Antitheatricalism – Ben Jonson

Antitheatricalism in Light of Ben Jonson's  Volpone Commentary by Joel Culpepper Crossdressing in England was mostly opposed by the Fundamentalist branch of the Protestant Church known as the Puritans. The Puritan dogma, much like the concept of transvestism, was constantly challenged. Puritans found resistance in the religious authorities of the Church of England and the English government. Before 1536, the Roman Catholic Church was unimpeded and always won over Puritan proposals regarding legislation. Without a cooperative political ear, the Puritans resorted to experimental spiritual expression by changing their social behavior and structuring. Due to these changes, a formidable way of attacking the theater's use of crossdressing was developed- public preaching and pamphlets. Other individuals and groups (like the Juvenalians) supported the moral and social reform movement by speaking and writing essays and books on the subject. Due to the nature the actor's role in Ben Jonson's  Volpone, the play was also implicated in this moral battle. The ideology behind the Puritan protest was based on biblical sentiment and the patristic literary tradition of Roman writers like Tertullian and St. Augustine. The Puritan's religious banner for combatting gender transgression was Deuteronomy 22:5- ‘The woman shall not wear that which pertains to a man, neither shall a man put on a woman's garment' (Tiffany 58). In general, pagan myths were also associated with crossdressing. Puritans like William Pryne labeled these actors as â€Å"beastly male monsters† that â€Å"degenerate into women† (Tiffany 59). Further, the Puritans feared that men dressing as women caused the men in the audience to lust for real females and to form homoerotic desires for the male actors (the reverse was also true for women). The Puritan fear also opposed androgynous Renaissance clothing and women's â€Å"male† hairstyles, as documented in Phillip Stubbes' 1583  Anatomy of Abuses. Jonson was more than aware of these Puritan sentiments. In  Volpone, Volpone hopes Celia will submit sexually and â€Å"have [her] in more modern forms†¦ such as a â€Å"Brave Tuscan lady, or proud Spanish beauty† (Campbell 3. 7. 226, 228). Volpone seems to be conveyor of Jonson's acknowledgment of the actor's transformative ability – a part of the playwright's (and the actor's) self concern of the real drama within a play, or metadrama. In Volpone's subsequent proposal to Celia, crossdressing is coupled with androgyny. Male and female spirits are joined in harmony because their lips â€Å"transfuse [their] wandering souls† (Campbell 3. 7. 234). One's point of view might relate this as a matter of homosexual or heterosexual sex. The passage could also (ironically) refer to the Puritan sponsored sacrament of marriage- a holy sacrament. It must also be mentioned thatVolpone's ending also provides an element of punishment for sins- lust, avarice and deception being among them. Jonson's blatant use of classical satire as farce links the feminine male with naivety or aggressiveness that demeans love and advocates the scholarly, independent male identity. The female image in his plays is often masculine- true to the actor's real physicality and the surrounding male chauvinist population. Interestingly, Jonson allows the head male character ,Volpone, to be exceedingly great at his craft of deception while the virtuous Celia adopts an irrational, painful way to keep herself a virgin. Celia vows she will swallow hot coals rather than submit to Volpone's desires. The Puritans' homophobia is also apparent in  Volpone. Volpone makes sure (through explanation) that even though he acted the part of Antonias (a supposed lover of a gay king) for the non-heterosexual King Henry III, he is a ladies' man. Volpone claims that he â€Å"attracted/ The eyes and ears of all the ladies present† (Campbell 3. 7. 164). In another reversal of gender, Lady Would-be notices her husband with someone she believes to be a female prostitute dressed as a young man. After belittling her husband for this by calling him a client of a â€Å"female devil,† she realizes her mistake and apologizes. This situation supports the possibility that Jonson believed the Puritans were making a mistake (like Lady Would-Be) in ignoring permanent, masculine reality and challenging the temporary ,imaginative, and effeminate role of actors for immorality. Morality, the main goal of the Antitheatrical movement in the Renaissance, was both supported and denounced by Jonson in various ways. However, the general perception is that Jonson (unlike Shakespeare) fueled the fires of degradation- implicating women with the weakness, lack of intelligence, and reason they were believed to exude. In the annals of theatrical history, Jonson's metadrama could be said to perpetuate this social stereotype. Nevertheless, Jonson's crossing of the gender line and sexual scenes like Volpone's â€Å"flashing† of Celia were enough to have religious, moral, and social commentators screaming blood murder. Two issues demand prominence in the play. While outwardly a play driven by blatant genderless controversy, the inward thematic, character-driven nature of  Volpone  suggests a conformity and adherence to the intellectual and theological moralism of the time. http://www. english. uga. edu/cdesmet/joel/PURITAN. html

Automobile Drivers Essay

Multi tasking has become common thing in today’s busy world. It is common to find somebody a person typing on the personal computer while taking his or her favorite drink and at the same time making a point to his friend on the other end of the line on the cellphone. This trend has been adopted by many in the current busy world. Many have argued that such an act saves time and allows somebody to accomplish so many asks within a given time. To some it has been a successful adventure but to others it has resulted to serious repercussions. Drivers have also been tempted to multitask while on the wheel, this is one of the most dangerous things to do while on the road. Use of cell phones while driving has become so common such that it attracted lawmakers’ attention as it is a disaster waiting to happen in this country. This habit has been equated to drunken driving which has claimed so many lives and left other serious injured through road accidents which have occurred in the recent past. Use of cell phone while driving is such a dangerous habit which puts the life of those driving and their passengers at risk. It is high time that a law was enacted prohibiting this particular practice before it gets out of hand. (Sturnquist, D 2006 29) Drivers who use the cellular phones either on hands free or handheld are as impaired as those who drive under the influence of alcohol. This was according to a research that was carried out by researchers from the University of Utah. The research showed that the use of hands free is just as distracting as the handheld mobile phones. To address this distraction the study recommended for the outlawing the use of cell phones while on the wheel. Use of the cell phone while driving has been known to cause physical and cognitive distraction on the driver, to start with when the phone rings the driver has to look for the phone, this means that his or her attention will be distracted as he picks the phones to answer the call. By the time the drivers mind hit back on the road an accident may have occurred or he might been forced to slow down to concentrate on the phone resulting into a traffic jam. This causes inconveniences to other road users and at the same time threatens the life of the driver as it is hard to concentrate in two involving tasks at the same time. Drivers who text while driving are even at a greater risk as this activity requires full attention than receiving or making a call. They need to look at different keys so that they can write a comprehensive text, in the course of locating these keys their eyes are off the road oftenly. It only takes a few seconds for a driver to make a mistake and through a flash of second an accident will have occurred. If strict laws were enacted prohibiting the use of short text messaging while the driver is on the road the number of accidents that have been occurring due to such a habit will be minimal. Some cities have put these laws in place and the results have been seen. The number of people driving while texting have decreased and so is the accidents. (Sturnquist, D 2006 30) Talking on the phone while driving is equally dangerous as texting, the driver will first be distracted by the ringing tone as the phone alerts him or her. This distraction can come at a time when the driver was at a point where maximum attention was required. This will drift the drivers’ attention from the road to the phone. To reach for the ringing phone or search for it the eyes will be moved from the road to the direction of the phone. The driver will have to remove one hand from the steering wheel and receive the call. As the conversation begins the drivers attention will be further drifted away to get the details. In such a situation he or she may not be in a position to apply brakes in case a pedestrian is closing the road or an approaching car comes by his side. The driver may also get news which might make him or her excited or greatly disturb. This will lead to loss of concentration as the driver tries to come in to terms with the news. He forgets that he was on the road as the mind tries to solve the current issue. At this point the driver is not in full control of the vehicle. Anything that requires an immediate action will make the driver panic and an accident will have occurred. (McDonald, K 2006 31) The use of cellular phones by automobile drivers is as dangerous as driving under the influence of the alcohol or even performing other tasks such as eating, operating a radio. The policy makers should come up with the strict laws which will restrict such a practice as it the only way through which the road carnage will decrease. Though cellular phones are convenient to use as people can communicate promptly regardless of the distance, it should be used cautiously especially for those who are driving as it might lead to serious repercussions. Whether one is sending a short message, making or receiving a call it equally dangerous as all these activities leads to the distraction of the driver. This distraction might cost one life or lead to the inconveniences of other road users. Prohibiting the use of cellular phones for the drivers might not be taken positively by the cellular service providers and the drivers themselves but it might be the only way through which the government can ensure that road accidents have been reduced. Use of phone while driving should be taken as dangerous driving as it risks the life of the drivers and other passengers as well as other road users. If drunken driving has been prohibited other dangerous habits should be outlawed so as the safety of the road users can be guaranteed. Work Cited McDonald, K Shifting Out of Pack, Lawyers and Judges Publishing (2006) Sturnquist, D Mobile Phones and Driving, Nova Publishers (2006)

Banyan Tree Branding the Intangible

Strategic Drift in RIM Research In Motion (RIM) is a company that has suffered from strategic drift. The essential problem created by RIM only focused upon their current technology, without evaluating the rapid changing among the competitors Apple and Android were using. RIM has simply made incremental changes to the same product which has not met the change in customers' needs (Dwyer and Edwards, 2008). The leaders at RIM are overestimated the BlackBerry's advantages, while Apple and Android roducts developed the use of apps, better operating systems, hardware and usability.The RIM BlackBerry phones have seemingly fallen behind this environmental change (Guman, 2012). It had caused shareholders angry and 11% shared drop as a senior RIM employee wrote an open letter to the Co-CEO's urging them for citing the company lacked of focusing the market change and fail to improving the business. It is evident that the leaders are entirely responsible for revolutionary change in RIM. In 2012, the revolutionary changing in the two dual CEOs Mike Lazard and Jim Balsillie had been stepped down and replaced by Thorsten Heins.Heins made a substantial changes to the company's leadership team. John & Katulis (2007) suggest that there are many fallings that could cause business decline or strategic drift and one of the main points they highlight is a lack of marketing skill, which could attributed to the leaders. Eden (1998) offers the idea that a loss of external confidence and reputation could be caused by strategic drift and in the case of RIM these marketing errors have certainly affected their reputation. Banyan Tree Branding the Intangible Banyan Tree Branding the Intangible Abstract Banyan Tree Hotels and Resorts had become a leading player in the luxury resorts and spa market in Asia. As part of its growth strategy, Banyan Tree had launched new brands and brand extensions that included resorts, spas, retail outlets, and even museum shops. Now, the company had to contemplate how to manage its brand portfolio and expand its business while preserving the distinctive identity and strong brand image of Banyan Tree, its flagship brand. Case Questions 1. What are the main factors that contributed to Banyan Tree’s success? 2. Evaluate Banyan Tree’s brand positioning and communications strategies. Can Banyan Tree maintain its unique positioning in an increasingly overcrowded resorts market? 3. Discuss whether the brand portfolio of Banyan Tree, Angsana, Colours of Angsana, and Allamanda, as well as the product portfolio of beach resorts and city hotels, spas, galleries, and museum shops fit as a family. What are your recommendations to Banyan Tree for managing these brands and products in future? Discussion of Case Questions 1. What are the main factors that contributed to Banyan Tree’s success? Banyan Tree’s success might be attributed to an verall well designed and executed external and internal marketing program, and in particular: †¢ Choice of target segment †¢ Positioning and branding strategy †¢ Product/service design and delivery †¢ Aggressive internal marketing †¢ Winning the support of local communities and public interest groups †¢ Pioneer status : first mover advantage †¢ Pro-environmental business practices Choice of target segment The large price gap in the luxury resorts market meant that middle upper class consumers must either stretch to pay for ultra luxurious resorts such as Aman, or settle for resorts, though luxurious, are catered to he masses. Ho recognized the business opportunity presented by the gap in the resorts market: there was room for something pricier and more exclusive that would better cater to these middle upper class consumers, who had better spending power than had the average consumer in the mass market, and would be able to afford and willing to pay for a more exclusive premium service offering. Moreover, as a result of today’s generally more hectic and stressful lifestyles, many well-to-do couples would appreciate Banyan Tree’s value proposition of a memorable, romantic holiday experience that would oth provide relaxation and create quality time for them to spend quiet moments together. Positioning and branding strategy Although Banyan Tree’s service offering was unique when it was first launched, this would not be a sustainable competitive advantage, as most tangible products could be easily copied by competitors. Establishing a strong service brand, however, would serve to distinguish Banyan Tree from competitors when they do jump on the bandwagon. Positioning as a sanctuary for romance and intimacy was well thought out, these being timeless attributes valued by many couples. A clear brand promise of romance and intimacy, which the company consistently delivered, also helped it achieve a clear and distinctive market position. That the company consistently delivered on its promise further reinforced what Banyan Tree stood for in the minds of its customers, thereby building both brand loyalty and emotional bonds. Product/service design and delivery The luxurious villas and distinctive native settings provided an excellent backdrop for guests to create memorable holiday experiences. Service employees were warm, sincere, and respectful; knew guests by their names; and emembered their preferences. Such personalized service delivery warmed guests, and helped them feel comfortable and relaxed, contributing to the entire customer experience. This was further enhanced by the feel-good factor that guests’ patronage helped to contribute to various social and environmental causes. Repeat patronage was also encouraged by the different services offered at differ ent locations, which gave satisfied guests an added incentive to visit Banyan Tree resorts around the world, to experience authentic flavors and practices of various local communities. As employees were given freedom to decorate the illas and in serving guests, even regular guests of a particular resort would have a different experience and may be pleasantly surprised every time they checked in. Such practices, together with continual service innovations, kept the Banyan Tree experience fresh and interesting. The whole Banyan Tree experience was engineered to appeal to one’s senses, giving guests a unique value proposition unlike the regular room stays offered by competitors then; such a service feature was also difficult to imitate, and successfully set Banyan Tree apart from other resorts in the market. Satisfied guests not only became loyal customers but lso helped spread positive word-of-mouth, which in turn gained the company new customers. Aggressive internal marketing Generous staff welfare policies created a strong sense of brand ownership among employees, which motivated them to achieve service excellence. Service staff served guests with passion and sincerity that could not be bought or easily copied by competitors. employees may not always provide the standard service across all the resorts nor always similar to that commonly found in five-star establishments in developed countries, their friendly and respectful attitudes towards guests more than made up for it and ctually provide an element of surprise even to the most regular guests. Winning the support of local communities andpublic interest groups The company’s considerable investments in conserving/preserving/promoting the social/cultural/natural environment beyond what was required of the company (without sacrificing on service quality) showed proof of corporate ethics that were driven by the management’s personal values. Such acts projected the Banyan Tree brand as being caring and sincere, consistent with its positioning of a romantic brand. Overall, Banyan Tree was viewed by guests, staff, local communities, and public interest roups as a warm, sincere, caring, ethical, and responsible company. Even when guests wander beyond the resorts’ compounds, the genuine feelings of hospitality and appreciation showed by the local communities at the villages made guests felt welcome and at home, making the entire stay pleasant and memorable. Such service capabilities were extremely difficult for competitors to imitate, requiring lots of investments in time, effort, and money by the firm to gain the trust and respect of both staff and the local community alike. Pioneer status: first mover advantage At a time when clinical spas were the norm, Banyan Tree invested in tropical garden spa pavilions, pioneering the concept of tropical spas and Asian therapeutic massages, a novelty which proved to be popular. Being the first in the market gave them a head start in penetrating the market. The lack of competition in the beginning also helped in consolidating the company’s position in the spa and resorts market. Establishments that were interested in providing similar spa services naturally approached them to establish an outlet in their premises, which helped further promote the concept of tropical garden spas beyond the regional markets. Pro-environment business practices Although being environmentally conscious sometimes resulted in costlier business decisions, for Banyan Tree, a major part of the resorts’ attraction was in the natural beauty of the location in which the villas were located. So, it made economic sense to protect and preserve the resorts’ surrounding environment to ensure that it remained an attractive tourist destination in the long run, or as Banyan Tree put it, â€Å"to prevent today’s darling from becoming tomorrow’s has-been. † Such pro-environmental business practices also generated a lot of positive publicity and won the ompany several awards, and these not only helped increase the brand awareness of Banyan Tree but also generated much interest among potential customers. At the same time, the company got the support of various public interest groups, such as environmentalists, and this saved the company from having to deal with any potential trouble that migh t have arisen from their development of the natural habitats of various flora and fauna for business purposes. 2. Evaluate Banyan Tree’s brand positioning andcommunications strategies. Can Banyan Treemaintain its unique positioning in an increasinglyovercrowded resorts market? Brand positioning is timely and appropriate in today’s hectic and stressful lifestyles Banyan Tree was positioned as a sanctuary that offered couples an exclusive romantic and intimate holiday experience. Positioned on such timeless attributes as romance and intimacy between couples, the positioning is timely and appropriate in today’s increasingly hectic and stressful lifestyle, where many couples are busy with their careers and have little time to spend together. Banyan Tree’s offering of an avenue to get away from it all and spend quality time together while relaxing and de-stressing would appear to be valued enefits sought by today’s busy couples. Being the first and only resort to be positioned as such, Banyan Tree occupied a unique position in the luxury resorts market when it first started. Focused promotion efforts with minimal wastage Banyan Tree’s communications program focused mainly on public relations and publicity, and direct marketing through its web site and sales offices that targeted wealthy consumers, with little emphasis on advertising. As advertisements were selectively placed in only high-end travel magazines that targeted the higher income and more sophisticated segment of the market, astage in advertising exposure is minimized. Showcasing the awards and accolades won credibly enhanced the brand’s reputation. Promotion through agents specializing in exclusive holidays adequately exposed Banyan Tree to its target segment of wealthy consumers. Efforts at obtaining and increasing editorial coverage on Banyan Tree both increased brand awareness in the industry and helped to sell the â€Å"Banyan Tree experience† credibly, coming from a neutral third party. Much positive publicity and public interest was generated as a result of the company’s investment in pro-environmental business practices, such as ponsoring various environmental conservation programs and community outreach programs. B esides being viewed as a caring and pro- environmental company, such publicity also drew attention to the natural beauty of the resorts and their environments, which helped the company to advertise its villas. Unique positioning sustainable? Whether Banyan Tree can maintain its unique positioning in the market would depend on how well it can keep its identity distinct and prevent competitors from encroaching into its turf. Generally, the positioning of providing romantic and intimate holiday experiences is not difficult to mitate; so is the concept of individual villas and any tangible offering. But, the overall service experience at Banyan Tree can still be unique, given its location specific service offerings and the uniqueness of the natural environment that Banyan Tree resorts are located. Although service innovations can be copied easily, the personality of a brand is less so, and the same can be said of the attitudes of staff and the local community at the resort destination, as well as the genuine feelings of hospitality shown towards guests. Banyan Tree had tried to appeal to â€Å"the senses,† ocusing on the overall customer experience and working on what the customer will ultimately bring home—memories. Judging from its success so far, it appears that even if competitors come up with similar lower-priced service products, it is unlikely that they would be able to replicate the total Banyan Tree experience so quickly. Perceptual mapping could be used to visualize the market positions of Banyan Tree and its sister brands relative to competitors in the industry. An example of a positioning map with the attributes price level and romantic versus sporty image is shown below: 4. Discuss whether the brand portfolio of BanyanTree, Angsana, and Colours of Angsana, as well asthe product portfolio of beach resorts and city hotels, spas, galleries, and museum shops fit as a family. What are your recommendations to Banyan Tree formanaging these brands and products in future? From luxurious six-star Banyan Tree resorts to small, individual Colours of Angsana branded hotels in exciting locations, these properties were bound together by one central theme: the romance of travel and the beauty of discovering the world. Banyan Tree targeted the higher end of the luxury resorts market Angsana was more mainstream and contemporary, targeting the wider market The Colours of Angsana range of boutique hotels catered specifically to the soft adventure tourism segment, locating in remote and exotic places that cannot justify the premium prices charged by Banyan Tree villas The various brands thus served to cater to different segments of the hotels and resorts industry, made distinct by price and benefits offered. The city hotel was also positioned similarly on romance and intimacy although it additionally catered to business travelers. There is a heavy emphasis on spa, designed to rovide an escape from the hustle and bustle of the city. It also offered various getaway/wedding packages for couples to indulge in romance and intimacy. The various facilities, such as spas and retail outlets, found across Banyan Tree resorts, were also available at Banyan Tree Bangkok. In particular, the hotel had an open-air rooftop lounge, Vertigo, at the top of the building, where guests c ould get a good view of the city; the lounge could also be used to host wedding receptions and other parties. Four broad product lines: accommodation, clubs, spas, and retail outlets Banyan Tree’s products and services could be lassified into essentially four product lines: hotels and resorts, clubs, spas, and retail shops, under various brands and sub-brands. Banyan Tree’s properties and spas could be classified under the business of travel and leisure. The retail shops augmented and helped to extend the overall service experience through the sale of products that consumers might use at home to replicate and remind them of the Banyan Tree experience. Also, the arts and crafts sold at the shops not only served to reinforce Banyan Tree’s brand personality, but also fitted in the travel industry, with the sales of indigenous products that tourists could buy s souvenirs. Achieving branding consistency through management by brand Management of the portfolio by brand would achieve more consistency in branding and positioning, and also make it easier to cross-sell and bundle products, although such an arrangement would require duplication in resources for various functions. Target customer Banyan Tree focused on its target customer segment which was high-end wealthy customers looking for exclusive luxury holidays. Banyan Tree knew exactly which customers they wanted to target and carried out its brand positioning accordingly. Advertisement The advertising was very minimal to maintain exclusivity† and it was carried out in top-of-the-line travel magazines that targeted its preferred customer segment. It never went in for a mass market strategy by selling through wholesale and retail agents. It became so successful and profitable owing to the fact that it ended up knowing its target customers so well, it met their needs better than other giant chains such as Hilton and Shangri-La. Brand Identity -Brand value / ethics / CSR : Environmental fr iendly, preservation of eco system, bio- degradable products, customer focus, -Brand Associations / Personality : Caring, Romance and intimacy, social and sensitive, rivate, cultural and authentic, -Brand Vision – sanctuary for the senses, building a necklace across the world -Brand Positioning (Category, POD, POPs, Value Prop) -POD : Pricing, experience – intimate moments, private pools, spas and art gallery, building memories, romance, CSR, customer involvement(environmental preservation), sense of place (different place -> different experience) -POPS : all attribute of luxury resorts(high service standard, 5 star training -Value Proposition – is ideal for †¦.. provide target market segment because they provide†¦.. better than their competition

Technology of Management in Organization Assignment

Technology of Management in Organization - Assignment Example The researcher of this essay analyzes and presents the importance of technology, that has risen in such leaps and bounds that organizations develop various management procedures and guidelines for the best implementation of the technology and to gain the utmost benefit of it. Change in organization today is evident. On the context of the technological change mainly there are two primary sources associated with such changes, the internal sources and the external sources. Owing to the amount of change in organizations, it is necessary for the organizations to possess a good mentor who can effectively guide the employees. Any good mentor in an organization should posses various characteristics like their willingness to share the skills, their knowledge and their expertise. The growing importance of technology in an organization has resulted in providing much importance to the technical workers. As the functioning of any organizations is almost impossible without the presence of technica l workers much emphasis is being given by the management in devising strategies to motivate and reward them. Motivation affects the morale of the employees and has a huge contribution in creating a positive work environment and it indulges an added responsibility on the employees to be concerned about the success of the organization. Knowledge management has evolved as one of the efficient tools for the increase of productivity in an organization and helps to develop the intellectual capital within an organization.

DIGITAL MEDIA PLATFORMS AND EDUCATION Essay Example | Topics and Well Written Essays - 250 words

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Discussion 10 Essay Example | Topics and Well Written Essays - 250 words

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MPH502-Introduction to Public Health (Module 4 CBT) Essay

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Permanent Vascular Access For Hemodialysis Health And Social Care Essay

Permanent Vascular Access For Hemodialysis Health And Social Care Essay Introduction: A progressive rise in the number of patients accepted for renal replacement therapy has been reported world wide . Permanent vascular access (VA) is the life-line for the majority of these patients, when hemodialysis is the treatment of choice. Thus, the successful creation of permanent vascular access and the appropriate management to decrease the complications is mandatory. A well functional access is also vital in order to deliver adequate hemodialysis therapy in end stage renal disease (ESRD) patients. Unfortunately, despite the advances in hemodialysis technology, in the field of vascular access in the last years the introduction of the polytetrafluoroethylene (PTFE) graft and the cuffed double lumen silicone catheter were the only changes. But the cost of vascular access related care was found to be more than fivefold higher for patients with arteriovenous graft (AVG) compared with patients with a functioning arteriovenous fistula (AVF) . It seems that the native arteriovenous fistula that Brescia and Cimino described in 1966 still remains the first choice VA . Thereafter, vascular access still remains the Achilles heel of the procedure and hemodialysis vascular access dysfunction is one of the most important causes of morbidity in this population . It has been estimated that vascular access dysfunction is responsible for 20% of all hospitalizations and the annual cost of placing and looking after dialysis vascular access in the United States exceeds 1 billion dollars per year . Nowadays, three types of permanent vascular access are used: arteriovenous fistula (AVF), arteriovenous grafts (AVG) and cuffed central venous catheters. They all have to be able to provide enough blood flow in order to deliver adequate hemodialysis, have a long use-life and low rate of complications. The native forearm arteriovenous fistulas (AVF) have the longest survival and require the fewest interventions. For this reason the forearm AV, is the first choice, fol lowing by the upper-arm AVF, the arteriovenous graft (AVG) and the cuffed central venous catheter as a final step . History of vascular access Vascular access for hemodialysis is closely associated with the history of dialysis. Glass needles were employed as vascular access when hemodialysis came into view in 1924. The first haemodialysis treatment in humans was carried out by Haas G who used glass cannulae to acquire blood from the radial artery and reverting it to the cubital vein . Venipuncture needles were used as means for blood acquisition from the femoral artery and its reinfusion to patient by vein puncture, in 1943 by Kolff W. . Regular hemodialysis treatments were possible in 1950s through the use of a medical apparatus ( Kolff s twin-coil kidney ), thus projecting the problem of a reliable, capable of repeated use vascular access. Today, the artery-side-to-vein-end-anastomosis has become a standard procedure . In 1952, Aubaniac had described the puncture of the subclavian vein . In the 60s, by using Alwalls experience, Quinton, Dillard and Scribner developed arteriovenous Teflon shunt . This procedure involved two thin-walled Teflon cannulas with tapered ends were inserted near the wrist in the forearm, one into the radial artery and the other into the adjacent cephalic vein. The external ends were connected by a curved Teflon bypass tube. Later, the Teflon tube was replaced by flexible silicon rubber tubing. After the advancement of permanent vascular access, the possibility of maintenance hemodialysis was a fact and therefore a groundbreaking procedure. In the subsequent years many variants of the AV shunt were used, with the majority of them concerning temporary vascular access from the onset of chronic dialysis treatment compensating for the time of AV fistulas absence or maturity. In 1961, Shaldon performed hemodialysis procedures by inserting catheters into femoral artery and vein, using the Seldinger-technique . Over time, vessels in different sites were used, including the subclavian vein jugular and femoral. In 1962 Cimino and Brescia described a simple venipuncture for hemodialysis . In 1963 Thomas J. Fogarty invented an intravascular catheter with an inflatable balloon at its distal tip designed for embolectomy and thrombectomy . The first surgically created fistula was placed in 1965, followed by further 14 operations in 1966. In 1966 Brescia, Cimino, Appel and Hurwich published their paper about arteriovenous fistula. Appell had performed a side-to-side-anastomosis between the radial artery and the cephalic antebrachial vein. One year later, in 1967, M. Sperling reported the successful creation of an end-to-end-anastomosis between the radial artery and the cephalic antebrachial vein in the forearm of 15 patients using a stapler . In the next few years this type of AV anastomosis received popular approval. However this procedure was cast aside as first choice AV, due to the increasing numbers of elderly, hypertensive and diabetic patients with demanding vessels and high risk of a stea l syndrome. End-to-end-anastomoses are still a common place technique in revision procedures. In 1968 Rà ¶hl L. published thirty radial-artery-side-to-vein-end anastomoses . After anastomosis was performed, the radial artery was ligated distal to the anastomosis, thus resulting in a functional end-to end-anastomosis. Today, the artery-side-to-vein-end-anastomosis has become a standard procedure . In 1970, Girardet R. and Brittinger W.D. described their experience with the femoral vein and artery for chronic hemodialysis. Experimental trials have been done by several authors in order to establish a permanent vascular access using subcutaneous tunnel. Brittinger W. was the first to implant a plastic valve as a vascular access in an animal model but unfortunately his efforts did not proceed to a human one . Moreover during the early 70s, Buselmeier T.J. developed a U-shaped silastic prosthetic AV shunt with either one or two Teflon plugged outlets which communicated to the outside of the body. The U-shaped portion could be totally or partially implanted subcutaneously . Subsequ ently pediatric hemodialysis patients were extremely favored by this procedure. New materials for AV grafts were presented in 1972, one biologic and two synthetic.. In 1976, L.D. Baker Jr. presented the first results with expanded PTFE grafts in 72 haemodialysis patients . In the years to come several publications indicated the benefits and the shortcomings of the prosthetic material in question remaining the primary choice of graft for hemodialysis VA to date. The same year two authors, Mindich B. and Dardik H. had worked with a new graft material: the human umbilical cord vein. . Regrettably so, this material did not succeed in becoming a revolutionary graft material due to its inadequate resistance against the trauma of repeated cannulation and their complication (aneurysm and infection). After the subclavian route for haemodialysis access was firstly introduced by Shaldon in 1961, it was further processed in 1969 by Josef Erben, using the intraclavicular route . In the next 20 y ears or so, the subclavian vein was the preferred access for temporary vascular access by central venous catheterization. Today, due to phlebographic studies revealing a 50% stenosis or occlusion rate at the cannulation site, subclavian route has been discarded. The subclavian stenosis and occlusion predispose to oedema of the arm, especially after creation of an AV fistula . The first angioplasty described by Dotter et al who introduced a type of balloon, was immensely conducive to the resolution of one of the most significant predicaments in vascular surgery and vascular access surgery . In 1977 Gracz K.C. et al created the proximal forearm fistula for maintenance hemodialysis, a variant of an AV anastomosis . An adjustment of this AVF became quite significant in the old, hypertensive and diabetic patients on the grounds that it allows s a proximal anastomosis with a low risk of hypercirculation . In 1979 Golding A.L. et al developed a carbon transcutaneous hemodialysis access device (CATD), commonly known as button, as a blood access not requiring needle puncture . As a procedure of third choice, these devices were expensive and never gained widespread acceptance. Shapiro F.L. described another type of A.L. button, a device similar to that developed by Golding . Angioaccess classification Years after the initial efforts to create the appropriate vascular access in order to perform a safe hemodialysis, modern Nephrologists have now the possibility to select the appropriate access for their patients. So the first distinction is made between temporary and permanent VA . Temporary VA with expected half-life less than 90 days, peripheral arteriovenous shunts and non cuffed double lumen catheters are included . Mid-term VA with expected half life in 3 months to 3 years include veno-venous accesses (tunneled cuffed catheters and port catheter devices) and arteriovenous internal shunts, requiring vascular graft synthetic (PTFE) or biologic (saphenous vein, Procol, etc.) material ,or external shunt. Long-term VA with an expected half-life more than 3 years includes virtually the native arteriovenous fistulas and the new generation of PTFE grafts . Acute hemodialysis vascular access They are used for urgent hemodialysis and should be easy to insert and available for immediate use. Currently there are available two types of such accesses: Non-tunneled dialysis catheters and cuffed, tunnelled dialysis catheters. Double-lumen, non-cuffed, non-tunnelled hemodialysis catheters are the preferred method for immediate hemodialysis when a long term access is not available. They are made of polymers which are rigid at room temperature to facilitate insertion but soften at body temperature to minimize vessel injury and blood vessel laceration. The proximal and distal lumens should be separated by at least 2 cm to minimize recirculation . These catheters can be inserted into the central veins: femoral, jugular, or subclavian veins . The femoral artery can be used as an access central vein when all others central veins have been excluded. A modified Seldinger guide wire technique is used for their insertion. Image guided assistance in placing these catheters is recommended to avoid or minimize some of the immediate insertion complications, but non-cuffed catheters are also suitable for use at the bedside of the patient The 2006 National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) guidelines recommend, after internal jugular or subclavian vein insertion, identifying radiographically any potential complications and confirming tip placement prior to either anticoagulation or catheter use . These guidelines also recommend ultrasound vessel identification prior to insertion. In general, now the subclavian catheters should be avoided because of the high incidence of vein stenosis and thrombosis. The maximum blood flow with this class of catheters is usually blood pump speeds of 300 mL/min, with an actual blood flow of 250 mL/min or less . Femoral catheters have to be at least 18 to 25 cm in length in order to have lower recirculation. The routine use-life of these catheters varies by site of insertion. In general, internal jugular catheters are suitable for two to three weeks of use, while femoral catheters are usually used for a single treatment (ambulatory patients) or for three to seven days in bed bound patients . However, the KDOQI guidelines suggest that non-cuffed, non-tunnelled catheters be used for less than one week and that cuffed, tunnelled catheters be placed for those who require dialysis for longer than one week . More recently a non-cuffed, non-tunnelled triple-lumen dialysis catheter has been developed. The purpose for third lumen is for blood drawing and the intravenous administration of drugs and fluid. In a multicenter, prospective study, blood flow rates and infectious complications were similar with double lumen catheter . Infectious complications are the principal reason why the catheter must be removed. Permanent Vascular Access Taking into consideration patient factors such as life expectancy, comorbidities, and status of the venous and arterial vascular system is very important in order to prescribe the appropriate access. Other factors are determined by the type of access itself, as arteriovenous fistula (AVF), arteriovenous graft (AVG), or TC which have a different effect on circulatory system. Also the duration of their functionality and the risk for infection and thrombosis are important factors to consider. Each type of surgical anastomosis has advantages and disadvantages . In 2002 the American Association for Vascular Surgery and the Society for Vascular Surgery published reporting standards according to which three essential components of VA should be mentioned: conduit (autogenous, prosthetic), location and configuration (strait, looped, direct, etc.) . Arteriovenous fistula An AVF is the preferred type of vascular access; it has the lowest complication rates for thrombosis (~ one-sixth of AVGs) and infection (~ one-tenth of AVGs) . There are 3 types of AVF s: à ¢Ã¢â€š ¬Ã‚ ¢ First type when artery and vein are connected in their natural position, either with a side-to-side or a side-artery-to-vein-end anastomosis. à ¢Ã¢â€š ¬Ã‚ ¢ Second type, where a vein is moved to connect to an artery in end-to-side fashion to either bridge a larger anatomical distance, or to bring the vein to the surface where it is accessible for cannulation and requires a tunnel to position the vein in its new location. à ¢Ã¢â€š ¬Ã‚ ¢ Third type where a vein is removed from its anatomical location and, is connected to an artery and vein in end-to-end fashion. Both second and third type requires the formation of a tunnel . End-to-end anastomoses are now rarely performed, since the complete disruption of the artery imposes a risk for peripheral ischemia and thrombosis. The most common surgical technique today is the side-to-end anastomosis. However technical problems as cutting the end of the vein in an oblique angle may create functional problems due to stenosis. An anastomosis more proximal in the arterial system should be smaller to prevent steal and limit maximal fistula flow, with the inherent complication of ischemic steal or heart failure . Arteriovenous fistula creation is often performed under local anaesthesia, with low morbidity and requires time for maturation. Data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) indicate that AVFs should mature at least 14 days before use . Fistula size and flow increase over time, of 8-12 weeks and the initial blood flow rates has a range of 200-300 mL/min. Placement of AVFs should be initiated when the patient reaches CKD stage 4, or within 1 year of the anticipated start of dialysis. A physical examination should document blood pressure differences between the upper extremities and an Allen test should be performed, the lack of a well-developed palmar arch predicts a higher risk for vascular steal symptoms if the dominant artery is used for forearm fistulas creation due to inadequate collateral circulation . Ultrasound must be done before surgical implantation because it can provide information for maximal surgical success by mapping arteries and veins; eg, a preoperative arterial lumen diameter >2 mm is associated with successful fistula maturation, while a diameter of 600 mL/min, a diameter >0.6 cm with discernible margins, and be at a depth of 0.6 cm (between 0.5 and 1.0 cm) from the surface 6 weeks after creation. In fistulas that are maturing successfully, flow increases rapidly post-surgery, from baseline values of 30-50 mL/min to 200-800 mL/min within 1 week, generally reaching flows >480 mL/min at 8 weeks .The AVFs must be evaluated 4-6 weeks after placement, and experienced examiners (eg, dialysis nurses) can identify non-maturing fistulas with 80% accuracy . Arteriovenous graft AVGs were the most commonly used type of dialysis access in the US however, they do not last as long as AVFs and have higher rates of infection and thrombosis . Grafts present a second choice of VA when AVF are not able to be performed because of vascular problems. They can be placed in the forearm, the upper arm, and the thigh, and can have a straight, curved, or loop configuration. They may offer a large surface area for cannulation. AVGs can be cannulated about 2-3 weeks after placement, although there are studies suggesting that immediate assessment after placement for PTFE AVGs is possible . This interval is needed in order to allow the surrounding tissue to adhere to the PTFE conduit, to reduce the postsurgical oedema and the risk for local complications such as perigraft hematoma and seroma . Tunnelled hemodialysis catheter TCs are used when AVFs or AVGs arent possible to be created for several reasons such as multiple vascular surgeries, that lead to vascular thrombosis or when patients have severe peripheral vascular disease or very low cardiac output. Its more often in paediatric and very old patients. Unfortunately they are associated with the highest infection rate and they are not a very long-term access option. Studies have revealed that central venous catheters are colonized within 10 days of placement; however, colonization of the catheter biofilm does not correspond to positive blood cultures or clinical signs of bacteremia . Recently Power A. et al published their experience with 759 TCs. The survival rate at 1,2 and 5 years was 85%, 72% and 48% respectively. The infection rate was 0.34 per 1000 catheter day showing with careful and appropriate use of TCs, they can provide effective and adequate long term hemodialysis and rates of access related infection almost similar to AVGs . Hemodialysis vascular access in children The choice of replacement therapy in children is variable. The registry of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS) reports that of patients initiating renal replacement therapy in paediatric centres : one quarter of children underwent preemptive renal transplantation, one half were started on peritoneal dialysis and one quarter were started on hemodialysis. Kidney transplantation remains the preferred therapy for paediatric patients therefore, many paediatric patients receive maintenance HD through an indwelling catheter in perspective of short HD period . In the United States less than 800 paediatric patients receive maintenance HD therapy, therefore surgical experience and clinical data for fistulae or grafts creation in small patients is limited due to rare need for such procedures. Smaller patients, especially those less than 10kg, are very demanding in surgical and nursing skill, this is significant reason the majority of smaller patients re ceive PD for their maintenance dialysis modality . Peritoneal dialysis is much more common in infants and younger children , significantly due to problems of vascular access. However, hemodialysis can be performed successfully in infants and very young children, as well . Children who will join in hemodialysis will need evaluation of their vasculature for placement of an arteriovenous (AV) fistula, arteriovenous graft, or cuffed double lumen catheter. The use of an AV fistula, the recommended type of vascular access in adults, is limited in children due to the size of their vessels. In the 2008 NAPRTCS annual report, vascular access for hemodialysis included external percutaneous catheter in 77.7 percent of patients, internal AV fistula in 12.3 percent, and internal and external AV shunt in 7.3 and 0.7 percent, respectively . K/DOQI has encouraged greater use of AV fistulas in larger children receiving hemodialysis who are not likely to receive a transplant within 12 months, with a goal of achieving more effective dialysis with fewer complications (eg, infection) than occurs with catheters. The choice of catheter size and configuration depends on the size of the patient. It is suggested by studies that in children as small as 4 to 5 kg a dual-lumen 8 Fr catheter can be well tolerated, and as the child becomes larger in size, a larger volume access can be placed . Vascular access should be able to provide sufficient blood flow and adequate dialysis with a Kt/V greater than 1.2. Kt/V is influenced further by the recirculation rate. Because flow rates in paediatrics vary by the size of catheter, which varies by the size of the patient, a recommended flow rate of 3 to 5 mL/kg/min is acceptable in most patients . Vascular access complications and Survival Studies have shown a mortality risk dependent on access type, with the highest risk associated with central venous dialysis catheters, followed by AVGs and then AVFs . The CHOICE study examined mortality based on access type in 616 hemodialysis patients for up to 3 years of follow-up. Central venous catheters and AVGs were associated with approximately 50% and 26% increased mortality, respectively, compared with AVFs with prevalence in men and elderly patients . Despite these findings and the KDOQI recommendations, dialysis access data from 2002-2003 showed that only 33% of prevalent hemodialysis patients in the US were being dialyzed via AVFs. Contrary in Europe and Canada, the majority of the patients (74% and 53% respectively) were being dialyzed via AVFs . Vascular access admissions continue to fall, with more procedures now performed in an outpatient setting, and are 45.1 percent below levels noted in 1993. By two-year time period, the adjusted relative risks of all- cause and cardiovascular hospitalization among hemodialysis patients vary little when compared to the reference period of 1997-1998; the risk of hospitalization for infection, however, is now 18 percent greater than in the reference period, while that of a vascular access hospitalization is 30 percent less. Among African American patients, the relative risk of an all-cause hospitalization or one related to infection is almost equal to that of white patients; the risk of a vascular access hospitalization, however, is 24 percent higher. In our previous work with 149 hemodialysis patients who had undergone 202 vascular access procedures (177 Cimino-Brescia fistulae and 25 PTFE grafts we found that the Cimino-Brescia fistula was used as the first choice of vascular access in all patients except one in the elderly group. PTFE grafts were the second or third choice in 7 patients younger than 65 and 15 in the elderly group (p: NS). The only reason for technique failure was vascular thrombosis in both groups (p: NS). Other complications were: aneurysms (10/48 and 14/101, p: NS), infections (0/48 and 2/101 p: NS) and oedema (0/48 and 6/101, p: NS). (Table à ¢Ã¢â€š ¬Ã‚ ¦.. Five-year technique survival of the first AV fistula in the two groups was 35% and 45% respectively (log-rank test, p: NS). (FIGUREà ¢Ã¢â€š ¬Ã‚ ¦..) Our findings suggested that there was no difference in vascular access complications across age groups and the survival of the first AV fistula is independent of age. Other encouraging results include a 22.9 percent fall in dialysis access admissions since 1999 for peritoneal dialysis patients, among hemodialysis patients, admissions for bacteremia/septicemia continue to rise sharply, reaching 112 per 1,000 patient years similar to the rate of 109 for vascular access infections, and possibly reflecting an increased use of cuffed catheters. In 2010 USRDS Annual Data Report hospitalization in 2008, increased again, to a point 45.8 percent above their 1993 level. In 2007-2008, women treated with hemodialysis were 16 percent more likely to be hospitalized, overall, than male. They also had a greater risk than men of cardiovascular, infectious, and vascular access hospitalizations 11, 14, and 29 percent greater, respectively. Recently unpublished our data are more different than those we published in 1998. We found in 189 patients that female had more possibility to start HD with double lumen catheter than male and also patients with heart failure ind ependent of sex. Female patients had PTEF grafts as first vascular access (p=0,023) and the elderly patients had more complications and more vascular access procedures (p=0.026). Non-tunnelled double lumen catheters complications The non-tunnelled double lumen catheters complications concern the insertion, the infection and thrombosis of the vessel. The severity and likelihood of insertion complications varies with the site of insertion. The complication rate and the severity are lowest in the femoral position. The primary problem is perforation of the femoral artery. Bleeding usually resolves within minutes of direct compression. Large femoral or retroperitoneal hematomas occur occasionally . Subclavian insertion complications are potentially more serious. Over-insertion of guide-wire can occasionally lead to atrial or ventricular arrhythmias. The vast majority of these are transient and hemodynamically insignificant . Penetration or cannulation of the subclavian artery can lead to hemothorax, which in some cases requires a thoracotomy tube. Cases of pericardial rupture and tamponade also have been described . Subclavian insertion from the left has an increased risk of atrial perforation which can present with acute hemopericardium upon initiation of dialysis. The incidence of pneumothorax varies from less than 1 percent to mor e than 10 percent of insertions, depending on the skill and experience of the physician. The risk of pneumothorax is greater from the left than right side, since the pleura and dome of the lung are higher on the left . Due to high rate of catheter-induced subclavian stenosis and subsequent loss of the ipsilateral arm for future hemodialysis access internal jugular vein insertion, particularly the right internal jugular vein is the preferred site of insertion. At internal jugular insertions carry a higher likelihood of carotid artery penetration, but a lower risk of pneumothorax (0.1 percent). Ultrasound guided cannulation of the vessel is recommended to minimize these complications. The location of the catheter tip in subclavian and internal jugular insertion should always be confirmed by fluoroscopy or x-ray prior to the initiation of hemodialysis or the administration of anticoagulants. Ultrasound-guided catheter insertion is lesser likelihood of arterial puncture or pneumothorax . Prevention and treatment of catheter thrombosis are important clinical issues. To prevent formation of thrombus, both lumens of the double lumen catheter are instilled with heparin following hemodialysis. The amount injected should only fill the catheter lumen to minimize systemic heparinization. Anecdotal evidence suggest that chronic anticoagulation with warfarin or low molecular weight heparin may also prevent catheter thrombus, due to either intraluminal clot or fibrin sheath formation . Lytic agents such as urokinase and alteplase are effective in treatment of catheter thrombosis. Alteplase has effectiveness rates in thrombosis treatment comparable to that observed with urokinase . However if non-cuffed catheters cannot have adequate blood flow then they should be exchanged. Ventral vein catheters are associated with the development of central vein stenosis . This complication appear s to occur more often with subclavian (40 to 50 percent of cases in some studies) than with internal jugular insertions (up to 10 percent) . It has been proposed that central venous cannulation creates a nidus of vascular injury and fibrosis. The rapid blood flows associated with the hemodialysis catheter then create turbulence that can accelerate endothelial proliferation, eventually leading to venous stenosis . The K/DOQI guidelines therefore recommend avoiding placement in the subclavian vein, unless no other options are available. If central venous thrombosis is detected early, it responds well to directly applied thrombolytic therapy or to percutaneous transluminal angioplasty when the fibrotic stenosis can be crossed with a guidewire . The infection risks associated with temporary double lumen catheters include local exit site infection and systemic bacteremia, both of which require prompt removal of the catheter and appropriate intravenous antibiotic therapy . Bacteremia gene rally results from either contamination of the catheter lumen or migration of bacteria from the skin through the entry site, down the hemodialysis catheter into the blood stream . Skin flora, Staphylococcus and Streptococcus species, are responsible for the majority of infections. There is conflicting evidence concerning the risk of infection based upon the site of insertion. In the largest prospective randomized study, the risk of infection was not reduced with jugular versus femoral venous catheterization . A prospective nonrandomized studies suggest that the infection risk appears to sequentially increase for hemodialysis catheters inserted into the subclavian, internal jugular, and femoral veins, respectively . Overall, compared with the subclavian vein, the internal jugular vein remains the preferred access site in ambulatory patients because of the high rate of central vein stenosis associated with subclavian vein catheterization (see above). In the Intensive Care Unit, either femoral or internal jugular vein placement is satisfactory, with the use of ultrasound making internal jugular vein placement safer. The best solution is to prevent the infection by proper placement technique, optimal exit site care and management of the catheter within the HD facility . Arteriovenous fistulas complications Complications of AVFs can be divided into early and late causes. Early causes include inflow problems such as small or atherosclerotic arteries, or juxta-anastomotic stenosis so a pre-operative evaluations for suitable access sites has to been performed . The aetiology of this acquired lesion is not entirely clear, but may be related to manipulating the free end of the vein, torsion, poor angulation, or loss of the vasa vasorum during anatomic dissection. This lesion often can be adequately treated with angioplasty or by surgical revision . Outflow problems may include accessory veins that divert blood flow from the intended superficial vessel to deeper conduits, or central venous stenosis in patients with prior central venous catheters. Vessels smaller than one-fourth of the fistula diameter are usually not hemodynamically relevant. Juxta-anastomotic stenosis and accessory veins are the most common causes for early failure AVFs when pre-operative evaluations for suitable access sites have been performed . Late causes for failure of AVFs include venous stenosis, thrombosis, and acquired arterial lesions such as aneurysms or stenosis. Venous stenosis may become apparent as flow decreases over time, worsening weekly Kt/V ([dialyzer clearance _ time]/body volume) or increasing recirculation. Native fistulas typically will not thrombose until flow is severely diminished. Static pressure measurements, which are helpful in graft monitoring, do not appear as helpful in AVFs, since collaterals surrounding the stenosis area often develop, effectively masking the rise in fistula outflow resistance. Stenotic lesions can be treated by angioplasty. Thrombectomy of fistulas, although technically more challenging than in AVGs, is often successful and if flow is re-established, primary patency is longer than in grafts . Aneurysms may form over the course of years as the fistula increases with increased flow and, unless associated with stenotic lesions, are more a cosmetic than functional concern. If the skin overlying the aneurysm is blanching or atrophic, or if there are signs of ulceration

Developing Critical Thinking Essay -- Critical Thinking Reflection

A person is not born as a good critical thinker. The first thing that is needed is a level of maturity having the ability to conceptualize and understand the world (Boss, 2010). The skills that are associated with a person that has good critical thinking are: Analytical Skills: recognize and evaluate arguments to filter through to the truth. Effective Communication: ability to listen, speak, and write effectively. Research Skills: ability to gather, evaluate, and create supporting evidence. (Boss, 2010) In teaching critical thinking, Dr. Chan and Dr. Lau (n.d.) explain good critical thinking, â€Å"as the foundation of science and a liberal democratic society. Science requires the critical use of reason in experimentation and theory confirmation. The proper functioning of a liberal democracy requires citizens who can think critically about social issues to inform their judgments about proper governance and to overcome biases and prejudice.† A person with a level of maturity that is able to be research issues, through being analytical, and done by using good communication skills can be considered a good critical thinker. In my life, I have gone from not being a good critical thinker to getting much better as I have matured. In my younger years I used many of the resistances to critical thinking. The one that I used most often was distraction. This was especially true when I was in college for the first time. Many things were able to distract me from focusing on the tasks at hand. Now in my forties returning to school I have more clarity around the goals and this lets me accomplish the tasks more easily. I can listen, analyze, and research the issues more quickly and with more focus to accomplish the mission then in ... ...t created the universe before the big bang? God might not be just a figment created by religion but could be the ultimate creator of all that we see. Works Cited Boss, J. (2010), Think: Critical thinking and logic skills for everyday life (1st ed.). New York: McGraw Hill. Chan, J. & Lau, J. (n.d.). Module: about critical thinking. Retrieved from http://philosophy.hku.hk/think/critical/ct.php Goleman, D. (2001). Daniel Golemen: emotional intelligence. Thinkers. Charter Management Institute. Retrieved March 10, 2012 from http://go.galegroup.com.ezp-02.lirn.net/ps/i.do?id=GALE%7CA85608627&v=2.1&u=lirn_crevc&it=r&p=GPS&sw=w Hasan, M. (2012, January 9). God need not be the enemy of science. New Statesman [1996], 141(5087), 19. Retrieved from http://go.galegroup.com.ezp-02.lirn.net/ps/i.do?id=GALE%7CA279138538&v=2.1&u=lirn_crevc&it=r&p=GPS&sw=w Developing Critical Thinking Essay -- Critical Thinking Reflection A person is not born as a good critical thinker. The first thing that is needed is a level of maturity having the ability to conceptualize and understand the world (Boss, 2010). The skills that are associated with a person that has good critical thinking are: Analytical Skills: recognize and evaluate arguments to filter through to the truth. Effective Communication: ability to listen, speak, and write effectively. Research Skills: ability to gather, evaluate, and create supporting evidence. (Boss, 2010) In teaching critical thinking, Dr. Chan and Dr. Lau (n.d.) explain good critical thinking, â€Å"as the foundation of science and a liberal democratic society. Science requires the critical use of reason in experimentation and theory confirmation. The proper functioning of a liberal democracy requires citizens who can think critically about social issues to inform their judgments about proper governance and to overcome biases and prejudice.† A person with a level of maturity that is able to be research issues, through being analytical, and done by using good communication skills can be considered a good critical thinker. In my life, I have gone from not being a good critical thinker to getting much better as I have matured. In my younger years I used many of the resistances to critical thinking. The one that I used most often was distraction. This was especially true when I was in college for the first time. Many things were able to distract me from focusing on the tasks at hand. Now in my forties returning to school I have more clarity around the goals and this lets me accomplish the tasks more easily. I can listen, analyze, and research the issues more quickly and with more focus to accomplish the mission then in ... ...t created the universe before the big bang? God might not be just a figment created by religion but could be the ultimate creator of all that we see. Works Cited Boss, J. (2010), Think: Critical thinking and logic skills for everyday life (1st ed.). New York: McGraw Hill. Chan, J. & Lau, J. (n.d.). Module: about critical thinking. Retrieved from http://philosophy.hku.hk/think/critical/ct.php Goleman, D. (2001). Daniel Golemen: emotional intelligence. Thinkers. Charter Management Institute. Retrieved March 10, 2012 from http://go.galegroup.com.ezp-02.lirn.net/ps/i.do?id=GALE%7CA85608627&v=2.1&u=lirn_crevc&it=r&p=GPS&sw=w Hasan, M. (2012, January 9). God need not be the enemy of science. New Statesman [1996], 141(5087), 19. Retrieved from http://go.galegroup.com.ezp-02.lirn.net/ps/i.do?id=GALE%7CA279138538&v=2.1&u=lirn_crevc&it=r&p=GPS&sw=w

The Birthmark, Rappaccini’s Daughter, and Ethan Brand Essay examples --

The Birthmark, Rappaccini’s Daughter, and Ethan Brand Hawthorne marks his characters as potential usurpers of God who are undermined by an inability to negotiate with human chaos. Confronted with examples of imperfection or fragmentation, the scientific minds of "The Birthmark," "Rappaccini ¹s Daughter," and "Ethan Brand" attempt to efface or fuse flaws as they seek an impossible ideal of total encapsulation and order. Unsatisfied with writing a Psalm, they try to script the entire Bible. This analogy is not incidental, the three stories are all, to some extent, revisions of the Garden of Eden tale. The trio attempts to reconfigure Original Sin, either by blotting it out or by internalizing and conquering sin to the point of self-deification. The latter is particularly key for Hawthorne, a writer who crafts his prose with immaculate precision and detail, ostensibly the marks of the omniscient narrator. Yet Hawthorne concedes the impossibility of full comprehension of a character, or at least his unwillingness to seek such a conclusive appraisal, and consequently refrains from directing the reader to a similar resolution. Fragmentation runs through "Ethan Brand," so much that the story is subtitled "A Chapter From an Abortive Romance." The fragments come to resemble irreconcilable pieces of nature. Framed by images of Bartram ¹s son playing with the "scattered fragments of marble" and of Bartram shattering Brand ¹s "relicsÃ…  into fragments," Hawthorne employs the occupation of lime-burner as a central metaphor of Brand ¹s search for the Unpardonable Sin (271, 287). Brand ¹s "Idea first developed" as a reaction to the processes of his profession, in which "blocks and fragments of marble" are converted to lime (272). The ... ... had indeed found the Unpardonable Sin" (279). If Brand is unsure, perhaps Hawthorne is as well. This may explain the subtitles of inclusion, as in "Ethan Brand," or "[From the Writings of Aubà ©pine]" from "Rappaccini ¹s Daughter." By acknowledging their status as small parts of (fictitious) greater works, Hawthorne denies any possibility that each story is the final word. Instead, he embraces the fragments as individual perspectives which may or may not reveal reality. Since each perspective is faulty, the only way to assure is an impossibly "objective" view is through such a perspectival collage. This may help explain why Hawthorne wrote as many short stories collections in his lifetime as novels†¹better for a dozen or so chaotic pairs of eyes to assess truth than an authorial Cyclops, lacking depth perception. The Birthmark, Rappaccini’s Daughter Ethan Brand

Essay --

Blair Khoker Religion and the Arts Professor Wendy Raver December 16th, 2013 Bharata Natyam The word â€Å"Bharata† comes from a combination of three main elements in Indian dance; Mood (bhava), melody (raga), and rhythmic timing (tala). The word â€Å"Natyam† means both dancing and acting. Bharata Natyam is from South Indian, specifically Tamil Nad. This dance style has been preserved mostly in the beautiful ancient temples and areas of Tanjore and Madras. South India has many sculptures of Gods and Goddesses who are lavishly decorated and ornamented and who show the art, religion, and culture of the country. Enakshi Bhavani describes these beautiful shrines and religious areas as being â€Å"an atmosphere of ancient India linger[ing] with a compelling fragrance† (28). Where this dance style originated is very important to how it is viewed today in modern times and western societies. In India, there are still ancient areas in which the traditions and teachings of Bharata Natyam are being studied, but how these teachings evolved into modern society is i mportant in understanding its religious impact on the Indian community. Bharata Natyam embodies three basic aspects of classical Indian dancing; The pure dance, dance embodying an expressive mood and dance containing a dramatic element. It must be strongly emphasized that Bharata Natyam in its true and proper form is studied in a very intense manner. In some cultures the dance is done to invoke gods and enact mythological events. The dancers go through immense amounts of training in order to be able to control every muscle in their body. The technical ingredients for physical mastery are swiftness, precision, suppleness, strength, instincts for time, agility, and lightness; but, one of the most i... ...yday lives and into a spellbound state of beauty. In the Bharata Natyam the dance techniques of pure dance consists of a number of combinations of postures. These combinations include the movement and coordination of the body, waist, arm, hand, leg, foot, head, and neck to various sets of words and beats. Beautiful gestures and arm positions combine to form the general beauty of posture. There are about 120 basic dance arrangements which can be further combined into hundreds of varieties of patterned dance movements. Although, dancers usually learn about forty to seventy basic movements and then study the intricate dances that include them. A recital or individual performance can go from one and a half hours to four hours long. Every performance in made up of the following parts (given in sequence), Alarippu, Jethiswaram, Shabdam,Varnam, Padam(s), and Thillana. â€Æ'

Plains Indians

The destruction of the Plains Indians' cultures connected with the technological developments and government actions in the United States. During the period of struggle between Indians and Whites in the late 19th century, Indian leaders often traveled east to plead their case before the federal government, with few results. The building of the transcontinental railroads and all their branches was an inevitable part of the Industrial Revolution that drove America following the Civil War. The Indians were repressed due to the railroad, which cut through their territory in the West, the declining population of the buffalo, wars, and the loss of their land to White settlement. The federal government tried to quiet the Indians' protests by signing treaties with the chiefs of the tribes. However, the treaties failed because those who signed didn’t necessarily represent groups of people in Indian culture, and in most cases, the Indians didn’t recognize the authority chiefs outside of their own tribes. In the 1860s, the U. S. government made new efforts to relocate Indians into even smaller reservations than before. Indians were often promised that they wouldn’t be bothered further if they would just move out of their ancestral lands, and often, Indian agents were corrupt and sold off cheap food and products to their own fellow Indians. White men often ignored the treaties, though, and frequently scammed the Indians. In frustration, many Native American tribes attempted to fight back. After the Civil War, the U. S. Army’s new mission became to move the Indians out of the West so the White settlers could move in. A couple of Indians and Whites battled between 1860s to 1890s in a series known as the Indian Wars. Many times though, the Indians were better equipped than the federal troops sent to stop their revolts because arrows could be fired more rapidly than their rifles. However, the invention of the Colt . 45 revolver and Winchester repeating rifle put the Indians at a disadvantage. During this period, there was much violence among the Indians and Whites. Generals Sherman, Sheridan, and Custer all battled Indians in battles such as Little Big Horn. The building of the railroads is connected with the settlement of the West and the steady destruction of Indian cultures. The main food source for Plains Indians were the bison. In the early days, millions of bison populated the American prairie, and by the end of the Civil War, there were still 15 million buffalo. Many people killed buffalo for their meat and their skin but many people killed the bison for sport and just left the rest of the carcass to rot. However, it was the expansion of the railroad that really started the bison massacre. Railroads enhanced the value of the land enormously, but made farmers dependent on railroads. The need for open land led them to kill off the bison for railroad land. Railroad construction led to further settlement of the West, which in turn complicated conditions for the Indian tribes. The Plains Indians were driven out of their territory and into too small reservations. With the expansion of the railroad, down came their number one food source, the bison. Inventions such as the Winchester, led to the disadvantage of Indians during battles when protecting their land. The wars, overall, also affected the Indians. The government actions, building of the railroad and other inventions, contributed to the steady decline in the Plains Indians' population.

Answers to Quiz #4

According to the IS-LM model, what happens in the short run to the interest rate, income, consumption, and investment under the following circumstances? (Assume everything else is held constant. ) a. The central bank decreases the money supply. i. The interest rate ________increases_______________________ ii. Income ____________decreases__________________________ iii. Consumption ___________decreases______________________ iv. Investment ___________decreases________________________ b. The government decreases its level of expenditures. i. The interest rate _________decreases______________________ ii.Income ___________decreases___________________________ iii. Consumption __________decreases_______________________ iv. Investment ___________increases________________________ c. The government imposes a new lower level of taxes. i.The interest rate _________increases______________________ ii. Income ________________increases______________________ iii. Consumption ___________increases______ ________________ iv. Investment ______________decreases_____________________ d. The government increases government spending while at the same time it increases taxes by exactly the same amount. .The interest rate __________increases_____________________ ii. Income _____________increases but by less than the change in government spending and the change in taxes_________________________ iii. Consumption __________decreases_______________________ iv. Investment ______________decreases_____________________ 2. Use the following information to answer this set of questions. An economy can be described by the following equations: C = 200 + 0. 75(Y – T) I = 200 – 25r G = 100 and is constant and exogenously determined T = 100 and is constant and exogenously determinedThe demand for real money balances = M/P = Y – 100r M = money supply = 1000 P = price level = 2 a. Write an equation for the IS curve for this economy. IS: Y = 200 + 0. 75(Y – T) + G + I Y = 200 + 0. 75Y -0. 75(100) + 100 + 200 – 25r Y = 500 + 0. 75Y -75 – 25r .25Y = 425 – 25r Y = 1700 – 100r b. Write an equation for the LM curve for this economy. Supply of real money balances = demand for real money balances 1000/2 = Y – 100r Y = 500 + 100r c. What is the equilibrium interest rate and the equilibrium level of output for this economy given the above information? 00 + 100r = 1700 – 100r 200r = 1200 r = 6 Y = 500 + 100 (6) Y = 1100 d. What is the equilibrium level of consumption and the equilibrium level of investment for this economy? C = 200 + 0. 75(Y – T) C = 200 + 0. 75(1100 – 100) C = 200 + 0. 75(1000) C = 200 + 750 C = 950 I = 200 – 25r I = 200 – 25(6) I = 200 – 150 I = 50 e. Suppose that the money supply is increased to 1200. What is the new equilibrium level of interest rate and the new equilibrium level of output for this economy given this change? What is the new equilibrium level of consumption ? The new LM curve is Y = 600 + 100r and the IS curve is Y = 1700 – 100r.Thus, 600 + 100r = 1700 – 100r 200r = 1100 r = 5. 5 Y = 600 + 100(5. 5) Y = 1150 C = 200 + 0. 75(Y – T) C = 200 + 0. 75(1150 – 100) C = 200 + 987. 50 f. Suppose that the initial information is true (no change in the money supply). If government purchases increase to 150, what is the change in output predicted by the Keynesian Cross diagram? What is the actual change in output based upon the IS-LM model? The change in output predicted by the Keynesian Cross diagram is equal to (1/(1 – MPC))(change in government spending) or (1/0. 25)(50) = 200.The actual change in output based upon the IS-LM model will be less than this. To see this you need to first write the new IS curve: Y = C + I + G’ Y = 200 +0. 75(Y – T) + I + G’ Y = 200 + 0. 75Y – 0. 75(100) + 200 – 25r + 150 0. 25Y = 475 – 25r Y = 1900 – 100r Then, combine this IS curve w ith the LM curve to have 1900 – 100r = 500 + 100r 1400 = 200r r = 7 Thus, Y = 1900 – 100r Y = 1900 – 100(7) Y = 1200 The change in output is from the initial level of 1100 to the new level of 1200, or a change of 100 which is less than that predicted by the Keynesian Cross diagram.

Early Learning and Childcare

Early learning and childcare 63 Trafford rd rushden northans nn10 Abigail wignall sh40856/NCC assignment 1 pg1 Task1. 1 From birth to adulthood children continually grow develop and learn,if children do not develop propely they may be unable to reach their full potential. All young people follow a similar pattern of develpoment,however each child is diffrent and may develop at a diffrent rate. There are three areas of development, physical, intellectual,social and emotional. heres is a guide of how they develop for the following age ranges â€Å"taken from study book early learning and childcare†. -3yrs physical development by6months a child will:  ·turn their head towars sounds and movement  ·watch an adults face while feeding  ·smile at familar faces and voices  ·reach up to hold their feet when lying on their backs  ·hold and shake a rattle  ·put everythings in their mouths between 6months and 1year  ·move from sitting with support to sitting alone  ·roll ov er from their tummy to their back  ·begin to creep, crawl or shuffle on their bottom  ·push on or push against adult hands or furniture to reach a standing position  ·raise arms to be lifted  ·turn and look up when they hear their name pat and poke objects when playing  ·pass objects from hand to hand  ·look for things thathave been hidden or dropped  ·reaches hand toward source of food Between one and two years  ·begin to walk  ·sits alone indefinitely  ·feed themselves  ·push and pull toys while walking  ·wave goodbye  ·point or make noises to indiacte wants  ·enjoy a picture book  ·shake head for no  ·uses thumb and first two fingers to grip  ·crawl upstairs  ·stoops to pick things up from floor  ·begins to show prefrence for onr hand  ·builds tower of few bricks  ·holds crayon in palm and makes marks on paper Between two and three  ·Kneels to play  ·throws kicks ball  ·builds larger bruck tower  ·pour liquids  ·uses pencil to m ake marks and circular scribbles Newborn to three months the social and emotional development should be the child very depdant on adults maily mother for comfort,cuddles and reassurance and the child will quieten while the adults do so. Between six to nine months the child enjoys the company of others and begin to like games such as peek a boo and show affection to known people but shywith strangers at one to two years their social development should extend to play alongside other children also like to please adults and perform to an audience.They may become upset and distressed if seperated from known adults, a object can be used for comfort. By two to three years they should be developing a sense of own identidy and want to do things themselves and demand adult attention and can become reluctant to share be prone to tantrums outburts but also enjoy playing with adults or older children who give attention, and play with others same age for short periods of time. intelectual develop ment between 0-3years should be begining to realise others are seperate beings from ourselves and become more confident but do still require adult reassurance.At 0-3 months language development should be making happy sounds 6-12 months they should be making babbling sounds and begin show feelings by squealing with pleasure, crying or laughing to show enjoyment. one to two years they should be joining words to make sentances and by two be using 50-150 words and start understand conversation and understand keywords. by 2-3 years should be able to put words together to make sentances scribble on paper use several hundread words by three be joining in songs and be asking questionns like how? why?. Physical development at age 3-7years yrs  ·jump with feet together  ·walk on tip toes  ·go up and down the stairs  ·catch and thow a ball  ·climb  ·paint  ·thread beads on to laces  ·gain controll over eating tools 4years  ·throw with aim  ·use sccissors  ·hold pencil be able draw houses/people 5years  ·hop  ·skip  ·ride bike  ·jump from height  ·climb confidently  ·write  ·thread needles  ·do laces and buttons (Information found children and young peoples workforce-early learning and childcare 2012) By 3-4years their intellectual development should be as follows, able sort objects into gropus eg colour or size.Understand simple tasks given for example fetch a story book and bring it to mummy. socialy and emotionaly they should have become more independant and self motivated feeling more secure and able cope with unfamilar faces and surroundings for small periods of time. By 4-5years grammar becomes more accurate and their questions become more complex communicating better, able understand books as a source of fun and begin to recoginze wn name and written words theve seen on few occasions, be able form some lettering and begin copying shapes.At age 5-7years they should be handling books well and understand text has meaning, be able make up stories and regonize an increasing number of letters linking them to sound. development at age 7-12 years should be thye child being able to run,hop skip,climb,swing confidently, and start enjoying team games and may misjudge their own abilty before age nine. Social and emotional development at this age range should becoming less dependant on adults nad enjoy being in a group of people at the same age wanting to fit in with the peer rules. They should have an understanding that certain behavoiurs are un acceptable.Begin form close relationships at age eight also becoming more aware of own gender can be bossy or arogant but enjoy playing with others same sex but need adult reassurance and help when comes to arguments in play. Intelecutaly at this age the child should be able to read,write and take an intrest in certain subjects he enjoys by around 9, also be knowing diffrence tenses and grammar,read out loud but may need help tackling complexities of spelling, their vocabular y will grow if adults introduce and encourage new words and ways of using lanuage.At the age 12-19years is said to be the period from childhood to adulthood could start at age 11 and last untill 19-20years. Adolesecnce is a transition period where young people grdually detach themselves from their parents, and form a close group of friends. many physical changes occur at this stage in life, changing their apperance and bodies, coordination and strength increase greatly although every persons rate can be diffrent.Adolesence for boys usually begins later than girls, boys begin to develop sex characteristics like deep voices body hair and muscle growth,testicals and scrotom growth begins in mid puberty penis growth beings a little later but continues growing for a longer period of time. Girls begin breast budding at around age ten, her pubic hair will begin to grow and darken and curl also body begins to to become more round developing curves of womanhood, By 13 some girls can almost b e physicaly mature, also this is average age to bein their menstral cycle this can depend on the age of pubertal onset.By age 15 a girl is most likely to e at her adult height and may have a woman figure but her hips and breasts may become fuller. Lanuage development in teenagers may become imtating but that is there way of testing out there new found language and skills like sarcasam, their logical thinking ability is also growing and maturing they may ut them into pratice by debate either fomaly or infomaly.