Jeffrey A Brinker, M.D.
- Professor of Medicine
- Joint Appointment in Radiology and Radiological Science
Language (aphasia) cheapest generic zyvox uk fungal infection, Motor skills (Apraxia) buy zyvox amex antimicrobial jacket, Object recognition (Agnosia) buy generic zyvox 600mg on line antibiotics for dogs uti, Head injury: Repeated concussions, loss of consciousness. Age: the probability of dementia approaches over 60 ages Diabetes: type of diabetics Stroke (blocked blood supply in the brain) High cholesterol: in arteries reduce oxygen level High blood pressure, neurological examination, cognitive and neuropsychological tests, brain scan, Obesity and lack of nutrition, Body mass index: Overweight and obesity Lower educational level Sleep apnea: it reduces oxygen to the brain and cognitive defcits Impaired vision or hearing Gait: "asymmetrical" and symmetrical" based on limb movement or a shuffing gait (like elephant walking symptoms) Infections: longitudinally in body, wound. History of family genetic ?(5% of the incidents of dementia diagnoses) Pressure, depression, delirium, all the psychological assessments, behavioral assessments, daily living activities Drugs: previous using drugs, current using drugs, and other chemical effects, poisons, side effects of drugs, benzodiazepines etc. Alcohol consumption before and current time Environmental factors: Lead, metal, iron, copper, jink Assessments of between other types of dementia and overlapping characteristics and others disorders. These are as following domains: Ask the Medical History Is there a clinical history of pathology dysfunction, previous medication consummation, and all the physical examinations Goitre, any kind of pain, urinary infection, poor appetite, constipations, strain, dependency for caring, slow pulse, wandering, dry skin or hypothyroidism? Dementia Treatment Gap Prince has reported that the dementia treatment gap of dementia is signifcantly high in even high income countries as well as in middle income and low income countries . Still the low level of dementia awareness, specialist care services, primary health care access and long term support care are not suffcient therefore the public awareness, care effectiveness, 25 MedDocs eBooks community health care services, interventions program of comorbidity, cognitive, mental and physical health, ageing, their access affordable, accessible health care is essential worldwide for the health professionals, caregiver and patients since all of these can lead treatment gap. Similarly, in 2021, over half a million people will be living with dementia that has gone undiagnosed. In high-income countries, only 20-50% of dementia cases are recognized and documented in primary care . This ?treatment gap is certainly much greater in low and middle income countries, with one study in India revealed 90% remain unidentifed [87,88]. Approximately 28 million of the 36 million people with dementia have not received a diagnosis. Therefore do not have access to treatment, care and organized support that getting a formal diagnosis can provide . Dementia consists of combination of 100 types of characteristics that is why diagnosis of dementia may be delayed or missed because early onset symptoms develop gradually and are often associated with the normal aging process. Also, symptoms of dementia can mimic as of a variety of disease conditions like; depression, delirium neurological disorder and other psychological disorders which can have all forms of dementia. In addition, a misdiagnosis and its mismanagement of the underlying cause of dementia is possible because there are many associated causes, among of them can be diffcult to diagnosis and management due to their hidden causes. The journal of American medical association highlighted the nurses six steps to manage dementia across all settings to help clinicians and effectively manage: 1) symptoms identify, 2) early behavioral systems screening, 3) delineate the triggers and risk factors, 4) appropriate intervention at the care spot, 5) evaluate the intervention, and 6) follow the patients improvement . The symptoms has also relate to a mild brain injury fall down, that could have occurred days or even weeks ago. Vestibular dysfunction, causing vertigo-like symptoms, is a common complication of mild brain injury. The Fragile X disorder show mild symptoms in the early years and Parkinson disease. Obstacles to Diagnose or Contributing for Timely Diagnosis, Effective Management and Care for Dementia. Diagnosis and management barriers are presented with regard to primary care doctors factors, patient factors and carer factors. These some issues are: time, communicating the diagnosis, negative views of dementia, diffculty diagnosing early stage dementia, acceptability of specialists and responsibility for extra issues, knowledge of dementia and ageing, less awareness of declining abilities and diminished resources to handle care, not specifed guidelines, poor awareness of epidemiology and less confdence to advise [91,92,93,94,95]. Obstacles to diagnose or contributing for timely diagnosis, effective management and care for dementia. Care givers factors Lack of knowledge/skills/ training and Residence in backward community. Lower level of education and Knowledge of Overlapping characteristics of dementia. Family status (Married, unmarried, widow, single, Medication confusing and delaying to Limited treatment options. Low insure, value of diagnosis and treatment Perception of limited treatment options. Less prioritize to discuss cognitive Emotional, fnancial or other burden of diagnosis Denial of assessment or treatment. Unwillingness, less confdent, fear negative Avoidance of pressure from patients and Insecure feeling to address the dementia. Less priority for dementia diagnosis and cognitive Perception of limited treatment options. Above these are the most observing barriers to diagnose the dementia for the primary care. These following 10 overall recommendations may help to minimize the dementia problem. These are; a) Provide treatment in primary caregivers, b) Make appropriate treatments available, c) Give care in the community, d) Educate the public, e) Involve communities families and consumers, f) Establish national policies, programs and legislation, g) Develop human resources, h) Link with other sectors, i) Monitor community health, J) Support more research . Screening Tools for Dementia In the clinical praxis, no ideal answer of the best dementia screening instruments with the general practitioners therefore between guidelines and practice in primary care is still a wide gap. In general practice when a person comes with complaining memory problems needs a number of detail tests for strong proof for further diagnosis. A key issue is what dementia assessments 29 MedDocs eBooks scale is appropriate for assessment because there are verities of tools have been discovered . Even though these following tools are commonly found easy to administer, effective, clinically acceptable and minimally affected by gender, ethnicity and education . Mostly these test will diagnose in four ways like; cognitive power, recovering power, recalling power and motor activity. However, many pieces of researches argue that the diagnostic methodologies make the diffcult for accuracy of screening test of dementia. Additionally the screening instruments are in limited level to examine in huge number of population. Assessment of dementia scales summarized by Sheehan, in different areas, these scales should use according to their areas . It is used with the multi cultural populations in Australasia however an Indian study has proofed to use in outside Australia because it shows useful .
- Rapid pulse
- Exercise regularly.
- Chest CT scan
- Ask that painful procedures not be performed in the hospital crib, so that the infant does not come to associate pain with the crib. Many hospitals have special treatment rooms where procedures are performed.
- Acute HIV infection
- Poor diet in infants
- Breathing support
- Manage the diarrhea
More research is not always a good thing; it is only a good thing when it is of suffcient quality generic 600mg zyvox visa antimicrobial and antibacterial. Moving forward buy zyvox 600mg low price antibiotic resistance reasons, journalists buy 600mg zyvox antibiotics bad for you, editors and science communicators have a major role to play in ensuring that policy initiatives or interventions are based on high quality evidence. Although few negative impacts have been found in relation to the time children spend using digital technology, in order to maximize the positive impact younger children may require provisions and support of a different nature than older children. Similarly, what is harmful for a very young child to see or do online may be largely unproblematic or even positive for an older child. In this respect, blanket-recommendations and policies are unlikely to be effective. Having also reviewed the hypothetical idea of addiction to digital technology, the contrast to time use studies has hopefully been made clear. In some countries, the idea of addiction to technology has been used to justify the incarceration of children in treatment camps despite a lack of evidence for the effcacy of such approaches (Aarseth et al. Media reports from these camps suggest that disciplinary methods employed by staff involved physical punishment and electric shocks (Russon, 2016; Ives, 2017). This violates several fundamental rights of children and could cause signifcant harm. Finally, children use digital technology for specifc reasons and are often able to articulate why they do it. Sometimes these reasons may not seem optimal from an adult point of view, but it is important to take their opinions and explanations seriously, even if we disagree. Adapting to the increased use of digital technology in society will demand some adjustments in how we parent children, carry out research and develop policy, among other things. The current situation is unusual as children are in many ways the pioneers and experts in this area, often the frst to try new applications and programmes sometimes even creating their own. Patterns of internet use and mental health of high school students in Istria County Croatia: cross-sectional study. Problematic internet use and psychosocial well-being: development of a theory-based cognitive?behavioral measurement instrument. Preference for online social interaction: a theory of problematic internet use and psychosocial well-being. Distinguishing addiction and high engagement in the context of online game playing. When addiction symptoms and problems diverge: A latent class analysis of problematic gaming in a representative multinational sample of European adolescents. Gaming (ad)diction: Discourse, identity, time and play in the production of the gamer addiction myth. Brief report: Association between socio-demographic factors, screen media usage and physical activity by type of day in Spanish adolescents. Drugs abused by humans preferentially increase synaptic dopamine concentrations in the mesolimbic system of freely moving rats. London: Sage 29 How does the time children spend using digital technology impact their mental well-being, social relationships and physical activity? Impact of Singular Excessive Computer Game and Television Exposure on Sleep Patterns and Memory Performance of School-aged Children. The benefts of Facebook ?friends?: Social capital and college students use of online social network sites. Domesticating play, designing everyday life: the practice and performance of family gender, and gaming. Everything in Moderation: Moderate Use of Screens Unassociated with Child Behavior Problems. Are screen-based sedentary behaviors longitudinally associated with dietary behaviors and leisure-time physical activity in the transition into adolescents? Seven fears and the Science of How Mobile Technologies May Be Infuencing Adolescents in the Digital Age. Associations between sport and screen entertainment with mental health problems in 5-year-old children. Working towards an international consensus on criteria for assessing internet gaming disorder: a critical commentary on Petry et al. The attitudes, feelings, and experiences of online gamers: a qualitative analysis. Patterns of adolescent physical activity, screen-based media use, and positive and negative health indicators in the U. Association between mobile phone use and depressed mood in Japanese adolescents: a cross-sectional study. The Wired Generation: Academic and Social Outcomes of Electronic Media Use Among University Students. How can we conceptualize behavioral addiction without pathologizing common behaviors? Use of information and communication technology and prevalence of overweight and obesity among adolescents. Brief report: Predictors of heavy Internet use and associations with health-promoting and health risk behaviors among Hong Kong university students. Motives predict addictive play behavior in Massively Multiplayer Online Role-Playing Games. Response to Shaffer (1996): the case for ?complex systems conceptualizations of addiction. Concurrent Associations between Physical Activity, Screen Time, and Sleep Duration with Childhood Obesity. Correlates of Total Sedentary Time and Screen Time in 9?11 Year-Old Children around the World: the International Study of Childhood Obesity, Lifestyle and the Environment.
Most symptoms that people with advanced dementia experience can be managed by those with generalist Bereavement knowledge of palliative care and good-quality nursing discount zyvox 600 mg with mastercard antibiotic used for kidney infection. People with advanced dementia experience a range of symptoms discount zyvox 600 mg with amex antimicrobial kitchen towel, which might be poorly detected and undertreated generic 600mg zyvox amex bacteria are the simplest single cells that. Considerable prognostic uncertainty exists; is similar to individuals dying with cancer. Prognostic tools have been at risk of aspiration, and have impaired immunological developed but little evidence is available to suggest that function increasing their risk of pneumonia, urinary knowing the prognosis changes management, improves infections, and other infections. Little other symptoms, and of psychological, social and evidence exists that artifcial nutrition and hydration spiritual problems is paramount. The goal of palliative reduce the risk of aspiration pneumonia, prolong life, or care is achievement of the best quality of life for patients improve nutritional status or quality of life. Their model of care stresses the Directly transferring interventions and models from importance of changing care goals throughout the course the cancer feld might not work. Improving occupational therapists, and social workers to address continuity of care could decrease costs by reducing patients’ and families’ complex medical, psychological, and emergency department visits and hospital admissions, social needs. The organ after the diagnosis of dementia, change outcomes or isation of care provision difers between countries, and improve the quality of death is unknown. People with services might be free at the point of delivery dementia, and their family and friends, fnd advance care or require individual purchase, sometimes with re planning discussions helpful, but value these plans as an imbursement. However, people with dementia use less ongoing process rather than committing an advance care health care even when freely available than others with plan to paper. Systematic their needs, so assessment and management of pain and reviews596,606–608and meta-analyses529,609of case management discomfort are key to providing good end-of-life care. Prognostic uncertainty exists, so the priority is adopting a 70% of the studies were of poor or fair quality, and needs-based care approach focusing on the person with assessed interventions that varied in content; duration dementia and their carers. Optimum palliative care for (most were 12–18 months); setting (eg, primary care, people with dementia recognises the role of family social services); integration with health systems; care members and that they might experience distress and team composition; intensity and method of contact; anticipatory grief. Training and educating nursing home whether they interfaced with patients, carers, or both; staf on end-of-life care improves knowledge and and which outcomes were targeted. Case management increases satisfaction with such care in bereaved family approaches also difer in the extent to which they are members and should be routinely implemented. The results of the reviews found It integrates the complex network of health and social care case management reduced carer burden and depression professionals needed in dementia and responds to patient (moderate efect size), but little evidence was available needs. Making Panel 5:Approaches to case management in dementia case management available, scalable, and sustainable will Individual needs require expanding and training the workforce. Care homes might not ofer specialist dementia services,615 despite around preferences, and priorities 80% of residents having dementia. Case management was associated both by clinical need and the organisational culture of with a low reduction in risk of nursing home admission the care home. Residents had models, which might be scalable with a larger potential fewer afective symptoms and staf a less adverse reaction workforce, are able to care for people with dementia and to residents’ behavioural difculties than those not in the have the potential to improve care. There is an absence of high-quality care home staf or multicomponent interventions have efectiveness and cost-efectiveness data, however. There reduced short-term inappropriate prescribing of is also heterogeneity between case management antipsychotic drugs in care homes, but evidence of long approaches, no manualised practice and standardisation, term efectiveness and sustainability is still needed. It However, a study635 in care homes that already had low should incorporate evidence-based interventions as best frequency of antipsychotic use found that reducing practice in dementia care. Case management might antipsychotics, without adding other interventions for improve patients’ quality of life and reduce nursing home neuropsychiatric symptoms is not helpful because 2716 A combination of communication Implementation of efective interventions requires strategies and clear procedures to increase physical and substantial training and longer term supervision or social activity might reduce or prevent agitation in care working alongside care home staf for a prolonged period. Care transitions from acute care to care homes require communication barriers to be addressed between Technological innovations in dementia care hospitals and nursing homes and between families Panel 6 gives an overview of available and possible future and care home staf in order to improve outcomes uses of dementia-related devices. The huge advances in for patients by lowering incidence of both transfer the development of health-care devices, including and transfer-related harm, such as mistakes in electronic health records, portal technologies, and medication. Given the progressive nature of Leadership in care homes dementia, certain devices might have a window of Leadership can play an important part in implementing usefulness to people with dementia and their carers. Despite the potential applicability of defned key characteristics of these models or information technological innovations, important challenges need about outcomes are available. The aim of technological innovations indicate that people with dementia might beneft from should be to improve care without unacceptably these models in their physical functioning; however, increasing risks for people with dementia and their comparative-efectiveness and cost-efectiveness research families. While some devices have the potential to enhance safety, they also Key points and recommendations raise concerns in relation to replacing or reducing Interventions in care homes require longer-term human contact. There is a responsibility, not just as safe, stimulating, and functionally enabling environ professionals but as a society, to implement this ments, and support and assist carers and professionals in evidence into interventions that are widely and improving quality of care. However, evidence on the efectively used for people with dementia and their efectiveness for most devices is not available. Interventions have to be accessible, therefore needed to protect people with dementia from sustainable, and, if possible, enjoyable or they will be overselling of inefective and potentially unsafe devices. Delivery of interventions will vary according to Technology is not a replacement for human contact. Interventions that provide both the dementia care: to prevent the preventable, treat the evidence and manuals with the necessary materials are treatable, and care for both the person living with easier to implement and to alter according to the country dementia and the carer. It is important to consider who brought these strands together, informed by our will deliver programmes and practicalities so that they understanding of the best evidence, and explained the are widely available to people with dementia and their reasons for our conclusions. Thus, while we recommend specifc that dementia impairs cognition and therefore challenges interventions to prevent dementia, diagnose it early, the ability of people to make decisions for themselves, manage the cognitive and neuropsychiatric symptoms, understand, and communicate what they want and need. All authors contributed to sections of the Research Council Cognitive Function and Ageing Collaboration. International statistical classifcation of diseases and related Ingelheim, Axovant Sciences, Lundbeck, and Nutricia, outside the health problems, 10th revision. Geneva: World Health Organization, submitted work; and he has been employed by the Department of Health 2016.
It is with these principles in mind that this report has been produced and has the following aims: I To bring together available and relevant evidence-based practice with a consensus of clinical opinion and experience buy cheap zyvox online antibiotic 5 day. I To provide a framework for good practice and for the development of multi-agency care pathways generic zyvox 600mg without a prescription infection 4 weeks after wisdom teeth removal. I To promote effective and timely assessment zyvox 600 mg with mastercard antimicrobial effect of chlorhexidine gluconate, diagnosis, and interventions for people with intellectual disabilities suspected or confirmed as having dementia and to ensure quality support to them and their staff and other carers. I To provide a set of standards of good practice against which service provision can be benchmarked and audited. I To provide a quality outcome measure to use to evaluate what the person with intellectual disabilities and dementia is experiencing in their care. I To promote the development of comprehensive and effective local services and to reduce the number of individuals who are failed by current service provision. The report was produced through the combined work of members of the working group and drew on the published evidence base and from the working group members’ extensive clinical experience in this area. Although this report has been undertaken primarily by psychologists and psychiatrists, we recognise that people with dementia must have effective multi-agency and multi-disciplinary services. We believe that this report will therefore be relevant to anyone who has an interest in dementia and people with intellectual disabilities, including health and social care professionals, families, paid staff, advocates, service providers and commissioners. We still cannot be prescriptive within the document, particularly about the choice of assessment tools, because the evidence is not available to support particular instruments. Decisions will still need to be made locally depending on local resources and configurations. However, the report is intended to highlight the specific issues that people with intellectual disabilities and dementia present, and to ensure that local services are timely, effective and ensure that the person continues to have a high quality, safe and person-centred lifestyle as the dementia progresses. This is a rapidly developing area with new knowledge and practice developing all the time. Research with people with intellectual disabilities and dementia is increasing, and will add to the evidence base. Finally, the report hopes to complement other publications and guidance in this area and to provide a way forward for supporting people with intellectual disabilities who develop dementia. Recognising the urgent need for change, he set targets for improvements by 2015 in three broad areas: 1) health and care, 2) the establishment of dementia friendly communities, and 3) improving dementia research. This document has been revised with these challenges in mind, paying particular attention to how they apply to people with intellectual disabilities. It sets out standards of clinical practice in the areas of assessment, diagnosis and interventions for people with intellectual disabilities who develop dementia with an emphasis on how people with intellectual disabilities who develop dementia can be best supported in a manner that maintains their dignity and quality of life. The strategy has three key steps: improved awareness and understanding of dementia and removal of the stigma that surrounds it; early diagnosis and intervention; and improving the quality of care for people with dementia by developing a range of services for people with dementia and their carers which fully meets their changing needs over time. The strategy had 17 objectives to be met in a five-year plan; the objectives included improving awareness and diagnosis, better access to care and advice, the needs of carers, the commissioning of health and social care services, better end of life care, workforce planning, and research. Key recommendations included: integrated working across all agencies; provision of memory assessment services as a point of referral for diagnosis of dementia; assessment, support and treatment (where needed) for carers; assessment and treatment of non-cognitive symptoms and behaviour that challenges; dementia care training for all staff working with older people; and improvement of care for people with dementia in general hospitals. These are all very much echoed in the National Dementia Strategy and in the Prime Minister’s challenge, suggesting that these and other previous reports are now having an impact. The above are examples of dementia-specific policies and guidance; however, there is also a broader context which is relevant to this updated guidance. First, is the serious problem of the potential for neglect and abuse within health and social care settings. Abuse of people with intellectual disabilities and those with dementia is not uncommon, whether in hospitals, family homes or residential care. The challenge is to prevent it, as far as possible, and to detect it and respond quickly where it is identified as having taken place. Guidance on their Assessment, Diagnosis, Interventions and Support 7 Secondly, the move towards individual health and social care budgets that aim to give choice and control to people in need of health and social care services including people with intellectual disabilities and people with dementia has become a reality. For people with disabilities this had its origins in the 1996 Community Care (Direct Payments) Act but in reality only in the last few years has it become the funding model of choice with the intention of extending it to other areas of need and to the funding of health care. Thirdly, there have been changes in the law and in international conventions that have implications for the way in which care is provided and in which choices are made as to the services people receive. Adults with Incapacity Act (Scotland) 2000 and the Mental Capacity Act (England and Wales) 2005. The Mental Capacity Act 2005 is well established in England and Wales although a recent post-legislative review by the House of Lords has raised concerns about its implementation. This ruling has broadened the definition of what is meant by ‘deprivation’ and it is likely that many more people with intellectual disabilities, and particularly those who have developed dementia, will be considered to be deprived of their liberties and in need of the safeguards. The Equality Act has also been enacted, requiring authorities to make ‘reasonable adjustments’ when seeking to meet the needs of people with disabilities. These various legal developments when taken together have very significant implications for the group of people that are the focus of this guidance. These include the need for effective partnership working between all agencies involved in the care of people with intellectual disabilities and dementia as highlighted in reports cited in the previous section. The working party recognises that each area will be configured to meet local need, but effective care can only be provided when there is good partnership working within health services – between intellectual disabilities and older people’s services, and across statutory, private and voluntary agencies. Regardless of how each service is configured, the working party has assumed that certain principles and ways of working are already integral to the delivery of services for people with intellectual disabilities, and that these will also be available to people with intellectual disabilities who develop dementia. It has also been assumed that services will be delivered in line with both their relevant mental capacity legislation, the Human Rights Act and relevant National Standards for dementia care. The life expectancy of people with mild intellectual disabilities now approaches that in the general population of a similar socio-economic status, but the life expectancy of people with more severe levels of intellectual disabilities remains reduced compared with the general population. Given these improvements, the overall population with intellectual disabilities is steadily increasing and it has been predicted that the proportion of people with intellectual disabilities over 65 years of age will have doubled by 2020, with over a third of all people with intellectual disabilities being over 50 years of age by that time (Janicki & Dalton, 2000; McConkey et al.
Cheap zyvox online. Step 2 DRY: How to dry a car - microfibre towel.
Our Constitution gives Congress the power to order generic zyvox on-line antibiotic how long to work give authors "exclusive right" to order 600mg zyvox with visa antibiotic treatment for gonorrhea "their writings buy generic zyvox 600mg on-line good antibiotics for sinus infection. Thus, if I write a book, and you base a movie on that book, I have the power to deny you the right to release that movie, even though that movie is not "my writing. The derivative right could be important in inducing creativity; it is not important long after the creative work is done. But the law should draw clear lines around regulated and unregulated uses of copyrighted material. When all "reuse" of creative material was within the control of businesses, perhaps it made sense to require lawyers to negotiate the lines. Think about all the creative possibilities that digital technologies enable; now imagine pouring cold, thick, sticky liquid into the machines. In each of these cases, the law should mark the uses that are protected, and the presumption should be that other uses are not protected. But as we are currently seeing in the context of the Internet, the uncertainty about the scope of protection, and the incentives to protect existing architectures of revenue, combined with a strong copyright, weaken the process of innovation. The law could remedy this problem either by removing protection beyond the part explicitly drawn or by granting reuse rights upon certain statutory conditions. Either way, the effect would be to free a great deal of culture to others to cultivate. There is no other policy issue that better teaches the lessons of this book than the battles around the sharing of music. It drove demand for access to the Internet more powerfully than any other single application. It may well be the application that drives demand for regulations that in the end kill innovation on the network. The aim of copyright, with respect to content in general and music in particular, is to create the incentives for music to be composed, performed, and, most importantly, spread. The law does this by giving an exclusive right to a composer to control public performances of his work, and to a performing artist to control copies of her performance. File-sharing networks complicate this model by enabling the spread of content for which the performer has not been paid. There are many who are using file-sharing networks to get access to content that is no longer sold but is still under copyright or that would have been too cumbersome to buy off the Net. There are many who are using file-sharing networks to get access to content that is not copyrighted or to get access that the copyright owner plainly endorses. The eagerness with which the law aims to eliminate type A, moreover, should depend upon the magnitude of type B. I assume, in other words, that type A sharing is significantly greater than type B, and is the dominant use of sharing networks. Nonetheless, there is a crucial fact about the current technological context that we must keep in mind if we are to understand how the law should respond. It is addictive today because it is the easiest way to gain access to a broad range of content. Today, access to the Internet is cumbersome and slow-we in the United States are lucky to have internet service at 1. But it will become a reality, and that means the way we get access to the Internet today is a technology in transition. The question should be, what law will we require when the network becomes the network it is clearly becoming? That network is one in which every machine with electricity is essentially on the Net; where everywhere you are-except maybe the desert or the Rockies-you can instantaneously be connected to the Internet. Imagine the Internet as easy to get as the best cell-phone service, where with the flip of a device, you are connected. In that world, it will be extremely easy to connect to services that give you access to content on the fly-such as Internet radio, content that is streamed to the user when the user demands. Here, then, is the critical point: When it is /extremely/ easy to connect to services that give access to content, it will be /easier/ to connect to services that give you access to content than it will be to download and store content /on the many devices you will have for playing content/. It will be easier, in other words, to subscribe than it will be to be a database manager, as everyone in the download-sharing world of Napster-like technologies essentially is. Content services will compete with content sharing, even if the services charge money for the content they give access to. Already cell-phone services in Japan offer music (for a fee) streamed over cell phones (enhanced with plugs for headphones). The "problem" with file sharing-to the extent there is a real problem-is a problem that file:///C|/Users/hamblebe/Desktop/Free%20Culture%20simplified%208000%20version. And thus it is an extraordinary mistake for policy makers today to be "solving" this problem in light of a technology that will be gone tomorrow. The question should not be how to regulate the Internet to eliminate file sharing (the Net will evolve that problem away). The question instead should be how to assure that artists get paid, during this transition between twentieth-century models for doing business and twenty-first-century technologies. The answer begins with recognizing that there are different "problems" here to solve. The "problem" with this content is to make sure that the technology that would enable this kind of sharing is not rendered illegal. You can think of it this way: Pay phones are used to deliver ransom demands, no doubt. But there are many who need to use pay phones who have nothing to do with ransoms. It may be unavailable because the artist is no longer valuable enough for the record label he signed with to carry his work. Either way, the aim of the law should be to facilitate the access to this content, ideally in a way that returns something to the artist.