Multiple Sclerosis A Common Disease That Affects The...

Multiple sclerosis (MS) is a common disease that causes disruption to the electrical functions of the immune system resulting in cognitive and motor functions to become destroyed. 1 Multiple sclerosis affects 350,000 people in the United States, however; 2.3 million people globally are known to have multiple sclerosis. 2 This disease has throughout the years been on the rise all over the world. This increase could be due to people moving from one region to another. 2 Women tend to be at greater risk of having multiple sclerosis than men. Women typically develop symptoms at the ages of 20 and 40 years while men are known to develop symptoms at a later age. 2 Caucasian women are more susceptible to developing multiple sclerosis while African Americans have a lower chance of getting this disease. 1 Considering that MS is a disease that affects the nervous system, there is no concise explanation as to what causes this disease. Tobacco products have been linked to causing MS as well as so me viruses and bacteria. 2 As viruses attack the brain and the spinal cord, the main compartments of our nervous system, this triggers an effect that causes extreme damage to the axons, specifically their mylenated areas.1 Multiple sclerosis triggers pain to the central nervous system, which destroys and prohibits proper functions. This disease is considered as being irreversible because of the damage done to the axons. 2 As damage to the axons is seen, lesions start to develop in the brain andShow MoreRelatedMultiple Sclerosis And Its Effects On The Central Nervous System Essay1389 Words   |  6 Pageshe life of someone living with Multiple Sclerosis is often quite different than normal. It consists of never-ending doctors appointments, not feeling well, difficulty doing everyday tasks, and much more. Multiple Sclerosis is the bee sting that one gets while laying out by the pool, the scrape a child gets on his knee, and the throbbing headache the mother has after a long day at w ork and the horrible cry of her child. The disease is heavy weighing on ones mind, body, and heart; yet, if one possessesRead MoreMultiple Sclerosis : A Nervous System Disease That Affects The Brain And Spinal Cord869 Words   |  4 PagesAbout Multiple Sclerosis Multiple sclerosis is considered a nervous system disease that affects the brain and spinal cord. The disease remains a mystery to this day since there are no known specific causes. It can be seen that multiple sclerosis is more prevalent in women than in men between the ages of 20-40 (Bethesda 2015). While the disease is typically mild in most cases, some severe cases may result in the loss in the ability to speak, walk, and write. Common symptoms of the disease includeRead MoreMultiple Sclerosis ( Ms ), Autoimmune, Inflammatory Disease Involving The Central Nervous System ( Cns ) Essay1102 Words   |  5 PagesProfessor Mirzatoni March 8, 2016 Multiple Sclerosis Multiple sclerosis (MS) is autoimmune, inflammatory disease involving the central nervous system (CNS). This disease is a result of the immune system attacking myelin proteins. Usually affecting younger people between the ages of 20 and 50 years, multiple sclerosis slowly destroys the myelin sheath that are located in the CNS causing them to eventually create scleroses, or hardened lesions. Symptoms of multiple sclerosis can be different, but visualRead MoreSymptoms And Treatment Of Multiple Sclerosis1107 Words   |  5 PagesMultiple sclerosis, or MS, is a very common disease that affects more women than men; at a minimum two to three times relevant in women (Harbo, 2013). Sadly, according to the National Multiple Sclerosis Society, since 1975, there has not been a successful national study of the prevalence in the United States. In order to improve reporting MS, the National MS Society established a method of testing administrative databases. In turn, the Society reported that MS organization have estimated 2.3 millionRead MoreSimilarities and Differences amongst Multiple Sclerosis and Muscular Dystrophy640 Words   |  3 Pagesbetween multiple sclerosis and muscular dystrophy. Multiple sclerosis is understood to be an autoimmune disease that affects the central nervous system. However, muscular dystrophy is a genetic disorder that affects the peripheral nervous system. Multiple sclerosis is seen as progressing asymmetrically from the loss of myelin. Likewise, muscular dystrophy presents with a symmetrical wasting of the muscle and distribution of weakness. Muscular dystrophy is a group of similar conditions that affect theRead MoreMultiple Sclerosis (Ms) Is A Disease That Impacts The Brain,1040 Words   |  5 Pages Multiple Sclerosis (MS) is a disease that impacts the brain, spinal cord and optic nerves, which is together known as the Central Nervous System (CNS). It is perhaps one of the most common neurological disorders, affecting about 1 per 1,000 of the population (Beaumont, 2008). Multiple Sclerosis means â€Å"Multiple Scars† due to the many scars (lesions) that are located in the CNS. This disease involves two main systems in the body, the Central Nervous System and the Immune System. The Central NervousRead MoreMultiple Sclerosis : An Autoimmune Disease978 Words   |  4 PagesIf you know anyone with Multiple Sclerosis or MS, you would know how terrible the disease is. Multiple Sclerosis is an inflammatory disease in which your immune system attacks the nerve cell covers in the brain and spine are damaged. The nerves in the body eventually deteriorate and it is fatal. According to the National Multiple Sclerosis Society, the cause of Multiple sclerosis is still unknown. There is not a cure at the moment for Multiple Sclerosis, but there are treatments that can speedRead MoreCase Study : Multiple Sclerosis ( Ms )1186 Words   |  5 Pages Reseach Paper of Multiple Sclerosis Zuemil De Jesus Claudio Universidad del Este Pharmacotherapy for Pharmacy Technician II Professor: Sonia Rivera March 15, 2015 Research Paper of Multiple Sclerosis The first case of multiple sclerosis (MS) was found in 1849. This disease is not contagious, but epidemiologists have identified some factor such as gender, generics, age, geography and ethnic background that may help determine what cause this disease. MS affects more than 2.3 millionRead MoreEvaluation Of A Case Study1571 Words   |  7 Pageshelping the doctor to conclude this is a factor to why the client is experiences this neurological deficits. Client doctor prescribed her Prednisone which has a positive affect helping to confirm the client diagnosis of Multiple Sclerosis. Researchers have concluded that Multiple Sclerosis occurs whereby the patient’s own immune system attacks the protein that is found in the myelin sheath and this result in the demyelination of the myelin sheath. So when there is lost of myelin in one’s body, blockingRead MoreEvaluation Of A Case Study1353 Words   |  6 Pageshelping the doctor to conclude this is a factor to why the c lient is experiences this neurological deficits. Client doctor prescribed her Prednisone which has a positive affect helping to confirm the client diagnosis of Multiple Sclerosis. Researchers have concluded that Multiple Sclerosis occurs whereby the patient’s own immune system attacks the protein that is found in the myelin sheath and this result in the demyelination of the myelin sheath. So when there is lost of myelin in one’s body, blocking

The Employment Of Contemporary Virtualization Technologies

Cloud Computing Anthony D Payne CSIA 412 Professor Miller March 1, 2015 Through the employment of contemporary virtualization technologies, with the incorporation of advanced tools that expands the coverage of the systems administrator, the cost and labor of operations will be significantly lowered. Efficiency improvement will have a direct impact on operation costs of many institutions. Resources that could have been used in the buying and maintaining data center infrastructure will be used in citizen centered services and other new innovations that can go a long way to assist the citizen and ensure smooth running of the government. Therefore, cloud computing will be a driving force to ensuring efficiency in the way public resources are managed to the advantage of the people. Every public office has a data center infrastructure where its data is stored and retrieved when needed. In most cases, this infrastructure is underutilized. With cloud computing, the data storage sections are eliminated because of pooling of IT Infrastructure resources and sharing across a large number of organizations and offices that are possible with cloud computing. The wastage that is realized when data centered are not utilized is thus eliminated because different offices have peak seasons in different times hence making the system to be put in use all year round. This ensures that public assets are better utilized and loses reduces or even eliminated. Due to fragmented nature ofShow MoreRelatedCloud Computing5889 Words   |  24 Pagescomputing is compelling, the security challenges it poses are equally striking. In this work we strive to frame the full space of cloud-computing security issues, attempting to separate justiï ¬ ed concerns from possible over-reactions. We examine contemporary and historical perspectives from industry, academia, government, and â€Å"black hats†. We argue that few cloud computing security issues are fundamentally new or fundamentally intractable; often what appears â€Å"new† is so only relative to â€Å"traditional†Read MoreImportance Of Relationship Marketing32123 Words   |  129 Pages | | | |8.3 CUSTOMER SUPPORT | | |9 |FINANCIAL BANKING TECHNOLOGY |38-39 | |10 |WHAT CUSTOMERS WANT |40-74 | |

Discussion about self assessment on the cultural competence

Question: Discuss about self assessment on the cultural competence? Answer: I am Lisa, a nursing student of a well known hospital of Australia. Here I am going to assess about the importance of cultural competence in the field of health care process. It is known that nurses have to communicate with the patients as communication and being respectful for their culture is very important in the treatment procedure (Purnell, 2012). So in the beginning of the self assessment I would like to tell about the process in which I usually treat all my patients. I usually treat all my patients irrespective of their cultures that is whether the patient belongs to any culture he or she will be treated as same as the others. In some cases when it is needed to maintain their cultures then I supposed to learn about their culture and their requirements and then I treat them according to their need (Jeffreys, Dogan, 2012). As for me the most important thing is the well being of my patients I usually do not impose my thoughts and value system to my patients. I also see the import ance of the use of local languages in the communication with the patients of different communities. I have found many patients with communication disabilities. For this reason I recognize the dissimilarity between the statement disability and communication dissimilarity. In the treatment procedure I have found the importance of the family in making decision of the treatment process for the patients. I come to know apply of foreign accent and imperfect English ability is not an indication of the capability of the good communication skill. If I have to treat the patients with different culture then I also have to know the use of those languages as well. Working in a community I have learnt the impact of different cultural practice in the child rearing process. The process that are mainly affected are like the discipline, feeding, dressing, toileting, communication etc. while working in the community I have found the impact of cultural practice on the education, role of family, faith b ased practice, role of genders, employments, view of wellness etc and its effect on the treatment process of the patients (Giger, 2014). I have found various views regarding the disabilities of the patients and their community member. Many of the community members possess various views regarding the medical treatment found in western countries. Many of them have been found the western treatment process very working in the treatment process and remaining members do not found it working. Along with the treatment procedures I have learnt the ways to understand the cultural views of my patients. The ways may include the eye contacts, use of gestures, interruption, and use of humor, decision making roles, and the topics they used for the conversation (Douglas, 2011). I have understood that for a nurse it is very important to be respectful for the cultural phenomena of every patient. To improve the transcultural healthcare the nurse have to be respectful for the decision of the patients a s well as the family member and along with this the communication skill have to be improved as it has very importance in the treatment procedure of the community patients. From this self assessment as a nurse I could feel that, being transcultural, one health care provider mainly nurses can actually feel what are the actual problem and its possible remedy. Not only that this also help me to understand various natures of the people present in the society, that in turn help me to in the treatment procedure of the community member. Reference List: Purnell, L. D. (2012).Transcultural health care: A culturally competent approach. FA Davis. Jeffreys, M. R., Dogan, E. (2012). Evaluating the influence of cultural competence education on students transcultural self-efficacy perceptions.Journal of Transcultural Nursing,23(2), 188-197. Giger, J. N. (2014).Transcultural nursing: Assessment and intervention. Elsevier Health Sciences Douglas, M. K., Pierce, J. U., Rosenkoetter, M., Pacquiao, D., Callister, L. C., Hattar-Pollara, M., Purnell, L. (2011). Standards of practice for culturally competent nursing care: 2011 update.Journal of Transcultural Nursing,22(4), 317.

Romeo and Juliet theatre production Essay Example For Students

Romeo and Juliet theatre production Essay For this piece of coursework I will explore and explain five tense and dramatic scenes from the play Romeo and Juliet by William Shakespeare. Using these scenes I will explain how a production at the Globe Theatre could have been presented to the audience of the time, to maximise the drama and the characterisations. In addition, I will consider how audience reaction and participation have changed over the centuries with varying approaches to the presentation of the story. Before proceeding with this essay I will now briefly explain some of the factors which coincide with the requirements of this essay question. For example, I will give a brief summarization of the story of Romeo and Juliet, an outline of some details about the Globe theatre, and a brief review of the rest of the essay question, for example, some of the factors which would influence how a production at the Globe Theatre could have been presented to the audience of the time, to maximise the drama and the characterisations. The famous story of Romeo and Juliet, based on the narrative poem, The Tragicall History of Romeus and Juliet by Arthur Brooke is a story of two lovers, as the prologue famously refers to as A pair of star-crossd lovers, who were secretly married and suddenly separated throughout their fearful passage of their death-markd love. The Globe Theatre was, like many others such as the Rose, the Swan and the Fortune a permanent playhouse built in London in the Elizabethan times. In 1596 James Burbage, a carpenter by trade, who owned the Theatre and the Curtain Theatre ran into difficulties when he tried to renew the ground lease of the Theatre. Negotiations yielded no viable solution, and James died, leaving his son Cuthbert to resolve the problem. The latter acted with daring and imagination. With the lease due to expire at the end of that year, on 28 December 1598 he had the building dismantled by a carpenter called Peter Street and twelve workmen. It was removed to a piece of land on the other side of the Thames I Southwark, not far from the Rose. In less than Eight months they built the Globe, the splendid wooden O mentioned by the chorus at the beginning of Henry V. Shakespeare, one of the five players in the Chamberlains company became a householder in the Globe, in other words owner of a share in the property. The Fortune, the Globe and the Theatre were able to accommodate audiences of between two and three thousand. Elizabethan audiences were in some ways more sophisticated than the audiences of the twentieth century. For example, when we go to see a new play or (more likely) a new film, we expect to find the novelty in the action. Some of the situations may be familiar; we may be able to anticipate the ending; and the characters (who should not be too different from the people we meet every day) may speak lines that we have heard before in other plays and films. But we do demand a new story. Shakespeares audiences had different expectations. They were happy to be given stories that they recognized, so long as the dramatists treatment was new and individual. It is possible to trace a source, or sources, for every one of Shakespeares plays. Some of Shakespeares plays present very well known stories-Antony and Cleopatra, for instance, or the range of plays dealing with the span of English history from the time of Richard II to the reign of Henry VI. Shakespeares researches were thorough: usually there is more than one source for a play. However, this is not the case in Romeo and Juliet as in this play Shakespeare relies almost entirely on a narrative poem, The Tragicall History of Romeus and Juliet by Arthur Brooke . The blend of interests and traditions In which Elizabethan drama took on board, such as elements from the Roman theatre as well as from Renaissance Italian and the popular Commendia dell arte, with its stock characters and half improvised plots, which were well known to English dramatists, as were the stately and declamatory tragedies of Seneca, combined to create a blend of interests and traditions which gave the Elizabethan drama one advantage that no modern theatre has. It made drama for the entire nation. The uninstructed groundlings flocked to it as eagerly as the lettered patrons in the covered seats. The fashionable gallant was there but so was the eager young scholar already dreaming of fame and genius. Therefore, from the beginning the Shakespearean drama has one great freedom; it does not have to channel itself to one stratum of public taste. I can be lowbrow or highbrow according to the needs of its subject matter. But this is not its only advantage. It has, in addition, the freedom conferred by the unfettered imagination. It is not a consumer-art but an art of participation. In Shakespeares day the theatre was an art full of participation. Not only did it make use of poetry, which draws the hearer into a close union with the speaker. It also employed the Ruth Draper technique of making the audience supply the visual background by imagination alone. The result was a freedom never again approached until the beginning of radio drama in the 1920s. Without waiting for tardy (late) changes of unconvincing scenery, the action can whisk from one country to another, from the deck of a ship to the streets of a city or from Mantua to Verona for example. However, audience participation was not the only way in which the spectator was drawn closer in unison with the speaker and conveyed a clearer picture of the drama being performed, there were many other factors that influenced this. For example, the characterizations and the language used by the characters would play as much of an important role in doing this. Also, in some cases the setting, scenery and atmosphere and props were included to add colour and excitement, for instance swirling swords in a battle scene would do this. Furthermore, In the sixteenth and seventeenth centuries Considering the time difference between now and then, to some extent just as in the theatre today sound effects and music, created by an orchestra or machinery would have been used at certain points to futher emphasize certain qualities of the speaker and of the drama being performed. I will now explain, how these features and others could have been used when presenting the play Romeo and Juliet to an audience of the time at the Globe Theatre to answer the essay question. * Scene One: For my first example of a tense and dramatic scene in the play, I have chosen, and will refer to the prologue. This is the first of the scenes in the play and is therefore important in terms of the play itself, as it sets the scene for what proceeds in the rest of the performance. The scene is presented to the audience by the chorus a single figure who is not a character and has no personality, his function is simply to explain the situation clearly to the audience. The scene, which is relatively short, as its purpose is simply to explain the situation, uses many dramatic words and phrases in order to silence a restless audience and settle the spectators into an appropriate mood for the first scene to commence. In the scene many dramatic words and phrases are used such as: Two households, both alike in dignity (noble, honorable), mutiny (violence), star-crossd lovers (ill-fated lovers) and but their childrens end, nought could remove (But no-one could stop the deaths of their children). These dramatic words and phrases would not only grab the audiences attention and settle them down ready for the main start of the play to proceed but also enhance the speech made by the chorus and the characterizations of the chorus which could further be re-enforced by strong, passionate body language and expressive facial expressions, which would enrich the characterisations of the chorus and show emotion for the spectators to receive and interpret for themselv es as part of audience participation in which, using the information given by the Chorus the spectators would, using their imagination supply the visual background and in turn, clarify for themselves what had been said. I will go into futher detail about audience participation as this coursework progresses. In addition, music and scenery were introduced in Elizabethan and Jacobean times and, as in other Shakespearean plays such as Twelfth Night which was filled with songs and particularly Anthony and Cleopatra in which unusual sounds were created, such as the noise of a sea-fight, dramatic sound effects may have been used at a certain point in the scene, either to add texture or to enhance certain qualities being performed. In this case dramatic sound effects may have been used in order to signal the end of a prologue and the commencement of the first scene. Moreover, this may have been more of a necessity than a luxury as the theatre had no curtains or blackout to indicate the end of a scene or act. Also, Shakespeare wouldnt necessarily have indicated the ends of scenes either. Therefore, these sound effects would not only create audience anticipation and add excitement, as the spectators await the opening of the play, but also more importantly inform the audience that the start of the play was commencing, additionally this way the spectators would not get lost between the scenes. Intervals between acts were introduced in the newer indoor theatres, whereas, as just mentioned the open-air theatres, such as the Globe tended to play without a break. The indoor theatres had an advantage in that they were covered over, so performances could be staged in bad weather and they were also lighted by candles so performances could be staged in the evening. However, the older, amphitheatre-style theatres such as the Globe would probably have created a more superior atmosphere than the newer indoor theatres as the audience at theatres such as the Globe were probably far more varied, including the richest and the poorest, while the audiences at the Blackfriars theatre for instance, generally consisted more of those of rather higher social status; this was inevitable because the indoor theatres were more expensive. Therefore, the crowd at theatres such as the Globe, which would include those of a lower social status and wealth were probably likely to have been more inclined to show their true emotions to make their presence felt than of the crowd at the indoor theatres, dominated mainly by the possibly more reserved upper-class. Finally, this scene, the prologue provides me with my first insight into audience participation in the Elizabethan theatre as due to it being such a short scene and one in which is to simply explain the situation, the audience would have only the choruses speech, including the dramatic words and phrases to go on. Therefore, for this scene as the chorus is explaining the situation in which the story is based upon it is important that the spectators would have to envision the situation in their mind in order to recreate the scene for themselves in order to gain a better and clearer understanding due to there being only the speech made by the Chorus to go upon. Consequently, audience participation would be important here because the words of the Chorus alone would provide the audience only with an insight into the situation and it may also have been difficult for the audience to hear what was being said by the actors if a gallant was sitting on-stage talking as the audiences commonly talked throughout the performances, despite pleas from playwrights for silence. Therefore, as a result of their participation, the audience would understand the situation better and this in turn would also help convey the information read by the Chorus clearly into their minds. I know from the pricing system that a social spectrum of people visited the theatre in Shakespeares time. In the open air theatres such as the Globe the prices varied from one penny to stand round the stage, to sixpence for a box. In the private theatres the standard entrance fee was sixpence and a stool on the stage itself cost another sixpence. Therefore, from this it is clear that the audience attending theatres such as the Globe would probably be very diverse in the sense of wealth and social status. Audiences would include such people as landed gentry, doctors, layers, gentlemen, servants and working people of all kinds. In other words, there was a much more varied audience than for most of our theatres today. The audience at the Globe was probably far more varied, including the richest and the poorest, while the audiences at the Blackfriars theatre generally consisted more of those of rather higher social status; this was inevitable because the indoor theatres were more expensive. Moreover, lots of people, especially Puritans, complained about the immoral people in playhouses, but the evidence suggests that in fact little crime was committed there. However, gallants were conspicuous at Blackfriars, where on one occasion there was a row because a gallant sat on the stage and obscured the view of a Captain escorting an Earls wife. I have chosen the prologue as one of my scenes because it is one of my favourite as it is brief, dramatic and informative as the scene informs me of the situation in which the story is based upon and uses many powerful words and phrases in the process which enhance the choruses speech making it more dramatic, in the theatre this would grab the attention of the audience. Also, I have chosen the proceeding because it is a scene of significance and importance as it opens the whole play and informs the audience of the situation with the two feuding families in Verona. It also settles the spectators into a mood in which is appropriate for the play to commence. In addition, I have chosen this scene because it would be impressive, majestic and quite a spectacle when performed at the Globe Theatre as the dramatic speech made by the single figure-the Chorus, alone on stage would be a quite a climatic event and opens what is one of Shakespeares most popular and well loved plays. I think the audience reaction would be of interest and expectation because I think the dramatic words of the Chorus would silence what would probably be a restless crowd into an appropriate mood ready for the play to commence, especially those groundlings who frequented the pit-which meant standing throughout the two hours traffic of a performance. Moreover, as the prologue to Romeo and Juliet calls it the spectators were eager for sensation and overwhelming emotion It was impossible to mumble words to jostling and undisciplined spectators: their attention had to be captured, this dramatic solo speech made by the Chorus may have in effect done this. * Scene Two: For my second example of a tense and dramatic scene in the play I have chosen and will refer to Act2 scene6. This scene would not be part of the play because the secrecy of it not being included would add a sense of danger to the performance. However, in the book Romeo and Juliet it is the scene where the marriage between Romeo and Juliet takes place and is undertaken by Friar Lawrence. The message conveyed by this scene to the audience is one of undying love- presented to the audience by the marriage between Romeo and Juliet, which took place without their parents consent, whose families, the Capulets and the Montagues strongly oppose each other and there is great rivalry between the two. Unlike most modern dramas, Elizabethan plays did not depend on scenery to indicate the setting (place) of the action. Generally, the setting was unknown to the audience until the characters identified it with a few lines of dialogue. Also, this was not helped by the fact there was no curtain on the main stage so one scene could follow another in quick succession. In addition, Elizabethan audiences behaved slightly differently compared to modern audiences today and what they are required to do. For instance, modern audiences are required to: keep silent during the performance, clap at the interval and conclusion, not eat or drink during performances and keep their attention on what is happening on-stage. Of course, all members of all audiences dont necessarily fulfill these conditions, but most people do, most of the time. However, Elizabethan audiences behaved slightly differently. For example, the audiences commonly talked throughout the performances, despite pleas from playwrights for silence. Moreover, if a gallant was sitting on-stage talking it would be very difficult for the audience to hear what was being said by the actors. Furthermore, the audience might well applaud, but they booed and hissed as well if they felt like it and hurled things at the actors when they disapproved of them. Food and drink were also served during the performance as yet another distraction. One of the things the actors complained about most was the cracking of nuts, which caused quite a lot of noise and disturbance. Finally, because conversations were going on and food and drink were being consumed, the audience were obviously not always attending to what was happening on-stage. The power of an actor would be shown by his ability to command the attention of the audience. It has been estimated that about 20 to 25 perce nt of the population attended the playhouses, which again is a far higher percentage than today. Therefore, it is possible that there are many factors which could be added to the drama and combined together to maximise the drama of the scene and the characterisations of the characters being played. Firstly, throughout this scene the atmosphere would have to be contained in order to convey the scene across to the audience, who were likely to be engaged in conversation with each other as clearly and inspiringly as possible, without boring the expectant audience by being too informative, plain, drab and serious. For example, as it is such a short scene the speeches made by the three characters: Romeo, Juliet and Friar Lawrence could be emphasized in a way which would offer the spectators more, grab their attention and keep it throughout the scene while retaining an essence of suspense which would retain audience anticipation and add excitement to the drama being performed before them. One way this could be achieved is by the use of costumes and sound effects. The absence or lack of scenery did not result in dull or drab productions as acting companies spent much money on colourful costumes, largely to produce visual splendor. Actors appeared in the most flamboyant and up-to-date fashions of their day, adding certain exotic or historical touches according to the character they were playing and the play being performed. The lavish clothes in which the actors were dressed in were often second-hand clothes bestowed by rich patrons. Therefore, this could have been applied, in context of the scene to create visual splendor and also to liven up the atmosphere and the impression the spectators receive, to create more interest from the spectators. Additionally, sound effects had an important part in Elizabethan drama. Therefore, in this case soothing, melodic music could have been played by the accompanying orchestra in the background in unison with the acting to add romance to the scene and also to maximise the characterizations being performed before the audience. This could further be enhanced by certain props being used, although very few props wee used during performances. For example, a canopy or a book may have been used by the actor portraying Friar Lawrence and also some musicians could have appeared on stools on stage, playing melodic music to further set the romantic scene and impression for the audience. Although the stage lacked scenery various props were used during performances such as, thrones, swords, banners, rocks, trees, tables and beds. In the play of the same name Richard III calls for two tents, one at each end of the stage. Finally, in terms of the language used by the actors playing Romeo and Juliet the language could be over-emphasized at times for instance, in order to express their love for each other for the spectators to receive. Additionally, the repetition of certain words and phrases would add to this and consequently maximise characterisations of the two. For example, line three of this scene, act2 scene6 opens with Romeo expressing his happiness proclaiming: Amen, amen! The additional exclamation of some sections of dialogue, such as this and other sections would furthermore enhance the language of the two characters as the actors could command the attention of the audience by grabbing their attention by the exclamation of some of their speech, at times of high emotion and happiness. In doing this, with the audiences attention the actors could then proceed with the rest of the scene, varying their styles of speech as they would have the full attention of most of the on-looking spectators. In doing this the actors would be commanding the attention of the audience and by virtue of this could create and retain audience anticipation by combining the previous devices and moreover varying their style of speech. For example, with the other features in mind the actors could give their speech in a slow or fast delivery for instance, giving a fast delivery when expressing feelings of happiness and emotion. The audience would enjoy this style of language as th ey loved overwhelming emotion and impassioned grandiloquence, metaphor and extremes. Moreover, It was impossible to mumble words to jostling and undisciplined spectators: their attention had to be captured. Therefore, this style of language would have particularly suited this passionate scene. Actors acting in a drama EssayIn this scene, the conclusion of the tragedy, Romeo visits Juliets tomb where he expects to find his wifes body. Romeo is no longer the dreamy youth that the audience met at the beginning of the play. He describes himself as a desperate man and, when Paris, who was laying flowers and placing scented water on the grave of Juliet, ignores his gentle warning, he fights with a serious determination which is totally different from the rough assaults of the servants (Act1,Scene1) and from the elegant sword-play of the young nobleman (Act3,Scene1). Romeo intends to kill Paris without ceremony and without delay and succeeds in doing so, however, he feels pity for the good gentle youth. He is preparing to lay Paris, tenderly, in the tomb when he looks on Juliets face. Although he is prepared for death, he in fact sees life: beautys ensign yet is crimson in thy lips and in thy cheeks. Here the audience would know that he is not deceived, and the tension would be great as Juliet might wake in time and all might yet be well. Here the characterizations of Romeo, such as the body language, speech and especially his facial expressions would have to be strong, powerful and emotional in order to convey the emotions felt by Romeo and the tension of the scene across to the audience in the foremost way possible and also to create a high-strung atmosphere which would in return, retain the audiences interest and anticipation, as they eagerly await the tense drama unfolding before their very eyes. The hope of Juliet waking in time would be vain, of course. Romeo drinks his poison, whose action is swift: he dies kissing Juliet, a second before Friar Laurence, stumbling in the graveyard, enters the tomb to comfort Juliet in her waking moments. As soon as she understands the situation, she acts-first kissing the poison on Romeos lips, then making sure of her death with Romeos dagger, which she plunges into her own breast: O happy dagger! This is thy sheath! Once again the citizens of Verona are drawn to the scene and Friar Laurence provides the narrative this time, freely confessing his own part in the events and offering himself for punishment. Capulet and Montague join hands but they have paid a high price for their new friendship. There was not much to be said: A glooming peace this morning with it brings; The sun for sorrow will not show his head. As mentioned previously, in this scene the characterisations of the particular characters in prominent roles such as Romeo, Juliet, Friar Laurence and indeed, the rest of the actors involved in the scene would have to be strong and full of emotion in order to convey the emotions felt by the characters and the sadness and woe of the climatic conclusion to the story which is the final scene, across to the audience. Indeed, in many ways the means in which this scene proceeded and was undertaken, when performed at the Globe Theatre would probably have taken a more basic and acoustic approach, when concerned in actually delivering the scene to the audience. However, this would not bring a dull or drab ending to what would conclude the whole play. For example, all actors required a combination of talent and dedication to their craft, for the theatres were commercial enterprises dependent on the success of the plays they performed. Therefore, the skills and qualities of the actors were paramount when performing on stage. Additionally, those who frequented the theatre, and in particular the pit-which meant standing throughout the two hours traffic of a performance, as the prologue to Romeo and Juliet calls it-were eager for sensation and overwhelming emotion-such as that in this final scene in Romeo and Juliet. Moreover, the spectators loved impassioned grandiloquence (characterized by a pompous or boastful manner and language),metaphor and extremes. It was impossible to mumble words to jostling and undisciplined spectators: their attention had to be captured. Moreover, a taste for thrills and horror was deeply embedded in popular audiences. Hence the success of revenge tragedies, rich in macabre scenes and spectacular effects. The strength of national feeling, stirred by the defeat of the Spanish Armada in 1588, and the craze for English history, revealed by the success of a play such as Marlowes Edward II, is futher evidenced by the popularity of the highly coloured scenes represented in chronicles in history plays. The din of battle, the clash of weapons, evoked strong emotion, while heroic deeds were an occasion to show actors in hand-to-hand combat. On that account, considering the contex of this scene, it is fair to say that, as mentioned before the emphasis would be put more on the characterisations and language of the actors than on visual effects, created by props and accompanying music and sound effects. However, these would have been used in order to accompany and express into more detail and to add character to the drama, as previously mentioned to gain more interest from the audience. As a result of this, audience participation would be made easier, as the spectators would have a better understanding of the drama because they would have more information to put into perspective and consequently, they would know what was happening and would therefore enjoy the scene more as they would be dragged into the drama and would find themselves anticipating what was going to happen next. Indeed if performed well this tense and dramatic scene above any others would probably have created the most audience participation and consequent ly anticipation as the spectators who were following the story by participating with the drama would eagerly be anticipating what would happen next. In terms of the characterisations and language of the actors, the factors which would fall into these categories that would play an important role in this scene would be details such as: the body language, facial expressions, movement, speed and pace of speech and, concerning the language of the characters details such as: the exclamation, repetition, slow or fast delivery of speech and the over-emphasis of words or phrases. Firstly, the basic features concerning the characterizations of the characters such as the body language, facial expressions, movement, and the speed and pace of speech of the characters would probably be the most important factors when concerned in acting out this scene as they would be the predominant form of communication between the actors and the spectators. Therefore, simple details could be added to the way the actors act out their role to enhance the characterizations of the of the characters in which they are playing. For example, with regards to this scene especially the body language and facial expressions of the characters, especially Romeo, Juliet and Friar Laurence would have to be strong , powerful, influential and resolute in order to convey the powerful meaning of the drama across to the audience and also to enhance, emphasize and distinguish the characterisations of the characters, especially their emotions which will in return help the spectators receive a better understanding of the emotions the characters were going through. Also, a result of this the spectators would enjoy the drama more as it would be more exciting, climatic and enthralling. In addition, the language of the characters such as the exclamation, repetition, slow or fast delivery of speech and the over-emphasis of words or phrases would be equally as important in this scene as any other factors and would in fact play a predominant role in this scene and also the whole play itself. For example, as mentioned before the exuberant audiences of the time were eager for sensation and overwhelming emotion, they shared a passion for language and loved impassioned grandiloquence, metaphor and extremes. Therefore, the diverse language in which Shakespeare used would provide much entertainment and enjoyment for the audience as in this scene the language is full of emotion and that combined with the sensation provided by the plot for this scene would retain the audiences interest and satisfy their expectations. By virtue of this the performers would be able to vary their style of speech, depending on the context of the scene. For example, in the scene the actor playing Romeo could go from using lots of repetition and over-emphasizing words in fast delivery in time of anger and anguish, to using passionate exclamation and saddened images in a slow delivery in points of sorrow, woe and grief. Moreover, in this scene and throughout most of the play, Shakespeare uses a wash of rich and vivid language. For instance, Shakespeare includes a lot of figurative language (use images-similes, metaphors), personification (describe something as a person), images such as olfactory images (use words to describe a smell) and rhythm in this scene and throughout Romeo and Juliet. As an example, rhyming couplets are sometimes used in dialogue which would in this case emphasize to the audience what is being said by the character. By a way of illustration, this is a section of dialogue taken from one of Romeos speeches in this scene, act5 scene3: Stay not, be gone: live, and hereafter say A madmans mercy bade thee run away. In turn this colourful, exciting, emotional and vibrant language would not only give the spectators more enjoyment, as they loved exciting language but also encourage and sustain audience participation as the spectators would have a clearer understanding of things due to this use of images based in Shakespeares language. This could futher be enhanced by the articulate (well spoken) language of the actors. This would over all create depth to the characterizations of the characters the actors were portraying and furthermore add to the exciting and powerful range of language used in the scene which the actors could use in their favour to command the audience by creating a varied display of emotions which would influence and retain the audiences interest, anticipation and participation because, as mentioned before, the spectators were eager for sensation and overwhelming emotion, they shared a passion for language and loved impassioned grandiloquence, metaphor and extremes. This scene may well have taken a more basic and acoustic approach when it was performed at the Globe Theatre in terms of delivering the scene to the audience. However, In many ways I know that the content of the scene, is a step up in level in terms of the language and characterisations than the previous scenes. However, this scene could still benefit from the use of some scenery, sound effects and music. For example, in terms of scenery various props could have been used to indicate the setting of the action and by virtue of this help the audience put things into context or perspective so they would have a better understanding of what was going on. For example, tombs could have been placed on the stage, with Juliet lay on one of them to indicate to the audience that it was the inside of the crypt where Juliet lays on her tomb. In doing this the audiences thoughts would be drawn to the stage as they would have something to focus on and would therefore find it easier to follow what was happening on stage, this would retain their interest. Finally, to conclude this scene it is possible that sounds could have been created and incorporated into various points in this scene In order to maximise the drama and characterizations. For instance, as in the film Romeo and Juliet familiar and distinctive sounding, melodic music was played over the acting at various points in the film in order to emphasize what was usually parts of sorrow and woe. In addition, this would have been the case in modern theatre and they would futher of enhanced the drama by dimming the lights for example. In this case, using the orchestra which accompanied the unfolding of a play with a varied range of sound effects and instruments, the same melodic sounding music, supplied by a combination of a harp, a flute, violins and a 12-string acoustic guitar could be played over the most dramatic parts of the scene in times of anguish, sadness and sorrow in order to maximise these emotions in order to convey them across to the audience so that the spectators feel the emotions the characters were feeling and also to futher add depth to the drama and characterisations. As a example, a particular point in which these sound effects could have been used would be at the end of the play in the last line of act5 scene3 where Prince Escalus reads the eternal line: For never was a story of more woe Than this of Juliet and her Romeo I have chosen act3 scene5 in which both Romeo and Juliet take their lives together and the two feuding families are united in grief because it is one of my favourite and I think is the most dramatic scene in the story. The performance is one of my favourite scenes because it is very dramatic and touching as Romeo is under the impression Juliet had died and consequently he takes his life when he discovers her in her tomb and Juliet does the same when she wakes up, this shows their love for each other. Also, as it is a tragedy the ending is very sad, however, in this case I think it is probably the best ending the story could have had because, to me it is satisfactory as it is a ending in which rounds off what is a very good story. If it was an ending in which the two lovers survived, they would still be separated and the tale of the two feuding families would persist or remain. In my opinion this would not be a satisfactory ending because from what had been a very dramatic story, set up for a dramatic climax, the story would just fizzle out and there would not really be any meaning to it and more importantly, the story would not be a tragedy. Over all I like and have chosen the scene because it is a very dramatic and touching scene and is one in which I believe is the most satisfying and convincing in the whole story. I think it would definitely come across as one of the finest and most dramatic scenes out of the whole play when performed at not only the Globe Theatre but other theatres past and present. * Conclusion: * The five tense and dramatic scenes in which I have chosen from Romeo and Juliet and have explained how a production at the Globe Theatre could have been presented to the audiences of the time, to maximise the drama and the characterisations, are more or less my five most favourite scenes from the story. However, my overall favourite scene is act3 scene1 in which there are many swordfights in the streets of Verona between the two feuding families, the Capulets and the Montagues, and as a result, in the main point in which the scene evolves around, following Tybalts killing of Mercutio, Romeo forgets his new bride and takes his sword to attack her cousin in an act of vengeance for the death of Mercutio, a fellow Montague. Consequently, as a result of his actions Prince Escalus banishes Romeo from Verona. Consequently, because of this I believe it is definitely one of the most significant and enthralling scenes in the whole story as it strongly influences what proceeds in the rest of the performance. Act3 scene1 is my favourite scene because it is very dramatic, action packed and exciting, and is one of only a handful of scenes in the whole story in which grabs my attention and keeps me reading on, eagerly awaiting what will happen next. Therefore, for this reason I found this scene the most exciting and exhilarating in the whole story. In addition to that, for me the scene created a build up of interest which made me start anticipating what would happen next as the story proceeded and I was intrigued into how the story would pan-out because of this dramatic twist in the tale in which Romeo is banished from Verona and is consequently separated from his love, Juliet. I anticipated that this would lead to a dramatic and exciting finale in which I would have to read on to find out what happened, as a result this is the scene which grabbed my attention and I became more attracted and enticed in the story. Finally, act3 scene1 is my favourite scene because it is the most action packed and exciting scene in the whole play and therefore, by virtue of this would be very impressive, inspiring and vibrant when performed at the Globe Theatre, in front of a buoyant and high spirited audience. * To a certain extent all of the scenes in Romeo and Juliet are dramatic in their own way, ranging from scenes of intense rivalry and passion, to scenes of great irony an woe. This is why the celebrated and famous story of Romeo and Juliet has captivated such a large audience both past and present. However, in my opinion the most dramatic scene in the story Romeo and Juliet is the final scene and the conclusion of the tragedy in which due to a tragic misunderstanding both Romeo and Juliet take their lives instead of the option of being apart from each other and as a result the two feuding families are united in grief. I strongly believe the performance is the most dramatic scene because it is the most emotional, sensational and touching in the whole story as Romeo is under the impression Juliet had died and consequently he takes his life when he discovers her in her tomb and Juliet does the same when she wakes up. To me this shows their undying love for each other and in turn fits the two famous and climatic descriptions the pair are given in the prologue a pair of star-crossd lovers who have death-markd love. For me the power and emotion that makes up this scene is far more dramatic than act3 scene1-the fighting scene, for instance because the sensational and moving way in which this scene and therefore the story is concluded is more touching than any other scene as it is a dramatic and poignant outcome in which the two main characters end their lives because they cannot stand being the apart. This is a far more dramatic outcome than act3 scene1 for instance as the characters killed in that scene are killed mostly out of violence and conceit, on the other hand in this final scene the characters end their lives together motivated by love and emotion. I believe this is far more dramatic than the characters being killed in battle as there is far more meaning, love and emotion behind this outcome and I believe most of the spectators in the Globe theatre, who, as I have mentioned before, were eager for sensation and overwhelming emotion would feel this highly dramatic passion too, in this scen e especially more than any other scene. Finally, as I have mentioned before about this highly dramatic scene, as it is a tragedy the ending is very sad, however, in this case I think the scene is probably the best ending the story could have had because, to me it is satisfactory as it is a ending in which rounds off what is a great story. To illustrate, If it was an ending in which the two lovers survived, they would still be separated and the story of the two feuding families would continue. For me this would not be a satisfactory ending because from what had been a very dramatic story, set up for a dramatic climax, the story would just fizzle out and there would not really be any meaning to it and more importantly, the story would not be a tragedy. Therefore, I believe this climatic, emotional and moving scene in which rounds off the story of Romeo and Juliet is the best way of concluding the story because it is a fitting and convincing ending to what the impassioned and ironic story of Romeo and Juliet builds up to. Over all I believe act5 scene3 is the most dramatic and touching scene in the story of Romeo and Juliet and I think it would definitely come across as one of the finest and most dramatic scenes out of the whole play when performed at not only the Globe Theatre but other theatres past and present. The scene is one in which I believe is in a sense the most satisfying, convincing and most definitely the most touching and in turn dramatic scene in the whole story and is perfectly rounded off with the fitting, emotional and eternal line spoken by Prince Escalus: For never was a story of more woe Than this of Juliet and her Romeo The Globe Theatre was a 17th-century English theater in Southwark, London, notable for the initial and contemporaneous productions of the dramatic works of English writers William Shakespeare, Ben Johnson, Beaumont and Fletcher, and others. The Globe was constructed in 1599 by English actor Richard Burbage in partnership with Shakespeare and others. The octagonal shaped outer wall of the theater enclosed a roofless inner pit into which the stage projected. Around the pit were three galleries (balconies) one above the other, the topmost of which was roofed with thatch. In 1613 a cannon, discharged during a performance of Shakespeares Henry VIII, set fire to the thatched roof and destroyed the building. The theater was rebuilt in 1614 but 30 years later was destroyed by the Puritans. In 1970 American actor and director Sam Wanamaker began raising funds to rebuild the Globe, and in 1996 the new theater, based on the design of the original structure, was opened.

Maus free essay sample

In the comic style book Maus, the theme of survival is expressed in many different ways. The Holocaust was a big part of the Jews heritage and not many survived. The amount of people that did survive by hiding and other things was very small. Luck plays a very big role throughout the book of Maus and as it did during the real life holocaust. And because of this luck, that’s why the few that survived, actually survived. Vladek was lucky as he had a good education, which allowed him to speak different languages to help him survive and was generally smarter than a lot of the others. In many occasions his survival was based on luck. It was luck when the bullet missed him at the prisoner’s camp. Also when he got kicked out of the house and found a construction site to hide in. He hid there for a while and didn’t get captured by the Nazi’s. We will write a custom essay sample on Maus or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Another example of luck is when he gets beaten up for throwing food to Anja, usually you would get killed but he was lucky enough to just get beaten up. In my opinion luck was the key role in Vladek’s survival. Another factor which contributed to survival was that he was very smart mentally. At first he was very stubborn and did not use his skills wisely or well, but as you read further into the book, he began using his intelligence to his advantage and it was this intelligence that helped him survive. There were also his resources that he had, such as people he knew. This enabled him to get the necessary food, supplies, protection and shelter to survive. He was smart enough to get the right supplies by trading with the Polish workers. He had the skill of repairing shoes which helped him to earn money in order to buy different things. Being resourceful came in handy when it came to the concentration camps. When he first escaped the Prisoner of War camps, Vladek disguised himself as a non-Jewish Pole so he could get on a train to go home. First, after Vladek and Anja were captured for trying to escape to Hungary, Vladek helped a Polish man write letters to his family. The letters had to be in German, and the man did not know how to speak German. The man, in return, shared his food with Vladek. Later, in Auschwitz, Vladek got on good terms with his Polish block supervisor by teaching him how to speak English. This saved him from being sent to the gas chambers on more than one occasion and earned him both food and a uniform that fit. The block supervisor also helped Vladek to get a job working in a tin shop. Maus explored the theme of ‘survival’ in many ways. Survival was hard and most people didn’t survive but for those who did, they suffered very much after. With things like depression from memories and also losing loved ones. The book also explores Vladeks clever use of the skills he has in order to keep himself from being killed on many occasions. If Vladek didn’t have the factors that contributed to survive, he would not be able to survive.

Gentic Catastrophe essays

Gentic Catastrophe essays While the 20th century was shaped largely by spectacular breakthroughs in the field of physics and chemistry, the 21st century will belong to the biological sciences. Scientists around the world are quickly deciphering the genetic code of life, unlocking the mystery of biological evolution on Earth. As a result of the new breakthrough in biology and biotechnology, our way of life is likely to be more fundamentally transformed in the next several decades than in the previous thousand years. By the year 2025, we and our children may be living in a world utterly different from anything human beings have ever experienced in the past (Rifkin 30). Some ideas in genetic science are fast growing dilemmas that society is going to have to deal with in time. Producing a superior race by altering peoples genetic code or cloning, is thought to be unethical. In the future what would stop families that can afford to program superior genetic traits into their fetuses at conception that will ensure their offspring an even greater biological advantage and thus a social and economic advantage as well. This would affect the people without an altered genetic code because as stated in Darwins theory that only the strong survive, people without altered genes would become less efficient and would not survive as well in society. Molecular biologist Lee Silver of Princeton University writes about that in a not too distant future, society will be made up of two distinct biological classes, which he refers to as the Gene Rich and the Naturals. The Gene Rich, who will account for 10% of the population, have been enhanced with synthetic genes and wi ll become the rulers of society. They would include Gene Rich businesspeople, musicians, artists, intellectuals, and athletes each enhanced with specific synthetic genes to allow them to succeed in their respective fields in wa ...

Network Topology Design Research Paper Example | Topics and Well Written Essays - 500 words

Network Topology Design - Research Paper Example r the case of these increasing numbers of employees, it is recommended for a company to use hierarchical topology where we will have a hierarchical network with one or more powerful server controlling the entire network; departmental server control lower levels of processing and network devices. A good example of this type of network is that of retail clothing with a central computer that stores the data about the sales activity. When it comes to the case of hundred employees or more, one is recommended to use a meshed network with a switch going them and a router (router can be used to connect LANs or WANs) extending the network. This is to make sure that there is efficient communication within the organization or a company. However, when designing a network topology which is a crucial step towards logical design phase of the top down-down networking scheming methodology. In addition, it is important for one to identify networks and interconnection points within it. A flat network t opology is sufficient for very small networks (ten employees or less); with this kind there is no hierarchy, each networking devices has its necessary job. But with the growing numbers of clients, it becomes undesirable, lack of hierarchy make trouble shooting difficult within the organization (Oppernheimer, 2004, p.133). When numbers of clients in organization increase, it recommended for the company to use meshed hierarchical design, there are two types of hierarchical models; partial mesh hierarchical model and full meshed model. In partial meshed hierarchical design, we have the core layers at the headquarters i.e. head of departments followed by the distribution layers. This kind of network topology is recommended for hundred clients in an organization. This model is usually implemented using hubs, with little mesh network among the clients. On the other hand, full meshed network topology can be used to meet the demands of large number of clients (two hundred employees); a good

Nutrition on a Patient with Acute and Recurrent Pancreatitis Essay

Nutrition on a Patient with Acute and Recurrent Pancreatitis - Essay Example The nurse is responsible in coordinating the orders by the health team. Evaluation should focus on the patient’s tolerance of the interventions implemented and reassessment of the overall nutritional status. Anthropometric measurement is part of every nutrition status assessment. In the patient’s case, it provides a notable impression of weight loss (approx. 20 lbs.)in the past two months based on the difference between the UBW as reported by the patient and his current weight. His present BMI is 20.7 (within the normal range). On the other hand, weight itself cannot be regarded as reliable since various factors may affect its accuracy, such as third spacing usually associated with pancreatitis (Lugli, Carli & Wykes, 2007). Thus, other tests should be considered to obtain the most accurate data on his nutritional status. Patient remained at NPO status 24 hours after admission. To maintain/ improve nutritional status, options for this patient include Total Parenteral Nutrition (TPN) or Enteral nutrition (EN). Both options are based on the â€Å"pancreatic rest† theory, in which the pancreas should be allowed to rest to regain functionality (Ioannidis, Lavrentieva & Botsios, 2008). TPN was considered as the gold standard of management in acute pancreatitis, but the risks of complications associated with this therapy lead to the change of intervention to the use of Enteral nutrition (McClave et al., 2006). When the patient’s condition does not improve, tube feedings might be ordered by the physician. According to Ioannidis, Lavrentieva and Botsios (2008), initial amount of nutritive solution administered should be 25 mL/h. This should gradually increase until the desired quantity (25 kcal/kg/day) is achieved in 24-48 hours. The formula for feeding should minimize the pancreatic secretion of digestive enzymes as much as possible. Thus, a fat- free elemental diet or

Eczema Nursing Presentation PowerPoint Example | Topics and Well Written Essays - 1750 words

Eczema Nursing - PowerPoint Presentation Example With relation to the differential diagnosis, a range of conditions need to be differentiated including psoriasis, fungal infections, scabies, scarlet fever, pityriasis rosea, measles, tinea corporis and squamous cell carcinoma. Introduction/Definition Eczema or dermatitis is a disorder in which the skin is inflamed (especially epidermis) along with the development of vesiculation sometimes in acute phases. It has been derived from the Greek word meaning to ‘boil out’, and hence medical practitioners consider it to look like the skin is boiling out. The condition is usually acute in nature, but can be a chronic inflammatory disorder of the skin causing pruritius, redness, vesiculation, which finally become encrusted, hemorrhagic, thickened and scales off (Vorvick, 2009). Some of the common types include:- Allergic contact eczema – Following contact with a foreign substance such as a poison, lotion, etc, there is a local allergic reaction Atopic dermatitis – It is a chronic inflammatory skin disorder and often accompanied with other disorders such as asthma and hay fever. It is commonly seen on the arms and at the back of the knees, and flare up periodically Contact eczema – the reaction is localised when a allergen is contact causing itching, redness and swelling Seborrheic eczema- Commonly called as dandruff and is a mild skin inflammatory disorder arising due to unknown reasons and causing scaling, redness and itching of the scalp and face Neurodermatitis – This is characterised by scratching or picking of the skin resulting in development of rashes Stasis dermatitis – Develops from congestion of the veins of the legs resulting in irritation of the overlying skin Dyshidrotic eczema – Commonly occurs on the palms and soles and is seen as deep-seated skin lesions Perioral eczema – Bumpy rash and ulcers that develop around the mouth Nummular eczema – This is a coin-shaped lesion that develops in an irritated portion of the skin causing scaling, itching and encrusting (MedicineNet, 2011). Pathophysiology The exact cause of eczema and dermatitis is still not clearly known, but it may be a result of interplay of host, genetic and environmental factors. Further, stress and various emotional disorders can worsen or exacerbate the condition especially atopic dermatitis (Mayo Clinic, 2011). Most of the eczema occurs due to a hypersensitivity reaction of the skin, causing chronic skin inflammation (Lehrer, 2009). Some of the eczemas are autoimmune conditions and some of them are genetically transmitted, running in families. Atopic dermatitis is known to be transmitted through a genetic route and is often associated with asthma and hay fever. However, this association is often being questioned, as not all individuals with atopic dermatitis have asthma and hay ever, and not all individuals with asthma and hay fever have atopic dermatitis. However, both these conditions tend to run i n families, and this may be due to common genetic trait being carried on (Mayo Clinic, 2011). Such disorder appears on trivial inflammation of the skin. Allergic eczemas are usually common and the individual may also have other allergic conditions such as asthma, hay fever, etc (DIS, 2011). There are several exacerbating factors for

Globalization Economy Nicaraguan

Globalization Economy Nicaraguan Globalization has had a great impact in the modern world, and has even come to affect the economy of several Latin American countries. However, has globalization affected the Nicaraguan Economical panorama? In order to answer this question, it is important to take Nicaraguas history into account, a history that has been smeared with endless corruption. Another idea that must be kept in mind is the term â€Å"globalization† has numerous amounts of definitions, so in order to identify the answer; a proper definition must be structured. Within the context of globalization, it is trivial to identify if the key treaties like the ALBA and the CAFTA have had any significant effect on the Nicaraguan economy. Through a careful evaluation, it will be noticed that Globalization has not had an impact in the Nicaraguan Economy yet; however the roots of globalization can already be traced to the economy. One of the limitations found in this research paper was the gathering of different sources from the rural sectors of the country, as the rural perspective of this essay is of much importance to define if globalization has affected Nicaragua or not. Introduction Globalization has started to influence the Nicaraguan economic scheme from the beginning of the 21st century. The Nicaraguan population should ask themselves if globalization would aid the economic stance they are in. Another question that must be asked is if the new trade agreements will benefit or harm the private sector of the rural Nicaraguan farmers. The last question to be answer is, â€Å"Globalization from what side?† as the American Hemisphere seems to be structured with a strong Capitalist giant on the top, The United States of America, and numerous amounts of underdeveloped Socialist countries, which can be said to be most of South America, consisting of Brazil, Chile, Argentina, Ecuador, Venezuela, and Bolivia, Uruguay all have socio-democratic governments, that exercise populist tendencies. Another point that should be kept in mind is the choice between the ALBA and the CAFTA, as the socio-democratic alignment that Nicaragua currently has should be kept in mind. Both treaties should be considered in the â€Å"global† sense as there are currently four enlisted countries in the ALBA agreement, which are Venezuela, Cuba, Nicaragua, Bolivia and Ecuador; while the CAFTA is conformed of The United States, Guatemala, El Salvador, Nicaragua, Honduras, Dominican Republic and Costa Rica. The main concern in regards to globalization may not even be of an economic impact, but rather on of an ideological degree. The Nicaraguan populations view on globalization is of a loss of national pride, as if the United States would take over the countrys economy; which to some extent is true. The ideological conflict, however, stands on whether to be a nationalist, a socialist or a capitalist. Nicaraguas preferences must be examined in order to determine if globalization will have an effect in the Nicaraguan economy. Nicaragua has a long history of corruption that can be traced back to the 1930s with the Somoza dynasty, and can then be followed along the list of Somoza family members onto the Sandinista Mandate and then into the 21st century with the newly elected â€Å"liberal parties†. It is important to recognize Nicaraguas background in order to determine if Globalization will benefit or harm the economy. In order to truly define the â€Å"sort† of globalization that suits Nicaragua best, a definitely structured definition must be established, as â€Å"globalization† is wide in the range of it meaning. Definition of Globalization The definition of globalization can be branched into three main concepts. The first of the concepts can be referred to as the â€Å"broad† point of view, in which globalization is interpreted without inclinations towards the foreign or domestic perspectives. In this notion, we call â€Å"globalization† when a company or multi-national industry invests capital in a usually underdeveloped economy such as Nicaragua. The other two perspectives stray apart when the question of â€Å"why would the companies invest in underdeveloped countries?† is asked. The â€Å"Imperialist† perspective bases itself on the moral principal of stimulating under developed countrys economies. In this lay out, a corporation such as Nike sets out a factory in the under developed country in order to provide jobs for the grand unemployed population. By providing such work, the corporation is thus permitted to pay low fees to its new employees. If a company does not wish to set up a factory in a new location, they can still enter the local markets through Commerce treaties. In Nicaragua there are two possible treaties, the CAFTA (Central America Free Trade Agreement) and the ALBA (Alternativa Bolivariana), the CAFTA being the most suitable, as it permits United States owned companies to compete in local markets. Taking the Imperialist point of view, the local population is given new choices in the market from which to buy from, choices that are sometimes less expensive and thus more economically feasible for a greater part of the population. The â€Å"Anti-imperialist† perspective, otherwise known as the down side to globalization, regards globalization as â€Å"Economic terrorism†. This point of view focuses on the injustices that these corporations bring upon the under developed countries. The first injustice is the claim that these companies pay a misery of a fee to the employees thus only keeping them busy instead of â€Å"feeding them†, reason for why this low pay condition is usually referred to as a â€Å"Sweat-Shops†. The most impacting injustice would be the fact that these corporations are allowed to compete in local markets. The reason for this claim is that the foreign companies offer products of a cheaper nature, and therefore encourage the local merchants to buy foreign products instead of local ones. Once the local products are not consumed, the national domestic companies thus run out of business placing people out of work. The only form of globalization encouraged in Nicaragua, is one through the ALBA agreement, as the conditions in this treaty are of Self-Growth concepts between allied Latin American countries Venezuela, Bolivia, and Nicaragua. Nicaraguas Economic Background during the Somoza era and the Sandinistas. In the 1936, the Nicaraguan population elected Anastasio Somoza Garcia to power. At this moment, the Nicaraguan economy is on the rise. The main exports were cattle and coffee, settling Nicaragua as one of the richest countries of Central America in the first half of the 20th century. Somoza Garcia, however set Nicaraguas faith by providing the United States with raw materials during World War Two for the Allied war effort. This close association with the United States set the Nicaraguas economical and political dependence to the will of the United States. During his presidency; however, he did not increase the Nicaraguan Economy to a significant degree, instead hes main dedication was of a personal extent. Somoza Garcias tactics consisted of diverting government funds to his own accounts, and purchasing government lands at ridiculously low prices. While the Nicaraguan economy remained at a flat constant, Somoza Garcias personal Bank accounts were at an all time raise. During the wartime, he attained numerous facilities to which income was due, facilities such as a cement factory, the national railroad, a cement factory, most textile plants, several electric power companies, the national airlines, and an extensive control over the banks. His personal income, after World War Two, was estimated to have been of 60 million dollars. After Somoza Garcias death in 1956, his younger son Anastasio Somoza Debayle took control of the presidency and succeeds his father in power. A few years later, after a rigged election, Luis Somoza Debayle, Anastasio Somozas older son, took control of the Nicaraguan presidency. During Luis Somozas presidency, the Nicaraguan economy was hit with a drop in Coffee production, as now the competitions for their main product had been expanded onto other locations and were purchased at even lower prices, causing Nicaragua to drop prices as well. It wasnt the coffee drop, however, that caused many grievances to the Nicaraguan Economy, it was the 1972 Earthquake that caused $15 million in damages. Richard Nixon, however, aided the Nicaraguan government with a donation of $50 million. The Nicaraguan Treasury only reported $17 million of that donation, while the other $33 million was believed to be in Luis Somozas personal bank accounts abroad. It was until 1980 that the Somoza dynasty was replaced by another sort of mandate, a leftist government. In 1980, the United States lifted its â€Å"protective shield† over the Somoza family and allowed internal social conflicts to rise out of control. Luis Somoza was then pressured by the United States to leave Nicaragua with the threat of freezing bank accounts that were located in United States banks. The country was therefore left in the hands of the Revolutionary party F.S.L.N (Frente Sandinista de Liberacion Nacional, which is translated to â€Å"Sandinista Front, for National Liberation†), which was commanded by Daniel Ortega. At the moment the F.S.L.N gained presidential authorities, the economic situation had an incredible deficit as major loans were issued from the World Bank. The F.S.L.N, or the Sandinista party for short, did not play a significant role for the Nicaraguan Economy, as their main intentions remained to â€Å"restore the social injustice†. Governmental and private lands were both confiscated and given to the Nicaraguan population as a sort of Land Reform. Not all the land was given to â€Å"the people†, most of it was kept by the high ranking officers such as Daniel Ortega, his brother Humberto Ortega, his right-hand man Tomas Borge and several other Sandinista generals. The countrys economic status dropped from being one of the richest countries in Central America, to being the poorest in the American Hemisphere, preceding only Haiti on the list. It is said by the Director of the Nicaraguan Economic Institute during the 1980s, father Xabier Golostiaga, that â€Å"the Sandinista government, when they took power, found a country with no financial resources†, and also stated that only 3.5 million dollars were found from the 19 banks that were nationalized; however, according Father Golostiaga, Nicaragua inherited a debt of $1.6 billion dollars, while more than half of that money was never used on the Nicaraguan grounds. Even though the Sandinista government is still regarded as a group of â€Å"bandits† in Nicaragua, they did relieve a great percentage of the external debt that Nicaragua had attained during the Somoza dynasty. At the beginning of the Sandinista mandate, influences shifted from the United States the Soviet Union. Nicaragua would engage in trade with the USSR instead of the United States, as the United States had placed Nicaragua in a sort of Financial Boycott. Once the Cold War was over, and ties with the USSR started to shed, the Sandinista government seemed to lose its grasp over the governmental panorama. In 1990, the Sandinista government accepted elections to go forth, losing to candidate Violeta Barrios de Chamarro of the U.N.O party (National Opposition Union). The Nicaraguan Economic panorama (between 1991 and 2007). In 1991, after the Nicaraguan Revolution and the decline of a communist dictatorship, finally, the first liberal government was established during the globalization era. The UNO mandate, cleared much of the economic rubble that the Sandinista dictatorship had left behind. During Violeta Barrioss presidency, she was denied compensation by the United States for damages during the â€Å"Contras† period. After this, donations from European countries were effected, as Nicaragua still remained the worlds second poorest country. It can be said that Nicaragua was institutionalized in a sort of rehabilitation for 7 years in order to get on its feet again. Seven years later, elections were carried out and the Nicaraguan , where people elected Arnoldo Aleman as president from the Liberal Constitutional Party (PLC). At this moment the economy was â€Å"up and running†; and was receiving donation from developed countries, receiving the most from Spain. Besides the flow of income, due to chronic corruption during his government, a 50 million dollar deficit was filed. Arnoldo Aleman had been diverting governmental funds to a private bank account in Switzerland and was arrested for corruption, and money laundry. Corruption had once again been in the hands of a single man. In 2001, Nicaragua saw yet another election, in which Arnoldos vice-president was elected president, president Enrique Bolanos. Nicaraguas economy suffered a stalemate, as president Bolanoss presidency served to â€Å"clean the corruption of the political panorama† and to pay off most of the debts that Nicaragua has inherited during the Sandinistas regime and the Somoza dynasty. The Economic effects of the ALBA and the CAFTA agreements. The CAFTA and the ALBA treaties share similarities within their texts; however, both treaties are approached from different perspectives. The ALBA treaty, is not just considered a treaty, according to Hugo Chavez, it is a bond between Latin American countries, and as Chavez stated: â€Å"Latin America will save itself alone†. So far, there are only 5 members to the ALBA treaty, which members are: Cuba, Nicaragua, Ecuador, Bolivia and Venezuela. The CAFTA on the other hand is seen as simply a â€Å"treaty† between the United States and Central America and the Dominican Republic. This approach by the United States has â€Å"scared off† most of the trust among the population, as it suits the symptoms of an economically manipulative doctrine. The points of the CAFTA are expressed as follows: President Hugo Chà ¡vez in his intervention in ALADI has summarized the principals ALBA as the following topics: 1. To promote the fight against the poverty 2. To preserve the autonomy and Latin American identity 3. The transference of technology, the technical assistance 4. The formation of human resources 5. To prioritize national companies us public beings suppliers 6. The agreements could not be obstacle to the diffusion of the scientific and technological progress 7. To face the abuse of the monopolies and oligopolies through effective mechanisms that assure fare competition 8. The foreign investors will not be able to demand the countries by the handling of state monopolies of public interest 9. Treatment special and differentiated to unequal economies to open opportunities to the weakest 10. Process of wide social participation, which can be characterized like democratic 11. Economic, social, cultural and civil rights should be interdependent, indivisible and can not be waived 12. The commercial interests of the investors will not be able to have supremacy over the human rights or over the sovereignty of the States 13. Creation of founds of structural convergence for the correction of asymmetries The different definitions of Globalization must be kept aside when comparing the ALBA and CAFTA, as the goal of a foreign agreement is to aid Nicaraguas economy regardless of ideological opinion. The CAFTA is regarded as the treaty that puts forth the â€Å"Americanization† of a country, as on the contrary, the ALBA encourages Nationalistic growth. The CAFTA agreement encourages United States corporations into investing their capital in underdeveloped countries in exchange for tax liberation, lower employee costs, and a guarantee in case of corporate loss due to a social instability. The preamble of such documents states: â€Å"The CAFTA is designed to eliminate tariffs and trade barriers and expand regional opportunities for the workers, manufacturers, consumers, farmers, ranchers and service providers of all the countries.† The CAFTA, however, interferes with the local market thus damaging the economy anyway, as the bankrupted domestic companies are fully taxed and pay proper salaries to their employees, when I the other hand the foreign corporations pay miserable fees and when in regard to domestic re-investment, the it is unclear of how much of the companys profits are to be invested. Nicaragua has approved the CAFTA; however it has not been publicly accepted, as in Nicaragua, the CAFTA can be understood in the context of a US strategy to divide opposition in negotiations for other larger trade agreements. Instead of aiding US companies, the objective of the ALBA agreement is to promote cooperation and collective development of the region with an emphasis on fighting poverty and social exclusion. The general feel of the can be appreciated in Venezuelan president Hugo Chavezs opening remark at the United Nations: ALBA is not an agreement of the elite. ALBA is born from down below, from the grassroots of the population, without the people no union would be possible and that is one of the criticisms that we have always made of other integration efforts. The objective is not necessarily to maintain high economic statistics or attract investment, but rather to benefit our populations, so that they have health care, education, jobs, and so they can get out of poverty. Another factor about the ALBA and the CAFTA that must be kept in mind is the alignment is the political alignment that Nicaragua maintains of a socio-democratic regime that owes alliances to Venezuela and Cuba, as the Sandinista party owed much of their existence to Cuba during the Cold War. Due to these populist tendencies, it could be said that, the ALBA is the more appropriate treaty to sign. Socio-Economic Perspective of Globalization It is of public knowledge in Nicaragua that most of the populations regard Globalization as â€Å"not welcome†. The socio-economic perspective of Globalization can be seen from two lights the rural and the industrial perspectives. The rural perspective of globalization can be expressed as the lower classs point of view, while the industrial would affect the middle and upper classes. In short, both of these perspectives contain the entire range of the Nicaraguan society. The people that constitute the rural perspective, also known as the Nicaraguan Farmers, do not welcome globalization because of the economic impact that it will cause society. For most farmers in the outskirts of Managua and on the borders of the country, the prices set by the CAFTA are below the prices they have been used to deal with, meaning that there will be an economic impact for that sector of society. The rural branch of society represents about 70% of the Nicaraguan population, meaning that to off-set an economic pendulum from this side will affect the countrys economy greatly. The industrial perspective of the socio-economic side to globalism might actually benefit from the â€Å"no tariff† agreements as machinery and foreign goods might be less expensive to ship in, and national products will be easier to export. The industrial sector of Nicaragua can be said to constitute by 30% of the population, however, even though it is a minority in regards to the rural sector, the industrial sector represents about 50% of the Gross domestic Product in Nicaragua. The choice between which treaty to chose seems to be the more difficult question as the ALBA benefits the rural sector with its standard wages, while the CAFTA would cause a significant impact in the economy. The industrial sector on the other hand would benefit from both the CAFTA and the ALBA, as the free commerce agreement of â€Å"no tariffs† would mean that the import export of Nicaragua will of a wider range. The issue in mind however, remains on the ideological alignment concern. The rural sector of the Nicaraguan population belongs to a new mix of ideologies, a mix of neo-socialistic liberalism, where a sense of national pride and populism makes the number one goal to push on the Nicaraguan economy. The CAFTA is not appreciated in this perspective as it is seen as an agreement that binds Nicaragua to the will of the United States prices and tariffs, therefore permitting the Unites States to have a sort of control over the Nicaraguan Economy. Nicaragua has already felt the United States economical grasp in the 1970s during the Sandinista government, where the United States employed a boycott on Nicaragua. The sense of resentment has not left the Nicaraguan panorama yet, which means it might take a long time for the CAFTA to be approved by the population. The ALBA in the other hand, is more widely accepted as it involves direct proposals by Venezuelan president Hugo Chavez. In current times, Nicaragua has approved both the CAFTA and the ALBA, the differences, however, are only visible in regards to the material â€Å"gifts† provided by Hugo Chavez. On the Economical perspective, both the ALBA and the CAFTA have not made and impact. Both treaties have rendered the Nicaraguan economy with the same Gros Domestic Product than the year before their signing. Conclusion Nicaragua has been a signatory of the CAFTA for over 3 years now and has also been a signatory of the ALBA treaty for over 1 year now; however both these treaties have not saved Nicaragua from the enormous deficit that it faces. In conclusion, it can be said that Globalization will have an impact in the Nicaraguan Economy in the long-run; however, in regards to Globalism of the Socio-democratic sphere, the Latin American countries should remain united and try to roll back influences from the United States in order to be financially dependent on its own. Nicaragua needs to be financially independent, however, in its current economical state; it cannot stand on its own two feet, which means it should have the temporary support of a greater power. The choices are obviously dived between the CAFTA and the ALBA, which are obviously a reflection of the United States and Venezuela. In the wider-picture, the choice between the ALBA and the CAFTA is the choice between Capitalist democracy and a socio-Populist democracy. The relationship between Nicaragua and the United States has not been as strong as the 1930s in the time of Anastasio Somoza Garcia. The constant intervention from the United States in Nicaragua has rendered a sense of mistrust. In actuality, the CAFTA seems like another brick to the wide and high wall that the United States has been building over Latin America, the first brick being the Monroe Doctrine, which guaranteed the United States right to intervene in any Central American nation if its freedom was being threatened. Even though Nicaragua is a signatory of both the ALBA and CAFTA treaties, so far the ALBA has aided the Nicaraguan economy more than the CAFTA, due to the multiple â€Å"gifts† given by Hugo Chavez to the Republic of Nicaragua, gifts such as Oil Plants. The bottom line, nevertheless, stays the same; Globalization will have an increasing effect on the Nicaraguan economy. Bibliography http://www.ustr.gov/Trade_Agreements/Bilateral/CAFTA/CAFTADR_Final_Texts/Section_Index.html http://www.venezuelanalysis.com/news/2360 Ministro de Estado de Venezuela para la Bancoex, Integracià ³n y Comercio Exterior http://www.globalization101.org/What_is_Globalization.html http://www.newdream.org/consumer/globalization.php http://www.country-data.com/cgi-bin/query/r-9212.html

Berkeleys Water Experiment :: Science Illusions Argument Papers

Berkeley introduces his water experiment in order to demonstrate that in perception the perceiver does not reach the world itself but is confined to a realm of representations or sense data. We will attempt to demonstrate that Berkeley's description of our experience at the end of the water experiment is inauthentic, that it is not so much a description of an experience as a reconstruction of what we would experience if the receptor organs (the left and right hands) were objects existing in a space partes extra partes. Our argument is that there is nothing in our experience of the illusion to suggest that under normal conditions perception does not reach the world itself. Traditionally Empiricists claim that all knowledge and all basic concepts are derived from experience. At the same time they argue that all experience is reducible to private entities, the so-called 'sense data'. Phenomenologists claim that there is nothing in experience itself to suggest that it is reducible to sense data, and that this doctrine is derived from metaphysical prejudices, the so-called 'assumptions of the natural attitude'. They argue that if we could in some way 'bracket' these assumptions and reflect only on our experience of perceiving and on the results of scientific measurements of our perceptual powers, we would discover that perception, rather than presenting us with private entities or 'data', 'opens up' to the world itself. (1) In A New Theory of Vision, Berkeley attempts to show that all experience is reducible to sense data by exploiting two types of argument. At times he exploits a scientific account of perception and of the functioning of the perceptual organs, while at other times he uses the argument from illusions. For example, he argues, that the experience of temperature can be understood with the analogy of the experience of pain, and just as the pain is not 'in the needle', so the warmth I feel is not in the fire. (2) He then argues in a similar vein that visual experience is reducible to collections of colour sensations because light passes into the eye ball and strikes the retina, in much the same way that a sharp object striking the skin produces a sensation of pain, such as a sensation of blue or red. (3) The sensation being the effect of the physical and chemical properties of the world on the sense organs and is as distinct from the world as photographic images are from the objects which cause them.

Adolescents With Food Allergy Health And Social Care Essay

Aim: To develop and formalize the Food Allergy Quality of Life Questionnaire-Teenager Form ( FAQLQ-TF ) in the Dutch linguistic communication. Methods: Ten nutrient allergic striplings ( 13-17 old ages ) were interviewed and generated 166 HRQL points. The most of import points were identified by 51 nutrient allergic striplings utilizing the clinical impact method, ensuing in the FAQLQ-TF incorporating 28 points ( mark scope 1 ‘no damage ‘ to 7 ‘maximal damage ‘ ) . The FAQLQ-TF, the Food Allergy Independent Measure ( FAIM ) and a generic HRQL questionnaire ( CHQ-CF87 ) were sent to 98 nutrient allergic striplings for cross-sectional proof of the FAQLQ-TF. Consequences: Construct cogency was assessed by the correlativity between the FAQLQ-TF and the FAIM ( rho 0.57, P & A ; lt ; 0.001 ) . The FAQLQ-TF had first-class internal consistence ( Cronbach ? 0.92 ) and discriminated between striplings who differed in figure of nutrient allergic reactions ( 1 nutrient allergic reaction vs. & A ; gt ; 2 nutrient allergic reactions, entire FAQLQ-TF mark, 4.3 vs. 3.5 ; p=0.037 ) , but did non know apart between reported anaphylaxis or non. The FAQLQ-TF correlated decrepit with 6 of the 11 CHQ-CF87 graduated tables, showing convergent/discriminant cogency. Decision: The FAQLQ-TF is the first self-administered, disease-specific HRQL questionnaire for nutrient allergic striplings. It has good concept cogency and first-class internal consistence and discriminates between striplings who differ in figure of nutrient allergic reactions. The FAQLQ-TF is short and easy to utilize and may hence be a utile tool in clinical research.Clinical DeductionsThe Food Allergy Quality of Life Questionnaire-Teenager Form ( FAQLQ-TF ) is dependable, valid, short and easy to utilize and therefore a utile tool in clinical research.Capsule sum-upThe FAQLQ-TF is the first self-administered, disease-specific HRQL questionnaire for nutrient allergic striplings. It is dependable and valid and hence a utile tool in clinical research in which HRQL is the result of involvement.Key wordsAdolescents EuroPrevall Food allergic reaction Health-related quality of life AdolescentsAbbreviationsHRQL Health-Related Quality of Life FAQLQ-TF Food Allergy Quality of Life Questionnaire – Adolescent Form FAQLQ-CF Food Allergy Quality of Life Questionnaire – Child Form FAQLQ-PF Food Allergy Quality of Life Questionnaire – Parent Form MI Mean Importance OI Overall Importance FAIM Food Allergy Independent Measure EO Expectation of Outcome IM Independent Measure CHQ-CF87 Children ‘s Health Questionnaire – Child Form AADR Allergen Avoidance and Dietary Restrictions EI Emotional Impact RAE Risk of Accidental Exposure DBPCFC Double-Blind Placebo-Controlled Food ChallengeIntroductionHaving a nutrient allergic reaction can be fatal and striplings are at the highest hazard of decease from nutrient allergic reaction ( 1-3 ) . It is estimated that 2.3 % of striplings are nutrient allergic ( 4 ) . The lone effectual signifier of intervention of nutrient allergic reaction is rigorous turning away of the implicated nutrient ( s ) and proviso of medicines for exigency intervention ( 5 ) . In malice of the high hazard of decease, nutrient allergic striplings really reported societal isolation as the most distressing facet of their disease ( 6 ) . In add-on, some striplings reported depression as a consequence of nutrient allergic reaction and this may take to troubles in school public presentation and leisure activities ( 7 ) . Therefore, nutrient allergic striplings need to be continuously watchful as to what they are eating in legion state of affairss and scenes and, along with the fright of allergic reac tions, this may hold a negative impact on quality of life. At present, no validated self-administered, food-allergy-specific health-related quality of life ( HRQL ) questionnaire exists for usage in striplings. A few surveies have reported that nutrient allergic reaction has a negative impact on HRQL in striplings. However, three restrictions arise when construing these surveies. First, no differentiation was made between striplings and younger kids ( 8-13 ) , whereas HRQL in striplings demands to be addressed individually, because HRQL may be influenced by the phase of neurocognitive and emotional development of an person ( 14 ; 15 ) . Second, HRQL questionnaires were administered to parents therefore mensurating parents ‘ perceptual experiences ( 8-13 ) . However, kids and parents differ in their positions and judgements about quality of life ( 16 ) . Finally, surveies used generic HRQL questionnaires ( 11-13 ; 17 ) or disease-specific questionnaires which have non been validated ( 8 ; 10 ) , whereas generic HRQL questionnaires are n on every bit sensitive as disease-specific HRQL questionnaires ( 18 ) and proof is highly of import in order to find whether the questionnaire is mensurating that portion of quality of life which is determined by the mark upset ( 19 ) . Therefore, we have developed and cross-sectionally validated the first self-administered, food-allergy-specific HRQL questionnaire for striplings, the Food Allergy Quality of Life Questionnaire-Teenager Form ( FAQLQ-TF ) . This questionnaire has been developed as portion of the EuroPrevall undertaking, a European multi-center research undertaking on nutrient allergic reaction. The FAQLQ-TF complements the late developed self-administered Food Allergy Quality of Life Questionnaire-Child Form ( FAQLQ-CF ) for kids aged 8 to 12 old ages ( 20 ) and the parent-administered Food Allergy Quality of Life Questionnaire-Parent Form ( FAQLQ-PF ) for parents of nutrient allergic kids aged 0 to 12 old ages ( 21 ) .MethodParticipants and processDuring point coevals, participants were recruited merely from our outpatient pediatric allergic reaction clinic. Two striplings were approached during a double-blind placebo-controlled nutrient challenge ( DBPCFC ) and, based on patient records, eight strip lings were approached by phone. All approached striplings ( niˆ?10 ) agreed to take part in an interview on the impact of nutrient allergic reaction on their day-to-day life. During point decrease and cross-sectional proof, participants were recruited from our outpatient pediatric allergic reaction clinic ( based on patient records or assignments for DBPCFC ) or were recruited by advertizement in local intelligence documents and through nutrient allergy support organisations ( the Dutch Foundation for Food Allergy and the Dutch Anaphylaxis Network ) . A missive of invitation, the questionnaire and a pre-paid return envelop was sent to suited striplings from our clinic and to striplings who responded to the advertizement. The missive of invitation stressed that engagement was wholly voluntary. When the questionnaire was non returned within a month, the stripling was contacted by phone as a reminder. Adolescents were non paid for their engagement in any phase of questionnaire development or proof. Before cross-sectional proof, the questionnaire was pre-tested in three striplings ( aged 13, 15 and 17 old ages ) . No major jobs emerged during this pre-test. Thereafter, the FAQLQ-TF, the Food Allergy Independent Measure ( FAIM ) and the CHQ-CF87, a generic quality of life questionnaire, were sent by mail to 98 nutrient allergic striplings. Some of them had participated in the point coevals ( 10 % ) or point decrease ( 49 % ) . Descriptive features were asked sing age, sex, type and figure of nutrient allergic reactions, type of symptoms and diagnosing. For the striplings recruited from our clinic, we checked patient records to find whether nutrient allergic reaction had been diagnosed by a DBPCFC. During all phases of questionnaire development and proof, all common nutrient allergic reactions and different types and badnesss of symptoms were represented. The survey was approved by the local medical moralss review committee ( METc 2005/051 ) who deemed that permission from the committee was non required.DevelopmentItem coevals For the development and proof of the FAQLQ-TF, the same methodological analysis was used as for the development and proof of the FAQLQ-CF, which is described in more item elsewhere ( 20 ) . Briefly, possible points for the new questionnaire were generated by questioning 10 nutrient allergic striplings ( aged 13-17 old ages ) . In add-on, literature reappraisal and adept sentiment were consulted. This resulted in an drawn-out point questionnaire of 166 points. Item decrease The drawn-out point questionnaire was sent to a different group of 51 nutrient allergic striplings to place the most of import points by utilizing the clinical impact method ( 22 ; 23 ) . The striplings were asked to bespeak the importance of applicable points utilizing a five-point graduated table. Frequency ( per centum ) was multiplied by average importance ( MI ) , ensuing in the overall importance ( OI ) of each point. The maximum possible OI was 5.0 ( 24 ; 25 ) . Items with the greatest OI were selected for the FAQLQ-TF, except one of any brace of points with an inter-item correlativity & A ; gt ; 0.85 and/or overlapping content ( face cogency ) . The selected points were worded as inquiries holding a seven-point response graduated table runing from ‘not troubled ‘ to ‘extremely troubled ‘ ( 23 ; 25 ) . A psychologist and a linguist reviewed the FAQLQ-TF for lucidity and easiness of usage.Cross-sectional proofConstruct cogency Construct cogency was investigated by computation of correlativity coefficients for the FAQLQ-TF with the Food Allergy Independent Measure ( FAIM ) . This attack has already been successfully implemented to formalize disease-specific HRQL questionnaires ( 9 ; 20 ; 21 ; 25 ) and it is particularly utile in anaphylactic upsets where no nonsubjective measuring of the extent or badness of disease exists ( 26 ) . The FAIM, which was besides used to formalize the FAQLQ-CF ( 20 ) , includes four Expectation of Outcome ( EO ) inquiries and two Independent Measure ( IM ) inquiries. The EO inquiries are based on the sensed outlook of patients of what will go on following exposure which is likely to be a impulsive force of quality of life ( 26 ) . The IM inquiries are based on the same rule and inquire about the sensed figure of nutrients one needs to avoid and sensed impact on societal life. We expected moderate correlativity coefficients ( 0.40-0.60 ) for the FAQLQ-TF with the FAIM. The proof of the FAQLQ-TF was carried out in the Dutch linguistic communication. The English version of the FAQLQ-TF and the FAIM are presented as Figure E1 and Figure E2 in the Online Repository. The Dutch FAQLQ-TF and the FAIM were translated into English by a native English talker and back translated by a native Dutch talker, harmonizing to the guidelines of the World Health Organization ( 27 ) . The original Dutch version was compared with the back translated Dutch version. No of import differences in content or significance of inquiries emerged. Discriminative ability To set up the discriminatory ability of the FAQLQ-TF, we compared the entire FAQLQ-TF mark for striplings who reported anaphylaxis ( i.e. striplings who reported two or more of the undermentioned cardiovascular symptoms ; giddiness, experiencing your bosom round fast, loss of vision, inability to stand, light headedness, prostration, loss of consciousness/passing out ) versus striplings who did non, for striplings who reported many nutrient allergic reactions versus striplings who reported few nutrient allergic reactions, for male childs versus misss ( 28 ) and for striplings who were recruited from our clinic versus striplings who were recruited by advertizement. Dependability The dependability of the FAQLQ-TF was assessed by administrating the questionnaire to 34 striplings on two occasions 10-14 yearss apart. Convergent and discriminant cogency To look into convergent and discriminant cogency, a generic HRQL questionnaire was administered: the Children ‘s Health Questionnaire-Child Form ( CHQ-CF87 ) ( 29 ; 30 ) . This questionnaire is self-administered by striplings and contains 87 points divided into 12 graduated tables. We expected weak correlativity coefficients ( 0.20-0.40 ) for the FAQLQ-TF with the CHQ-CF87.Statistical analysesThe natural FAQLQ-TF and FAIM scores 0 to 6 were recoded as 1 to 7. The entire FAQLQ-TF mark is the average mark of all points with a scope of 1 ‘no damage ‘ to 7 ‘maximal damage ‘ . To measure concept cogency, Spearman ‘s correlativity coefficients were calculated between the FAQLQ-TF and the FAIM. The allotment of the points of FAQLQ-TF into spheres was based on factor analysis ( chief constituent analysis with Varimax rotary motion ) ( 31 ) and face cogency determined by a clinical expert panel ( BMJFdB, JNGOE and AEJD ) ( 14 ; 32 ) . To look into the inter nal consistence of the FAQLQ-TF and the spheres, Cronbach ‘s ? were calculated. An ? greater than 0.70 indicates good internal consistence ( 33 ) . The Mann-Whitney trial was used for mensurating the discriminatory ability of the FAQLQ-TF. The dependability of the FAQLQ-TF was assessed by ciphering the intraclass correlativity coefficient of the repeated FAQLQ-TF measuring ( 34 ) . Finally, convergent and discriminant cogency were assessed by ciphering Spearman ‘s correlativity coefficients between the FAQLQ-TF and the CHQ-CF87 graduated tables. Statistical analyses were performed with SPSS for Windows 14.0 ( SPSS Inc. , Chicago, IL, USA ) .ConsequenceDevelopmentDescriptive features of the striplings involved in the point coevals and point decrease are shown in Table 1. The drawn-out point questionnaire was returned by 46 striplings ( response rate 90 % ) . The OI tonss of all 166 points of the drawn-out point questionnaire ranged from 0.00 to 2.89. The point decrease re sulted in the choice of 28 points ( OI & A ; gt ; 1.37 ) for the FAQLQ-TF ( Table 2 ) .Cross-sectional proofParticipants The questionnaire bundle including the FAQLQ-TF, the FAIM and the CHQ-CF87 were returned by 75 striplings ( response rate 77 % ) . One stripling was excluded because the descriptive features were losing from the questionnaire, ensuing in 74 assessable questionnaires for the cross-sectional proof. Forty-three striplings ( 58 % ) were recruited from our clinic, of which 19 ( 26 % ) had a nutrient allergic reaction confirmed by a DBPCFC. The other striplings from our clinic had a physician-diagnosed nutrient allergic reaction ( skin asshole and/or blood trial ) and the bulk was expecting DBPCFC. All striplings recruited by advertizement ( 42 % ) reported physician-diagnosed nutrient allergic reactions. Descriptive features of the striplings involved in the cross-sectional proof are shown in Table 1. There were no important differences in descriptive features between male childs and misss, between striplings recruited from our clinic and striplings recruited by advertizement or between s triplings with a physician-diagnosed nutrient allergic reaction and striplings with a nutrient allergic reaction diagnosed by DBPCFC. Construct cogency Most points of the FAQLQ-TF correlated significantly with at least one of the FAIM inquiries and with the mean of the FAIM inquiries. Five points did non correlate with any of the FAIM inquiries and were hence excluded from the questionnaire. The validated FAQLQ-TF therefore consists of 23 inquiries. As expected, we found moderate correlativity coefficients between the FAQLQ-TF and the FAIM. The entire FAQLQ-TF mark correlated significantly with the average FAIM ( rho 0.57, P & A ; lt ; 0.001 ) and with the single FAIM inquiries ( Table 3 ) . This important correlativity coefficient was found for striplings with a nutrient allergic reaction diagnosed by DBPCFC and for striplings with a physician-diagnosed nutrient allergic reaction ( entire FAQLQ-TF mark with the average FAIM, rho 0.76, P & A ; lt ; 0.000 and rho 0.52, P & A ; lt ; 0.000, severally ) . These consequences support the concept cogency of the FAQLQ-TF. That is, the FAQLQ-TF steps that portion of quality of life that is a ffected by nutrient allergic reaction. Expectation of Outcome inquiry 3 ( EO3 ) did non correlate with any of the single HRQL points and is therefore improbable to be an appropriate independent step for nutrient allergic reaction in striplings. Therefore, we excluded this inquiry from farther analyses.Sphere construction and internal consistenceThe 23 points of the FAQLQ-TF were subjected to factor analysis ( chief constituent analysis ) , which revealed 5 factors with characteristic root of a square matrixs & A ; gt ; 1. To assistance in the reading of these factors, Varimax rotary motion was performed for 5, 4 and 3 factors. These groupings were reviewed by an adept panel, and based on face cogency the grouping of 3 factors made the most sense. This grouping revealed the undermentioned spheres: Allergen Avoidance and Dietary Restrictions ( AADR ) , Emotional Impact ( EI ) and Risk of Accidental Exposure ( RAE ) . These three factors showed a figure of strong burdens ; all exceed 0 .300, which is regarded as an acceptable standard ( 31 ) . The adept panel allocated 3 points to a more appropriate sphere based on face cogency. The FAQLQ-TF and the spheres had first-class internal consistence with Cronbach ‘s ? transcending 0.70 ( Table 3 ) .Discriminative abilityAdolescents who reported two or more nutrient allergic reactions reported a significantly more impaired HRQL than striplings who reported merely one nutrient allergic reaction ( entire FAQLQ-TF mark 4.3 vs. 3.5 ; p=0.037 ) . There was no important difference in entire FAQLQ-TF mark between striplings who reported anaphylaxis ( cardiovascular symptoms ) and striplings who did non describe anaphylaxis ( 4.5 vs. 4.0 ; p=0.184 ) or between male childs and misss ( 4.0 vs. 4.3 ; p=0.324 ) . Adolescents who were recruited by advertizement reported a significantly more impaired HRQL than striplings recruited from our clinic ( entire FAQLQ-TF mark 4.6 vs. 3.9 ; p=0.015 ) . Dependability The entire FAQLQ-TF mark intraclass correlativity coefficient was 0.98 ( 95 % assurance interval, 0.95-0.99 ) , bespeaking first-class test-retest dependability. Convergent and discriminant cogency The entire FAQLQ-TF mark correlated weakly with 6 of the 11 CHQ-CF87 graduated tables. In add-on, the spheres of the FAQLQ-TF correlated weakly with several CHQ-CF87 graduated tables ( Table 4 ) . This indicates that both questionnaires step constructs that are partially related ( i.e. convergent cogency ) . However, as expected the correlativities are weak and sometimes even absent because the CHQ-CF87 is a generic quality of life questionnaires and hence non every bit sensitive as the disease-specific FAQLQ-TF ( i.e. discriminant cogency ) .DiscussionWe have developed and validated the first health-related quality of life ( HRQL ) questionnaire particular for striplings with nutrient allergic reaction, the Food Allergy Quality of Life Questionnaire-Teenager Form ( FAQLQ-TF ) . We found that the FAQLQ-TF has good concept cogency and first-class internal consistence ( Table 3 ) . In add-on, the FAQLQ-TF discriminates between striplings who differ in figure of nutrient allergic reacti ons. Finally, the FAQLQ-TF showed convergent/discriminant cogency ( Table 4 ) , which supports the demand for a disease-specific quality of life questionnaire for nutrient allergic striplings. It is known that HRQL may be influenced by the current phase of cognitive, societal and emotional development of an person. Therefore, it has been argued that HRQL in striplings should be measured by agencies of a specific instrument ( 14 ; 15 ) . The FAQLQ-TF was specifically designed for nutrient allergic striplings aged 13 to 17 old ages. Age rightness was ensured by bring forthing and including merely points that were regarded as of import by nutrient allergic striplings ( clinical impact method ) . The FAQLQ-TF focal points on the perceptual experiences of the striplings themselves, because the questionnaire is self-administered. Many of the points in this instrument are specific to striplings. An illustration is ‘Carrying an Epipen ‘ . The Epipen issue in nutrient allergic striplings is in harmony with the literature. It has been reported that striplings raise concerns about its size and portability ( 35 ) and sometimes striplings do non transport it based on societal fortunes and sensed hazards ( 36 ) . Despite our age specific attack and the separate development of kid and adolescent questionnaires, it is striking that about two tierces of the adolescent inquiries in the FAQLQ-TF correspond to the kid inquiries in the FAQLQ-CF ( 20 ) . Therefore, although we generated many age specific points, there are seemingly ‘general ‘ nutrient allergic reaction points that are of import in kids and striplings. Furthermore, we found that the three most of import points that impair quality of life were the same in kids and adolescents ( ‘Always be alert as to what you are eating ‘ , ‘The ingredients of a merchandise alteration ‘ , ‘Able to eat fewer merchandises ‘ ) . An unexpected determination was that EO3 ( Chance of deceasing when by chance exposed ) was non correlated with any of the points of the FAQLQ-TF. This may bespeak that fright of deceasing of nutrient allergic reaction is non a driving force of quality of life in striplings, which may be characteristic and specific for striplings. It has been reported that striplings perceived their anaphylaxis as ‘no large trade ‘ ( 35 ) . In add-on, striplings are at the highest hazard of decease from nutrient allergic reaction ( 1-3 ) . This high hazard may be the consequence of underestimate of the badness of nutrient allergic reaction and the belief of striplings that they will non decease from any cause, including their nutrient allergic reaction. In fact, there were no striplings in this survey who reported ‘always ( 100 % opportunity ) ‘ of deceasing when by chance exposed, whereas this was reported by 5 % of kids and 4 % of grownups in other FAQLQ proof surveies ( non shown ) . Although non statistically important, this is a notable observation. The wrong belief of immortality of striplings may ensue in risk-taking behaviour that may increase the hazard of deceasing from a nutrient allergic reaction. Therefore, doctors and other health-care suppliers should be cognizant that underestimate of nutrient allergic symptoms may be of import when reding striplings with nutrient allergic reaction. When comparing the discriminatory consequences of the FAQLQ-TF with the FAQLQ-CF ( 20 ) , two interesting observations emerged. First, there was no important difference in entire FAQLQ-TF mark between striplings who reported anaphylaxis ( cardiovascular symptoms ) and striplings who did non. The same consequence was found in kids ( 20 ) . Second, striplings who were recruited by advertizement reported a significantly more impaired HRQL than striplings recruited from our clinic. This difference was non important in kids, although a tendency was seen ( 20 ) . It may be that striplings see safety and security by being looked after in the clinic, whereas striplings outside the clinic experience more uncertainness and insecurity about their nutrient allergic reaction ( 37 ) . Most striplings recruited from our clinic were known to us for many old ages ( average figure of old ages since first visit 12.5 ( SD 5.4 ) ) . In add-on, it has late been shown that parental trait anxiousness is hig her in parents of kids with a suspected nutrient allergic reaction who refused to take part in a DBPCFC than parents who did take part ( 38 ) . Since it is known that parental anxiousness is related to child anxiousness ( 39 ) , it may be that the striplings in our survey recruited by advertizement have higher degrees of trait anxiousness than striplings recruited from our clinic and may therefore hold more damage in quality of life. This survey may hold some restrictions. First, the proof of the FAQLQ-TF was carried out in the Dutch linguistic communication. The FAQLQ-TF was carefully translated into English utilizing the guidelines of the World Health Organization. The cogency of the English linguistic communication version of this questionnaire is presently being investigated every bit good as versions in several other European linguistic communications. Our experience with the Dutch Vespid Allergy Quality of Life Questionnaire was that the English interlingual rendition validated good ( 25 ) . It is possible, nevertheless, that cultural differences may act upon the ability of our questionnaire to place the most of import points for nutrient allergic patients in different cultural or lingual scenes. Second, patients were recruited at our clinic and by advertizement. These patients may differ from each other, for illustration in footings of degree of information about their nutrient allergic reaction. However, we did non happen important differences in the descriptive features between these groups and other possible differences would non hold adversely influenced the proof process, where a spectrum of badness is good to obtain optimum correlativities. Third, some of the points in this questionnaire are likely to be clip sensitive in the long tally. For illustration, new labelling Torahs could do the labelling points included in this questionnaire obsolete. It is likely that in clip, this questionnaire will necessitate some updating and version. Finally, this study describes merely the cross-sectional proof of the FAQLQ-TF. Currently, the longitudinal proof of the questionnaire is being investigated ( i.e. the capacity of the FAQLQ-TF to mensurate differences in HRQL over clip ) . In drumhead, we have developed and validated the first HRQL questionnaire particular for nutrient allergic striplings, the Food Allergy Quality of Life Questionnaire-Teenager Form ( FAQLQ-TF ) . We found that this questionnaire is valid and dependable and it is short and easy to utilize. The FAQLQ-TF will be therefore a suited questionnaire for clinical research in nutrient allergic striplings in which HRQL is the result of involvement.RecognitionsThis work was funded by the EU through the EuroPrevall undertaking ( FOOD-CT-2005-514000 ) . We would wish to thank Dr. GFEC van Linden new wave lair Heuvell, medical psychologist, and Karel Verbeek, linguist, for reexamining the drawn-out point questionnaire and the FAQLQ-TF and Tina van der Velde for executing the test-retest of the FAQLQ-TF.