29, 31, 32, although several researchers have indicated that intragenic methylation might inhibit gene transcription 24. However, the correlation between gene-body methylation and expression levels in bovine placentas is non-monotonic and the moderately expressed genes show the highest methylation in gene-body 22. Our data demonstrated that methylation in the gene-body of Tibetan chicken may decrease gene expression. However, methylation in gene-body is just one of the thousands of factors that affect gene transcription. Therefore, further studies centering on the DNA methylation of certain regions that display distinct effect in gene regulation are compulsory to clarify the complicated epigenetic mechanism underlying high-altitude environments and its relationships with adaptations to hypoxia and high-dose ultraviolet radiation in high-altitude environments.In summary, the present study provides the first comprehensive analysis of genome-wide DNA methylation patterns in the blood of highland chicken, and our results can be used for future studies on epigenetic gene regulation in highland chicken. This study contributes to the knowledge on epigenetics in highland animals.References1. Tirado-Magallanes, R., et al., Whole genome DNA methylation beyond genes silencing. Oncotarget, 2017. 8(3) p. 5629-5637.2. Li, S., et al., Genome-wide analysis reveals that exon methylation facilitates its selective usage in the human transcriptome. Brief Bioinform, 2017.3. Keown, C.L., et al., Alle le-specific non-CG DNA methylation marks domains of active chromatin in female mouse brain. Proc Natl Acad Sci U S A, 2017.4. Daxinger, L. and E. Whitelaw, Transgenerational epigenetic inheritance more questions than answers. Genome Res, 2010. 20(12) p. 1623-8.5. Chen, Z.J., Genetic and epigenetic mechanisms for gene expression and phenotypic variation in plant polyploids. Annu step up Plant Biol, 2007. 58 p. 377-406.6. De Prins, S., et al., Influence of ambient air pollution on global DNA methylation in healthy adults a seasonal follow-up. Environ Int, 2013. 59 p. 418-24.7. Bollati, V., et al., Changes in DNA methylation patterns in subjects exposed to low-dose benzene. Cancer Res, 2007. 67(3) p. 876-80.8. Xing, C., et al., Methylation and expression analysis of tumor suppressor genes p15 and p16 in benzene poisoning. Chem Biol Interact, 2010. 184(1-2) p. 306-9.9. Kim, K.Y., et al., Association of low-dose exposure to persistent innate pollutants with global DNA hypomethylation i n healthy Koreans. Environ health Perspect, 2010. 118(3) p. 370-4.10. Pilsner, J.R., et al., Influence of prenatal lead exposure on genomic methylation of cord blood DNA. Environ Health Perspect, 2009. 117(9) p. 1466-71.11. Crews, D., et al., Transgenerational epigenetic imprints on mate preference. Proc Natl Acad Sci U S A, 2007. 104(14) p. 5942-6.12. Srivastava, S., et al., Association of polymorphisms in angiotensin and aldosterone synthase genes of the renin-angiotensin-aldosterone system with high-altitude pulmonary edema. J Renin Angiotensin Aldosterone Syst, 2012. 13(1) p. 155-60.13. Li, M. and C. Zhao, Study on Tibetan Chicken embryonic adaptability to chronic hypoxia by revealing differential gene expression in heart tissue. Sci China C Life Sci, 2009. 52(3) p. 284-95.14. Li, R., et al., SOAP2 an improved ultrafast tool for short(p) read alignment. Bioinformatics, 2009. 25(15) p. 1966-7.15. Turner, T.L., et al., Population resequencing reveals local adaptation of Arabidop sis lyrata to serpentine soils. Nat Genet, 2010. 42(3) p. 260-3.16. Liu, S., et al., Population genomics reveal recent speciation and rapid evolutionary adaptation in polar bears. Cell, 2014. 157(4) p. 785-94.17. Li, Q., et al., Genome-wide mapping of DNA methylation in chicken. PLoS One, 2011. 6(5) p. e19428.18. Hu, Y., et al., Comparison of the genome-wide DNA methylation profiles between fast-growing and slow-growing broilers. PLoS One, 2013. 8(2) p. e56411.19. Carrillo, J.A., et al., Methylome Analysis in Chickens Immunized with Infectious Laryngotracheitis Vaccine. PLoS One, 2015. 10(6) p. e0100476.20. Tian, F., et al., DNMT gene expression and methylome in Mareks disease immune and susceptible chickens prior to and following infection by MDV. Epigenetics, 2013. 8(4) p. 431-44.

Outpatient Treatment for Mental Health in New York

Out longanimous Treatment for Mental wellness in modernistic YorkMichael WoodworthFor mevery individuals in the United States, noetic and behavioral illness is something they must deal with on a daily priming. For m either of those, the depression, anxiety, and feeling of partlessness has become the norm callable to a lack of interposition options. As the number of affected individuals grows, out tolerant clinics be becoming the preaching of choice for many Ameri bottom of the innings and in newfangled York this trend as well holds true.With the third highest population in the United States, impudently York is home to all over one million individuals suffering from psychic illness. According to the 2015 census, the number of individuals suffering from mental illness had reached an all-time high of 900,000 adults and 528,000 adolescents (Friedman, Woods, LaPorte, 2016, p. 4). Despite the alarming increase in numbers, less than 20% of those affected by mental illness rec eive adequate, if any intervention at all (Friedman, Woods, LaPorte, 2016, p. 4).Although this may be partly due to the individual choosing not to receive perplexity, I believe there is a steer correlation between the policies and procedures smart York has put in place that govern the access, equal, and quality of mental health c are. The New York State Office of Mental Health currently has over 50 categories of policies and procedures that govern treatment options, approved providers, medication, and criteria diligents must pair to be treated, just to name a few (Office of Mental Health, 2017). As a result, many individuals choose to self-medicate or exactly ignore their symptom rather than deal with the bureaucracy that surrounds behavioral health as well as the negative stigma associated with anyone receiving the treatment.Of the 20% of individuals receiving mental health serve in New York, nearly 71% are through outpatient treatment advantages. Outpatient treatment pull round as a personal manner of providing access to individuals who are suffering from disorders that may not require intensive inpatient treatment. They are capable of treating disorders such as depression, anxiety, grief, phobias, trauma, and so forth.Overview on Outpatient Care SystemsOutpatient care give the axe provide a wide variety of services to individuals seeking assistance with their mental and behavioral health. These services include, but are not limited to individual counseling, aggroup therapy, acupuncture, massage therapy, DBT, art therapy, interventions, couples and family therapy, and alcohol and drug detox. These services are based on rigorousness and need and are often delivered by peer advocates, licensed counselors, suckle practitioners, case managers, clinical psychologists, psychiatrists, and medical doctors.New York State offers dickens main avenues of treatment to those seeking outpatient care these are the hospital systems and the health comput er programs available within the club. For many people in New York, there are only two ways into these outpatient programs. The first being through a referral from a qualified healthcare professional (QHP). This croupe include a primary care physician, clinician, psychologist, nurse practitioner, among otherwises (Friedman, Woods, LaPorte, 2009). The routine is through court mandated supervision and treatment, and with one in 52 adults in New York on probation or parole, this accounts for many outpatient treatment referrals.The head teacher at present becomes, with such incredible services available why are only 20% able to get them? The answer lies within the policies. Although the policies do provide expectations and restrictions regarding cost and quality, the majority of outpatient policies cogitate on access. These policies not only determine who is eligible to receive services, but besides what services are cover by Medicaid and other redress. So lets take a look at just how these policies hinder so many New Yorkers from receiving adequate services.Hospital SystemsWith the hospital system, as with any business, accessibility comes down to resources and in many hospitals the resources are limited. As a result, outpatient care is taciturn for those that will not only benefit from it the virtually, but in any case those who will bring the hospital the most profit. Most of the individuals in New York who are receiving mental health treatment are covered by Medicaid. Those covered by Medicaid are by definition poor, and despite the need for the treatment are unable to pay the out of pocket expenses associated with it (Garfield, 2016). This fact has had significant run on the insurance makers to establish a magnetic dip of criteria that must be met in order for Medicaid to pay for the total treatment. In addition, they developed a list of reasons that a hospital can forswear mental health services to patients.Unfortunately in New York, many of the hospitals corroborate a board of directors that support little to no medical experience. Instead they are comprised of wealthy and powerful business professionals from within the community. For example, one prominent hospital in Upstate New York has a board of directors that consists of several CEOs and presidents of companies that have direct ties to the local congressmen and assemblymen. One of the members of the board is actually a longtime friend of the current Governor of New York. These ties to politicians along with a lack of medical knowledge often result in policies and decisions being made for the sole purpose of profit rather than care and in turn make access much more difficult.Community Based ServicesThe second healthcare system is that of community based resources. This is where the bulge of outpatient mental health treatment occurs. Many of these resources are non-profit organizations that rely heavily on documentation from the state. Accessibility to these r esources are governed by the overall state calculate and is solely based on where the money needs to be allocated that year. As a result, many community resources are limited in the number of patients they can treat due to the limited annual funds available. Much like the hospitals, this causes the community resources to deny service to many individuals that need treatment.In general, these services are delivered in three ways and are typically based on the severity of the need. Hospitals offer outpatient mental health counseling for individuals who may require a higher(prenominal) level of intensity. Hospitals often utilize psychiatrists who have the ability to recommend and prescribe psychotropic medications for those suffering from severe mental disorders such as schizophrenia.The second option for patients is a privately or publically run outpatient clinic. These facilities ordinarily employ licensed clinicians who are supervised by a clinical psychologist. Although they can o ffer the same level of counseling services as the hospital, they are not equipped to prescribe or monitor medications. These facilities are primarily use to focus on the less intensive mental health disorders such as depression, anxiety, PTSD, and addiction.The third option is counseling and guidance through a spiritual leader. Although this option can provide assistance with minor mental health issues, it is seldom covered under insurance. This is due to the fact that in most cases, the ghostly leader does not possess the required education or credentials to be recognized by the state as a legitimate motley of mental health treatment. However, as a result many religious leaders choose to pursue degrees in mental health so they can better serve their congregation.Barriers to CareNew York has several different levels of care which include intensive outpatient treatment, outpatient treatment, step down treatment, continuing day treatment, and assertive community treatment (Friedman , Woods, LaPorte, 2009, p. 12). Each of which is a step within the continuum of care provided by New York State Office of Mental Health. Generally speaking, these steps are rough-and-ready when utilized appropriately by the patient and followed through with by the provider.Unfortunately the greatest barrier falls in the follow through of both the patient and the provider. With over 380,000 adults and 575,000 adolescents in New York suffering from severe and persistent mental illness (Friedman, Woods, LaPorte, 2009, p. 12), it is easy for a patient to fall through the cracks of the system. Many providers have limited time and resources to track down a patient that missed an appointment, or just check in on a regular basis to see if they are alright. As a result, many patients will feel unsupported and scrown treatment all together.As previously stated, outpatient is usually reserved for those with a professional referral and as such the access can at times seem quite limited. In t he clinics that I have worked in, a patient could arrive only after a referral had been received. After they have arrived, they would undergo several interviews and assessments to determine if they would benefit from the treatments the clinic offered. If they would, then they could begin treatment. If however they were thought to not benefit, they would be referred to another clinic or to the local hospital for further consideration.In New York, the need for mental health services are far greater than the resources available and therefore every clinic and outpatient service does seem to have an extensive waitlist for services. I was a case manager for a supportive living program working with veterans suffering from mental health disorders as well as addiction and chronic homelessness. My program was a 12 month intensive treatment program and had 24 beds/apartments available. At any presumptuousness time, the waitlist for this program had well over 50 individuals listed on it.Outpat ient access is a serious concern in New York and so far has left much to be desired. For many individuals who require outpatient mental health services, access comes with three major barriers Finding a clinic, getting approval from Medicaid and insurance, and physically getting to the clinic. Far too often these barriers hinder individuals from receiving adequate, if any services they so desperately need.With the constant change to Medicaid press release services and insurance, it is difficult for clinics to accept every patient in need. With private insurance, managed care, and straight Medicaid placing strict eligibility and billing restrictions on the clinics, it is amazing that they are able to hold on open at all. These regulations are causing the clinics to become more business focused instead of focusing on the real reason they exist.As a result of the clinics focusing more on the business, they are more inclined to accept patients that they can profit from the most. This u ltimately tends to sway more towards those with private insurance as they are more apparent to get approval for ongoing treatment. This leaves the majority of individuals suffering from mental health disorders to fend for themselves.As with any treatment, a referral is required to receive treatment in an outpatient slewting. Attempting to get this referral poses the second struggle to accessibility. Many of those suffering from these disorders do not have a primary physician and are likely to go to free clinics if they seek assistance at all. As a result, many individuals are simply prescribed medications like sertraline by the attending physician and told that they have a cookie cutter diagnosis of depression or anxiety. On average, it takes nearly six months of trial and wrongful conduct in medication before a referral is given and accepted by insurance or Medicaid. In far too many situations, the individual has given up on treatment before reaching the six months.Getting to a clinic often poses a barrier to those in a low income bracket. These individuals are unable to purchase transportation on their own and rely heavily on others or public transportation to maintain mobility. This requires them to find clinics that are on bus or subway line if they live in the city, or friends and family if they live in a more rural location. This causes un needed instability in treatment due to the patients inability to commit to a treatment schedule.For the more than 30 million adults in the United States that require but do not receive mental health services, 45 percent claim that the cost is the biggest deterrent. The average outpatient service can cost between $100 and $5,000 based on the service and the credentials of the provider (Babakian, 2013). In New York City the average rates for outpatient services are as follows$80 $120 for a 45-55 trice standard counseling session (Babakian, 2013).$200 $300 for a 45 minute session with a psychologist or psychiatrist (Babakian, 2013).$60 $100 for group sessions facilitated by a licensed provider (Babakian, 2013).$300 $ 460 for individual art, music, and/or recreation therapy sessions with a licensed provider (Babakian, 2013).As with any healthcare service these can be paid for using self-pay, private insurance, and government insurance such as Medicaid and Medicare. Unfortunately due to the restrictions imposed by the mental health policies in New York, many individuals are forced to pay a significant amount out of pocket. As a result, many outpatient providers offer patients slip scale charges which can be 30 percent lower than standard fees, payment plans with and without interest, and in some situations income based fees (Babakian, 2013).Although outpatient treatment is covered by most insurance, it is seldom covered in full. This causes many patients to stop treatment as a result of an inability to pay the deductible or co-pay. At this time, New York does not offer any additional assistan ce with co-pays or medical bills for individuals receiving outpatient services. However, if the patient were to be admitted to an inpatient clinic as a result of a mental hygiene arrest or emergency room visit, it would be covered in full by many insurance providers including Medicaid. This creates a situation that is harmful in that we do not offer treatment as an early intervention but rather offer it after the individual has reached a respite point.In order to get an insiders opinion of the current barriers within outpatient care, I was able to interview Megan Cortese, LCAT. Ms. Cortese is a licensed art therapist and senior clinician in a very prominent outpatient clinic in Rochester, NY. During the interview I simply asked her what she sees as a barrier to her current and future clients.When asked what she would want to change about the overall way mental health services are provided, she had the following to say.The current system of mental health services has two major fla ws funding and accountability. Ms. Cortese stated that due to budgetary restrictions, lack of government funding, and overall economy struggles the quality of care is becoming lower. She stated that the clinical staff are underpaid and told to meet with as many clients as possible in a day. She stated that this causes many clinicians to burn out and therefore provide a subpar level of treatment.Ms. Cortese also stated that the lack of accountability from patients on Medicaid is ridiculous. She stated that when a patient on Medicaid does not show to an appointment that there are no penalties to the patient such as the cancelation fee that those of us with private insurance would have. Ms. Cortese stated that this causes patients to continuously miss appointments and therefore miss out on beneficial treatments. look of CareAs for quality of care, New York does seem to excel at regulating the providers and clinics. The New York State Justice Center monitors, regulates, investigates, an d enforces all policies regarding the fair treatment of individuals under care. As a result, every clinic is held to the same standards and accountability in regards to the treatment of patients. Although this is beneficial in providing adequate and proper treatment to all those knotted in outpatient clinics, it is only effective if the patients are able to receive services.Policy and InfluenceSo now that we have reviewed how these polices can hinder treatment, we must adjoining understand not only how the policies come to be, but also who has the power to influence them. Health polity in todays modern world poses several labyrinthine legal, ethical, and social questions and as such require qualified individuals to write, approve, and integrate them into the current healthcare systems. As with the nation as a whole, New York relies heavily on Government officials to accomplish this objective while simultaneously respect and protect the rights of patients. As a result, several hi ghly different and complicated groups are tasked with the prudence of these policies.Healthcare policies in New York are developed through the three branches of government the judiciary, legislature, and executive branches. The judiciary branch is responsible for overseeing new policies to ensure that they do not violate any human rights as well meet all legal and financial guidelines. The legislature reserves the right to conduct hearings in an attempt to gather sufficient data from all parties involved with the policy. This ultimately provides additional checks and balances to ensure the legality and effectiveness of the proposed policy. The executive branch, or Governors office retains the power to sign the new proposed policy into law after it has made it through the checks and balances from the judicial and legislative branch (Gostin, 1995).Now despite a significant set of checks and balances within New York, policies are not always reviewed as they should be. Far too often m embers of the three government branches are influenced by outside factors and groups. As previously mentioned, outpatient treatment in New York has many governing bodies which along with providers, insurance companies, and several special interest groups all have a way of influencing the current policies. Each of these groups have a significant impact on the access, cost, and quality of care that patients receive while participating in outpatient services. The real question is who has the power and are they using it to benefit the patient or are they simply looking out for their bottom line.So lets start from the bottom of the pecking order and work our way up. At the bottom of the outpatient ladder are the small and seldom heard from special interest groups. In New York these are groups such as NAMI (National Alliance on Mental Illness), NMHA (National Mental Health Association), as well as smaller support groups located throughout the state. The main focus of these groups is to e ducate the public, influence change and improvement, and advocate for the patients.Many of these groups rely heavily on petitions and public outcry to influence change and policy at the higher levels of the state government. Even though these groups do not carry the influence of some other groups, with a mass of concerned voters behind them, they are usually quite effective.Sitting on the next rung of the ladder are the providers who influence treatment and policy by acting as a deciding factor as to what if any treatment is recommended. The providers are in essence the frontline of the outpatient world. The providers conduct the assessments that provide the information to choose the most beneficial treatment option. The providers are able to influence policy by simply choosing a course of action. If the majority of providers choose the same treatment for a particular diagnosis, then it is likely that the governing bodies will consider that to be the go-to treatment. Once this is th e case, it is very likely that policies will be rewritten to reflect this treatment as the acceptable one.Sitting on the next rung is the insurance companies. The insurance companies have significant influence over policy simply because they pay for it. Insurance controls who gets treatment, where they get treatment, and what quality of treatment they can receive. This is of course all based on what tier level the patients insurance plan is on. Ultimately, the insurance company has the ability to approve or deny treatments simply based on the overall cost and as a result many patients are unable to access necessary treatments and medications.Now, at the top of the ladder is the state agencies such as Department of Health (DOH), Office of Mental Health (OMH), State Legislature, and the Governor. It is implied that these people have the ultimate influence over access, cost, and quality of outpatient mental health treatment. Policy recommendations are delivered from the DOH and OMH to the legislature who then agrees and passes them along to the Governor, or disagrees and sends them back to the agencies for revision. Once in the hands of the Governor, the policy is either approved or denied.As most healthcare in New York is Medicaid funded, the Governor has significant influence over who gets treatment and what treatments are offered simply by approving the state budget. If the Governor approves a policy that allows more access to treatment, he must also approve an increase in measurees to maintain funding. However, if the Governor does not pass a policy for increased care, they may lose ratings and therefore votes. As a result, it is a very complex equilibrate act when influencing health care policy.Although the aforementioned groups seem to have the most influence over health care in New York, I stumbled crosswise a group of individuals that seem to have influence over the Governor himself. The United Healthcare Workers Union (1199SEIU) is a union of pharmacis ts, nurses, and physicians located throughout the nation. The prestigious power of this group is astounding. In 2009, the full power of this organization was felt by then Governor David Paterson.With a severe surge in Medicaid be in New York, Governor Paterson proposed $3.5 billion in cuts to the Medicaid program. The Governor proposed shifting monies away from inpatient hospitals and into outpatient clinics which were significantly less expensive (Eide DiSalvo, 2015). This would have resulted in a 2% loss in revenue for the inpatient hospitals annually.Medicaid is the primary source of funding for the inpatient hospitals which employ a majority of 1199SEIU members. The union responded to the Governors proposal with a serious ad blitz which cost over $1 million per week. After a month of adds belittling the Governor, Paterson retreated and instead approved tax increases and cuts to other programs (Eide DiSalvo, 2015). As a result of the serious influence by the 1199SEIU, the ove rall quality, access, and cost of care suffered. In an act that simply secured their own interests, the patients suffered.Overall, the diverse and effective variety of outpatient treatments available in New York is quite impressive and could provide much needed assistance to many individuals. However, the lack of accessibility and change magnitude out of pocket costs create significant barriers to those individuals who need the treatment the most. In order for New York to effectively serve those needing mental health treatment, it is necessary for the policymakers to begin thinking in terms of care rather than profit.ReferencesBabakian, G. (2013, December 17). How Much Does Mental Health Care Cost? Retrieved from Clear Health be https//clearhealthcosts.com/blog/2013/12/how-much-does-mental-health-care-cost-part-1-series/Cortese, M. (2017, January 29). Outpatient Barriers. (M. Woodworth, Interviewer)Garfield, R. (2016, October 19). The Coverage Gap Uninsured Poor Adults in States t hat Do Not Expand Medicaid. Retrieved from Kaiser Family Foundation http//kff.org/uninsured/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/Lawrence Gostin, J. L. (1995). The formulation of health policy by the three branches of government. Retrieved from The National Academies of Sciences Engineering Medicine https//www.nap.edu/read/4771/chapter/17Michael B. Friedman, G. W. (2009). New York States Mental Health System. New York Mental Health Association of New York City.Office of Mental Health. (2017, January 1). OMH Official Policy Manual. Retrieved from Office of Mental Health https//www.omh.ny.gov/omhweb/policymanual/contents.htmStephen Eide, D. D. (2015). The Union That Rules New York. The City Journal.

Cleveland Not Cleaveland :: History, City Life

Cleveland, Ohio wasnt always what it appears to be today. Cleveland is a very progressive culturally diverse city. It is steeped in history and culture and its residents have had a considerable impact on American culture and the way we live today. Cleveland is nothing but exciting. Cleveland is filled with great structure, history, and has wonderful attractions.Cleveland is an extraordinary city. Cleveland contains one of the oldest neighborhoods and has some very interesting ones at that. The Tremont neighborhood is one of Clevelands oldest and most historic neighborhoods. Tremont is known for its numerous and varied restaurants (Mitchell, Tremont Neighborhood 1). The St. Augustines Catholic Church is located in the Tremont neighborhood and is of Victorian Architecture. The St. Johns Cantius is favored by the polish community and is excessively located in Tremont neighborhood (Mitchell, Tremont Neighborhood 2). Tremont can be exciting. Throughout the year, a variety of events tak e place in Tremont, such as, monthly art walks, Taste of Tremont Festival, Tremont finesse and Cultural Festival, Church of the Assumptions Greek Festival, and the St. John Polish Festival. Another great neighborhood in Cleveland is North Coast Harbor. Lake Erie is simply beautiful. Lake Erie is used for recreational activities (Mitchell, shell Things About Living In Cleveland 1). There are two trolleys downtown. There are two lines for the trolleys (Mitchell, Get on Board the New RTA Downtown Trolleys 1). Cleveland is an abominable city to live in and is very diverse.Cleveland has a long and rich history. Cleveland was founded in 1796 (Cleveland 161). The first steamboat on Lake Erie was used for trade during the 1820s. John d. Rockefeller started the Standard crude Company during the 1860s (Cleveland, Ohio 1). During the Civil War, Cleveland was part of the underground railroad (Usa Cities Online 3). Cleveland is the worlds first city to be electrically lighted in 1879 (Ohio Facts and technicality 3). Americas first traffic light was in Cleveland on August 5th, 1914 (Ohio Facts and Trivia1). The Cleveland Orchestra was founded in 1918 (Gale 172). The Cleveland clinic is one of the best hospitals in the United States. The Cleveland clinic was established in 1921 by three WWI surgeons George Washington Crile, Frank Bunts, and William Lower (Mitchell, About The Cleveland Clinic 1). In Cleveland Harbor, The U.S.S. Cod is a WWII submarine in which visitors can climb in (Pearson 2). It also contains aspects of what Clevelands society is today.

Cognitive-Behavioral Therapy And Exposure With Response Prevention In T

Cognitive-Behavioral Therapy And Exposure With Response Prevention In The Treatment Of Bulimia Nervosa Bulimia nervosa is an eating disorder with psychological, physiological, developmental, and heathen components. The disorder is commonly characterized by binge eating followed by inappropriate compensatory behaviors, such as self-induced vomiting, excessive exercise, fasting, and the misuse of diuretics, laxatives or enemas. Patients properly diagnosed with bulimia nervosa digest many psychological and physiological problems. In order to alleviate these problems for the patient, usually some type of intervention is required. Considering the financial costs to the patient who seeks treatment, it is important to refer effective and efficient treatment programs. Due to the wide variety of individual patient differences, it would be unwise to proclaim one treatment method as the universal cure for bulimia nervosa. However, identifying what methods work under particu lar conditions may help therapists tailor an individualized treatment program after a thorough assessment of the client. Having this knowledge would potentially save both the client and the therapist a lot of time and frustration not to mention, the patient would be on the path to recovery sooner. Kaye et al (1999) stress the importance of making progress towards the understanding and treatment of anorexia and bulimia nervosa, in order to generate more particular(prenominal) and effective psychotherapies and pharmacologic interventions. In this paper, I will present my analysis of two methods used to treat bulimia nervosa. The first method is cognitive-behavioral therapy for bulimia nervosa this method is quite popular among psychologist... ...ing in bulimia nervosa A crossover study. Journal of Nervous and Mental Disease, 177, 259-266. Sloan, D. M., & Mizes, J. S. (1999). Foundations of behavior therapy in thecontemporary healthcare context. Clinical psychol ogy Review, 19, 255-274. Spangler, D. L. (1999). Cognitive-behavioral therapy for bulimia nervosa An illustration Journal of Clinical Psychology, 55, 699-713. Steel, Z. P., Farag, P. A., & Blaszczynski, A. P. (1995). Interrupting the binge-purge cycle in bulimia The use of planned binges. International Journal of Eating Disorders, 18, 199-208. Vaz, F. J. (1998). Outcome of bulimia nervosa signal indicators. Journal ofPsychosomatic Research, 45, 391-400. Walsh, B. T., & Devlin, M. J. (1998). Eating disorders Progress and problems. Science,280, 1387-1390.