Communication and Information Technology Essay Example for Free

Communication and Information Technology Essay Technological advancement have improved and eased the communication process. With the world revolving around technology, almost all tasks have been simplified consequently reducing the number of hours that one can perform a certain task. It has helped in the organizing information, thus enabling access and retrieval of information easy. The use of technology has helped many organizations cut on costs at the same time increasing efficiency and promptness in service delivery. In the medical arena, most of the up to the standard hospitals or healthcare systems have adopted the use of technology in delivering of their services. This has brought about comfortably and the feeling of appreciation to the patient or the person who is being served as it gives an aura of value for money and the sense of embrace of technology in this technological era. Electronic Medical Records is one of these technologies (Kluge, 2001). With the capacity to hold limitless information and being able to be changed to fit the current need, this technology has helped in the healthcare practitioners to deliver services in a more organized manner and without having delays as compared to if everything was done manually. Consequentially, this reduces costs and improves the picture of the organization at the same time fostering monitoring ability of the organization of the number of clients visiting the healthcare facility. Electronic Medical Record is computerized kind of information keeping in which information is compressed as it is converted in a digital format. This allows for consumption of minimal space while keeping the office of operation clean, tidy and attractive (Fins, 2008). This creation of space enables the expansion of services offered in the healthcare facility as there is more space of operation. Access of information becomes easy and convenient thus increasing the morale of the staff in service delivery. It offsets the possibility of committing unnecessary mistakes while delivering services because of handwritten records which are not legible. This program makes it possible transfer information from one healthcare system to another thus making it possible to treat patients in the shortest time possible as their medical records are delivered in the shortest time possible electronically. By use of this technology, it is possible for parents to monitor their kids’ wellbeing without having extra cost of travelling to where they are to check on their progress. It also makes it possible for patients to assess their medical record and also get their results without much problem of waiting till they are given to them manually. Other electronic communication delivery services like the use of voice over have helped in the reduction of the amount of work that one does in calling patients manually so that they can be attended to. It is just a simple task of just announcing a patients name and they go to the corresponding room in which they will be served. This has increased efficiency and effectiveness in serving clients (Fins, 2008). This sets a kind of an order which they patients follow and allowing for easy dissemination of information, loud enough for everyone to hear, thus, patients do not have to suffer the discomfiture of not having heard their names being mentioned by a caller physically since this system is fitted with speakers loud enough to be heard clearly. Other technologies like the Practice management software ensure the smooth running of the healthcare system giving medical practitioners a humble time in their operations on a daily basis. This wads off possibilities of confusion and lets them (medical practitioners) operate in an orderly manner. The information which this software can handle is all inclusive and does not only include the client’s bio data but also other aspects of the healthcare organization like bills and transactions going on. (Klug, 2001) It works just the same way as the EMR only that it comprises of the management aspect of healthcare system in its daily operations. Apart from keeping a track on patients’ conditions and appointments, the system is used to develop bills and keep a record on the same so that thee reports can be used whenever need arises. It keeps every transaction and activity on record so that it becomes possible for any practitioner to know what was done the previous day and by who, which patient was attended to and by who so that he/she is able to know exactly where to start as concerns a specific task. This just as the EMRs has a way of cutting costs and increasing effectiveness. This is because all information as concerns any patient is stored electronically and retrieved with ease when need arises, thus avoiding the possibility of confusing one’s medical data with another persons (Fins, 2008). This enables a medical practitioner to prescribe the right medicine to the right person while at the same time allowing for generation of information about the right bills for the client in accordance to the medical procedures and medication accorded to him or her. Other systems like the electronic health systems keep a full medical history of a patient. It keeps essential information that can be used by the doctor or any medical practitioner to offer quick and effective diagnosis of a patient. All healthcare reports about a certain patient are stored in this system including drugs prescribed to the patient every time he/she attends that healthcare facility. It is also inclusive of all test results of that particular patient as well as x-rays and the response of the patient towards a certain medication. All this information is essential for up to level health care treatment of any patient. It keeps off the agony of a patient for having to answer tedious questions about their past medical history every time they visit a healthcare facility, as information about them is stored electronically and retrieved on every visit. This medical history is updated time to time on the occasions that a client visits for the purpose of seeking for treatment. The use of electronic technology in healthcare systems has more pros than cons. This is because as enumerated above, it has advantages to both the client and the healthcare facility. The fact that it increases efficiency and effectiveness can not be underscored while at the same time reducing operating costs of the facility. Clients are served to their liking and while their medical record is kept safely and is retrieved during the time of need with a lot of ease (Kluge, 2001). One of the major disadvantages is that information about a patient can be copied maliciously and tampered with. If the entire system should break down, then volumes and volumes of information are lost. It would be a good thing if all the above system could be integrated into one piece. This will ease operation even more as all the operations are under one click of a ‘mouse’. It could also be improved in such a way that clients can access their information wherever and whenever they are. Reference Fins, J. (2008). Web of Care: How Will the Electronic Medical Record Change Medicine? The Hastings Center Report, Vol. 38, pp. 67-88 Kluge, E. (2001). The Ethics of Electronic Patient Record

Social Media for PR: Implications and Opportunities

Social Media for PR: Implications and Opportunities Mandy Soh The Role and Implications of New Media for PR Introduction With the introduction of the internet comes new media, which in recent years have seen PR practitioners having to adapt and change their approach to cater to the online community. According to Dewdney Ride, new media can be described as â€Å"the preferred term for a range of media practices that employ digital technologies and the computer in some way or another (James, n.d.). New media also provides a wider reach than traditional media, being portable and easily accessible. This essay seeks to explore the opportunities and threats presented to PR practitioners with the introduction of new media. Using a local case study, this essay will also discuss how new media has changed the way PR practitioners engage with their organizational stakeholders, as well as how it has impacted public relations practices today. Case Study – SMRT In 2011, SMRT trains experienced periodical breakdowns during the months October through December. The most prominent incidents being the December 15 and 17 breakdowns, believed to have been the worst train breakdowns in 24 years of operations, sparking angry netizens to take to social media platforms such as Twitter to express their outrage over the unreliability of the train service (Low, 2011). These breakdowns affected some 5,000 commuters during the evening peak hour (Sim, 2011). Netizens were further enraged by the surfacing of a photo on Twitter depicting a photo taken on an SMRT taxi which shows the message starting with â€Å"Income opportunity† before explaining the breakdown (Barimen, 2011). Prior to the episodes, an announcement was made by SMRT to increase train fares starting the following year. This fostered a sour attitude towards SMRT among Singaporeans, and negative comments were buzzing around the various social media sites. Impact of New Media on SMRT’s PR Practice Throughout these incidents, SMRT continued to disregard feedback on their official Facebook and Twitter pages, instead going on to offer vouchers to its subscribers and followers. The only â€Å"official† responses to confused commuters among the chaos seem to be coming from only one SMRT Ltd Feedback, a troll account which emerged during the crisis. Without any clear answers on SMRT’s official channels, the comments from the troll account only further added to the public’s confusion and doubt. Only after 15 hours have elapsed has SMRT began providing information and responding to the situation. The organization, in its failure to communicate timely with the public in times of crisis, has lost their trust. This is despite the fact that there have been no major episodes in their history of operation. The incident has shown that organizations should have a tested plan in place to be able to communicate with the stakeholders efficiently in times like this. Because of the fast transfer of information in the age of new media, employees who manage the social media platforms have to exercise discretion on the appropriate times to put up certain content. In the case of SMRT, instead of responding to queries during the crisis, employees instead put up voucher offers, which was of no help clearing the air of doubts. Opportunities for Better Engagement with Stakeholders Despite the negative impact that new media has on public relations practices, it has also presented a series of opportunities for PR practitioners. Because of its wide reach, organizations can now use new media to launch a direct dialog with their stakeholders with ease. Platforms such as forums and blogs allow for PR practitioners to establish a two-way communication, allowing them to better understand the feedback of the public. When the public is engaged in this process, it creates brand awareness and a word-of-mouth effect. It is also easier for the organization to rally support from the public, by empowering them to make certain decisions. This will result in a higher number of people who would champion the organization’s cause. When there is a need for fast transfer of information, like in times of crisis, organizations can harness the use of new media to get their messages out. This allows for control of the situation on the organization’s part. The organization can even garner the public’s comments and come up with better solutions to solve the problem. Social media sites such as YouTube and Facebook can also be used as publicity vehicles. One such example is from Coca-Cola, which in 2012 released a YouTube video titled â€Å"Hug Me by Coca-Cola†. In the video, several Singaporeans can be seen obtaining a bottle of Coca-Cola from a vending machine. Instead of the traditional vending machine which dispenses with the slotting of coins, this particular machine dispenses upon a hug to it. The video generated more than a million views, with many netizens praising the organization’s creativity. Threats to PR Practices In spite of the opportunities for PR practitioners to effectively use new media as a source of communication with the public, certain threats are present as well. Janal (1998) argues that â€Å"too many companies go on the web without a set of goals†, suggesting that there are no incentives to move the public to be committed instead of just curious. In such cases, Theaker (2004, p. 264) suggests that PR practitioners work with the marketing department to ensure that sites are tested before they are fully launched, instead of conducting such testing on the public. PR practitioners also have to work harder to keep up with the trends to be able to fully understand the social media lingo. On top of that, they have to be more responsive because of the fast transfer of information with lesser effort. Organizations also have to work harder to establish credibility with the reduction of face-to-face interaction, which may create misunderstandings easily. Conclusion In the age of new media, there are many considerations and skills PR practitioners have to be sensitive to and develop to better reach out to their intended public. However, with proper research and strategizing, new media can be a very powerful tool for PR practitioners. Apart from this, PR practitioners also have to remember that having a better engagement with the public will lead to better reach for the organization. Instead of using new media to generate a large number of likes, genuine engagement of the public will ultimately lead to brand loyalty. The use of new media can be a double-edged sword in cases like SMRT. If PR practitioners are able to be well attuned to the sensitive nature of it however, new media can be effectively used to reach out to a wide number of stakeholders, thereby establishing their organization’s reputation. References Barimen, A. (2011, December 21). Not So SMRT: A Case Study of Communications Failure. Retrieved April 6, 2015, from http://www.skribeproductions.com/2011/12/21/not-so-smrt-a-case-study-of-communications-failure/ James, M. (n.d.). A review of the impact of new media on public relations: Challenges for terrain, practice and education. Asia Pacific Public Relations Journal, 8. Retrieved April 7, 2015, from http://www.academia.edu/1529188/A_review_of_the_impact_of_new_media_on_public_relations_Challenges_for_terrain_practice_and_education Low, I. (2011, December 16). Singapore’s MRT Breakdown Chaos Leaves Thousands Stranded. Straits Times Indonesia. Retrieved April 6, 2015, from http://thejakartaglobe.beritasatu.com/archive/singapores-mrt-breakdown-chaos-leaves-thousands-stranded/485081/ Sim, R. (2011, October 18). In Singapore, 5,000 Commuters Affected by MRT Disruption. Straits Times Indonesia. Retrieved April 6, 2015, from http://thejakartaglobe.beritasatu.com/archive/in-singapore-5000-commuters-affected-by-mrt-disruption/472390/ Theaker, A. (2004). Using the internet effectively in public relations. InThe Public Relations Handbook(2nd ed., p. 264). England, Abingdon, Oxfordshire: Routledge. Malaria: Causes, Prevention and Treatments Malaria: Causes, Prevention and Treatments Introduction There are over 100 species of malaria parasites the most known to cause death is in Africa called plasmodium falciparum (Malaria No More 2014). Only female anopheles mosquitos can transmit malaria (Malaria No More 2014). The malaria parasite is a member of the apicomplexa they are characterized by a set of organelles (Greenwood et al., 2008). These organelles are known as apical organelles because are located at the end of the parasite (Greenwood et al., 2008). This plasmodium parasite has cycles to develop in the mosquito (Greenwood et al., 2008). When this parasite enters the body through the mosquito it invades the liver there it multiplies 10,000 times two weeks in, the parasite goes into the blood stream where it infects the red blood cells (Malaria No More 2014). Currently 1 million people are dying from malaria and 500 million cases (Greenwood et al., 2008). As of now 2 billion are at risk of malaria mostly affecting poor populations around subtropical and tropical areas because the temperature and rain are better for the development of the malaria causing parasites in mosquitos (Greenwood et al., 2008). Malaria is a mosquito borne disease caused by a parasite (Centers for Disease Control and Prevention, 2014). It usually causes chills, muscle pain, fever, and flu like illness (Malaria.com, 2011). It can also cause severe problems such as damage to the brain, heart, kidneys, and lungs (Malaria.com, 2011). When malaria is untreated it develops severe complications and causes death (Malaria.com, 2011). Malaria is caused when a mosquito infected with parasites bites a person (Malaria.com, 2011). In some rare occasions people can get it when they come in contact with infected blood (Malaria.com, 2011). Review and Results of Case Study In this study a 46 year old male was admitted to a hospital in Saudi Arabia (Hussain et al., 2008). 10 days before he was admitted had many symptoms which included abdominal pain, vomiting, and loose stools. He also got bloody diarrhea a day before his admission (Hussain et al., 2008). He didn’t appear to have a fever or cold and flushing of face and his medical history was great (Hussain et al., 2008). Once he was admitted he had a report of his blood film which was negative for malaria parasites (Hussain et al., 2008). His examination showed that he had diffuse congested mucosa of the stomach (Hussain et al., 2008). His blood, urine, and stool culture reports were all negative (Hussain et al., 2008). They did find hematological findings which were anaemia with hemoglobin because of the destruction of the red blood cells (Hussain et al., 2008). He had a slightly impaired renal function but his liver function tests were normal. 5 days after his admission on a routine peripheral smear they reported a sexual form of plasmodium malariae (Hussain et al., 2008). They didn’t know if he had malaria because he had no signs of organ damage and didn’t fulfill the World Health Organization criteria of sever malaria (Hussain et al., 2008). The patient had recent history of travel to Pakistan without taking chemoprophylaxis for malaria since malaria is widely distributed in Pakistan (Hussain et al., 2008). This patient was given drugs and blood to correct anaemia from malaria and gastrointestinal bleeding (Hussain et al., 2008). He was later released four weeks later (Hussain et al., 2008). Analysis Malaria is a parasite called plasmodium malariae which starts of in the mosquito (Collins Jeffery, 2007). The mosquito has a small number of sporozoites that go to the salivary duct it is then injected to the venules of the bitten human (Collins Jeffery, 2007). When the parasite enters the blood stream, within an hour the sporozoites attack’s the liver (Collins Jeffery, 2007). Once inside a parenchymal cell the parasite matures in 15 days (Collins Jeffery, 2007). Within this time period thousands of merozoites are produced. These merozoites invade the red blood cells and start the erythrocytic cycle (Collins Jeffery, 2007). After a developmental cycle happens in the red blood cells, for a couple of days some merozoites are released and reinvade more red blood cells (Collins Jeffery, 2007). While the malaria parasite is multiplying in the red blood cells it has to be moving between cells otherwise it will get cleared out by the immune system (Harvard School of Public Health, 2012). In the parasites nucleus there is a gene called virulence which encodes a protein on the surface of the parasite to allow it to enter the blood cells where it can turn off and on to hide (Harvard School of Public Health, 2012). It is able to turn off the gene by packing the gene up into a tight ball in the nucleus to turn back on it simply unpacks itself from the ball (Harvard School of Public Health, 2012). The parasite forms a protein which binds to a specific antigen called Duffy antigen (GenePlanaet, 2012). This antigen is common in our blood cells this makes a Duffy antigen system which is like the AB0 blood system (GenePlanaet, 2012). People with Duffy positive have these antigens Duffy negative doesn’t (GenePlanaet, 2012). The malaria parasite needs these Duffy proteins to enter the blood stream and develop the infection (GenePlanaet, 2012). People with Duffy negative are resistant to malaria because they don’t have this antigen (GenePlanaet, 2012). Symptoms and Tests There is uncomplicated which last 6-10 hours which has a cold stage a hot stage and a sweating stage (Centers for Disease Control and Prevention, 2014). In a cold stage the person has a sensation of a cold and shivers (Centers for Disease Control and Prevention, 2014). The host stage consists of fever, headaches, vomiting, and seizures in young children (Centers for Disease Control and Prevention, 2014). The sweating stage is when the person sweats and returns to a normal temperature and experience tiredness (Centers for Disease Control and Prevention, 2014). Some symptoms of this are fever, chills, sweat, headache, nausea and vomiting, body aches, and general malaise (Centers for Disease Control and Prevention, 2014). Some physical symptoms may include increased respiratory rate, weakness, elevated temperature, enlarged spleen, enlarged liver and perspiration (Centers for Disease Control and Prevention, 2014). Sever malaria has different results a person might have seizures go into a coma or other neurologic abnormalities (Centers for Disease Control and Prevention, 2014). They can also experience server anemia because of the destruction of their red blood cells. Acute respiratory distress, abnormalities in the blood, low blood pressure, kidney failure, and metabolic acidosis are other results of server malaria (Centers for Disease Control and Prevention, 2014). Tests that were given in this case study were blood smears, endoscopic examination, and abdominal ultrasound. Blood smears are taken from a finger prick (webmed, 2011). When the doctors do blood smear tests they use thick and thin blood smears to know if someone has malaria (webmed, 2011). It will let them know the percentage of red blood cells that are infected with the parasite (webmed, 2011). When they do a thick blood smear a drop of blood is put on a glass slide for examination (webmed, 2011). These tests are more useful to determine the presence of the parasite because they use a larger sample of blood to examine (webmed, 2011). A thin blood smear is a drop of blood that is spread across the slide this helps them know what type of malaria the patient has (webmed, 2011). In this case the blood film came back negative for malaria parasites (Hussain et al., 2008). They performed an endoscopic exam in which they found a diffuse congested mucosa (Hussain et al., 2008). They also did an abdominal ultrasound which came out normal (Hussain et al., 2008). There are other ways to test for malaria for example there are various test kits to detect antigens form malaria parasites these kits are usually used where microscopic diagnosis is not available (Centers for Disease Control and Prevention, 2012). There is also a molecular diagnosis where the parasite nucleic acids are detected through a reaction using polymerase chain (Centers for Disease Control and Prevention, 2012). They can also do a serology test that detects antibodies against malaria parasites (Centers for Disease Control and Prevention, 2012). This test uses indirect immunofluorescence or enzyme linked immunosorbent (Centers for Disease Control and Prevention, 2012). This test does not detect the current infection what it detects is the past exposure (Centers for Disease Control and Prevention, 2012). There are lateral strip tests what these tests allow them to do is to target histidine rich protein 2 of the malaria parasite and its specific lactate dehydrogenase (Kakkilaya, 2011). Theses don’t require any type of machinery so they can be performed anywhere (Kakkilaya, 2011). The kidney and liver are checked to see if they have any damage to see if they have malaria or rule it out. Treatments There are several treatments and that are given to stop the malaria parasite from developing in the blood. Some of them are chloroquine, malaron, lariam, quinine, doxycycline, clindamycin, and quinidine (Centers for Disease Control and Prevention, 2012). Chloroquine helps prevent the malaria parasite to develop in the blood (WebMed, 2014). Cholorquine stops the parasite by blocking the chemical that protects the parasite from haem which is toxic to it (NetDoctor, 2013). This drug is taken orally and it is taken weekly for 4 weeks (NetDoctor, 2013). Malarone stops the parasite from reproducing by blocking an enzyme called dihydrofolate reductase which helps reproduce (NetDoctor, 2013). The dihydrofolate reductase enzyme makes folinic acid from folic acid and this is essential for the parasite to make a new DNA which is needed to reproduce (NetDoctor, 2013). Lariam kills the malaria parasite but it is not understood how it does this (NetDoctor, 2013). This drug is useful for travellers to areas where it is known to be (NetDoctor, 2013). Quinine is used to treat malarial infections it attacks the parasaite once it enters the red blood cells and stops it from multiplying (NetDoctor, 2013). Doxycycline is an antibiotic that stops the parasite (NetDoctor, 2013). It stops it from producing proteins that are needed to stay alive and multiply once it stops it then it is killed by the immune system (NetDoctor, 2013). Quinidine is used for severe cases of malaria it is directly given into a vein for 7 days in a hospital because the person’s heart needs to be monitored (NetDoctor, 2013). In this case the patient was given quinine infusion for 48 hours after the 48 hours he was given 600 mg of quinine orally (Hussain et al., 2008). He was also given some supportive drugs orally for a week which consisted of 500 mg of doxycycline, 40 mg of pantoprazole, and 200 mg of ferrous fumarate for 7 days (Hussain et al., 2008). He was has also given two pints of blood. Four weeks after these drugs were given to him he was discharged from the hospital with a negative blood film for malaria and he did not have any symptoms since his arrival to the clinic (Hussain et al., 2008). He was asked to come back to do further tests to be assured the malaria parasite was gone but he did not return to the clinic (Hussain et al., 2008). Conclusion Malaria can be prevented and if infected it can be treated. It is caused by a parasite that only female mosquitoes can carry. When these mosquitos go and take blood meals they transmit the human it bites. The parasite makes its way to the liver by masking itself from the body so it won’t detect it and eliminate it where later it makes its way to the blood stream and attacks the red blood cells. As of now there are many cases of malaria mostly in the African regions. Although there are treatments for malaria there are still a lot of people who die from it. Children and pregnant women have a higher risk of dying of malaria. Malaria can also be confused with other diseases because the symptoms are similar. This parasite is a very sneaky which likes to hide and wait for a period of time to multiply and prepare to attack the body. Although this might be the case there are plenty of test given to find out if someone has malaria to stop it before it can really do some server damage to the liver. There are some good drugs to help eliminate this parasite from our bodies. Sometimes people might think that this parasite is gone some people that have recovered from the first episode of this illness there might be several attacks called relapses this could happen within a moths or even years of having no symptoms. This usually occurs because they have stage parasites in the liver that reactivate. There are treatments given to reduce the chances of having these relapses. This can be a dangerous disease if not treated on time, but it can be prevented by tests to diagnose it before it is too late.

The clinical efficacy of salvia officinalis

The clinical efficacy of salvia officinalis An evaluation of the clinical efficacy of Salvia officinalis, Salvia lavandulaefolia and Melissa officinalis for the prophylaxis, management and amelioration of cognitive dysfunction: with particular reference to Alzheimers disease and non-Alzheimer-type senile dementias. 1. Introduction Dementia is a collection of symptoms caused by a chronic, global deterioration of cognitive function. It can occur at any age but is most prevalent in the elderly and increases with age (Beers et al. 2006: 1811). Around 5% of people over 65, 25% over 80 and 45% over 85 have some form of dementia (Knapp et al. 2007: 10; Collins 1997: 185). The population is aging and whereas today there is an estimated 700,000 people in the UK suffering from dementia, this number is set to increase to more than a million by 2025. The huge impact dementia has on society, devastating families and costing around  £17-18 million annually cannot be overstated (Knapp et al. 11). Early identification and safe, effective, intervention is therefore important. Dementia may be classified as Alzheimers or non-Alzheimer-types (Beers et al. 2006: 1811). The most common dementia is Alzheimers disease (AD) (Grossman et al. 2006: 985), affecting around 20 million people worldwide (Akhondzadeh et al. 2003: 53) and accounting for around 62% of dementias (Knapp et al. 2007: 11). Non-Alzheimer-type dementias typically affecting those over 60 include vascular dementia (27%), Lewy body dementia and fronto-temporal dementia (Knapp et al. 29). Cognitive disorders are treated allopathically with drugs that have yet to show real benefits and have a number of side-effects and contraindications. The need for safer, more effective treatments has led to increasing interest in the use of herbs for their management (Akhondzadeh and Abbasi 2006: 117). A variety of herbs, for example Salvia officinalis, Rosmarinus officinalis, Mellissa officinalis, Ginkgo biloba (Heinrich et al 2004: 234), Withania somnifera (Howes et al. 2003: 12), Centella asiatica (Chevallier 1996: 78) and Panax ginseng (Mantle et al. 2000: 207) have long-standing traditional use as memory-enhancing herbs. Consequently a number of clinical studies have been conducted to assess the efficacy of some of these herbs, most notably Ginkgo biloba, Salvia spp. and Mellissa officinalis, in the treatment of cognitive disorders. Of these, only clinical trials of Gingko biloba have been extensively reviewed (Birks and Grimley Evans 2002; Ernst et al. 1999; Oken et al. 1998). This present review aims to fill this gap by providing up-to-date information on whether clinical studies of Salvia spp. and Mellissa officinalis support their traditional use as cognition enhancers. To inform herbal practice it will evaluate clinical studies to assess whether the results have determined safe, effective herbal strategies and prescription for prophylaxis, management and amelioration of cognitive decline. 2. The literature review 2.1. Background: clinical presentation and pathology Although much scientific progress has been made since 1907 when Alois Alzheimer first described a case of dementia with â€Å"peculiar patches† disseminated throughout the cerebral cortex (Collins 1997: 185), there is still much to learn about the aetiology and pathogenesis of Alzheimers disease and other dementias (Knapp et al. 2007: 11). The onset of dementia is insidious, often beginning as mild cognitive impairment (MCI) and progressing to severe dementia over time (Loveman et al. 2006: 4). In the early stages, episodes of mild forgetfulness or misplacing possessions are often attributed to normal aging. Patients commonly suffer from anomic aplasia and agnosia but retain language comprehension (Collins 1997: 186). Dementia becomes more apparent when sufferers are unable to learn new information, to register the content of a conversation, or to recall recent events or the names of family members. Unlike those with benign forgetfulness, dementia patients are unaware of their amnesia. Frequently, there are mood changes, depression and other psychologic disturbances. Language comprehension fails (aphasia) and eventually patients may simply repeat what they hear or be unable to speak at all. Visuospacial deficits usually occur at a late stage (Collins 1997: 186). Those affected have difficulty in copy drawing simple obj ects. Differential diagnosis between MCI subtypes of various and complex aetiologies is challenging (Kidd 1999: 145). As some MCI subtypes are reversible (Levey et al. 2006: 992) prophylaxis for dementia could potentially encompass a range of varied or unknown aetiologies and risk factors. Knowledge of these and an awareness of differing clinical presentations are therefore important (Levey et al: 991). Additionally, an understanding of current orthodox treatment strategies and key neurochemical impairments in dementia can inform herbal practice of the most likely therapeutic actions of herbs. 2.1.1. Alzheimers disease As clinical studies have indicated that mild to moderate Alzheimers disease (AD) responds better to allopathic drugs than severe AD (Levey et al: 2006: 993), to prevent transition of MCI to AD early diagnosis is important. Evidence suggests that MCI associated with memory loss most commonly leads to AD (Levey et al. 991) and results of a clinicopathologic study of 80 subjects with MCI through to autopsy suggest that depression is one of the first features of AD (Galvin et al. 2005: 763). Formation of diffuse neuritic senile plaques in the brain is characteristic of AD but as these can only be determined from biopsy (Collins 1997: 186) probable diagnosis is made by clinical neuropsychological testing (Grossman et al. 2006: 986) such as the Mini Mental state Examination (MMSE) (Alzheimers Society 2002: 436), while magnetic resonance imaging can corroborate diagnosis by identifying areas of temporal neuronal loss (Vandenberghe and Tournay 2004: 347). Progression of AD is unremitting for around 5-10 years until death ensues. In the final stages sufferers may develop apraxia, with difficulty in performing familiar tasks. A common cause of death is pneumonia when patients eventual difficulty with eating results in aspiration pneumonia (Collins 1997: 186). The loss of faculties has been ascribed to both structural and neurochemical abnormalities (Perry et al. 1996: 1063). Senile plaques in the brains of AD patients contain amyloid and tau protein (microtubule associated protein) (Collins 1997: 188). Since isolation of b-amyloid peptide from cerebral vessels in AD patients (Wong et al. 1984: 8729), the accepted hypothesis for the pathogenesis of AD has been the ‘amyloid hypothesis, which proposes that AD is due to excessive formation of extracellular b-amyloid (Ab?) from amyloid precursor protein (APP), a membrane protein in neurons (Grossman et al. 2006: 986). It is thought that Ab molecules initiate a toxic cascade long before plaque forms by causing an inflammatory reaction, disrupting synaptic function and causing neurons to degenerate (Grossman et al. 986) with a loss of cholinergic fibres in the basal forebrain. In vitro results suggest that Ab enters mitochondria and induces free radical damage (Reddy 2006: 9). Intracellular neurofibrillary tangles are believed to be formed by abnormal phosphorylation of tau proteins (Tanzi and Bertram 200 5: 545), particularly in the hippocampus and neocortex, areas of the brain involved in memory (Mantle et al. 2000: 202). To date, thirteen genes have been implicated in AD (Bertram et al. 2007: 17). Of sporadic late onset Alzheimers up to 40% of cases may be due to a faulty gene on chromosome 21, ApoE4, an isoform of the ApoE gene that encodes for apolipoprotein, an astrocytic protein that may play a role in the reparative process in the brain. ApoE4s pathogenetic mechanism may be to enhance amyloid deposits within tissue by accelerating cleavage of b-peptide (Collins 1997: 189). Possession of a gene implicated in AD does not necessarily result in its development, the likelihood of which is further complicated by the potential role of environmental factors such as viruses and toxins in combination with genetic factors (Bird 2005: 864). 2.1.2. Vascular dementia Vascular dementia (VaD) is any type of dementia caused by cerebral blood vessel disease (Micieli 2006: S37). Onset of VaD is usually abrupt. Imaging may reveal areas of multiple infarcts (Collins 1997: 191) but their presence does not necessarily imply dementia (Grossman 2006: 987). According to Looi and Sachdev (1999) it is not possible to differentiate between AD and VaD with neuropsychological testing. Speech and language difficulties associated with vascular dementia may be mild or there may be a more pronounced aphasia as in multi-infarct VaD (Collins 1997: 191). 2.1.3. Frontal lobe dementia Frontal lobe dementia or Picks disease is uncommon and is characterised by neuronal loss and gliosis. Rarely, there are fibrillary inclusion bodies in the neurons. Presentation of frontal lobe dementia differs from AD in that the first symptoms are a change in personality rather than memory loss (Collins 1997: 193). 2.1.4. Lewy body dementias Dementia with Lewy bodies may differ to AD in its presentation in that patients suffer from marked visual hallucinations. Additionally, cognition tends to fluctuate between normality and confusion. Parkinsonian features such as shuffling gait, tremor, bradykinesia and rigidity are prevalent. Sleep behaviour disorder, such as acting out attacking themes, may appear years before other signs of the disease (Grossman et al. 2006: 989). 2.2. Risk factors Factors believed to pose a risk for developing dementia include cardiovascular disease, being female, a family history of dementia, Downs syndrome, older age, head trauma, diabetes and lower educational standards (Collins 1997: 186, 188; Lebson et al. 1997: 301). 2.2.1. Cardiovascular disease: Patients may have more than one type of dementia concurrently (Beers et al. 2006: 1811). This is compounded by results of a number of epidemiological studies suggesting that cardiovascular disease increases the risk of developing AD (Stampfer 2006: 12). Using transcranial Doppler ultrasonography Sun et al. (2007: 152) demonstrated diminished cerebral blood flow velocities in MCI patients who also carried the ApoeE4 allele. Risk factors for VaD are believed to include artherogenic factors such as hypertension, hyperlipidaemia, diabetes, and cigarette smoking (Micieli 2006: S38). Conversely, there are indications from clinical trials that nicotine has a protective effect for AD (Breteler et al. 1992: 71). Results of a randomised, double-blind, multicentred trial in which subjects with hypertension were treated with antihypertensives or placebo suggest that hypertension is a risk factor for developing both AD and VaD. Antihypertensives reduced risk by 55%. The results were significant as subjects had similar characteristics, the sample size was large (3228) and equally divided into placebo and treatment groups. Median follow-up was 3.9 years (Forette et al. 2002: 2047). 2.2.2. Head trauma: A meta-analysis by Fleminger et al. (2003: 858) replicated earlier findings by Mortimer et al. (1991) that head injuries pose a risk for AD but only in males, thought to be due to an early protective effect of oestrogens in females (Fleminger et al. 860). Bias may have been introduced into both studies as informants recalled the injuries. 2.2.3. Diabetes mellitus: Given that diabetes mellitus (DM) is a known risk factor for vascular disease it is not surprising that most studies on the development of vascular dementia in DM patients have shown a positive association (Biessels 2004: 10). Studies on DM as a risk factor for AD, however, have yielded conflicting results, possibly due to study limitations such as small sample sizes and selection bias (Leibson et al. 1997: 301). Large longitudinal studies may be more reliable. A population-based historical cohort study of 1,455 cases followed over 9,981 person years found a statistically significant positive association (Leibson et al. 304). According to results from the Framlingham Study, diabetes may not be an independent risk factor for developing AD but risk is strongly associated with possession of the ApoE4 genotype (Akomlafe et al. 2006: 1551). 2.2.4. Hormones: Women are twice more likely than men to suffer from AD. Although this may be partly due to women having a longer life expectancy (Beers et al. 2006: 1814) there is evidence to suggest that a decline in endogenous oestrogen in later life plays a role in its pathogenesis. Oestrogen is believed to stimulate cholinergic activity, reduce oxidative stress related cell damage, reduce vascular risks, reduce Ab formation and promote synaptic activity (Zandi et al. 2002: 2123; Hoskin et al. 2004: 141). Evidence from studies to determine whether oestrogen-containing hormone replacement therapy (HRT) in women has a protective effect on the brain, however, is conflicting (Colucci et al. 2006: 1376) but this may be due to differences in methodology and confounding factors (Resnick and Henderson 2002: 2171). For example, in one large prospective study that found a positive correlation between HRT use and a significant reduction in AD development, patients with dementia were asked q uestions regarding previous use of HRT (Zandi et al. 2124) yet accurate recall in a dementia sufferer cannot be guaranteed. Results of a retrospective case-control study suggesting the likelihood of women developing AD increases with number of pregnancies (Colucci et al. 2006: 1375) could be of little value. Cases with previous head injuries, low educational standards, both considered risk factors for AD (Collins 1997: 186; Fleminger et al. 2003: 858), and those who had used HRT, were not excluded from the study. There is evidence to suggest testosterone may delay AD onset in men. Men over 32 years of age who were free from AD at baseline (n = 574) were followed for a mean of nineteen years (Moffat et al. 2004: 188). Long-term free testosterone levels were significantly lower in men who developed AD. Due to conflicting results and confounding factors in the research the clinical evidence for risk factors for dementia is inconclusive. However, although more research is needed the results can assist in informing herbal practice. 2.3. Orthodox treatment strategies As cholinergic neurotransmitters are believed to have a role in memory function (Grossman et al. 2006: 985) symptomatic treatment for subtypes of dementia is similar and focuses on acetylcholinesterase (AChE) inhibition with drugs such as donepezil, rivastigmine and galantamine (Loveman et al. 2006: 8). According to Delagarza (2003: 1366) loss of cholinergic neurons causes a decrease in acetylcholine and subsequent drop in AChE with a compensatory rise in butylcholinesterase (BChE). Nicotinic receptors also decrease. Rivastigmine also inhibits BChE; galantamine also acts on nicotinic receptors. Depression in dementia is treated with non-anticholinergic antidepressants as anticholinergic drugs exacerbate symptoms (Beers et al. 2006: 1814). Another drug, memantine, a N-methyl-D-aspartic acid (NMDA) receptor antagonist (Grossman et al. 987), licensed to treat moderate to severe AD, acts by modulating the action of the neurotransmitter glutamate, which is believed to be associated with c holinergic damage and neurodegeneration when secreted in excess (Loveman et al. 2006: 8). Dizziness, diarrhoea, headaches, nausea and vomiting were found by a meta-analysis of dementia drugs to be common adverse events with anti-cholinesterases and memantine (Loveman et al. 2006: 49). Furthermore, their long-term benefits are inconclusive (Loveman et al. 145). Similarly, their use for vascular or Lewy body dementia is controversial as a review of clinical trials data deems there is insufficient evidence for their efficacy. Trials were of generally poor quality and with inconsistent findings (Maggini et al. 2006: 457). Other potential drugs for AD include 70 new compounds formulated to interfere with the toxic amyloid cascade or to target inflammation, oxidation or apoptosis (Grossman et al 2006: 987). As g-aminobutyric acid (GABA) agonists can impair memory GABA antagonists are also being developed (Association of the British Pharmaceutical Industry). 2.4. Potential herbal treatment strategies In view of the hypothesised pathological sequelae, risk factors and current orthodox treatment of dementias, efficacious herbs for these conditions could potentially have one or more of AChE-inhibiting or cholinergic, antidepressant, hypotensive, hypoglycaemic, antioxidant, anti-inflammatory, GABA modulator, nicotinic agonist, testosterogenic and oestrogenic actions. According to Kennedy and Scholey (2006: 4614) orthodox AChE inhibitors are not well tolerated by patients as they are toxic alkaloids and European plants traditionally used for cognitive enhancement may therefore provide non-alkaloid safer alternatives. To this end Salvia officinalis, Salvia lavandulaefolia and Melissa officinalis, members of the Labiatae family (Lamiaceae), have been extensively investigated in vitro. 2.4.1. Salvia spp. Salvia is the largest genus in the Labiatae family with over 700 species. The most common European species are Salvia officinalis L (garden or common sage) (Figure 1) and Salvia lavandulaefolia Vahl (Spanish sage), both of which originate on the shores of the Mediterranean (Kennedy and Scholey 2006: 4614). S. officinalis is an aromatic, evergreen shrub up to 75 cm in height with greyish-green oblong to lanceolate opposite leaves covered in a fine down. It has bluish-violet, two-lipped flowers arranged in whorls (Wildwood 1998: 202). S. lavandulaefolia has narrower leaves and a lower spreading habit (Sergei Savelevs Database). Sage was used in medieval Europe as a tisane for prolonging life and is a traditional spring tonic for strengthening weak constitutions (Lipp 1996: 63). According to Culpepper (1826: 147) ‘Sage is of excellent use to help the memory, warming and quickening the senses and an old country remedy, which indicates its efficacy for inflammation: ‘A sunburnt face is eased by washing with sage tea (Page 1978: 41). Other traditional uses are for headaches and migraine (Page: 34). The major active constituents of the leaves of both species are believed to be the volatile oils (1.0-2.8%), containing monoterpenes such as a-pinene, b-pinene, 1-8-cineole, camphor, geraniol and thujone (Kennedy and Scholey 2006: 4615). S. officinalis contains around 50% a- and b- thujone whereas only traces have been found in S. lavandulaefolia. As thujone, a terpenoid ketone, is potentially neurotoxic, S. lavandulaefolia may provide a safer alternative than S. officinalis to orthodox dementia drugs (Perry et al. 1999: 530). However, S. officinalis is toxic only at doses of over 15 g (Grainger-Bissett and Wichtl 2001: 441) but the oil should not be ingested. Both species contain polyphenolic compounds including rosmarinic acid, methyl carnosate, luteolin, luteolin-7-0-glucoside and caffeic acid (Kennedy and Scholey 4615), triterpenes eg oleanic acid and the flavonoids 5-Methoxysalvagenin (Barnes et al. 2002: 408) and hispidulin (Johnston and Beart 2004: 809). 2.4.2. Melissa officinalis M. officinalis L (balm, lemon balm) (Figure 2) originates from the eastern Mediterranean region and western Asia and is now widely cultivated in the west (Grainger Bissett and Wichtl 2001: 329). It is a bushy perennial, about 60 cm high with bright green, lemon-scented leaves in opposite pairs. Small labiate flowers grow in whorls and change colour from pale yellow to white or pale blue. Fresh leaves should be collected when young (Wildwood 1998: 175). It has been in medicinal use as a nervous system restorative for over 2000 years (Kennedy and Scholey 2006: 4617). The London Dispensary (1696 cited in Grieve 1931) states: ‘An essence of Balm, given in Canary wine every morning will renew youth, strengthen the brain John Evelyn wrote: ‘Balm is sovereign for the brain, strengthening the memory and powerfully chasing away melancholy (cited in Grieve 1931). There are no known contraindications or adverse effects (Barnes et al. 2002: 339). M. officinalis contains 0.2-0.3% essential oil (EO) consisting of over 70 components including around 60% monoterpenoid aldehydes and over 35% sesquiterpenes. The principle monoterpenes include citronellol, neral, geranial, methyl citronellate, ocimene; major sesquiterpenes include b-caryophylene and germacrene D. The herb also contains flavonoids, caffeic and chlorogenic glycosides, polyphenolic acids such as rosmarinic acid, and triterpenes (Granger Bissett and Wichtl 2001: 330). 2.5. Possible mode of action of phytochemical constituents in dementia 2.5.1. Antioxidant properties Numerous studies have been conducted on Salvia officinalis in a search for natural antioxidants to use in the food industry. Consequently, results of chemical tests on purified extracts of the herb have suggested that phenolic compounds rosmarinic acid, carnosic acid, carnosol, carnosoic acid, rosmadiol, rosmanol, epirosmanol, isorosmanol, galdosol methyl carnosate, 9-erythrosmanol and luteolin-7-0-glucopyranoside have significant antioxidant activity (Bertelsen et al 1995: 1272; Cuvelier et al. 1994: 665; Pizzale et al. 2002: 1651; Miura et al. 2002: 1848; Wang et al. 1998: 4869). S. lavandulaefolia dried leaf extracts in ethanol, chloroform and water, and various EO monoterpenes were assayed for antioxidant properties in phospholipid microsomes. The extracts and monoterpenes a-pinene, b-pinene, 1-8-cineole, camphor and geraniol and thujone all showed significant antioxidant activity (Perry et al. 2001: 1351). The extracts showed greater antioxidant activity than any individual monoterpenes, which suggested a synergistic effect (Perry et al. 1352). Ferreira et al. (2006: 35) measured the antioxidant properties of EOs, decoctions and ethanolic extracts of M. officinalis and S. officinalis relative to b-carotene. The EO and decoctions of both herbs showed significant antioxidant activity. Lima et al (2007) found methanolic and aqueous extracts of S. officinalis prevented lipid peroxidation in hepatoma cells. As there were more phenolics in the methanol extract it was thought there were other antioxidant compounds in the aqueous extract. Ethanolic EO extract from dried M. officinalis investigated for its ability to inhibit lipid peroxidation in vitro showed a dose-dependent (10-20 mg) 80-90% protection of linoleic acid from peroxyl radical attack. As no rosmarinic acid was detected in the EO the antioxidant action was attributed to squalene (Marongiu et al. 2004: 790). Considering there are potentially 70 constituents in the EO it is unlikely that this would have been the only active phytochemical but composition of the oil varies according to harvesting, origin and climate (Grainger-Bissett and Wichtl 2001: 329). Interestingly, M. officinalis prepared as a tea demonstrated significant antioxidant capacity, which corresponded to high phenolic content, when assayed with the ABTS (2,2/-azinobis 3-ethylbenzothiazoline-6-sulfonic acid) radical decolourisation assay (Ivanova et al. 2005: 147). 2.5.2. Anti-inflammatory activity Chloroform, aqueous and ethanol extracts and monoterpenes of S. lavandulaefolia, were tested for their ability to inhibit formation of pro-inflammatory eicosanoids thromboxane B2 (TXB2) and leukotriene B4 (LTB4) in leucocytes (Perry et al. 2001: 1348). The chloroform and ethanol extracts showed significant inhibition of LTB4. Alpha-pinene and geraniol showed weak selectivity for LTB4 and TXB2 respectively (Perry et al. 1351). The results support the traditional use of S. lavandulaefolia as an anti-inflammatory herb but indicate that it is the sum of the whole plant phytochemicals acting in synergy that are likely to contribute to this action. A standardised ethanolic extract containing 9.9% rosmarinic acid (RA) from the leaves of S. officinalis reduced Ab-induced neuronal cell death, Ab-induced lipid peroxidation, reactive oxygen species formation, DNA fragmentation and tau protein hyperphosphorylation in vitro (Iuvone et al. 2006: 1143). Kimura et al (1987) found rosmarinic acid (RA) had the ability to inhibit pro-inflammatory cytokines in human polymorphonuclear leucocytes (PMNs) in vitro. As both species contain RA these results suggest antioxidant, anti-inflammatory and neuroprotective properties of M. officinalis and the Salvia spp. against Ab-induced neurotoxicity. 2.5.3. Oestrogenic activity A range of concentrations of EO, ethanolic, chloroform and aqueous extracts and isolated monoterpenes of S. lavandulaefolia were assayed in yeast culture for oestrogen-binding properties. The EO showed weak oestrogenic activity at low concentrations. The aqueous and ethanolic fractions and geraniol showed significant oestrogenic activity (Perry et al. 2001: 1352). The results of this experiment support S. lavandulaefolias use as an oestrogenic herb. The effects of S. officinalis in combination with Medicago sativa were assessed on menopausal symptoms related to oestrogen deprivation. Hot flushes and night sweats were completely eliminated in 20 out of 30 women (De Leo et al. 1998: 207). These effects were attributed to dopaminergic actions but it is not clear for which herb. S. officinalis does, however, contain geraniol found to be oestrogenic in vitro (Perry et al. 2001: 1352). 2.5.4. Acetylcholinesterase inhibitory activity M. officinalis EO demonstrated strong AChE inhibition in homogenised human brain tissue but ethanolic extract of the dried leaf had no effect. Ethanolic fresh leaf extract showed a weak effect (Perry et al. 1996: 1064). Conversely, when EOs and ethanolic extracts of M. officinalis were assayed in solution with AChE negligible results were obtained for its inhibition by EO and significant results for its ethanolic extract (Ferreira et al. 2006: 34). Dried, reconstituted ethanolic, ethyl acetate or aqueous extracts of M. officinalis, yielding 10mg/ml, demonstrated weak AChE inhibitory activity when assayed in a chemical system using thin layer chromatography (Salah and Jà ¤ger 2005: 146). The herbs were purchased from local suppliers in the Lebanon so their quality is unknown. S. officinalis EO and ethanolic extract assayed in solution with AChE showed moderate AChE inhibitory activity (Ferreira et al. 2006: 34). Moderate (dose-dependent) AChE and weak BChE inhibition was demonstrated by ethanolic extracts of fresh and dried S. officinalis and S. lavandulaefolia in human brain homogenates. The EOs had significant effects but not the individual constituents (camphor, thujone, cineole, caffeic acid and borneol) (Perry et al. 1996: 1066). The findings suggest a major synergistic effect of the constituents (Perry et al. 2000: 895), which was later confirmed by Savelev et al. (2003: 667). The results for camphor conflict with another experiment in which S. lavandulaefolia EO and isolated monoterpenes a-pinene, 1-8-cineole and camphor demonstrated AChE inhibitory activity in human erythrocytes. Ethanolic extracts of dried S. officinalis, S. lavandulaefolia and M. officinalis were assayed for acetylcholine (ACh) receptor activity in human brain homogenate. All plants demonstrated ACh receptor activity and M. officinalis had the highest nicotinic displacement value (Wake et al. 2000: 108). 2.5.5. GABA modulation Methanol extract from S officinalis leaves revealed the flavonoids apigenin, hispidulin and cirsimaritin functioning as benzodiazepine receptor-active components (Kavvadias et al. 2003: 113), suggesting a potential calming effect for the herb, which may be relevant to AD. 2.6. Evaluation of in vitro studies According to the results all three herbs may have AChE inhibitory, anti-inflammatory and antioxidant properties, and S. lavandulaefolia and S. officinalis may have and oestrogenic properties (Appendix I, Table 1, page 36) and a sedative effect for S. officinalis. Although these results are interesting in vitro systems cannot be extrapolated to humans and clinical evidence is necessary to support findings. For example, they cannot determine effective human dosage or mode of administration. They largely do not account for potential synergistic effects of the herbs nor do they provide an indication of in vivo physiological, pathological and genetic, or environmental, influences. Furthermore, the extent to which phytochemicals in herbs are effective in dementia may depend upon their bioavailability in the brain (Anekonda and Reddy 2005: 371). It is worth noting, however, that as terpenoids tend to be lipophilic they are able to cross the blood brain barrier (Houghton and Howes 2005: 12). Some results are conflicting but they may depend on methodological quality and design. The experiments cited above vary widely in their approach with regard to extraction methods and assay methods. Savelev (2003: 667) has demonstrated how two different methods used for exploring interactions between the same agents may give different results when applied to the same set of data. Consistency of results may also be affected by differences in harvesting times and quality of herbs. Results for M. officinalis are particularly inconsistent but, according to Perry et al. (1996: 1068) most commercial sources of the EO are adulterated. Additionally, variation in media composition is known to affect the outcome of in vitro tests (Maurer and Kuschinsky 2006: 73). Consequently, in vitro experiments can only provide an indication of the clinical efficacy of therapeutic interventions. However, despite the inherent difficulties of in vitro research with herbs, there is considerable consistency with their potential value in dementia prophylaxis and management (Appendix I, Table I, page 36). Promising results in vitro of constituents of plants traditionally used to enhance memory, and subsequent interest in their potential actions in the brains of human patients, has generated clinical trials of M. officinalis and Salvia spp. for dementia. These will be reviewed. 3. Method A computerised literature search was conducted on the Allied and Complementary Medicine Database (AMED) including CINAHL Database, EMBASE, Pascal Biomed, Biological Abstracts, RCN Journals Database and IPA (International Pharmaceutical Abstracts); PubMed, the Cochrane Collaboration, Bandolier, the NHS Centre for Reviews, The National Research Register, ADEAR (Alzheimers Disease Education and Referral Centre database), PLoS (Public Library of Science), Herbalgram and Alt HealthWatch as well as hand-searching in books and journals. Literature searches dated back to 1985 and the final search was in April 2007. Key words in medical subject headings (MeSH) for an initial search in various Boolean combinations were: memory, cognitive dysfunction, dementia, Alzheimers, herbal, botanicals, phytotherapy, complementary and alternative. Also, in a second search these MeSh terms were entered with key herbs: Salvia, sage, Melissa and lemon balm. Inclusion criteria Controlled clinical trials, observational studies and case reports. Herbs for which there are at least two clinical studies in relation to cognitive enhancement. Exclusion criteria Due to the limitations and ethical considerations of animal experiments the review is restricted to human trials. Trials with combined preparations are excluded. Due to time constraints and a restriction to papers in the English language a complete systematic review is not viable at this time. To eliminate

Copyrights And Patents :: essays research papers

Everyday businesses provide the world with products and services. People in general are just not self-sufficient. Who has time to make their own clothes, own meals,clean their own house, or even watch their own kids? Today’s every growing business world and advancements in technology make it extremely easy to obtain anything one could ever desire provided they have the money to buy it. Many people gained great success and wealth from their original product and business ideas. People have alsogained great wealth from borrowing, stealing or adapting from one â€Å"original† idea.   Ã‚  Ã‚  Ã‚  Ã‚  The majority of copying and fraud involves software and clothing items. (Edwards6) One aspect of this is known as bootlegging. this is where someone copies a program, CD, performance, etc., and sells it on the streets. According to Mike Edward’s of the International Federation of the Phonographic Industry claims that world wide CD piracy accounts for 6.5% of the industries annual sales.   Ã‚  Ã‚  Ã‚  Ã‚  A different approach to borrowing one’s idea doesn’t nessacarily copythe product. Instead it involves misleading the consumer. As in one case, the Miller Brewing Company developed a new beer with a label similar to Annheuser Busch’s, who is currently the number one brewer in America. The â€Å"new brew† was aimed at taking away sales from â€Å"the King of Beers.† (Melcher 37)   Ã‚  Ã‚  Ã‚  Ã‚  Logos are also often copied. A logo is defined as an advertising symbol or message that represents a product or a service. In one case, OJ Simpson has agreed to share marketing rights with the Florida Department of Citrus to use his initial in connection with orange juice. (Wells 1)   Ã‚  Ã‚  Ã‚  Ã‚  Materials can be illegally duplicated in many different ways. This includes everything sharing software, to copying CD’s, to illegal sweatshops. Commercial goodshave either patents which are supposed to protect them from illegal duplication.   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Digital technology is becoming a big problem for graphic artists who are trying to protect their creations. Scanners have made it very easy to duplicate images instantly. The creator must apply for a copyright in order to be able to sue for fraud. Images that are not copyrighted are in the public domain. Also, copyrights expire 50 years after the creator’s death. (Baer 163)   Ã‚  Ã‚  Ã‚  Ã‚  China plays a major role in copyright piracy. Officials estimate that China exports about $827 million dollars a year of impostor products. An example of this is shampoo with a familiar American brand label, but containing different ingredients than the US versions. Copyrights And Patents :: essays research papers Everyday businesses provide the world with products and services. People in general are just not self-sufficient. Who has time to make their own clothes, own meals,clean their own house, or even watch their own kids? Today’s every growing business world and advancements in technology make it extremely easy to obtain anything one could ever desire provided they have the money to buy it. Many people gained great success and wealth from their original product and business ideas. People have alsogained great wealth from borrowing, stealing or adapting from one â€Å"original† idea.   Ã‚  Ã‚  Ã‚  Ã‚  The majority of copying and fraud involves software and clothing items. (Edwards6) One aspect of this is known as bootlegging. this is where someone copies a program, CD, performance, etc., and sells it on the streets. According to Mike Edward’s of the International Federation of the Phonographic Industry claims that world wide CD piracy accounts for 6.5% of the industries annual sales.   Ã‚  Ã‚  Ã‚  Ã‚  A different approach to borrowing one’s idea doesn’t nessacarily copythe product. Instead it involves misleading the consumer. As in one case, the Miller Brewing Company developed a new beer with a label similar to Annheuser Busch’s, who is currently the number one brewer in America. The â€Å"new brew† was aimed at taking away sales from â€Å"the King of Beers.† (Melcher 37)   Ã‚  Ã‚  Ã‚  Ã‚  Logos are also often copied. A logo is defined as an advertising symbol or message that represents a product or a service. In one case, OJ Simpson has agreed to share marketing rights with the Florida Department of Citrus to use his initial in connection with orange juice. (Wells 1)   Ã‚  Ã‚  Ã‚  Ã‚  Materials can be illegally duplicated in many different ways. This includes everything sharing software, to copying CD’s, to illegal sweatshops. Commercial goodshave either patents which are supposed to protect them from illegal duplication.   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Digital technology is becoming a big problem for graphic artists who are trying to protect their creations. Scanners have made it very easy to duplicate images instantly. The creator must apply for a copyright in order to be able to sue for fraud. Images that are not copyrighted are in the public domain. Also, copyrights expire 50 years after the creator’s death. (Baer 163)   Ã‚  Ã‚  Ã‚  Ã‚  China plays a major role in copyright piracy. Officials estimate that China exports about $827 million dollars a year of impostor products. An example of this is shampoo with a familiar American brand label, but containing different ingredients than the US versions.

Techniques Used in Morris Glietzmans Boy Overboard Essay -- essays re

In Morris Glietzmans heart breaking but remarkable book Boy Overboard, he shows how the corrupt government in Afghanistan has forced out many of its inhabitants making them try to leave the country by avoiding the government and staying in refugee camps until they can leave is in the country. Morris Glietzman shows the pressure put on the families in Afghanistan through similes, metaphors, and humour. The Afghanistan government or the Taliban as they are called, are very harsh and unfair with the laws that are in place in Afghanistan and are not nice to the families in the country. Woman are treated very unfairly in Afghanistan for minor crimes, and are whipped or killed for a crime such as showing there ankles in public or not being with a male person of there family while outside. Similes are used throughout Boy Overboard to show a comparison in the readers mind. By using a comparison with another obje0ct and using like or as to show this comparison the object can be shown to be something normally not possible for the person or object to be or do. One example in the story B...

“The Mission” Film Analysis

?The nature of greed is that it compels us to do dangerous things. It disregards the feelings and positions of others and instead replaces them with what we want out of the situation. Latin America, a beautiful part of the world rich with history and culture, knows exactly what greed can do, especially to hungry imperialists seeking to plunder the resources and vitality within its borders. An aggressive desire for wealth, riches, spices, and other material things have made Latin America an arena for violence against native Latin Americans.In the film The Mission, director Roland Joffe shows us the power of faith in religion and God as well as the dangerous result of passion and greed coming together as one. ?In this film, a Jesuit priest named Father Gabriel goes into the deepest parts of the Latin American jungle and seeks to evangelize the local tribe living there. Although they are initially wary of him, the natives eventually begin to trust him and allow him to convert them.Mendo za, played by Robert De Niro, is a former slave trader who after killing his brother in a fit of rage, decides to join Father Gabriel in his missionary work and spreads the values of the mission and religion. Their hard work and unity as a mission is threatened when the Portuguese attack and attempt to control the land and people the mission is founded on. Father Gabriel, a man full of faith in God and religion, seeks nonviolent means to fight the Portuguese. Mendoza, however, after vowing to also act nonviolently, breaks his promise and teaches the natives how to fight against the Portuguese.The film, unlike most other films, does not have a happy ending. Eventually, almost everyone perishes and only a few are left to spread the values of love, faith, religion, and to rebuild the community that they grew to respect and cherish. ?Religion and the church play a huge role in the film. Despite the obvious fact that the premise of the film is about a priest evangelizing native Latin Ame ricans, the religious aspect of the film emits a sense of love, benevolence, and goodwill. The filmmaker suggests that unlike many other â€Å"invaders† of Latin America, the Christian missionaries wanted to entirely devote themselves to the natives.They devoted themselves faithfully and were willing to preserve the natives’ pure way of life, unlike many invaders who came into Latin America and attempted to halt all that was common and introduced new ways of living. The filmmaker tells us that in order to represent the values of Christianity, people must devote themselves fully and be willing to make sacrifices, just like Father Gabriel and Mendoza did for the natives and the mission. ?Another theme in the film is the union of greed and passion. It is no surprise, especially to Latin America, that the desire for worldly things can cause great destruction and tragedy.The two main reasons the mission was threatened in the film boils down to imperialism and greed, which a re essentially interchangeable. To imperialize a country is to be riddled with greed and hunger. Greed, desiring to possess more than one needs or even deserves to possess, is conveyed endlessly throughout the film. The Portuguese only wanted to gain the mission and land for profit. Even worse, after they would gain the land they so desperately desired, they would enslave the people and make them operate under Portuguese rules to further their profit and power.In this film, greed and power undermine morals and the ethics of human kind. The filmmaker showcases the worst traits in man, in which the desire for mere things cause man to slaughter man and disregard the love and respect humans should have for one another. ?The film, although tragic and essentially very morbid, mirrors the historical realities of the time and illustrates Latin America’s struggle to keep itself a stable, prospering region despite the invading forces of greedy, insatiable imperialists.

Comprises the spiritual, material, intellectual and emotional features Essay

It comprises the spiritual, material, intellectual and emotional features of a society and includes, in addition to the arts and letters, the value systems, traditions, modes of life and beliefs of the society. It also absorbs from other cultures and undergoes changes with time, sometimes beneficial, sometimes regressive. When the word â€Å"culture† is mentioned, we can think of many things as â€Å"cultural†, such as language, clothings†¦ etc, because we classify cultures of different places. However, culture is so valuable that it has to be kept for thousands of years,and passed on by one generation to another. Culture is so important that it is more than its distinct visible features, if we extends this to the inner self of a person, to members within a society, further to the whole community, maybe we can find some answers by finding out how they are affected by culture. Culture represents a whole community, to investigate how culture changes one’s inner values, we have to define some common beliefs, just like clothing that has some features that help distinguish its cultural background. People having the same cultural background, in general, are likely to behave in a similar way, because their education and religion background have also cultural elements. It is true that personalities are different for everyone, but culture can affect people to a certain degree because it provides an environment from which they obtain their values, especially for children at young age. For example, chinese are generally considered to be more respectful but the westerners are more open-minded and outspoken, their education style has played an important role, because in Chinese culture children have to learn to be composed and be polite and there is a border line between teachers and students, whereas in western they tend to be active to be appreciated by the teachers. Therefore people from different cultural backgrounds will have a diversity of ways expressing the same intention. Culture is important because it has some values that are automatically fill in a person’s mind through an environment, which changes one’s deeds. Culture also plays an important role to the interactions between members within a community. When the same culture can cause similarities of values, this can bond people with the same culture together because they will feel comfortable and easier because it confirms their values. On the other hand, they may find other cultures odd if they neglect cultural difference. Culture can pull a person closer, or further away to the majority, therefore culture is very important to the communication network in a society as well, maining the relationship among people. Since culture can form invisible bonds between members in the community, this can hold people with the same cultural background together, passing on the values. This propogation of values is can not only transmit culture knowledge and retain the relationship among people, it also builds up a long term tradition after years and years. Culture is strengthened in this way because it can give background and reference to its later generations of its ability of keeping the long-term tradition, gaining the sense of belonging of people to the country of that culture. It is important in terms of the development of a community as a whole, as it forms cultural groups together which help passing culture on from one generation to the next one, maintaining the existence of some traditional values. Culture contains elements that affect one’s inner values other than just external characteristics, which those values play an important role in his whole life. The communications between people are also based on culture to some extent and this forms cultural groups, passing cultural knowledge on, building up a cultural status to a country for years which people with the same cultural background will find them belonging.