Theories of Consciousness: History, AI and Animals

Theories of Consciousness: History, AI and Animals Consciousness Andrew P Allen History and Philosophy People can mean various things when they talk about â€Å"consciousness†. At a simple level, one can mean awareness of one’s world or one’s internal drives (e.g. thirst). A more complex form of consciousness is awareness of one’s own awareness, the consciousness that allows people to psychologise about themselves. Approaching the concept from a different angle, â€Å"consciousness† sometimes means the sense of what it is like to be someone or have a particular experience. Although we may have a sense of what an experience is like, it is very difficult to describe exactly what the experience is like (c.f. Ned Block, 1990, for an interesting discussion). A key issue within philosophy of mind is the â€Å"mind-body problem†: can a physical body produce a subjective, apparently non-physical mind, and if so, how? Materialists take the position that the mind is the product of the brain, while dualists hold that body and mind are not the same thing. The position of dualism is typically associated with Rà ©nà © Descartes, who suggested that mind and body are two different types of matter (see http://plato.stanford.edu/entries/dualism/#HisDua for a discussion). In attempting to explain how the brain produces awareness, neuroscientists would tend towards materialism. Regarding brain and consciousness, Place (1956/1990) has drawn an analogy with clouds and the droplets of water that form them. Although a cloud observed at a distance and droplets of water observed close-up seem very different, the many droplets of water nonetheless make up the cloud. So it (perhaps) is with the brain and consciousness; the firing of a neuron may seem very different from a mental image of a new car, but there is no reason to say that this mental image cannot consist of nothing more than the action of many neurons. Daniel Dennett has criticized what he calls the â€Å"Cartesian theatre†; a given place in the brain where sensations, memory traces etc. are combined to form consciousness. There is a danger of positing a neural â€Å"homunculus† (a â€Å"little man† in the head) which observes the various non-conscious parts of the brain and turns them into conscious experience. It does at least seem evasive to propose a single part of the brain is responsible for turning sensations from unconscious information processing to conscious experience without specifying the process whereby such a change occurs. Dennett is setting a high bar for the neural correlate of consciousness (see below); you have to give a full explanation of how the process of consciousness is brought about by the brain without suggesting that some brain area just acts in a conscious way. If we accept that the brain (and the rest of the body?) produces consciousness, then we have to reject dualism (Edelman, 2003), or at least a strong version thereof. Edelman points out that consciousness has a wide range of interesting properties (e.g. it feels unitary, so it seems it requires the binding of multiple sources of sensory information). He suggests that evolutionary pressure would favour cognitive structures which could integrate information from multiple sources. Consciousness in the brain Given that consciousness is stopped when the activity of some regions is stopped, it seems fair to assume that the brain may be responsible for consciousness. However, the question remains: how do these brain regions lead to the conscious experience (Churchland, 2012)? Crick and Koch (1998) highlight some of the key issues. At any time, the brain is doing a lot of things, but only some of these things appear in our consciousness. Is there anything special about the neurons involved in consciousness and their type of firing? What about the connections between them? There has been some interest in finding a so-called neural correlate of consciousness. Edelman (2003) takes the approach of looking at connections. He posits â€Å"re-entry† as a process which could account for how functionally distinct parts of the brain co-ordinate their activities to produce a combined output. It involves recursive signalling over multiple pathways which are used simultaneously. He suggests that this process allows for the binding of outputs from different brain areas to form an integrated sense of experience. Edelman suggests the thalamocortical system as â€Å"a dynamic core† for consciousness. The thalamic intralaminar nuclei (ILN) may play a particularly important role in consciousness; it projects axons widely to all cortical areas, and small lesions to the ILN are associated with significant loss of awareness (Bogen, 1997). Note that the ILN may be necessary but not sufficient for consciousness; it is through its interaction with corticol regions that it could produce something like consciousness. The thalamocortical system conta ins functionally distinct sub-parts which may act semi-independently, while also being able to integrate information between themselves. By suggesting that consciousness could be brought about by brain processes and their interaction, Edelman’s idea may avoid falling into the trap of the Cartesian theatre. Attention and consciousness At first, it might seem like attention and consciousness might be the same thing; when we attend to something, we are conscious of it, and when we are conscious of something, we are attending to it, right? However, it has been argued that you can have either consciousness or attention without having the other (Koch and Tsuchiya, 2007). They cite work which uses interocular suppression (i.e. presenting different images to each eye in order to reduce perception of some/all of these images) to present both a nude image and a meaningless scramble of its pixels, while simultaneously rendering the nude image invisible to consciousness. Nonetheless, heterosexual participants attend to nude images of the opposite sex more than scrambled control images (Jiang et al., 2006). Hence, attention without consciousness! Another example of attention without consciousness is blindsight, where patients with damage to the primary visual cortex can report properties of visual stimuli above chance level, but without awareness of having seen anything (Weiskrantz, 1997). Subliminal presentation of stimuli can be processed by brain areas associated with emotional processing, such as the amygdala (Naccache et al., 2005). I’m less convinced by Koch and Tsuchiya’s argument that one can have consciousness without attention. Their argument seems to be based on limiting their point to top-down attention processes. For example, they suggest that one can make out the gist of an image after a very brief presentation. Of course, there may be little top-down processing going on here, and 30 ms may be too short a time to talk about â€Å"sustained attention†, but after all, one has to orient to the image in order to perceive it. Perhaps you may see it otherwise Are non-humans conscious? Trying to define consciousness at a brain level may be even more difficult when it comes to non-human animals. This question is also important for the ethical consideration of neuroscientists who work with animals. If one is to work with a particular species, one should at least try to be aware of its capacity for suffering. Panksepp (2005) argues that affect is largely produced by processes concentrated in subcortical, limbic regions in the mammalian brain. He defines consciousness as brain states which are associated with feeling or experience. He distinguishes raw, primary-process consciousness from secondary consciousness, which can relate to how external events relate to internal states, and tertiary consciousness, which is basically meta-cognition. Panksepp attacks what he seems to perceive as a wilful ignorance of the affective experience by neuroscientists working with animals, and criticises those who suppose that all consciousness is dependent upon the advanced linguistic and reasoning skills possessed by humans. However, the fact is acknowledged that outward behaviour may give a misleading impression of internal affective states. Nonetheless, he defends an internal affective life in animals, citing evidence of differing vocalisations of rats in response to environments associated with pleasurable/unpleasant drugs (Burgdorf, Knutson, Panksepp, Ikemoto, 2001a, 2001b), as well as neural mechanisms underlying desire for certain drugs which are similar to those in humans. Given similar subcortical machinery in other mammalian life, such research may give insight into the affective life of humans. However, studying consciousness in animals can be tricky; although anaesthesia is often used in certain techniques, if one wishes to study consciousness then any form of anaesthesia or sedation may bias results (Crick Koch, 1998). The work of Gallup (1970) used a simple behavioural test to examine self-awareness in chimpanzees. A mirror was inserted in their environment. Although the animals initially responded socially to it, they began to groom in response to it. When they were marked with a red dot in their sleep they used the mirror to try to clean the dot off. However, this level of performance was not evident in other primates. However, the so-called â€Å"hard problem of consciousness† (what is it really like?) may be insoluble. Thomas Nagel (1974) famously used animal life as an illustration of how difficult it is to grasp qualia (i.e. the subjective feeling of what something is like) by asking the question â€Å"what is like to be a bat?† Aside from bringing up again the issue of knowing others’ minds, the comparison here is stronger because it shifts from trying to second-guess the thoughts of fellow humans to trying to imagine the thoughts and feelings of a strange species. The implication is that, even if we were to understand all the neural processes tied up with the bat’s nervous system which bring about consciousness, we would still not be able to fully imagine what it is like to be a bat. Artificial intelligence and models of altered consciousness Although a large proportion of neuroscience involves backwards engineering of the brain (i.e. taking something which has already been engineered by evolution and trying to tease apart its structure and function), artificial intelligence, by engineering intelligent systems, can also be used to observe if a particular account of how the brain works actually produces a comparable output when you run it through a computer program (if the program doesn’t produce the same output as the â€Å"natural† brain, this may pose a problem for your theory, or vice versa). (Note this process of back-propagation is somewhat reminiscent of Edelman’s idea of re-entry). Takeno has found that the robot can distinguish between its own image in a mirror from either a second robot or another robot which follows the test robot’s instructions. The robot is equipped with LED lights allowing it to demonstrate distinct responses to its own mirrored behavior compared to that of another robot, including another robot engaging in the same behaviour (Takiguchi, Mizunaga, Takeno, 2013). See the following brief video: https://www.youtube.com/watch?v=TK0M02aKXLE A neural network was used to model how the excessive loss of synapses during adolescence could lead to auditory hallucinations reported in schizophrenia (Hoffman McGlashen, 1997). Pruning was carried out in a â€Å"Darwinian† fashion by removing neural units which were less well-connected to other units, in addition to modelling cell death which could be associated with excessive loss of neurons. Excessive loss of neural units produced a model of hallucination whereby words were coming up as perceived at the output layer of the network even when words were not being entered at the input layer. Although the authors admit that such models are vastly simplified models of the real thing, by reproducing (modeled) phenomena visible in the world (in this case, auditory hallucinations), they allow one to study such phenomena by testing if the mechanisms one hypothesizes explain such phenomena (in this case, excessive loss of neurons involved in working memory) actually produce the ph enomenon under investigation. Interestingly, the neurons pruned were modeled on corticocortical connections rather than thalamocortical connections (the type suggested by Edelman to play a key role in producing conscious experience itself). Consciousness: a clinical case A vegetative state is where a patient shows no overt signs of awareness, even though they are visibly awake. However, the idea that people in a persistent vegetative state lack consciousness has been challenged by recent research. Patients in a minimally conscious state or persistent vegetative state have been instructed to perform mental imagery tasks while undergoing fMRI (Monti et al., 2010). The tasks used are associated with activity in the parahippocampal gyrus and the supplementary motor area; areas which are associated with actually carrying out the activity. A minority of the participants showed activity in response to the tasks similar to healthy controls. However, bearing in mind that information can be processed without conscious awareness (as alluded to in the discussion of attention and consciousness), is it possible that this brain activity may have emerged automatically, without the patients having any conscious awareness of the scene described to them by the research ers? Such an interpretation is challenged by the following finding: a number of healthy controls and 1 patient were asked questions, and instructed to think of one mental image if the answer was â€Å"yes† and a different mental image if the answer was â€Å"no†. The patient showed signs of being able to complete this task. The fact that the participants could control what was imagined suggests that they may have been aware of their own awareness. Adrian Owen talks about these issues at the following link: http://tedxtalks.ted.com/video/TEDxUWO-Adrian-Owen-The-Quest-f Embodiment The idea that the brain is, or at least is very much like, a computer is quite popular. Indeed, computers themselves have increasingly sophisticated artificial intelligence. Of course, a lot of the information we process is not purely symbolic for us; it is viscerally linked to our bodily states and physiological drives, and thus embodied. Returning to the question of what it is like to be a bat, we can consider the brain of this animal and how it works, but even if we could understand all brain functions of the bat, there would still be other differences between our species. For example, bats have wings which they can use to fly. What is it really like at a subjective level to do this? If we were to both given the chance to experience this kind of flight, your answer to this question could be completely different from mine, and yet perhaps we would both be right about our own experience. References Block, N. (1990). Inverted Earth. Philosophical Perspectives, 4, 53-79. Bogen, J.E. (1997). Some neurophysiologic aspects of consciousness. Seminars in Neurology, 17(2), 95-103. Burgdorf, J., Knutson, B., Panksepp, J., Ikemoto, S. (2001a). Nucleus accumbens amphetamine microinjections unconditionally elicit 50 kHz ultrasonic vocalizations in rats. Behavioral Neuroscience, 115, 940–944. Burgdorf, J., Knutson, B., Panksepp, J., Shippenberg, T. (2001b). Evaluation of rat ultrasonic vocalizations as predictors of the conditioned aversive eà ¯Ã‚ ¬Ã¢â€š ¬ects of drugs. Psychopharmacology, 155, 35–42. Churchland, P.M., (2012). Consciousness, in: Gregory, R.L. (Ed.), The Oxford companion to the mind. Oxford University Press, Oxford, UK. Crich, F., Koch, C. (1998). Consciousness and neuroscience. Cerebral Cortex, 8, 97-107. Edelman, G. (2003). Naturalizing consciousness: A theoretical framework. PNAS, 100(9), 5520-5524. Gallup, G. 91970). Chimpanzees: Self-recognition. Science, 167(3914), 85-87. Hoffman, R.E., McGlashen, T.H. (1997). Synaptic elimination, neurodevelopment, and the mechanism of hallucinated â€Å"voices† in schizophrenia. American Journal of Psychiatry, 154, 1683-1689. Jiang, Y., Costello, P., Fang, F., Huang, M., He, S., (2006). A gender- and sexual orientation-dependent spatial attentional effect of invisible images. Proceedings of the National Academy of Sciences 103, 17048-17052. Koch, C., Tsuchiya, N., (2007). Attention and consciousness: two distinct brain processes. Trends in cognitive sciences 11, 16-22. Monti, M.M., Vanhaudenhuyse, A., Coleman, M.R., Boly, M., Pickard, J.D., Tshibanda, L., Owen, A.M., Laureys, S., (2010). Willful modulation of brain activity in disorders of consciousness. New England Journal of Medicine 362, 579-589. Naccache, L., Gaillard, R., Adam, C., Hasboun, D., Clà ©menceau, S., Baulac, M., Dehaene, S., Cohen, L., (2005). A direct intracranial record of emotions evoked by subliminal words. Proceedings of the National Academy of Sciences of the United States of America 102, 7713-7717. Nagel, T. (1974). What is it like to be a bat? Philosophical Review, 83, 435-450. Panksepp, J. (2005). Affective consciousness: core emotional feelings in animals and humans. Consciousness and cognition. Place, U.T., (1956/1990). Is consciousness a brain process?, in: Lycan, W.G. (Ed.), Mind and cognition: An anthology. Blackwell, Malden, Massachusetts, pp. 14-19. Takiguchi, T., Mizunaga, A., Takeno, J. (2013). A study of self-awareness in robots. International Journal of Machine Consciousness, 5, 142. Weiskrantz, L. (1997). Consciousness lost and found. Oxford: Oxford University Press. Database Migration and Architecture: Bee Colony Optimization Database Migration and Architecture: Bee Colony Optimization Abstract: It is compulsory for two servers to be compatible if you have to either import or export the data. All the servers have unique protocol service through which they communicate. It is not possible for a server to directly transmit or receive the data from any other server. A live example is the developed codes at different platforms like JAVA, Visual Studio and others. This task becomes more sophisticated when it comes to communication of data along with its architecture. This paper focused their work in migrating the data from one server to another with the use of XAML protocol in which three servers have been included to migrate the data. The first server is the server from where the data has to be migrated, the second server is the server where data is fetched to be migrated and the third server is the server where data has to be migrated. The entire work has been performed using Development tool visual studio 2010 with data base connectivity with SQL SERVER 05. In this pa per we are proposing a technique for migration of the platform architecture along with the data with perfect accuracy to another cloud platform using Simple Bee Colony Optimization (BCO) concept will take a lot of effort due to the sophisticated architecture of a system protocol. This may lead to a new era in the cloud computing. Keywords: BCO, Data Migration, XAML, SQL SERVER 05. INTRODUCTION: Cloud computing is an Internet based computing technology, where the word ‘cloud’ means Internet and ‘computing’ refers to services that can accessed directly over the internet. Cloud provider maintains the cloud data server or cluster that is collection of computer to provide computing services on a large scale. For providing both software services as well as management services this scale can be used. Any device like PCs’, tablets, smartphones, etc. personal can provide access to cloud computing services, as these devices can connect to the internet. This is because the technology infrastructure of cloud computing is not based on consumer premises. Cloud computing comes in various forms, shapes, and sizes as there is variety of cloud formations [1]. Cloud Computing can be also described as type of application and platform. Platform means to supply the servers or machines; machine can be virtual or physical. Machines can be configure and reconfigure. Type of application depends on the demand of its user, various resources are available over the internet through cloud computing. Resources come in forms – hardware and software resources can be used in scalable and flexible manner. Also the costs can be reduced. There are mainly three aspects of cloud computing: Iaas (Infrastructure as a Service) – number crunching, data storage and management services (computer servers). SaaS (Software as a Service) – ‘web based’ applications (like Gmail). PaaS (Platform as a Service) – essentially an operating system in the cloud like Google AppEngine [2]. Data migration the term ‘migration’ is the process of moving from one location to another. In the process of Data migration, the data is transferred between various computer systems, storage types, or formats. To achieve an automated migration, data migration is usually performed programmatically. To give an efficient data migration method, data is mapped to the new system from the previous old system providing a design by data loading and data extraction. Programmatic data migration consists of many steps but it mostly includes data extraction in which the data from the old system writes to the current system [3]. In migration, to improve the quality of data, eliminate the redundancy or invalid information, manual and automated data cleaning is mostly done. Before deploying to the new system, various migration steps like designing, extraction, loading, cleaning and verification are mostly repeated for many applications whether of high or moderate complexity. Four major types of data migration: Application migration Database migration Storage migration Business process migration BEE COLONY OPTIMIZATION (BCO): The bee colony optimization (BCO) has been recently introduced as new approach in the field of Swarm Intelligence. There is a colony of honey bees that can extend their selves over the long distances. To exploit large number of food bees extend itself in multiple directions at the same time. The artificial bees represent the agents, which collectively solves complex problems. The algorithm BCO is inspired by the original behavior of the bees’ in nature. By creating colony of artificial bees, BCO can successfully used to solve complex problems. The behavior of the artificial bees is partially similar to the behavior of bees’ in nature and partially dissimilar to the behavior of bees’ in nature. The BCO algorithm is basically, based on population. The population of the artificial bees searches for the valid solution in the population. An artificial bee solves complex problems and described as agents. One solution is generated to the every problem by the artificial bees [4]. Bee colony optimization consists of two phases: A) Forward pass: In forward pass, search space is explored by every artificial bee, also obtains a new solution and improves the solution and then bees’ again go back to the nest. B) Backward pass: After bees’ go back to the nest they shared the solutions of various information. RELATED WORK Consiglio Nazionale delle Ricerche et.al (2012) explain the working over the cloud platforms for the last few decades. According to him the general migration issue raises when your data is not secure at the one platform. Now the issue comes that whether we can transfer the data with the architecture from one end to another. He proposed that if we can use the TCP/IP technique to find out at which server the data is going to be migrated and if we can configure it to the server from where the data has to be migrated can make a difference into the migration but he did not talk about how an existing architecture allows the second server to be configured into itself [5]. Diva Agawam talks about the server compatibility, according to them as a basic network the PC equipments had been over, with the popularization of technology of embedded system and the internet. Traditional Ethernet fields are infiltrated from embedded equipments . Besides PC, there are several embedded equipments as nodes present. User can easily refer the correlative information if he has the web server accessing permission. The administrator can easily manage and validate the equipments but accessing it over IP, is a great challenge [6]. R.SUCHITRA said that in cloud environment, there is necessity of Server consolidation of virtual machines for cost cutting and energy conservation. With live migration server consolidation can be achieved of virtual machines. For Server Consolidation, we propose a been packing algorithm which is modified to reduce the instantiation of new servers and to avoid the migrations that are not necessary. The algorithm is simulated using multiple test cases and using java. For live migration of virtual machines, ideas are taken from the decreasing strategy of First Fit algorithm [7]. Jayson Tom Hilter talks about the SOAP proto calling in his words. SOAP is a messaging framework, based on XML. Over the internet for exchanging formatted data, SOAP is specially designed. It can be understand with the example of sending the complete documents and using reply and request messages or. It is not affected with the different operating system, programming languages, or platform of distributed computing. A more efficient way was needed to explain the messages and how these messages are communicated. The WSDL (Web Services Description Language) is a specific form of an XML Schema, implemented by Microsoft and IBM for defining the XML message, its operation, and its protocol mapping of a web service used during SOAP or other XML protocol [8]. Qura-Tul-Ain Khan, Said Nasser â€Å"talks that cloud computing is a computing platform which is present in large data center. To deliver cloud computing resources various problems occurs like privacy issues, security, and access, regulations, reliability, electricity and other issues. In every field cloud computing is able to address the servers to fulfill their wide range of needs [9]. RESULTS The proposed architecture migration system has been implemented using VSUAL STUDIO 2010. The performance of various database migration and architecture migration system is analyzed and discussed. Two servers minimum are involved in the data migration. To migrate the architecture system by using XAML language pattern avoiding the time delay of the data migration and ensuring the security analysis of the data getting migrated. The purpose of this work is justified when the data along with the architecture is migrated to another platform. To attain the goal, a mid level XAML architecture would be drawn which would show the compatibility with both the server. In the process, the middle server would first analyze the architecture of the first server from where the data has to be migrated and would generate the XAML for it. As XAML is one of the most light weight language and it is supported by all other platforms also, it would be easier for the second server to adapt the language. The mi ddle server would do amendments in the local XAML according to the architecture which has to be migrated to the next sever. Once the second XAML is generated, it would use the TCP IP protocol service along with the SQL Query injector to transfer the XAML from one end to another and would migrate the architecture completely. The successful migration of the architecture is examined by various parameters. Three parameters are used: Accuracy Reliability Error rate Accuracy: Accuracy is the proximity of measurement results. Here we describe the accuracy in terms of percentage. Percentage ranges from 0-100. Here we attain the highest accuracy that means data is migrated successfully [10]. (1) where, TN is the number of true negative cases FP is the number of false positive cases FN is the number of false negative cases TP is the number of true positive cases Fig.(a) Accuracy graph As shown in the above graph, maximum accuracy is attained i.e, 95% and more than this. In this proposed model for migration accuracy achieves best results. Reliability: Reliability is the ability of a component or a system to perform the tasks successfully for a given time under provided conditions. It is the Consistency and validity of test results determined through statistical methods after repeated trials without degradation or failure [11]. (2) Where, R(t) = reliability e = exponential (2.178) ÊÅ ½ = failure time m = mtbf (mean time between failures) t = time Fig. (b) Reliability graph As shown in above graph, maximum accuracy is attained i.e, 93% and more than this. In this proposed model for migration reliability achieves best results. Error Rate: An Error rate is a deviation from accuracy or correctness. A mistake is an error caused by a fault: the fault being misjudgment, carelessness, or forgetfulness [12]. (3) where, , (energy per bit to noise power spectral density ratio) or, Es/ (energy per modulation symbol to noise density). Fig.(c) Error Rate graph As shown in above graph, minimum error rate is attained i.e, 5%. In this proposed model for migration error rate is very less. As mentioned above the three parameters are evaluated from the proposed work. Accuracy, Reliability and Error rate, all three parameters achieves best results. Table I: Accuracy, Reliability and error rate values (in %) calculated from different data’s schemas that are migrated. Fig. (d) Graph represents above table values per number of time execution The above figure has two axis x-axis represents the number of time the execution takes place and y-axis represents the percentage of all three parameters. CONCLUSION This research has a great scope in reducing the load over the server to provide the optimized result. In this work done till now, it successfully migrates the generated architecture and its data to another server. Here proposed a new approach based on Bee Colony Optimization (BCO) technique and Go Daddy server. The transfer accuracy is almost 90-95 percent. For successful migration XAML is used, as XAML is one of the most light weight language and it is supported by all other platforms also, it would be easier for the second server to adapt the language. Error rate is very less, so the proposed approach works well in migration. In future, this approach can be applied to the system with more than two servers in the migration. The current system does not evaluate any computation time for the evaluation that how much time has been elapsed in the transfer. So in future time elapsed in transferring the data taken into consideration. Also, the transfer of the data is limited i.e. in the generation of the architecture system; you cannot generate more than a fixed number of columns. Reactive Arthritis: Causes, Features and Treatments Reactive Arthritis: Causes, Features and Treatments Reactive arthritis Minor changes. References reduced. 64.58 Reactive Arthritis Ramesh M Bhat M and Rochelle C Monteiro Introduction Reactive arthritis (ReA) is defined as an episode of peripheral arthritis of more than one 1-month duration occurring in association with conjunctivitis and urethritis and/or cervicitis. It is triggered by an infection, most often in the gastrointestinal or urogenital tract. It is also known as Reiter’s syndrome, Feissinger– Leroy’s disease, Brodie’s syndrome and conjunctivo-urethro-synovial syndrome. The term ReA Reactive arthritis was originally introduced to define a sterile joint inflammation during and after an infection elsewhere in the body. The definition was later modified since nucleic acids and bacterial antigens were found in the inflamed joints. ² Etiology  Aetiology Reactive arthritis (ReA) follows an infection in the urogenital tract (venereal form) or gastrointestinal tract (dysenteric form). The venereal form follows recent sexual contact, whereas the dysentricdysenteric form is associated with a wide variety of intestinal pathogens and non-specific diarrhoeal illnesses. The most common organisms implicated are as follows: Post Post-dysenteric form: Salmonella (different serotypes), Yersinia tuberculosis, Shigella flexneri, Shigella S. sonnei, and Campylobacter jejuni. These organisms are found to be HLA HLAB27– dependent. Hence, Individuals individuals with HLA-B27 positivity are strongly predisposed to develop the disease. Post Post-venereal form: Chlamydia trachomatis. Some newer organisms have been implicated recently in causation of reactive arthritisReA, namely Chlamydia C. pneumonia, Mycoplasma hominis, Mycoplasma M. fermentans, Neisseria Gonorrhoeagonorrhoeae, Borrelia burgdorferi, Clostridium difficile, ÃŽ ²-haemolytic streptococci, Propionibacterium acnes, EscherischiaEscherichia coli, Helicobacter pylori, Calmette CalmetteGuerin bacillus, Brucella abortus, Leptospira , Bartonella, Tropheyreyma whippeli, Gardnerella vaginalis, Giardia lamblia. ³ Drugs are generally not implicated in the aetiology of reactive arthritisReA;, however, a single case of Lithium lithium precipitating pre-existing ReA1: Kindly check for clarity>aOKctive arthritis has been described.à ¢Ã‚ Ã‚ ´ Pathobiology The prevalence of ReAactive arthritis is estimated to be 0.1% worldwide. The disease mainly affects people in the 2nd 4thsecond to fourth decade of life. The Infection infection occurs 1–4 weeks following genitourinary infection, with a male–female ratio of 9:1. The Enteric enteric type has an equal incidence in both males and females.à ¢Ã‚ Ã‚ ¶ Systemic Featuresfeatures The disease primarily affects the joints, eyesà ¢Ã‚ Ã‚ ·, the skin and genitalia. Rarely, patients present with cardiac, renal, and neural abnormalities. Arthritis Articular manifestations are most commonly of an acute, non-destructive oligoarthritis usually affecting the large joints of the lower limbs which persists for 4–5 months. ‘Sausage digit’ or diffuse swelling of an entire toe/finger occurs in 16% of patients. Enthesitis is another characteristic feature of patients with ReA. It is defined as an inflammation of the ligaments and tendons at their site of insertion into the bone. Patients may also develop heel pain and achilles Achilles tendonitis. Sacroiliitis is another distinctive feature of the disease which results in a low back pain.8-10 Urethritis ReAactive arthritis usually follows 1–3 weeks after an episode of urethritis. Urethritis may occur even in post postdysenteric cases. The non nonspecific urethritis presents with mild non-purulent urethral discharge. Haemorrhagic cystitis and prostatitis may develop in a few patients. In females, it manifests as cervicitis associated with cervical discharge. Rarely, bleeding and abdominal pain may occur.à ¢Ã‚ Ã‚ µ Mucocutaneous lesions Keratoderma blennorrhagica or Pustulosis pustulosis palmoplantaris is a specific cutaneous lesion in ReA. Patients present with pustules over the palms and soles which are gradually covered with thick horny crusts. Lesions may coalesce. Psoriasiform lesions are also common (Fig. 58.1). The biopsy of of skin lesions with acanthosis and epidermal neutrophilia (Fig. 58.2) Circinate balanitis is a painless geographic dermatitis occurring over the glans penis (Fig. 58.31). In addition, small, shallow ulcers are seen over the glans and urethral meatus and also over the oral cavity. Nail changes are a common finding and include subungual hyperkeratosis, onycholysis, ridging and nail shedding.10,11 Visceral lesions Visceral involvements mainly include the cardiac, renal and neural systems. Cardiovascular manifestations present as conduction delays and aortic disease. Proteinuria, microhaematuria, aseptic pyuria, and rarely, glomerulonephritis occur when the renal system is involved. Transient neurologic dysfunction such as cranial or peripheral nerve palsies have been described in some patients.10 The disease is usually self selflimiting. The joint manifestations regress completely within a few months (3–5 months). Enthesopathy, balanitis and psoriatic lesions may persist even after joint inflammation has subsided. Recurrences are common. Some patients develop chronic polyarthritis, usually HLA HLAB27– positive individuals.12 Ocular Featuresfeatures Bilateral mucopurulent conjunctivitis is the most common ocular manifestation of ReA that occurs in more than 50% of patients. It is one of the important components of the triad of the disease. Occasionally, the conjunctivitis may be purulent but remains transient, mild and associated with a sterile discharge. It subsides within 1–4 weeks. Acute anterior uveititsuveitis may be found in about one-fifth of cases, especially in those who are positive for HLA-B27.7 Other ocular complications of ReA include keratitis, corneal ulcer with or without hypopyon, episcleritis, scleritis, papilloedema, retinal oedema, retinal vasculitis and retrobulbar neuritis. ¹Ã‚ ³ Vision is usually impaired from corneal scar or recurrent chronic uveitis causing secondary glaucoma, complicated cataract or cystoids macular oedema. ¹Ãƒ ¢Ã‚ Ã‚ ´ Diagnosis Laboratory findings in ReA are non-specific and do not usually provide a conclusive diagnosis regarding the aetiology. Prognosis Individuals who are HLA HLAB27– positive have a more severe disease form. Male gender and a positive family history for spondyloarthropathies, ankylosing spondylitis and recurrent episodes of arthritis are indicators of a bad prognosis.9 Treatment Patient education has plays a major role in patients with ReAactive arthritis. The chronic relapsing nature of the disease should be explained to the patients for better compliance with therapeutic modalities. Conjunctivitis is usually self-limiting. A slit slitlamp examination is necessary to rule out uveitis, which if present has to be managed with topical corticosteroids, cycloplaegics and mydriatics. Keratoderma blenorrhagicablennorrhagica is treated using topical steroids and keratolytics. Low potency topical steroids are used in circinate balanitis.10 Non Nonsteroidal anti antiinflammatory drugs (NSAID’s) are highly effective in pain management in patients with ReAactive arthritis. Intra Intraarticular steroids are advocated in oligo/monoarticular disease. The use of systemic steroids has been discouraged except in severe cases where short courses may be given.15 Antibiotics are useful in the post postvenereal form of ReAactive arthritis. Their role in the post postdysenteric form remains controversial. Commonly used antibiotics include erythromycin, ciprofloxacin, tetracycline and doxycycline.11 In patients who fail to respond to the above mentioned conventional therapy, a more aggressive therapeutic approach is needed. This includes Disease disease modifying anti antirheumatic drugs (DMARD’s). References 1. Fisk PK. Reiter’s disease. British Med J 1982; 284:3. 132. Kingsley G, Sieper J. Third international International workshop Workshop on Reactive arthritis Arthritis, 23–-26 September, 1995, Berlin : An overview. Ann Rheum Dis 55:564–570. 143. Kiss S, LetkoE, Qamruddin S, et al, Long-term progression, prognosis and treatment of patients with recurrent ocular manifestations of Reiter’s syndrome. Ophthalmology 2003;110::1764–1769. 154. Schumacher HR Jr., Reactive arthritis. Rheum Dis Clin North Am 1998; 24:261–-273. Early Years Care and Education: History and Policies Early Years Care and Education: History and Policies This essay explores the range of early year settings that are involved in the care and education of young children, and discuss the roles and responsibilities of the professionals who work at these settings. Two critical incidents will be focused upon with the use of a Personal Reflection Diary, which has been taken throughout Practical Placements. The diary will emphasize the roles and responsibilities of the professionals that are key within the setting. The essay will also evaluate the curricula appropriate to the setting that were visited during placement and compare it to another practice setting. The essay will finish with a personal statement defining what has been learnt from the experiences. First, the history of care and education of young children will be reflected upon. Next, there will be a discussion on social care and health care legislation which is affiliated to the support of childrens health and safety (historical to present day). A Reflective Account will follow, which will consider two incidents which identifies the roles of the professionals who work in various settings. Subsequently, the author will define the importance of reflective practice. Finally, conclusions will be drawn as to whether the objectives have been met. History of care and education- Education sector first started and when did children become important? Pre 1870 there was no organised system of education. Instead children were sent out to work to earn money for their families. Some children attended schools run by charities and churches or Dame schools run by women for young children. There were fee paying schools for those rich enough to afford them or the wealthier children were taught at home by governesses. In the social legislation of this period education did not become a real priority until the year of the first Education Act, 1870. The 1870 Education Act also known as the Forster Act, that we have the real birth of the modern system of education in England. This not only gave rise to a national system of state education but also assured the existence of a dual system voluntary denominational schools and nondenominational state schools. The act required the establishment of elementary schools nationwide. These were not to replace or duplicate what already existed but supplement those already run by the churches, private individuals and guilds. Elementary education became effectively free with the passing of the 1891 Education Act. The1870 Forster Education Act set up mass primary education (education for everyone). It was introduced because the government was worried that the working class was becoming revolutionary and also because it was thought that Britains economy was falling behind the rest of the world. The education received therefore a strong emphasis on obedience to authority. The Victorians soon realised the importance to read and write. Passage of the Education Act of 1870 was an important event because the act established compulsory elementary schools for all children from the age of 5. All children had to attend school until they were 10 years old. Education Legislation (historical to present day). By 1880 many new schools had been set up by the boards. This made it possible for the 1880 Education Act to make school attendance compulsory for all children up to the age of ten. The school boards were abolished under the 1902 Education Act. In their place Local Educational Authorities (LEAs) were created to organize funding, employ teachers and allocate school places. Under the 1918 Education Act school became obligatory for all children up to the age of 14. The Act was conceived by the liberal MP Herbert Fisher (1865-1940). Other features of the Act included the provision of additional services in schools, such as medical inspections, nurseries and provision for pupils with special needs. During the 1920s and 1930s Sir Henry Hadow (1859-1937) chaired a consultative committee that was responsible for several important reports on education in England. In 1926, a report entitled The Education of the Adolescent looked at primary education in detail for the first time. It prioritized activity and experience, rather than rote learning and discussed, for the first time, the specific needs of children with learning difficulties. The report also made the important recommendation of limiting class sizes to a maximum of thirty children. In 1931, another report was published: The Primary School was influenced by the educational ideas of Swiss psychologist, Jean Piaget and advocated a style of teaching based on childrens interests. The 1944 Education Act saw the introduction of the tripartite system. Devised by Conservative MP Rab Butler (1902-1982), the Act introduced three different types of school: Grammar schools for the more academic pupil, Secondary Modern schools for a more practical, non-academic style of education and Technical schools for specialist practical education. Pupils were allocated to a particular type of school by taking an examination called the 11- Plus, which was also introduced under the Act. Secondary education now became free for all and the school-leaving age rose to 15. Comprehensive schooling was recommended in a document issued by the Labor Government in 1965 called the Circular 10/65. The system was developed in contrast to the tripartite system and was instead intended to suit pupils of all abilities. The Plowden Report is the unofficial name for the 1967 report of the Central Advisory Council for Education (England) into Primary Education. The report was called Children and their Primary Schools and was named after the chair of the Council, Lady Bridget Plowden (1910-2000). It observed that new skills were needed in society, stating that, the qualities needed in a modern economy extend far beyond skills such as accurate spelling and arithmetic. They include greater curiosity and adaptability, a high level of aspiration, and others which are difficult to measure. (The Plowden Report: Children and their Primary Schools, London: Her Majestys Stationery Office, 1967.) The Education Act 1973 stated that schools leaving age was raised to 16. The National Curriculum was introduced in the 1988 Education Act. It made all education the same for state-funded schools, ensuring that all pupils had access to a basic level of education. A selection of subjects was made compulsory including maths, English, science and some form of religious education. It also introduced sex education for the first time. Pupils were divided into Key Stages, depending on their age, Key Stage 1 for pupils aged 5-7, Key Stage 2 for pupils aged 7-11, Key Stage 3 for pupils aged 11-14 and Key Stage 4 for pupils aged 14-16. The General Certificate of Secondary Education (GCSE) was introduced to replace O-levels and the Certificate of Secondary Education (CSE). In 1996, the Conservative government introduced the first stage of a Nursery Voucher scheme. The Voucher scheme allowed parents to use vouchers worth up to  £1,100 per child for up to three terms of part-time education for their 4-year-old children, in any form of preschool provision. However, in 1997, the incoming Labour Government abolished the voucher scheme and made its own plans for the development of early years services. The government provided direct funding to preschool institutions for part-time places for 4-year-old children and an increasing number of part-time places for 3-year-old children. Around 1999, the government introduced a Foundation Stage of early learning, which is a new stage of education for children age 3 to the end of their reception year when they will be 5. The Labour government revealed plans to introduce City Academies in 2002 as part of a five-year plan to improve education. City Academies are designed to improve inner city education by building new schools, introducing new technology and changing the ethos of schools. The scheme is controversial since schools will only get academy status if they raise  £2 million from private funds. Various types of early years education provisions There are a number of various types of early years education settings that can offer the free entitlement: day nurseries, private nursery schools, maintained nursery schools and nursery classes attached to primary schools, preschools and playgroups, primary school reception classes, where schools operate an early admission policy to admit four year olds, accredited child minders who are part of networks approved to deliver early education and Sure Start Childrens Centers. Theorists who may have impacted upon early years provision. The first infant school was opened by Robert Owen (1771-1858), utopian radical socialist reformer-mill owner who had set up crà ¨ches for the children of his workers as well as housing and health facilities. Pestalozzi (1745-1827) attracted the attention of some education reformers. Pestalozzian schools attempted to recognise the specific requirements of young children. Also very influential was the kindergarten movement, Froebel (1782-1852). First opened in England in 1851 Froebels vision was to educate the whole child. Outdoor activities played a signiFIcant part, but his vision was of the children as plants in the garden of the school flowering and blossoming under the correct care and attention as you would care for a plant. Gradually though the more precise nature of Froebels pedagogy and philosophies got taken over by a wider emphasis on play combined with domestic tasks as defined by the theories of psychologists. Stanley Hall (1884-1924) and John Dewey (1859-1952) Also these kindergartens were also rescuers of the children of the urban poor so the teachers became more like social workers. Another significant figure was Maria Montessori (1870-1952). Her work came to be seen as more a preserve of middle class private nurseries but originally she worked with deprived children of Naples and aimed to develop cognitive physical linguistic social and self care skills through carefully structured play activities and equipment. Advocate of natural materials wooden blocks sandpaper letters. She thought that too many brightly coloured toys and pictures could over stimulate. Children were taught to concentrate on one activity the put it away and move on to the next one. Margaret McMillan (1860-1931), was a Christian socialist and was regarded as the originator of Nursery School concept. Opened an open air nursery school in London in 1913 focus on sense training and health of the young child. Sand water clay and paint free cooked meals fresh air covered area so the children could be outside as much as possible. Roles of professionals that work in early years Then Early Years Practitioners (EYP) will be trained to often work as part of the team of skilled and committed people working with children in early years settings or wider childrens services. Take responsibility for leading and managing play, care and learning. Have a secure and up-to-date knowledge and understanding of early years practice with children from birth to five; and be skilled and effective practitioners. In addition to this, EYP will have an important role in leading and supporting other staff by helping them to develop and improve their practice, establish and maintain positive relationships with Children and communicate and work in partnership with families, carers and other professionals. Social care and health care legislation which is affiliated to the support of childrens health and safety (historical to present day) Range of health care settings in early years. There are many types of social and health care in early years for example Health clinics, residential care, home visiting scheme, children centres, paediatric services. Health and social care professionals, for example: Health visitors, GPs, midwives, childrens centre staff, social workers and mental health services.