Language is difficult. Basically all language is asking or answering a question.
This can be internal or external as to whether the person being addressed is self or other.
Communication and understanding are the motifs, the reason for using language.

We can only understand what our particular mindset lets us understand.
Hence some truths and understandings are not available to everyone.

[Digress second and third body problem, Einstein, No channel to the other person[s]].

 

verbs

Understanding Transitive and Intransitive Verbs
Intransitive verbs are verbs which cannot have a direct object. If you add a direct object to an intransitive verb then you get a sentence which doesn’t make any sense.

Examples:  I swim the purse.    I go a pizza. , “swim” and “go” are intransitive verbs. At least, in English…

As a general rule, consider the English tense of any verb (my examples here all use past tense), and then ask the question “What?”, using the same tense of the auxillary verb:

  • I drank. What did you drink? Drink is a Transitive verb (it takes an object– I drank beer, for instance).
    I wrote. What did you write? Transitive.
    I saw. What did you see? Transitive.
    I came. What did you come? That makes no sense– Come must be Intransitive!

It is most often verbs of Personal Motion/ Action or States of Being that are Intransitive.I was born. What did you born? Nonsense; State of being; Intransitive.
I sat. What did you sit? Motion. Intransitive
I laughed. What did you laugh? Action. Intransitive.

In Italian, it seems that there are always some irregularities. But, for the most part, the English definition holds true.
In Italian, Transitive verbs use the auxillary verb form of AVERE, while Intransitives normally use the auxillary verb form of ESSERE/ STARE when combined in the past participle tenses.
You just have to memorize certain Italian verbs because some of them can be used in both Transitive and Intransitive forms, while others are Intransitive in English but Transitive in Italian. For example:
Abbiamo corso per dieci minuti (We ran for ten minutes). Intransitive, but using AVERE in Italian.
Ho lavato la macchina (I washed the car). –What did I wash? The car. Transitive.

Note  Mi sono lavato la faccia (I washed my face). –Reflexive verbs are (edit) usually Intransitive.

Imperative fun

Let’s try to use the expression let’s do things a lot today in many ways.

I will give everyone a list of verbs and we will make as many sentences and ideas as we can.

Let’s go, where and why   Intransitive

andiamo al negozio per compare un giornale di leggere.

andiamo al cafe di bevere  una tasse di cafe con nostri amici.

Prendiamo il autobus finale alla citta stasera per videre I fuochi d’artificio.

let’s eat what and how Transitive

let’s sit down where and why  Reflexive hence Intransitive

Dimmi Dammi shimmy shammy

give me your name or tell me your name?

Dimmi il tuo nome. Tell me your name is the right way to say this in Italian.

Though one could say Dammi il tuo nome it is wrong hence not used.

Here the verb Dicere is used, it means to say or to tell-

Sensodione

The attack, when it came, was unexpected, high level and no holds barred.

As the saying goes, no plan survives the first contact with the enemy.

Hosie was in bathhouse, in the pool, in the fast lane and in good spirits.  Savannah was walking briskly in her white, golden clasped high heels, wheeling the communication trolley when the glass doors at the end of the atrium exploded inwards shredding the palm trees and cyclid pots protecting the entrance. Matt the security guard at the eastern entranced  was knocked to the ground, blood flowing from his face and nose into the pool waters as he lay limp and drowning.  Savannah screamed and collapsed on her knees hol ing her right shoulder.
Hosie hit the red duress alarm on the pool side and grabbed a speargun from the recess flipping on to his side to watch the door. Three men burst through the shattered door glass, wearing goggles, masks and holding  laser  light .394 Glocksheims. Hosie let the first spear loose ripping through the air and lodging in the upper chest base of the neck, Pivoting his aim he took out the second man through the right eye, dived as bullets cut up the water towards him from the third.

His thoughts went back to the plan, to Ritchie’s paranoia and concern re his reflexes. Your’e getting old mate, nearly 25, Why bother with the risk?.He smiled. Ritchie was the dork, the true computer geek bought to life. he could no more fire a gun straight than ride a skateboard.

s

Infection occurs when skin comes in contact with contaminated freshwater in which certain types of snails that carry the parasite are living. Freshwater becomes contaminated by schistosome eggs when infected people urinate or defecate in the water. The eggs hatch, and if the appropriate species of snails are present in the water, the parasites infect, develop and multiply inside the snails. The parasite leaves the snail and enters the water where it can survive for about 48 hours. Larval schistosomes (cercariae) can penetrate the skin of persons who come in contact with contaminated freshwater, typically when wading, swimming, bathing, or washing. Over several weeks, the parasites migrate through host tissue and develop into adult worms inside the blood vessels of the body. Once mature, the worms mate and females produce eggs. Some of these eggs travel to the bladder or intestine and are passed into the urine or stool.

Symptoms of schistosomiasis are caused not by the worms themselves but by the body’s reaction to the eggs. Eggs shed by the adult worms that do not pass out of the body can become lodged in the intestine or bladder, causing inflammation or scarring. Children who are repeatedly infected can develop anemia, malnutrition, and learning difficulties. After years of infection, the parasite can also damage the liver, intestine, spleen, lungs, and bladder.
Common Symptoms

Most people have no symptoms when they are first infected. However, within days after becoming infected, they may develop a rash or itchy skin. Within 1-2 months of infection, symptoms may develop including fever, chills, cough, and muscle aches.
Chronic schistosomiasis

Without treatment, schistosomiasis can persist for years. Signs and symptoms of chronic schistosomiasis include: abdominal pain, enlarged liver, blood in the stool or blood in the urine, and problems passing urine. Chronic infection can also lead to increased risk of liver fibrosis or bladder cancer.
Epidemiology & Risk Factors

Schistosomiasis is an important cause of disease in many parts of the world, most commonly in places with poor sanitation. School-age children who live in these areas are often most at risk because they tend to spend time swimming or bathing in water containing infectious cercariae.
If you live in, or travel to, areas where schistosomiasis is found and are exposed to contaminated freshwater, you are at risk.

Areas where human schistosomiasis is found include:

Schistosoma mansoni
Distributed throughout Africa: There is risk of infection in freshwater in southern and sub-Saharan Africa–including the great lakes and rivers as well as smaller bodies of water. Transmission also occurs in the Nile River valley in Sudan and Egypt.
South America: Including Brazil, Suriname, and Venezuela.
S. haematobium
Distributed throughout Africa: There is risk of infection in freshwater in southern and sub-Saharan Africa–including the great lakes and rivers as well as smaller bodies of water. Transmission also occurs in the Nile River valley in Egypt and the Mahgreb region of North Africa.
Found in areas of the Middle East.
A recent focus of ongoing transmission has been identified in Corsica.
Diagnosis

Stool or urine samples can be examined microscopically for parasite eggs (stool for S. mansoni or S. japonicum eggs and urine for S. haematobium eggs). The eggs tend to be passed intermittently and in small amounts and may not be detected, so it may be necessary to perform a blood (serologic) test.
Safe and effective medication is available for treatment of both urinary and intestinal schistosomiasis. Praziquantel, a prescription medication, is taken for 1-2 days to treat infections caused by all schistosome species.

Page last reviewed: June 22, 2018
Content source: Global Health, Division of Parasitic Diseases
Schistosomiasis

Comments

Multiple issues and comments.

We are in a very delicate and difficult period at the moment with the Royal Commission fueling concern and complaints. The organisation must respect this state of affairs and take a pro active response to it.

Complaints are always going to occur and  we do have systems in place but in recognition of the heightened atmosphere we have to use our in place mechanisms and adopt extra ways of coping.

Complaints need to be raised to a number one priority. This means looking more closely at the ones we have and looking for ways to detect them in advance plus reacting to both the known and perceived ones with more vigor.
One way of detecting them is from the smaller complaints e.g. around bell call times. Family, if aggrieved or concerned will report smaller problems first. These should not be to many in number but provide an opportunity for the care manager to discuss the immediate concern and make inquiries about any other broader concerns. This same approach should be used to concerns around the meals and room and patient care.I would go so far as to listing each complaint in a record for the hostel etc. and requiring that the staff have had a family meeting or discussion. If further points of concern are raised it must be drawn to the attention of management and follow up visits weekly arranged with the family and resident to ensure that all issues have been addressed and satisfied. Further the family should be encouraged and made comfortable to come forwards early if new problems arise.
This will not stop new issues due to behavioral or medical problems arising but it will guarantee both a good reputation inside the hostel for helpfulness and reduce the distress the family feels when incidents do arise. Provided we try to do the right things and we also do have insurance, together that will get the resident and staff through difficult times.

Medication and the new electronic medication system. * and a recent complaint.

The comments made have exposed the problems that have always existed in the medical medication system. Medicines have many uses but many side effects. All medicines are poisons but we use them where their good outweighs their harm.There is great responsibility in giving drugs and medications to residents. A wrong dose, an omitted dose, a wrong patient and there is a possible severe risk that could perhaps have been avoided.

This is why doctors have had to sign medication charts personally and write each one out legibly by hand. Nurses administering them had to know the drugs, know the doctor, ensure themselves that the dose seemed correct and then sign, often with a counter signature, to ensure the right dose gets to the right person at the right time.

Advantages for the new system were that
medication orders would be more legible [note by law they were already legible],
the difficulty in reading multiple medication charts.
Missed medication signatures [?] [note by law they were always meant to be signed].
Reducing staff time giving out medication.
Eliminating the need to fax G.P.’s and Pharmacy.

The ecase MMS [medication management system] has not to date shown these advantages. The very medications that re most problematical, Drugs of addiction, antibiotics, variable dose drugs like insulin and warfarin and all the prns cannot be put on the system. As well as long term injectables which poses a problem with the psychotropic medications.

Instead there is now an extra layer of computer generated drug charts sitting side by side with the unchartable drugs. Further these drug charts cannot be accessed or modified by the doctors easily as yet. As I forecast 20 years ago, 10 years ago, 2 years ago and last meeting the technology in the medical field is very slow at catching up to that expected in the rest of the world. The programs available everywhere have not been fully developed and reactive.

On the positive side the lists that are available are both readable and easy to send on to doctors and hospitals and pharmacists.Technology will catch up as we use more computer generated forms. We do not need to throw the baby out with the bathwater.

However the problems that existed before still exist now and are slightly worse with the new charts because we are now more reliant on the Doctor/Nurse/Pharmacist nexus than before. In an age where doctors are not available to or will not visit nursing homes to authenticate the drug charts and worse, initial the changes that occur. Putting our staff and residents at risk.

We need to reinforce the use of the old drug charts and regimes strictly for all the computer unchartable drugs. We need to open up lines of communication with the doctors and pharmacists [pay them more?] and work on ways to get the doctors in town to team up to help. One suggestion in this new era could be to open a clinic up on site or employ a GP or 2 by Shepparton Villages.

 

Pain management.

A third major issue. Pain is different from person to person and as people age communication of the pain can be very difficult, especially with dementia. Pain can be chronic in many elderly people due the the various types of arthritis. Fractures occur more commonly. Cancer develops and is a cause of ongoing increasing pain needing palliative care. Documenting the pain is both difficult and time consuming. Pain can also be quite variable making it difficult to quantify. Some patients do not wish to take treatment.Some people become addicted to the medications. Different charting methods exist. Treatments can be medical or non medical.
The three parameters though are the nursing staff, the resident and the family.
The staff are perceptive to pain in residents and need to be listened to when they raise the subject. Residents will usually complain when they feel their pain as at a level and intensity that needs treatment. Family are very sensitive to suffering in their loved ones and again need to be listened to and involved in the treatment where possible.If any of these three conditions are met then using a pain tool can be an extra help to all but it is the clinical judgement and patient/family concerns that need addressing more than the pain tool.
This is an area where other indicators like call bell numbers, incontinence, reduced mobility and pressure ulcers can be both useful for diagnosing the pain and also diagnosing those residents and families who need to be more involved in the care to reduce complaints.
PRN medication is not just an overused choice that can be reduced by other measures. PRN medication is vitally important in managing fluctuating arthritis pain and headaches. It is essential in palliative care to reduce breakthrough pain. There is always a trend to push regular medication for pain relief on elderly people only to find a few days later that they do not wish to take it. This leads to calls to the doctor to amend it to regular and then back to PRN. In my experience it is better to leave it to PRN  unless there is documented regular use for 4 weeks.

Dementia and Dementia training.

Complaints and feedback6 provide feedback is too long at 21 days needs to be within 24 hours or immediately.

Risk map residents at risk

failure to identify and report an incident [complaint]

Internet impeding access to medical records    scripts

Aged Care issue date Jan 2015 ACQSC

Make it easy to complain

QCG Framework SVN.

Minimum restraint Open discolsure

 

Imperatives

Imperatives come in 3 flavours with 5 personal pronouns. The personal pronouns are
Tu/Lei which is you, singular, and Voi/Loro which is you, plural. Also Noi, which is we.
They all involve action in the present moment only, no past or future concerns.

The suggestion imperative is the first person plural, we, [Noi].
All other imperatives use the second person, you, singular or plural, polite or personal.
Tu/Voi are used in addressing members of the family, our group, close friends and children. Informal and personal.
Otherwise Lei and Loro are used with people in authority and strangers. Formal and polite.
The personal pronouns are important and silent [unspoken]. You need to know which ones you are using by practice.

The three Imperative forms are suggestions, ordinary imperatives and negative imperatives.

Suggestions.
These are made using the stem of the word with the plural present tense -iamo and an exclamation mark.
These use the personal pronoun we [Noi]  and are equivalent to the English “Let us do this [action]” or colloquially “Let’s”. They are very common, easy and useful.
Andiamo has two different special meanings.
The  Imperative suggestion [and order], Andiamo! let’s go!.
The ordinary meaning  andiamo, we go, or we are going and sometimes loosely we will go.
They are completely different meanings and all imperatives are pronounced with emphasis.
All have a hidden Noi in front of them.
Let’s try [proviamo!}, let’s learn [impariamo!] Italian at U3A. Let’s have [abbiamo!] a coffee afterwards and let’s have a good time [divertitiamoci].

Ordinary imperatives are a little tricky as there is a difference in using the formal form of you compared to the informal. We normally use the informal with a silent tu or voi.
Learn the informal first and use it all the time.
For tu we simply add -a to the stem of all are, iare verbs.
Add i to all the others.
Jump [salta] to it! Sell [vendi] this!
For voi we use the normal plural second person tense ending for all verbs.
Parlate!  Vendete!  Finiscite!

Transitive verbs  need an object e.g. vendilo/la[sell this] though sometimes it is implicit.  Intransitive verbs don’t.
Reflexive verbs are usually intransitive.

Negative Imperatives.
The negative imperative for tu only in all conjugations is formed by placing the word non before the infinitive.
Non parlare, don’t speak. Non dicere, don’t say. Non finire, don’t finish.
Voi simply uses non in front of the normal plural present tense e.g. non vendete.

Irregular verbs break the rules and have to be learned by repeated use. They are the most important verbs the Italians use and have usually been shortened to help the language flow Some examples,
Andare to go vado, vai, va, andiamo, andete, vanno.
Dare ( sort of donare) to give, do, dai, da, diamo, date and danno.
Stare to stay,  sto, stai, sta,stiamo, state and stanno
Fare to do,  faccio,  fai, fa, fiamo, fate and fanno
Dire (really (dicere) to say dico, dici, dica, diciamo, dicete and  dicono
Their imperative forms for tu are
Vai, Da, Sta, Fa,  Di, but in common use one can use vai/va, dai/a, Stai/sta and fai/fa interchangeably.

-Note,
Using the formal pronouns Lei and Loro is not done very often but it can come up in conversation and books.
There is a simple rule for Lei [the singular form of Tu].
You throw your books out the window and use the opposite of what we just said.
All the verbs that take -a now take -i and all the verbs that took -i now take –a.
For Loro [voi] the plural the same rule –ano becomes –ino and -ino or –eno becomes -ano.
Be aware as you will see examples occasionally but do not put any effort into it as once you get the informal verbs right, which is easy, the formal version will slowly fall into place without trying.
Study the informal!  Studia l’ínformale!