Free Essays on Computer Simulation

WARSIM 2000 is simulation software, used by the armed forces. Extensive, thorough, and tiring work has been done on thgis program. It covers almost all aspects and situations required for realistic, meticulous and a complete simulation. Information Technology has lead to the advancement of the tools required to build the simulator. Information Technolgy’s guideleines and technolgy have reinforced this creative simulator General Description of Operational Capability. WARSIM 2000 will increase the effectiveness of commander and battle staff training by dramatically increasing the realism and the scope of the available training environment. In conjunction with other services' simulations, WARSIM 2000 will provide a complete operational environment with scenarios drawn from the entire operational continuum to support Army, joint and coalition force training distributed across the globe. a. The WARSIM 2000 simulation system will use a computer-based simulation and associated hardware to support the training of unit commanders and their battle staffs from battalion through theater-level as well as to support training events in educational institutions. Designed and built using modern computer technology, modern software engineering techniques, and validated algorithms and databases, it will allow units world-wide to train using their organizational equipment. A key feature of the system will be its use of technology to minimize the total Army's overhead associated with supporting training. The system will be designed to meet emerging Distributed Interactive Simulation (DIS) standards and protocols to facilitate linkages with DIS compliant simulators and live training events. b. The WARSIM 2000 simulation system will consist of, or use, several components: (1) Computer-based battle simulation models that portray the joint and combined environment needed to s... Free Essays on Computer Simulation Free Essays on Computer Simulation WARSIM 2000 is simulation software, used by the armed forces. Extensive, thorough, and tiring work has been done on thgis program. It covers almost all aspects and situations required for realistic, meticulous and a complete simulation. Information Technology has lead to the advancement of the tools required to build the simulator. Information Technolgy’s guideleines and technolgy have reinforced this creative simulator General Description of Operational Capability. WARSIM 2000 will increase the effectiveness of commander and battle staff training by dramatically increasing the realism and the scope of the available training environment. In conjunction with other services' simulations, WARSIM 2000 will provide a complete operational environment with scenarios drawn from the entire operational continuum to support Army, joint and coalition force training distributed across the globe. a. The WARSIM 2000 simulation system will use a computer-based simulation and associated hardware to support the training of unit commanders and their battle staffs from battalion through theater-level as well as to support training events in educational institutions. Designed and built using modern computer technology, modern software engineering techniques, and validated algorithms and databases, it will allow units world-wide to train using their organizational equipment. A key feature of the system will be its use of technology to minimize the total Army's overhead associated with supporting training. The system will be designed to meet emerging Distributed Interactive Simulation (DIS) standards and protocols to facilitate linkages with DIS compliant simulators and live training events. b. The WARSIM 2000 simulation system will consist of, or use, several components: (1) Computer-based battle simulation models that portray the joint and combined environment needed to s...

WISNIEWSKI - Surname Meaning and Origin

WISNIEWSKI - Surname Meaning and Origin The Polish surname Wisniewski is generally a geographical surname deriving  from the place of origin of the original bearer, indicating a man who originally came from one of dozens of Polish villages named Wisniewo or Wisniew. The name roughly translates to town with a cherry tree, from the root wisznia, meaning cherry tree. WiÅ›niewski is the 3rd most common surname in Poland. WiÅ›niewska is the feminine version of the surname. Surname Origin:  Polish Alternate Surname Spellings: WISNIEWSKI, WISNIOWSKI, WISNIOWOLSKI Where do People with the Surname WISNIEWSKI Live? According to WorldNames publicprofiler, individuals with the last name Wisniewski are found in the greatest numbers in Poland, followed by the United States, Germany and Australia. The largest number of individuals named Wisniewski are found in northern Poland, especially the voivodeships (provinces)  of Kujawsko-Pomorskie,  Warminsko-Marzurskie,  Mazowieckie, Zachodniopomorski and Pomorskie.  The Polish-specific surname distribution map on moikrewni.pl identifies surname population at the district level, identifying over 52,000 people with the WiÅ›niewski surname living in Poland, most living in ToruÅ„, Ã… Ãƒ ³dÃ… º, Bydgoszcz, GdaÅ„sk, PoznaÅ„, InowrocÅ‚aw, Szczecin, Brodnica and Plock. Famous People with the Surname WISNIEWSKI James Wisniewski - American professional ice hockey playerMichaÅ‚ Krystian WiÅ›niewski - Polish pop singerDavid Wisniewski - English-born childrens authorJanusz Leon Wisniewski - Polish author Genealogy Resources for the Surname WISNIEWSKI WISNIEWSKI Family Genealogy ForumSearch this popular genealogy forum for the Wisniewski surname to find others who might be researching your ancestors, or post your own Wisniewski surname query. FamilySearch - WISNIEWSKI GenealogyAccess over 250,000 free historical records and lineage-linked family trees posted for the Wisniewski surname and its variations on this free genealogy website hosted by the Church of Jesus Christ of Latter-day Saints. DistantCousin.com - WISNIEWSKI Genealogy Family HistoryExplore free databases and genealogy links for the last name Wisniewski. WISNIEWSKI Surname Family Mailing ListRootsWeb hosts a free mailing list for researchers of the Wisniewski surname.   The Wisniewski Genealogy and Family Tree PageBrowse genealogy records and links to genealogical and historical records for individuals with the Polish surname Wisniewski from the website of Genealogy Today. Polish Genealogy Databases OnlineSearch for information on Wisniewski ancestors in this collection of Polish genealogy databases and indexes from Poland, the United States and other countries. Looking for the meaning of a given name? Check out First Name Meanings Cant find your last name listed? Suggest a surname to be added to the Glossary of Surname Meanings Origins. - References: Surname Meanings Origins Cottle, Basil. Penguin Dictionary of Surnames. Baltimore: Penguin Books, 1967. Menk, Lars. A Dictionary of German Jewish Surnames. Bergenfield, NJ: Avotaynu, 2005. Beider, Alexander. A Dictionary of Jewish Surnames from Galicia.  Bergenfield, NJ:  Avotaynu, 2004. Hanks, Patrick and Flavia Hodges. A Dictionary of Surnames. New York: Oxford University Press, 1989. Hanks, Patrick. Dictionary of American Family Names. New York: Oxford University Press, 2003. Hoffman, William F. Polish Surnames: Origins and Meanings.  Chicago:  Polish Genealogical Society, 1993. Rymut, Kazimierz. Nazwiska Polakow.  Wroclaw: Zaklad Narodowy im. Ossolinskich - Wydawnictwo, 1991. Smith, Elsdon C. American Surnames. Baltimore: Genealogical Publishing Company, 1997. Back to Glossary of Surname Meanings Origins

Business ethics. Social enterprise and business and poverty Essay

Business ethics. Social enterprise and business and poverty. Responsible investment - Essay Example This essay describes action of SELCO in her social entrepreneurship responsibility. SELCO has set example in social entrepreneurship both in India and worldwide. The company successfully presented solar electricity for lighting and power to the less privileged persons in the society. SELCO faced several challenges before succeeding in her operations and objectives in helping the poor. It initially grew purposely through gaining of enough capital and experience thus making it to attempt expanding her networks, which greatly interfered with her financial status. The company then increased the price of the solar panels thus causing a serious decline in the sales and the general operations of the company. Investors were not impressed by the decline of the business and forced the company to lay off employees and contract the business in 2000s. In 2008, SELCO acquired finance from the World Bank and International Finance Corporation to streamline the company although the company remained a for profit organization. However, the director of the company was able to obtain new investors who were aligned with the mission of the company thus making the company to keep her sales and service organization intact. The director was also able to boost the morale of the company’s employee who helped it to continue devising innovative solar solutions. The company successfully devised the solar system that could suite specific needs of the needy urban and rural persons. This was indeed a very good way of achieving social entrepreneurship objective of fulfilling the society needs. SELCO was able to design solar panels that exactly met the needs of the society by beginning with a broad needs assessment of specific part or activity of the underprivileged people in the society (Crane and Matten 2010, p. 474-476). The company ensured that they designed solar panels for street vendors, midwives and even the rural farmers who were in dire of the solar panel. The redesigning process involved many different activities that would ensure that the needs of particular markets were met. The company ensured that her operations were client based thus causing it to restructure and redesign her solar panels. SELCO was able to acquire funds from the World Bank and IMF perhaps due to her social objectives. It also gained publication due to her social entrepreneurship objectives. The company also arranged for financial assistance for the rural people who could not afford to buy even the cheap user customized solar panels. This slowed the company’s growth and made it to earn small levels of profit. The company could also not align her social objectives with the investors needs. Responsible Investment Responsible investment is one of the optimistic emerging trends in the financial world that integrates financial goals with positive business values that shapes the society future. Responsible investments vary because some companies may invest in the environmental factor s, employees’ welfare or society effects such as smoking. Responsible investment is a very vital area in doing business since sustainable society is crucial to the company’s values. Although it is important for organizations to reconcile society’s needs and the business objectives, the main problem is linking the economic, social, and environmental advantages with the

Evaluate the implications for the maritime component of the likely Essay

Evaluate the implications for the maritime component of the likely characteristics of future conflict - Essay Example The Cold War was precipitated by the bipolarity that prevailed during the rivalry of the United States and the Soviet Union for influence and power. In studying the causes for these major conflicts, one will see their marked differences. Chester Crocker, Fen Osler Hampson and Pamela Aall have argued that any theories about war must reject that it is constant or at least must be modified to include many variables that explain observed variation.1 In talking about future war, it is, hence, difficult to predict. But history, after numerous wars, and the current military, political and economic trends have equipped us with enough knowledge to understand what will characterize the future conflicts and how they will affect the their components today onwards. The significance of this kind of analysis and discourse is that, as we sufficiently understand the political, economic and social circumstances that lie behind the decisions for violent actions, we are in a better position not just to be ready but also to utilize the knowledge for use in conflict prevention. More importantly, it underscores the reality that war remains primarily a tool of politics in the hands of willful leaders. For this paper, I will explore several variables of future conflict that is affecting and will affect the maritime forces including: the actors in conflict both state and non-state entities; the nature of future war; inter-state warfare; the changing nature of future threat; the changing roles and missions that future conflict may require of maritime forces; the effect of the new roles and responsibilities that are required by future conflict on maritime forces; and, how the asymmetric warfare looks like at sea. The numerous wars that the world has seen have different characteristics in regard to scale, period, casualties, among other characteristics. It varies in form (interstate, intrastate), regional concentration, frequency, intensity, and other

Qing China and the consequences of the golden age Essay Example for Free

Qing China and the consequences of the golden age Essay The â€Å"Prosperous Age† was a period where Qing China experienced a drastic increase in population, flourishing trade and commerce, and a remarkable level of social and political stability during the reign of Emperor Kangxi, Yongzheng and Qianlong. However, its brilliance was overshadowed by its subsequent consequences and China was soon at its breaking point in the 19th century. This essay would then evaluate on the implications of the â€Å"Prosperous Age† and how the long-term consequences proved to be more negative in the 19th century due to a string of crisis, and subsequent problems that continued even in modern China of the 20th century. Negative Unanticipated Long Term Consequences Reversal of Trade Fortunes with Britain During the 18th century, there was mounting European demand for Chinese goods (Hung, 2011). Britain in particular, had strong liking and demand for Chinese goods especially tea. Hence, it led to the outflow of British silver into China, but little inflow of silver back into the British economy resulted in China enjoying a trade surplus (City University HK, 2007) while Britain suffered from a trade deficit. To redress this deficit, Britain began to smuggle and sell opium in China (City University HK, 2007). China’s attempt to prohibit opium then resulted in the Opium Wars and suffered a tragic defeat. The defeat in the Opium War led to the signings of unequal treaties . Upon signing of the unequal treaties, much Chinese marked it as the beginning of a century of shame and humiliation. Although China was never formally colonized, the lack of ability to defend its basic sovereign rights and ability to govern its own country made it look like a like semi-colonized state of Britain. Consequently, the Qing government was seen as weak and inefficient to combat against the foreigners and much Chinese lost faith in the Manchurian Qing government. As a result, this gave rise to the Boxer Rebellion (1899-1901) where violent revolts and attacks were targeted against foreigners as a sign to resist their influence. Boxers, supported by China, suffered a yet another defeat and were forced to sign yet another unequal treaty: Boxer Protocol, where the reparations drastically crippled the Chinese economy till the mid 20th century (Zheng, 2009). Thus, we can see that the initial trade surplus, a sign of â€Å"Prosperous Age† resulted in British to redress the situation by selling opium to the Chinese led to the Opium Wars and the unequal treaties which greatly weakened Qing China internally and externally in the 19th century. China’s failure to counter foreign influence led to their continued defeat in the Boxer Rebellion at the end of 19th century, where another unequal treaty continued to cripple her till mid 20th century , thereby demonstrating the long term consequence of the â€Å"Prosperous Age† was indeed negative in the long run, especially since the consequences did not confine just to the 19th century but even stretched to the 20th century. Reforms did not keep up with population boom During the â€Å"Prosperous Age†, China’s population tripled from less than 150 million to over 400 million (Perkins, 1969). Civil Service Exam however continued its strict quota for passing (Bentley Ziegler, 2003) and that meant a lower ratio of scholar to population passes. The frustration of students led to the rise of influential leaders like Hong Xiuquan who sought for reforms which led to the Taiping Rebellion . Coincidentally, the backbone of his rebels were the poor peasants who were forced out of arable lands and were socially upset and frustrated, which was also due to the consequence of the population boom. The consequence of the Taiping Rebellion led to a weakened Qing as they were forced to decentralize power to provincial elites to deal with the crisis and this power was never fully recovered even after the rebellion was suppressed (Sng, 2011). Provincial elites who did not return the power were a growing sign of defiance and could have the possibility of rising up against the imperial court. The unneeded civil unrest caused by Taiping Rebellion also served to exacerbate subsequent crisis like the Northern Chinese Famine (1876-1879) where the government was severely blamed for not providing sufficient aid. The excess unrest and loss of power proved to be detrimental in the 19th century as it crippled China and the country with no official political bloc stepping up to assist with the problems and crisis. In short, China was in a total disarray and chaotic. Lack of technological advancement Qing China favoured political and social stability over technological innovation which they feared would lead to unsettling changes. Furthermore, the vast population available to firms was a cheaper alternative to increase output, rather than investment of new technologies which was costly (Bentley Ziegler, 2003). This proved to be adverse in the 19th century when China engaged in wars. In the Opium Wars, the Qing military was no match against the British who utilized better technology to triumph (Tanner, 2010). The first defeat resulted in Treaty of Nanjing which ceded Hong Kong to Britain. Subsequent wars like the First Sino-Japanese War (1894-1985) had China suffering a crushing defeat against a more superior and modernized Japanese army. China then ceded Taiwan, Penghu and the Liaodong peninsular to the Japanese. It clearly implied that China could not defend its own sovereign ground and indicated how backward the Chinese army. It questions the right of China to even claim rights over those territories if she could not even defend it properly. The problem gets exemplified into the 20th century when China continued to suffer several defeats to the Japanese in the Second Sino-Japanese War . Even with the Self-Strengthening Movement (1861-1895) which was embraced to modernize China was insufficient. The subsequent defeats to Allied forces in the Boxer Rebellion and Japanese in the Sino-Japanese Wars marred the success of the movement. Especially significant was the defeat in First Sino-Japanese war as for the first time in over 2000 years of history, regional dominance in East Asia shifted from China to Japan (Johnson, 2010). Coupled with the defeat, China’s international and regional standings were challenged and staged subsequent revolutions that led to other problems and the eventual demise of Qing. Positive Long Term Unanticipated Consequences Building a new foundation based on common people The end of Taiping Rebellion inspired nationalists (Del Testa Lemoine Strickland, 2001) to fight for the betterment of Chinese. It was because of the consequence of the â€Å"Prosperous Age† that led to the decisive rise of nationalist to seek for reforms. An example would be the decentralizing of power, which meant many parties would be involved in decision-making process, rather than just the monarch government. This would ensure that concerns are taken into deliberation before decision-making that will benefit majority of the Chinese, rather than the imperial court only. The nationalist dream then culminated in the 1911 Revolution in the early 20th century, where the Qing was overthrown and the Republic of China was established. Nevertheless, the dream of the nationalist was short-lived due to a power struggle within. Even though election was scheduled for 1913, but it soon became clear than Yuan Shikai wanted to establish his own power base. Sun Yat Sen was then forced into exile after he stepped down as head of the newly formed Kuomintang (Foster, 2007). The new government was then monopolized by Yuan and led to decades of political division and warlordism, including monarchy restoration (Blecher, 2010). Therefore we can see that the perceived benefits from the consequence of â€Å"Prosperous Age† in the 19th century did not fully materialize in the 20th century. Monarchy restoration was attempted and defeats the purpose of the promised sharing of power with the people initially. Political and social unrest persisted even with the new government which culminated in the May Fourth Movement (1919). Hence, we can see that China did not become better even with the end of Qing. It would be judgmental to argue that the initial rise of nationalists had resulted in a better China. It would be fairer to argue that the initial rise of nationalists led to more power struggle and dissident movements like the Chinese Warlord Era (1916-1928) as there were no strong political forces to enforce stability and order until the Chinese Communist Party (CCP) came in 1949. Conclusion Hence, we can see that the consequences of the â€Å"Prosperous Age† proved to be more negative. The severity of the negative consequences shed light on the crises in the 19th century which crippled China internally and externally. The impact of the consequences was so overwhelming that it even snowballed to the 20th century and further crippled modern China. In contrast, the perceived positive consequences was that it built the foundation but the problem was that the foundation was weak and unstable which in turn led to more problems which culminated in more movements and revolutions. Furthermore, problems like sovereign issues were not solved by reforms or China’s surge in military strength but rather treaties that returned territories to her under imminent conditions . Thus, we can see that the long term consequences were more negative in the 19th century as it continued the crippling of China economically, socially and militarily and as well as set the stage for the movements and revolutions in the 20th century which did not necessary bring about stability and communal power amongst its people until the CCP came into power in 1949. References Hung, H.F. (2011), Protest with Chinese characteristics: demonstrations, riots, and petitions (p24-26). USA: Columbia University Press Qian Long Emperor’s Letter to George III, 1793, retrieved from Sanders Morillo Nelson Elleberger (2005), Encounters in World History: Sources and Themes from the Global Past, Volume 2 (p289). McGraw-Hill Sng, T.H (2011, Oct 4). Size and Dynastic Decline: The Principal-Agent Problem in Late Imperial China 1700-1850. City University of HK Press (2007), China: Five thousand years of history and civilization (p109). Hong Kong: City University of HK Press Perkins, D.H. (1969). Agricultural development in China, 1369-1968. Chicago: Aldine Bentley Ziegler (2003). Traditions and Encounters (p724-740). New York: McGraw-Hill Tanner, H.M. (2010), China: From the Great Qing Empire through the People’s Republic of China 1644-2009 (p77). USA: Hackett Publishing Company, Inc. Del Testa Lemoine Strickland (2001). Government leaders, military rulers and political activist (p86). Greenwood Publishing Group Foster, S (2007). Adventure Guide China (p18-19). Hunter Publishing, Inc. Blecher, M.J. (2010). China against the tides: restructuring through revolution, radicalism, and reform (p205). Continuum International Publishing Group Johnson, R.E. (2010). A Global Introduction to Baptist Churches (p267). Cambridge University Press Zheng, J.G. (2009). Historical dictionary of modern China 1800-1949 (p32). USA: Scarecrow Press

Dr. Strangelove, by Stanley Kubrick :: Dr. Strangelove Essays

  Ã‚  Ã‚  Ã‚  Ã‚  In Dr. Strangelove, Stanley Kubrick took a serious issue and turned it into a political comedy. He was able to illustrate a satire of the hazardous notion of a nuclear war and the insane individuals who were coordinating it, and furthermore, addressed the issue of stereotyping. This movie was created in 1964; today in 2005, we still have nuclear weapons. Yes, the United States and other countries still have nuclear weapons, however, a question does arise, do we still have insane individuals coordinating war plans and security procedures? If you are expecting to find the answer in this essay, do not continue reading for that reason, the answer will not be found in this essay. The reason being is the answer needs to be realized and determined by every individual, not just me. However, if questioned that in Dr. Strangelove was there an individual who was insane and should he have not been placed in command of a military base, then I would have to answer yes there was such an individual. This individual was General Jack Ripper.   Ã‚  Ã‚  Ã‚  Ã‚  I think that it was not coincidental that Kubrick named this individual Jack Ripper, but purposely did so. The real Jack Ripper was a serial killer. Not only does the name fit with the character in Dr. Strangelove, but also the images and actions often associated with the serial killer. Silent and cruel attacks, nighttime, darkness and dense fog are a few images associated with the serial killer. In the movie General Ripper was in a dark office, he ordered Wing Attack Plan R to bombard the Soviet Union with a nuclear bomb before they could respond, and right before killing himself he was in a cloudy/smoky room. The Wing Attack Plan R is my analysis of the silent and cruel killings. The cloudy/smoky room is the dense fog. And finally the darkness of General Ripper’s office fits with the darkness image. What was the purpose of General Ripper when looking at the movie as a whole?   Ã‚  Ã‚  Ã‚  Ã‚  It is my analysis that Kurbrick was not just showing America the stupidity of nuclear war, but was also showing that the United States government often makes mistakes. One mistake, not just in the movie but in life, is the allocating of power to an individual who is not fit, whether mentally or physically, to have this power. When these individuals are allocated this power their actions can have a worldly consequence.

Most Important Mnemonics for Step 2 Cs

HISTORY & PHYSICAL EXAMINATION HPI (history of present illness) ALL CASES: OPD CSF AAA PAIN: OPD CSF LIQR AAA OPD CSF ABCDO FLUIDS: (Vomiting, Diarrhea, constipation, cough, vaginal discharge) O Onset of the symptom + precipitating factors P Progression D Duration C Constant /Intermittent S Settings F Frequency L Location of the symptom (forehead, wrist†¦ ) I Intensity of the symptom (scale 1-10, 6/10) Q Quality of symptom..BCDSPP(burning,Cramping,dull,Sharp,pulsating,pressure like) R Radiation of the symptom ( to left shoulder and arm) A Associated symptoms ( palpitations, shortness of breath) A Alleviating factors (sitting with my chest on my knees) A Aggravating factors (effort, smoking, large meals) A Amount B Blood C Color C Consistency C Content D Duration O Odor UG Hx: OPD-CSF-AAA + FINISH PUBC F Frequency (How frequent do u have to pass urine? ) I Incontinence (Do u have trouble holding Ux until u get to BR? ) N Nocturia ( do u have 2 wake up @ Night to go to BR? I Incom plete emptying (do u feel fullness even after Ux) S Stream (How is ur flow of urine? is it cont. or is there any dribbling after Ux? ) Strain (Do u have to strain during Ux) Stone (have u passed stones in the past? ) H Hematuria (did u notice any blood), Hesitancy (do u have 2 wait b4 starting Ux) P Pyuria (was there any pus in ur Ux? ) U Urgency (do u have 2 rush to BR to Ux? ) B Burning (dysuria) (does it burn) C COLOR 1 [email  protected] com PMH (past medical history) PAM HUGS FOSS P Previous presence of the symptom (same CC), Past Medical problems (^BP, ^BS,U , idney prob. Rhinitis,Sinusitis, sthma,) A Allergies (drugs, foods, chemicals, dust †¦ ) M Medicines (R U taking any prescription medications/any over-the-counter med. ), H Hospitalization for any illness in the past (Trauma, surgery) U Urinary changes ( esp if diabetic, elderly†¦ ) G Gastrointestinal complains (diet changes, bowel movements†¦ ) S Sleep pattern(difficulties falling/maintain asleep,wake up ,snoring,med. to help sleep, how many hour, nightmares) F Family history (similar chief complaints/serious illness)/ Fevers, Chills/ Fatigue O OB/GYN history (LMP, abortions, para†¦ LMP RTV CS PAP S Sexual habits (active/preferences/STD/no. of partners/contraception/pregnancy/ last pap smear) Q 1. â€Å"Mr. John, Are you Sexually Active? † Q 2. â€Å"How Many Partners are you active with? † Q 3. â€Å"Are your partners male or female or both? † [Unless the SP says wife or husband in Q 2] Q 4. â€Å"Do you use protection during intercourse? † Q 5. If yes in Q. 4 â€Å"What kind of protection do you use? † Q 6. Ask about anal intercourse in male homosexuals Q 7. h/o STD's; Rx for STD's S Social Hx (job/house/smoking/alcohol/recreational drugs/†¦.. ) WAD SAD TOES Social Hx WAD SAD TOESW Weight A Appetite D Diet S Smoke (cigarettes, marijuana, how much, how many years) A Alcohol (what type of alcohol, how often, how much ,consider doing CAGE question. ) D recreational Drugs (what drug, how do you use it, any IV drug use? ) T Travel /Trauma O Occupation (what do you do for living? ) E Exercise S Stress HEADACHE OPD CSF LIQRAA + DIAGRAM Head trauma/Seizure/Weak,Numb Tears / visual changes Flu Vomit/ Speech Neck stiffness 2 [email  protected] com Ped Hx (Child with fever) CUB FEVERS + PAM IF BIG DEALS-T C Colds-runny nose,cough,chest pain, fast respirations,SOB-CRYâ€Å"how is ‘cry of ‘baby? U Urination-increased or decreased urination, # of diapers, any odour, colour of urine Ulcers in mouth B Bowel changes: Diarrhea-frequency, onset, mucus/pus/blood in stool, any crying during defecation Discharge Q’s (ABCD-O: Amount, Blood, Content, Consistency, Color, Constant/Intermittent, Duration, Odor/Onset) F Fever & chills E Ear pulling V Vomiting E Ear/eye discharge, Ear hearing, Eye vision R Rash S Seizure-any jerky movements, which part of body? Any leakage of urine or stool during fits, and postictal irr itability or loss of consciousness. Stress (bet wet, DM) P Past medical/Past surgical Hx / Previous Hospitalizations.A Allergies, effect on child/parents (bet wet, DM), Activities M Medications, Menstruating (female child >10yo) I Ill contacts F family history B Birth Hx I Immunizations G Growth n development, ht, wt, milestones SSC-WTD: S(1), S(6),C(9),W(12),T(15), D(30) smile, sit, crawl, walk, talk, dress wks: 1,6,9,12,15,30 D Day care / Difficult swallowing E Eating habits, feeding of baby A Appetite L Look of the baby or appearance, Last check-up S Sleep T Travel recently Premenopause : H Hot flashes A Atrophy of vagina D Dryness of vagina O Osteoporosis (council) C Coronary artery disease HADOC [email  protected] com ObGyn Hx : LMP RTV CS PAP L LMP (when was ur LMP? ) M Menarchae (how old were u when u had ur 1st period? P Period (how many days ur period last? ) R Reglarity ( R ur periods regular? ) T Tampoons (how many pads do u use in a heavy day? ) V Vaginal DID: discharg e, itching , dryness (have u ever had any vag discharge? ABCDO. do u have any vag. Itching? ) C Cramps (Dysmenorrhea) do u have abd cramp with ur period? S Spotting ( intermenstrual / post coital ) have u ever bled (. ) ur cycles?Did u ever notice any bleeding after intercourse? P Pregnency ( Hx & complications) have u ever been pregnant? How many times? A Abortion/miscarriage (Any miscarriages or abortions? In ? month of ur pregnancy? ) P PAP smear(have u been getting regular PAP sm ? when did u have the last PAP sm ) (any Female>50 yo:ask about:1-R u taking vit D & Ca,2-have u ever tried HRT? ) If suspect abuse SAFE GARDS S Safety inquiry (Do you feel safe at home? ), Sex ever forced? A Alcohol abuse (does your hubby abuses alchol? ), Attacked Children?F Friends/Family who are aware( Dos any1 f ur friend/Fam know of this) Fractures (Abuse ever resulted in fractures? ) E Emergency plan (u have emergency plan? ), Ever tried to leave/divorce? why not? G Guns at home (are there any we apons @ home? Attacked with it? ) A Afraid of husband R Relationships with husband (how is ur relationship with husband? do you feel Threatened when he is around? For how long? D Depression (lost wt/appetite/sleep), Drugs (does husband use recreational drugs) S Suicidal (idea/plan/attempt) (ever felt like ending it all up? ) 4 [email  protected] com Diabetic pt â€Å"FU/Med Refill† D Duration of disease I Insulin regimen/ oral hypoglyemics regimen A A1c hg -> Gluc. monitoring (fast, home, HgA1c) B Blurry vision (retinopathy) E Extremity (foot ulcer/infection T Tingling/numbness (neuropathy) I Infections (resp/urinary) C Cardio Risk Factors (HTN, CHOL, Heart disease) Counseling DM & HTN M Medications (regularity) E Exercise ( for obese/sedentary life styles) D Diet Modification( Salt/Fatty foods) O Opthalmoscopic exams (annual routine) W Weight Management (/control) S Sugar Check upsDIABETIC MEDOWS Neuro cases â€Å"LOC† P Palpitations A Aura â€Å"b4 problem† S Shaking (duration) S Spinning/ lightheaded B Bladder incontinence / Bowel incontinence L Loss of consciousness (duration) T Tongue biting/ tinnitus & hearing loss S Speech difficulties/ Sleep disturbance A Ataxia â€Å"gait† N Numbness/nausea & vomit D Difficulty breathing W Weakness I Injury (trauma) & fall C Confusion after the event / Visual disturbance H Headache PASS BLT SANDWICH -And to make sure you got it completely don't forget the MinMental Stat.Exam 5 [email  protected] com MINI MENTAL O Orientation X3 â€Å" time, place, persons† R Registration â€Å"I’m going to say 3 objects†Ã¢â‚¬ ¦ then repeat A Attention â€Å"spell world backwards† R Recall what were those 3 items again? L Language â€Å"Repeat after me.. â€Å"No, ifs, ands, or buts† 2 Identify two objects â€Å"what is this.. pen.. and this†¦ paper† 3 Obey 3 commands â€Å"take a piece of paper, fold in ? , put on floor† R â€Å"Read 3 commands on this paper and do what it says† W Write a sentence D Draw, copy the image ORARL23RWDForgetfulness/ Memory Loss / Dementia/ Alzheimer’s FORGETS HIM + DEATH SHAFT F FAINTING / Flashes/ FHx of Alzheimer 0 ORTHOSTATIC HYPOTENSION R RUNNING URINE â€Å"INCONTINENCE† G GAIT E EYE[VISION] T TRAUMA, TINGLING S STRENGTH,SEIZURES H HEADACHE I INFECTION [SYPHILIS, MENINGITIS] M MOOD ADL – Activities of daily living D Dressing E Eating A Ambulation (can you find your way thru home) T Toiletry (do you manage your toiletry unassisted) H Hygiene IADL – Instrumental activities of daily living S Shopping H Housekeeping A Accounting F Food prep (do u do your cooking ) T Transportation (do you drive? How is your sight, hearing? 6 [email  protected] com Foot / Heel / Knee / Back pain OPD-CSF-LIQORAAA +WET SURF-D -‘CIS’ W Work /Weakness / Walking habits /Wt loss E Eye infection redness T Trauma to foot /Tingling& Numbness / Tender S Stifness in other join ts/leg Swelling /long Standing hours/morning Stiff/sound U Urethral discharge /ulcer R Rash/ Redness of skin of joint F Fever & chills& night sweat D Deformity / Dysurea IN CASE OF BACK PAIN ADD: CIS; Cancer Hx /IV DRUGS/ Steroids 4 long time Depression: (Psychiatric Hx Checklist) SIGME CAPS DHAT +2 (+MMSE: ORAL23RWD) S Sleep (difficulties falling/maintain asleep, wake up, snoring, med. o help sleep, how many hours, nightmares), Stress, Support I Interest, What do you do in your free time? How are you doing in your job? do you enjoy what you do? G Guilty M Mood. ( anxious, sad, hopeless, lonely? Memory problems E Energy C Concentration A Appetite, changes in your Weight P Psychomotor agitation/retardation (do you feel easily agitated or angry/do u feel not to do anything? ) S Suicide: thoughts, plan, attempts(do u have pills/guns @ home? D Delusions/Drugs H Hallucinations/Hopes A Attitude towards life (positive negative frame of mind) T Thyroid dysfunctions (ABCD HV for HYPOTHYROID) also need to ask : Do u realize that u have problem ? Do u want help? ( if patient was sent or asked by anyone to consult doc ) HYPOTHYROID APPETITE BOWEL-constipation COLD INTOLERANCE DEPRESSION HAIR FALL VOICE-Hoarseness 7 [email  protected] com ABCD HV Hearing loss: P Pain D Discharge F FB I Imbalance N Noise R Ringing S Spinning T Trauma Dx ABD Signs PDF IN RST CKMG MIOR (MIOR assoc. ith Appendicitis) C Cullen $- periumbilical discoloration (Retroperitoneal He,pancreatitis, AAA rupture) K Kehr $ –sever Lt. Shoulder pain- Splenic rupture, ectopic pregnancy M Muphy’s $- Abrupt interruption of inspiration on palp of RUQ- acute cholecystitis G Gray-Turner $, Discoloration of flank (same as Cullen $) M Mc Burney’s $- Tenderness 2/3 from ASIS to Rt of umbilicus I Iliopsoas $, Hyperextention of R hip Cx ABD pain O Obturator $- Internal rotation of flexed R hip Cx ABD pain R Rovsing $- RLQ pain upon palpation of LLQ DDNasuea & Vomiting A Anorexia M Metabolic( DKA )/Meds O Obstruction (pyloric /Intestinal) P Pregnancy I Inflammation( Pyelo/Cholecysto/Appi/Pancreas/PID) N Neurological (BETA)= Bleed/Encephalitis/Tumor/Abscess G Gastroenteritis A MOPING 8 [email  protected] com Cranial Nerves: 2 optic 3 4 6 5 7 Oculomotor Trochlear Abducent Trigeminal -Test visual acuity -Test pupillary reflexes (direct) -Test accommodation reflexes -Assess pupillary reactions to light -Assess corneal reflection -Perform H-test for EOM -Sensory: close eyes,touch face where? Motor: Assess strength of muscles of mastication;bite down and palpate masseter Ask patient to; -smile -wrinkle forehead, -blow out cheeks -close eyes -whisper, -Weber -Rinne tests Assess movements of the soft palate; swallow and palpate neck Assess strength of trapezius & sternocleidomastoid muscles; -shrug shoulders up -move neck to side against resistance Ask patient to protrude tongue (assess for fasciculation, atrophy & Deviations) -stick your tongue up -move it side to side facial 8 V estibulocochlear 10 vagus 11 accessory 12 hypoglossal 9 [email  protected] com – Mr. ? – Good morning Mr. , I am Dr. Khalil, an attending physician in this hospital. SHAKE HANDS First I’ll ask u few Qs. and do brief physical exam. Meanwhile if u have any Qs, feel free to ask me, ok? – Let me make u more comfortable DRAP PT. – I’ll be sitting & writing some notes while we’re talking, is that ok? †¦THANK U. – Please tell me what brought u in today Mr. ? †¦Ã¢â‚¬ ¦.. – I. C. , can u tell me more about †¦Ã¢â‚¬ ¦.. â€Å"c. c. † Mr. I’d like to ask u few Qs. about ur health in the past, is that ok? Mr. now I’d like to ask u few Qs. bout ur habits, is that ok? Now I’d like to ask u few personal Qs. I assure u that all info. Will be kept confed. ok? Now, let me ask u few Qs. about health of your family members, ok? Does any body in ur family have any med. Conditions? Mr. thank u. I am done e history, let me summarize for it, As u mentioned, u have †¦.. Do u have any Qs. for me? Mr. Now I need to examine u. may I proceed? But 1st let me wash my hands. Ok? Mr. Thank u for ur cooperation. I am done e phys. Exam let me give my impression. Based on ur Hx & my PE, it seems that u might have†¦.. ut it could be something else/ †¦or†¦, so to arrive at right D, I ‘ll run some tests & order imaging studies such as †¦.. once I’ve result we’ll meet again discuss various ttt. Options. – Do u have any Qs. for me? SHAKE HANDS & LEAVE ROOM 10 [email  protected] com HISTORY HPI: OB/GYN: LMP†¦, regular periods every†¦.. Weeks ,lasting†¦.. Days. Menarche at age†¦ Uncomplicated NSVD at full term.. Years ago. ROS: negative except as above. Allergies: NKDA Medications: none PMH: PSH: SH: smoke /alcohol / illicit drugs/sex / job /exercise FH: noncontributory PHYSICAL EXAM Patient is in no acute distress OR looks .. anxious,tired, †¦) ( The source of information is the patient’s mother. the mother of a †¦. -month/year-old female/male c/o her child having †¦.. ) VS: WNL (except for temp. Of †¦) HEENT: NC/AT, PERRLA, no conjunctival pallor. No fundoscopic abnormalities. Nose,mouth and pharynx WNL Neck: Supple, No LAD, thyroid normal, no carotid bruits. Chest: no tenderness, clear breath sounds bilaterally. Heart: RRR, normal S1/S2, no murmurs, rubs or gallops Abdomen: soft, non-tender, non-distended, +BS, no guarding, no hepatosplenomegally Extremities: no edema, normal DTR in lower extremities Skin: no rash Neuro:MMSE: AOx3, spells backward, recalls 3 objects, Cranial nerves: 2-12 grossly intact, Motor: strength 5/5 throughout -sensory: intact to soft touch and pinprick, DTR: symmetric 2+ in all extremities (or lower extremities), – Babinski bilateral, Gait: normal, Cerebellar: – Romberg, rapid alternating movement and heel to chin test normal and symm etric 11 [email  protected] com UWShort UWLong 1 16-31-37 2 1-13-1925-35-39 24 25 4-5-1822-24 29 15 28 20 21-40 12 7 43 10 FA Full 19 1-2 38 6 3 FA Mini CASE 23-24 Urine problem Alcoholism 19 Abd pain Heel pain Chest pain 13 8 31 5 6 7 4 6-26 10 38 42 34 11 UL pain 31 Shoulder pain 21 Knee pain 27 32 Back pain 37 Calf pain Vomiting â€Å"adult† 18 Vomiting â€Å"child-TEL† 7-8 33 Fever â€Å"child† 5-28 20-22 Diarrhea Rectal bleeding Constipation 9 Night sweat 21 Hemoptysis 9-10-40 12 Chronic cough 15-16-17 8 Fatigue 15 Wt loss 16 Wt gain 17 dysphagia 18 1 Headache 3 Depression 4 psychosis Anxiety Seizure –new onset Amenorrhea Menopause 25 26 Menstrual problems 26 Vaginal discharge 12 [email  protected] com 12 23 13 30 9 33 14 16 17 18 19 20 21 22 23 12 36 13 27 23 6 2 22 41 30 36 41 3 17 32 34 14 11 39 30 14 15 30 10 5 7 6 27 28 14 8 32 27 29 11 2 [email  protected] com 35 33 26 31 4 29 29 11 25 34 Forgetfulness Frequent falls DM New DM drug refill BA drug refill HTN drug refill HIV drug refill Vaginal bleeding Obesity Spells â€Å"LOC† Terminal cancer Confusion Tremors Pre-employment Domestic violence Sexual assault Insomnia Dizziness Numbness-weakness Jaundice â€Å"adult† Jaundice â€Å"Neonate† Enuresis Palpitations SOB Smoking cessation Hallucinations +ve Pregnancy test Pain with sex MVA Sore throat Difficult swallowing Hearing loss Blurred vision Erectile dysfunction Behavioral problem â€Å"child† Skin rash 3 FA cases GIT Trauma Resp Cardio Ped Neuro Endo Psych Renal ObGyn Pain DM/HTN Jaundice Fever Fatigue 1-2-5-11 3-21-27-31-37-38 4-9-10-41 6-20 7-8-28-30-36-39-40 12-14-18-22-23-29 13-24 15-16-17-34-35 19 25-26-32-33 FA cases 1-2-3-21-38-6-27-37 13-20-36 11-39 7-8 15-16-17 14 [email  protected] com