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ideas †¢ thinkers †¢ practice david a. kolb on experiential learning David A. Kolb's model of experiential learning can be found in many discussions of the theory and practice of adult education, informal education and lifelong learning. We set out the model, and examine its possibilities and problems. contents: †¢ introduction †¢ david a. olb †¢ david kolb on experiential learning †¢ david kolb on learning styles †¢ issues †¢ developments – jarvis on learning †¢ a guide to reading †¢ links †¢ how to cite this piece As Stephen Brookfield (1983: 16) has commented, writers in the field of experiential learning have tended to use the term in two contrasting senses. On the one hand the term is used to describe the sort of learning undertaken by students who are given a chance to acquire and apply knowledge, skills and feelings in an immediate and relevant setting.Experiential learning thus involves a, ‘direct encounter w ith the phenomena being studied rather than merely thinking about the encounter, or only considering the possibility of doing something about it. ‘ (Borzak 1981: 9 quoted in Brookfield 1983). This sort of learning is sponsored by an institution and might be used on training programmes for professions such as social work and teaching or in field study programmes such as those for social administration or geography courses.The second type of experiential learning is ‘education that occurs as a direct participation in the events of life' (Houle 1980: 221). Here learning is not sponsored by some formal educational institution but by people themselves. It is learning that is achieved through reflection upon everyday experience and is the way that most of us do our learning. Much of the literature on experiential learning, as Peter Jarvis comments (1995: 75), ‘is actually about learning from primary experience, that is learning through sense experiences'.He continues, â €˜unfortunately it has tended to exclude the idea of secondary experience entirely'. Jarvis also draws attention to the different uses of the term, citing Weil and McGill's (1989: 3) categorization of experiential learning into four ‘villages': Village One is concerned particularly with assessing and accrediting learning from life and work experience†¦. Village Two focuses on experiential learning as a basis for bringing change in the structures†¦ of post-school education†¦. Village Three emphasizes experiential learning as a basis for group consciousness raising†¦.Village Four is concerned about personal growth and self-awareness. These ‘villages' of approaches retain a focus on primary experience (and do not really problematize the notion of experience itself). Jarvis (1995: 77-80) makes the case for a concern for secondary or indirect experience (occurring through linguistic communication). While there have been various additions to the literatu re, such as the above, it is the work of David A. Kolb (1976; 1981; 1984) and his associate Roger Fry (Kolb and Fry 1975) that still provides the central reference point for discussion.Following on from Kolb's work there has been a growing literature around experiential learning and this is indicative of greater attention to this area by practitioners – particularly in the area of higher education. David Kolb's interest lay in exploring the processes associated with making sense of concrete experiences – and the different styles of learning that may be involved. In this he makes explicit use of the work of Piaget, Dewey and Lewin. David A. Kolb David A. Kolb is Professor of Organizational Behavior in the Weatheread School of Management.He joined the School in 1976. Born in 1939, Kolb received his Batchelor of Arts from Knox College in 1961, his MA from Harvard in 1964 and his PhD from Harvard in 1967. Besides his work on experiential learning, David A. Kolb is also kno wn for his contribution to thinking around organizational behaviour (1995a; 1995b). He has an interest in the nature of individual and social change, experiential learning, career development and executive and professional education. David Kolb on experiential learning David A.Kolb (with Roger Fry) created his famous model out of four elements: concrete experience, observation and reflection, the formation of abstract concepts and testing in new situations. He represented these in the famous experiential learning circle that involves (1) concrete experience followed by (2) observation and experience followed by (3) forming abstract concepts followed by (4) testing in new situations (after Kurt Lewin). It is a model that appears time and again. Kolb and Fry (1975) argue that the learning cycle can begin at any one of the four points – and that it should really be approached as a continuous spiral.However, it is suggested that the learning process often begins with a person car rying out a particular action and then seeing the effect of the action in this situation. Following this, the second step is to understand these effects in the particular instance so that if the same action was taken in the same circumstances it would be possible to anticipate what would follow from the action. In this pattern the third step would be understanding the general principle under which the particular instance falls.Generalizing may involve actions over a range of circumstances to gain experience beyond the particular instance and suggest the general principle. Understanding the general principle does not imply, in this sequence, an ability to express the principle in a symbolic medium, that is, the ability to put it into words. It implies only the ability to see a connection between the actions and effects over a range of circumstances. (Coleman 1976: 52). An educator who has learnt in this way may well have various rules of thumb or generalizations about what to do in d ifferent situations.They will be able to say what action to take when say, there is tension between two people in a group but they will not be able to verbalize their actions in psychodynamic or sociological terms. There may thus be difficulties about the transferability of their learning to other settings and situations. When the general principle is understood, the last step, according to David Kolb is its application through action in a new circumstance within the range of generalization. In some representations of experiential learning these steps, (or ones like them), are sometimes represented as a circular movement.In reality, if learning has taken place the process could be seen as a spiral. The action is taking place in a different set of circumstances and the learner is now able to anticipate the possible effects of the action. Two aspects can be seen as especially noteworthy: the use of concrete, ‘here-and-now' experience to test ideas; and use of feedback to change practices and theories (Kolb 1984: 21-22). Kolb joins these with Dewey to emphasize the developmental nature of the exercise, and with Piaget for an appreciation of cognitive development.He named his model so as to emphasize the link with Dewey, Lewin and Piaget, and to stress the role experience plays in learning. He wished to distinguish it from cognitive theories of the learning process (see Coleman 1976). David Kolb on learning styles David Kolb and Roger Fry (1975: 35-6) argue that effective learning entails the possession of four different abilities (as indicated on each pole of their model): concrete experience abilities, reflective observation abilities, abstract conceptualization abilities and active experimentation abilities.Few us can approach the ‘ideal' in this respect and tend, they suggest, to develop a strength in, or orientation to, in one of the poles of each dimension. As a result they developed a learning style inventory (Kolb 1976) which was designed to pl ace people on a line between concrete experience and abstract conceptualization; and active experimentation and reflective observation. Using this Kolb and Fry proceeded to identify four basic learning styles. Kolb and Fry on learning styles (Tennant 1996) Learning style Learning characteristicDescriptionConvergerAbstract conceptualization + active experimentation†¢ strong in practical application of ideas †¢ can focus on hypo-deductive reasoning on specific problems †¢ unemotional †¢ has narrow interests DivergerConcrete experience + reflective observation†¢ strong in imaginative ability †¢ good at generating ideas and seeing things from different perspectives †¢ interested in people †¢ broad cultural interests AssimilatorAbstract conceptualization + reflective observation†¢ strong ability to create theoretical models excels in inductive reasoning †¢ concerned with abstract concepts rather than peopleAccommodatorConcrete experience + active experimentation†¢ greatest strength is doing things †¢ more of a risk taker †¢ performs well when required to react to immediate circumstances †¢ solves problems intuitively In developing this model Kolb and Fry have helped, along with Witkin (1950), have helped to challenge those models of learning that seek to reduce potential to one dimension such as intelligence (Tennant 1997: 91). They also recognize that there are strengths and weaknesses associated with each style (and that being ‘locked into' one style can put a learner at a serious disadvantage).However, there are a number of problems with the model. Issues Here I want to note six key issues that arise out the Kolb model: It pays insufficient attention to the process of reflection (see Boud et al 1983). While David A. Kolb's scheme ‘has been useful in assisting us in planning learning activities and in helping us to check simply that learners can be effectively engaged', they comment , ‘it does not help†¦ to uncover the elements of reflection itself' (ibid. : 13), see reflection. The claims made for the four different learning styles are extravagant (Jarvis 1987; Tennant 1997).As Tennant (1997: 91) comments, even though the four learning styles neatly dovetail with the different dimensions of the experiential learning model, this doesn't necessarily validate them. David Kolb is putting forward a particular learning style. The problem here is that the experiential learning model does not apply to all situations. There are alternatives – such as information assimilation. There are also others such as memorization. Each of these may be appropriate to different situations (see Jarvis below). The model takes very little account of different cultural experiences/conditions (Anderson 1988).The Inventory has also been used within a fairly limited range of cultures (an important consideration if we approach learning as situated i. e. affected by environ ments). As Anderson (1988, cited in Tennant 1996) highlights, there is a need to take account of differences in cognitive and communication styles that are culturally-based. Here we need to attend to different models of selfhood – and the extent to which these may differ from the ‘western' assumptions that underpin the Kolb and Fry model. The idea of stages or steps does not sit well with the reality of thinking.There is a problem here – that of sequence. As Dewey (1933) has said in relation to reflection a number of processes can occur at once, stages can be jumped. This way of presenting things is rather too neat and is simplistic – see reflection. Empirical support for the model is weak (Jarvis 1987; Tennant 1997). The initial research base was small, and there have only been a limited number of studies that have sought to test or explore the model (such as Jarvis 1987). Furthermore, the learning style inventory ‘has no capacity to measure the deg ree of integration of learning styles' (Tennant 1997: 92).The relationship of learning processes to knowledge is problematic. As Jarvis (1987) again points out, David Kolb is able to show that learning and knowledge are intimately related. However, two problems arise here. David Kolb doesn't really explore the nature of knowledge in any depth. In chapter five of Experiential Learning he discusses the structure of knowledge from what is basically a social psychology perspective. He doesn't really connect with the rich and varied debates about the nature of knowledge that raged over the centuries within philosophy and social theory.This means that I do not think he really grasps different ways of knowing. For example, Kolb focuses on processes in the individual mind, rather than seeing learning as situated. Second, for David Kolb, learning is concerned with the production of knowledge. ‘Knowledge results from the combination of grasping experience and transforming it' (Kolb 1984 : 41). Here we might contrast this position with Paulo Freire. His focus is upon informed, committed action (praxis). Given these problems we have to take some care approaching David Kolb's vision of experiential learning.However, as Tennant (1997: 92) points out, ‘the model provides an excellent framework for planning teaching and learning activities and it can be usefully employed as a guide for understanding learning difficulties, vocational counselling, academic advising and so on'. Developments – Peter Jarvis on (experiential) learning Jarvis (1987, 1995) set out to show that there are a number of responses to the potential learning situation. He used Kolb's model with a number of different adult groups and asked them to explore it based on their own experience of learning.He was then able to develop a model of which allowed different routes. Some of these are non-learning, some non-reflective learning, and some reflective learning. To see these we need to trace ou t the trajectories on the diagram he produces. reproduced from Jarvis 1994 Non-learning: Presumption (boxes 1-4). This is where people interact through patterned behaviour. Saying hello etc. Non-consideration (1-4). Here the person does not respond to a potential learning situation. Rejection (boxes 1-3 to 7 to 9). Non-reflective: Pre-conscious (boxes 1-3 to 6 to either 4 or 9).This form occurs to every person as a result of having experiences in daily living that are not really thought about. Skimming across the surface. Practice (boxes 1-3 to 5 to 8 to 6 to either 4 or 9). Traditionally this has been restricted to things like training for a manual occupation or acquiring particular physical skills. It may also refer to the acquisition of language itself. Memorization (boxes 1-3 to 6 and possibly 8 to 6 and then either to 4 or 9) Reflective learning: Contemplation (boxes 1-3 to 7 to 8 to 6 to 9). Here the person considers it and makes an intellectual decision about it.Reflective pr actice (boxes 1-3 (to 5) to 7 to 5 to 6 to 9). This is close to what Schon describes as relfection on and in action. Experiential learning (boxes 1-3 to 7 to 5 to 7 to 8 to 6 to 9). The way in which pragmatic knowledge may be learned. While this represents a useful addition to our thinking about learning, a number of problems remain. There is still an issue around sequence – many things may be happening at once, but Jarvis' model falls into trap of stage thinking. As with Kolb's work there is a limited experimental base to support it.We can also ask questions as to whether these are different forms or routes – or can they grouped together in a different and more compact way. Further reading and references The literature around this area can be pretty dire. We have picked one or two of the better collections/explorations plus a couple ‘standards'. Boud, D. et al (eds. ) (1985) Reflection. Turning experience into learning, London: Kogan Page. 170 pages. Good collec tion of readings which examine the nature of reflection. The early chapters make particular use of Dewey and Kolb. Boud. D. and Miller, N. eds. ) (1997) Working with Experience: animating learning, London: Routledge. Useful collection of pieces exploring experiential learning. The editors focus on animation (not so much in the French and Italian senses as ‘breathing life into' – to activate, enliven, vivify. Includes introductory and closing pieces by the editors: Brookfield on breaking dependence on experts; Smyth on socially critical educators; Heron on helping whole people learn; Tisdell on life experience and feminist theory; Harris on animating learning in teams; and Mace on writing and power.Fraser, W. (1995) Learning From Experience. Empowerment or incorporation, Leicester: National Institute of Adult Continuing Education. Examines APL / APEL and asks what is lost and gained in the translation of private experience into the public sphere. Based on the experience of various courses. Jarvis, P. (1987) Adult Learning in the Social Context, London: Croom Helm. 220 pages. Peter Jarvis uses Kolb's model to explore the process of learning in context. The result is a better appreciation of context and the ability to approach memorization, contemplation, practice etc.However, he also inherits a number of problems e. g. around stages. The model is revisited and summarized in P. Jarvis (1995) Adult and Continuing Education. Theory and practice 2e, London: Routledge. Johnson, D. W. and Johnson, F. P. (1996) Joining Together: Group theory and group skills, 6e. , Boston, Mass. : Allyn and Bacon. 612 pages. Rightly popular practical groupwork guide with plenty of examples and exercises, plus some good foundational chapters. It was one of the first texts to pick up on Kolb and to link experiential learning with the work around groups by Lewin and others.Chapters on group dynamics; experiential learning; group goals and social independence; communications w ithin groups; leadership; decision making; controversy and creativity; conflicts of interest, the uses of power; dealing with diversity; leading learning and discussion groups; leading growth and counselling groups; and team development, team training. Keeton, M. T. (ed. ) (1976) Experiential Learning, San Francisco: Jossey-Bass. Ageing but still useful collection. See, in particular, Coleman's contrasting of information assimilation with experiential learning. Kolb, D.A. (1984) Experiential Learning, Englewood Cliffs, NJ. : Prentice Hall. 256 pages. Full statement and discussion of Kolb's ideas concerning experiential learning. Chapters deal with the foundation of contemporary approaches to experiential learning; the process of experiential learning; structural foundations of the learning process; individuality in learning and the concept of learning styles; the structure of knowledge; the experiential learning theory of development; learning and development in higher education; li felong learning and integrative development. Mezirow, J. 1991) Transformative Dimensions of Adult Learning, San Francisco: Jossey-Bass. 247 + xix pages. Develops a comprehensive theory of how adults learn by making meanings of their experiences. Particular focus on perspective transformation. Weil, S. Warner & McGill, I. (eds. ) (1989) Making Sense of Experiential Learning. Diversity in theory and practice, Milton Keynes: Open University Pres s. The texts on experiential learning tend to be rather atheoretical (and often precious). This text doesn't totally escape this – but has a number of useful contributions. ReferencesAnderson, J. A. (1988) ‘Cognitive styles and multicultural populations', Journal of Teacher Education, 39(1): 2-9. Brookfield, S. D. (1983) Adult Learning, Adult Education and the Community Milton Keynes Open University Press. Borzak, L. (ed. ) (1981) Field Study. A source book for experiential learning, Beverley Hills: Sage Publications. Dewey, J. (19 33) How We Think, New York: Heath. Houle, C. (1980) Continuing Learning in the Professions, San Francisco: Jossey-Bass. Jarvis, P. (1994) ‘Learning', ICE301 Lifelong Learning, Unit 1(1), London: YMCA George Williams College.Jarvis, P. (1995) Adult and Continuing Education. Theory and practice 2e, London: Routledge. Kolb, A. and Kolb D. A. (2001) Experiential Learning Theory Bibliography 1971-2001, Boston, Ma. : McBer and Co, http://trgmcber. haygroup. com/Products/learning/bibliography. htm Kolb, D. A. (1976) The Learning Style Inventory: Technical Manual, Boston, Ma. : McBer. Kolb, D. A. (1981) ‘Learning styles and disciplinary differences'. in A. W. Chickering (ed. ) The Modern American College, San Francisco: Jossey-Bass. Kolb, D. A. (with J. Osland and I.Rubin) (1995a) Organizational Behavior: An Experiential Approach to Human Behavior in Organizations 6e, Englewood Cliffs, NJ: Prentice Hall. Kolb, D. A. (with J. Osland and I. Rubin) (1995b) The Organizational Behavi or Reader 6e, Englewood Cliffs, NJ: Prentice Hall. Kolb. D. A. and Fry, R. (1975) ‘Toward an applied theory of experiential learning;, in C. Cooper (ed. ) Theories of Group Process, London: John Wiley. Schon, D. (1983) The Reflective Practitioner, New York: Basic Books Tennant, M. (1997) Psychology and Adult Learning 2e, London: Routledge. Witkin, H. and Goodenough, D. 1981) Cognitive Styles, Essences and Origins: Field dependence and field independence, New York: Links Experiential learning: helpful review of sites by Tim Pickles. Experiential Learning Theory Bibliography: Prepared by Alice Kolb and David Kolb, this is an extensive bibliography of on experiential learning theory from 1971-2001. Acknowledgement: The workshop picture representing experiential learning is from the EFEO Action Workshops in 2008. It was taken by devilarts and is copyrighted. It is reproduced here under a Creative Commons licence (Attribution-Non-Commercial-Share Alike 2. Generic) flickr: http://ww w. flickr. com/photos/devilarts/2458317215/. How to cite this article: Smith, M. K. (2001). ‘David A. Kolb on experiential learning', the encyclopedia of informal education. Retrieved [enter date] from http://www. infed. org/b-explrn. htm.  © Mark K. Smith 1996, 2001. infed is a not-for-profit site [about us] [disclaimer] provided by the YMCA George Williams College. Give us feedback; write for us. Check our privacy policy and, when copying, our copyright notice. Join us on Facebook and Twitter. 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Women’s Rights Movement

The Women’s Rights Movement Women’s Suffrage is a subject that could easily be considered a black mark on the history of the United States. The entire history of the right for women to vote takes many twists and turns but eventually turned out alright. This paper will take a look at some of these twists and turns along with some of the major figures involved in the  suffrage  movement. The first recorded instance in American history where a woman demanded the right to vote was in 1647.Margaret Brent, a property owner in Maryland wanted two votes in the newly formed colonial assembly to represent her vote and the vote of Lord Baltimore whom she held power-of-attorney. (Pleck, 2007) The governor eventually turned down her demands. The 1790 constitution of New Jersey allowed women property owners the right to vote through a loophole that stated that â€Å"all inhabitants† that met property and residence requirements could vote.This loophole was closed in 1807 by a state legislator that had almost lost an election due to a women’s voting bloc. Other than these isolated incidents the first organized women’s  suffrage movement  can be traced back to the mid 1800’s with the  Seneca Falls  Convention. The organized movement started at Seneca Falls, NY with a meeting called by Elizabeth Cady Stanton and Lucretia Mott. (National Women's History Museum, 2007) Both women received their start in the women’s suffrage movement by being active in the abolitionist movement.Elizabeth Cady Stanton was an important element of the Women’s Rights Movement, but not many people know of her significance or contributions because she has been overshadowed by her longtime associate and friend, Susan B. Anthony. However, I feel that she was a woman of great importance who was the driving force behind the 1848 Convention, played a leadership role in the women’s rights movement for the next fifty years, and in the wor ds of Henry Thomas, â€Å"She was the architect and author of the movement’s most important strategies ad documents. † Elizabeth Cady Stanton was born in 1815 into an affluent family in Johnstown, New York.Now, while Stanton was growing up, she tried to imitate her brother’s academic achievements due to the fact that her parents, Daniel and Mary Livingston Cady, preferred their sons to their daughters. In trying to copy her male siblings, she got an extraordinary education: she went to Johnstown Academy and studied Greek and mathematics; she learned how to ride and manage a horse; she became a skilled debater; and she attended the Troy Female Seminary in New York (one of the first women ‘s academies to offer an advanced education equal to that of male academies) where she studies logic, physiology, and natural rights philosophy.However, it wasn’t her education, but watching her father, who was a judge and lawyer, handle his cases, that cause her to become involved in various women rights movements. Stanton and Mott attended the World’s Anti-Slavery Convention in London in 1840 and were refused seating for being women. After this incident the two women started seeing a connection between the plight of slaves and the treatment of women in the United States. The women’s movement took a back seat to the slavery movement during the American Civil War as the women turned their attention to working through the war.However, after the war was over the women’s movement thought they were in a good position to win some key battles due to their war work and the attention being paid to equal rights at the time. This was not to be so as the Republicans in power believed that women’s suffrage would hurt their chances to push forth rights for freed slaves because of the widespread unpopularity of women’s rights. (National Women's History Museum, 2007)   After the war the women’s movement split into r ival factions with Stanton and Susan B.Anthony forming the National Woman’s Suffrage Association and Lucy Stone and Julia Ward Howe forming the American Woman’s Suffrage Association. The NWSA did not support the passing of the 15th amendment because the amendment did not address the giving of equal rights to women as well as blacks and fought against the passing of the amendment as a result. The AWSA supported the 15th amendment and wanted to fight for women’s rights in the states separately. Pleck, 2007) The two movements eventually reunited in 1890 to become the National American Woman Suffrage Association led by Susan B. Anthony until 1900 when Carrie Chapman Catt took over. Catt was integral in the strategy to work for women’s suffrage on both the federal and state level upon her re-election to president of the NAWSA in 1915 which led to another faction split between the NAWSA and a group led by Alice Paul who believed that the major push of the fight needed to be focused at the federal level. About. com, 2007)   Finally all the hard work of the women’s movement paid off in the summer of 1920 with the ratification of the 19th amendment. This was not an easily won victory however. Congress first took up the issue in 1915 but the bill lost in the voting and was shelved for almost three years. (â€Å"Women's Suffrage,† 2007) On the eve of the vote President Wilson made a widely publicized appeal for the passage of the bill and this time the bill barely passed with the need two-thirds majority.However, the bill failed to gain the necessary votes to pass the Senate even with another of President Wilson’s appeals for the passage of the bill. The bill would be voted down twice over the following year before finally gaining enough votes to pass due to Congress’ interest in having the issue solved prior to the presidential elections slated for 1920 and on June 4, 1919 the Senate voted to pass the bill to add the amendment to the constitution securing women’s rights. The effects of the 19th amendment on the United States can be seen everywhere.More women now hold public office and the United States even has a woman running for the Democratic nomination for president. The women’s voting block is one politicians cannot forget about and still have hopes of being successful. The ability of women to vote, even though sparsely used until the 1980s, changed how companies did business and what legislation was passed for respect of the potential voting power of women. More women friendly policies exist, both in the workplace and in general life, which can be attributed to the hard work of the pioneers in the women’s movement.Knowing that men controlled the ability of women to vote and that a way of life would be drastically changed makes the gains of women to vote even more amazing. I can stand back now and admire the bravery of the women who fought for what was and is right fully theirs and for the bravery of the men to do the right thing by allowing women equal rights. You can just reflect about today’s life and affairs to see that the shift from legal rights to suffrage was successful.Our public offices consist of many great female leaders, and the future for America is brighter with collaboration of men and women alike. The efforts of Alice Paul and Lucy Burns were indeed not in vain as they rallied up people to protest in unison and the results are evidenced by the American political structure today. References About. Com. (2007). Women's History: about Carrie Chapman Catt. Retrieved November 25, 2007, from About. com Web Site: http://womenshistory. about. com/library/bio/blbio_catt_carrie_chapman. htmNational Women's History Museum. (2007). Women's Suffrage exhibition. Retrieved November 25, 2007, from National Women's History Museum Web Site: http://www. nwhm. org/exhibits/tour_02-02d. html Pleck, E. (2007). Women's Suffrage. Retrieved Nov ember 24, 2007, from Scholastic Web Site: http://teacher. scholastic. com/activities/suffrage/history. htm Women's Suffrage. (2007, November 26). In Wikipedia, the free encyclopedia. Retrieved November 26, 2007, from http://en. wikipedia. org/wiki/History_of_women's_suffrage_in_the_United_States

Benjamin West, his times and his influence Essay

Benjamin West paintings Introduction   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Benjamin West was an Anglo-American artist who was born on October 10, 1738 in Springfield Pennsylvania in the present day campus of Swarthmore College in a house now called the borough of Swarthmore. He was the tenth child of John West and Sarah Pearson. Benjamin died on March 11, 1820 in London at the age of 81. During his time, he concentrated in artwork. He left a great mark through his historical artwork. The artwork by Benjamin West made during the days of exploration and during the American struggle for independence helps us greatly in understanding the history of the Americans. In his artwork, West used an artistic style he termed as â€Å"epic representation†, which entailed the use of expressive figures, compositional schemes and colors to make it easy for the observer to identify the scene easily.Benjamin West did his first painting in 1745 when he was only 7 years old. He was left to look after his sister’s infant daughter while the sister and mother were working on the flower garden. He was impressed by the smiling baby and took a paper and a pen which were on the table and made the first painting work. When the mother and sister came back, they saw the painting and were very much impressed for it really resembled the young kid. Benjamin’s mother appreciated him and this developed confidence in him even though he had initially tried to hide the paper from his mother. He later interacted with the Native Americans who taught him how to make paint from riverbank clay mixed with bear grease in a pot. Little was it expected that this would turn out to be his line of professional his life. He best fitted in this area mainly because he was not well endorsed with formal education (West and Charles 1950).Benjamin West excelled in painting and storing the American and English history such that studying the American or English literature may not be very possible without mentioning or referring to the work of Benjamin West. His artwork remains a very crucial source of American literature for he was able to store history at a time when means of history keeping were not so well established. He stored the life of the Americans before America attained self-governance in his paintings.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Benjamin west painted portraits in Pennsylvania from 1746 to 1759 where he designed the ‘death of Socrates’ from an engraving in Charles Rollin’s ancient work. This work latter came to be credited as â€Å"the most ambitious and interesting painting produced in colonial America†. Because of his great artworks, West interacted with many great people such as Dr. William Smith who was the provost, college of Philadelphia and Benjamin Franklin, who was an outstanding American statesman who played a great role in America’s struggle for self-governance. It is from this close interaction that Benjamin West painted Benjamin Franklin’s portrait.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In his interactions, West met several painters from whom he learnt more painting techniques. Hemet John Wollaston, a painter from London from whom he learnt how to paint the shimmer of silk and satin. He also learnt from him the style of putting big almond shaped eyes to all his artwork. Later on, West was sponsored and travelled to Italy where he furthered his painting skills by copying Italian paintings (Helmut and Allen 1986)   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   On his way back to America, West decided to pay a visit to England, though; his visit turned to a stay when he met William Allen who had sponsored him to Italy. They stayed together for a month, and latter visited his half-brother Thomas west. In England, he continued with his paintings. He painted his first picture in England, Angelica and Medora, and was shown at the exhibition in spring gardens in 1764 together with Cymon and Iphigia, which he had painted in Rome. Benjamin West married an American, Elizabeth Shewell, in 1765 at St Martin-in-the-Fields. While in England, he was introduced to senior clergymen such as Thomas Newton who was the bishop of Bristol, James Johnson, who was the bishop of Worcester, Robert Hay Drummond who was the Archbishop of York, among others.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   These clergymen commissioned work for Benjamin west. He proposed to decorate St Paul’s cathedral with paintings, however, his proposal was rejected by the bishop of London. He then proposed to paint an altarpiece for St Stephen Walbrook and his proposal was accepted. For his great works in England, West came to be named, â€Å"American Raphael†   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Drummond once tried to make west give up portraiture and devote himself to more ambitious composition. He tried to convince the king to patronize Benjamin West, however; things didn’t work out well for him. The king gave him the first commission of painting the departure of Regulus from Rome. West was soon on very good terms with the king because of his great work. They held lengthy discussions about the state of art in England, and that is when the idea of establishing a royal college began. In 1768, the college was established, and Joshua Reynolds became its first president. In 1772, Benjamin West was appointed by King George as the historical painter to the court at a fee of  £1,000 annually. He made many historical paintings among them a set of 28 works for a chapel at the castle with the theme â€Å"the progress of revealed religion† and nine portraits of royal family members, two been for the king. From 1791 to his de ath, Benjamin West remained the surveyor of the king’s picture.One of the greatest paintings of Benjamin West was the death of General Wolfe, made in 1770 and exhibited at the Royal Academy in 1771. This painting raised mixed reactions when it was exhibited. Joshua Reynolds, the then president of the Royal academy, termed it as overambitious. However; the painting became one of the most frequently reproduced images. This painting was a demonstration of the French and Indian war, showing of his general Johnson saving a wounded French officer from the Tomahawk of a North American Indian in 1768. Other historic paintings of Benjamin West include the death of Nelson which was made in honor of Horatio Nelson, who died at the battle of Trafalgar.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   When Reynolds died in 1792, West became the president of the Royal Academy up to 1805 when he resigned and was replaced by James Wyatt. One year later, he was re-elected the Academy president and served the president until his death. The fact that West was serving as the president of the Royal Academy in London had a significant effect to the Americans. Many American artists such as Augustus Earle, Ralph Earl, Samuel Morse, Charles Wilson, Mathew Pratt, among others, studied under him in London (Wetton & Jarvis, 1821)Benjamin West also did a series of religious paintings. He painted his first religious artwork Christ healing the sick at the beginning of the 19th century, which he intended to present as a gift to a Quaker hospital in Philadelphia. However, it dint happen as he had planned for he later sold the artwork to a British company at  £3,000. The organization presented it to the National Gallery. West later on made a copy to send to Philadelphia.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The outcome of that painting led him to doing even larger religious works such as death on a pale horse which was exhibited in 1817. He also made artistic representation of the conversion of Paul in his modeling of the altarpiece at St Paul’s church in Birmingham.In his life, Benjamin west demonstrated a very strong sense of determination. Despite the fact that he was not so much educated, he still worked hard and emerged as one of the great painters of his time. He was not the kind to give up easily on a task he had set forth to undertake.Despite Drummond’s attempt to make him give up portraiture and entirely devote himself to more ambitious compositions, he never gave in to Drummond’s wishes. Drummonds plot to convince the king to patronize him latter ended up strengthening the relationship between Benjamin West and the king. It is the same relationship that led to the establishment of the Royal Academy which turned out to be an important institution to both the English people and the Americans. He ended up serving as the president of the Academy until he died at his house in London on 11th march 1820.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   When he exhibited his painting, the death of General Wolfe, it was termed as overambitious. This, however, did not hinder him from exhibiting it, and it latter turned out to be one of the most frequently reproduced images of the time.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Benjamin West proposed a project to decorate St Paul’s cathedral in 1766 though his proposal was rejected by the bishop of London, he didn’t give up making other proposals. Eventually, his proposal to paint an altarpiece for St Stephen Walbrook was approved.Benjamin was a man of determination and the desire to achieve whose success mainly originated from his character of not giving in to discouragements and opposition. This determination helped him and helped his people.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Benjamin’s personal interests are clearly portrayed in his artwork. It is apparent that he had an interest in political and leadership affairs. In his lifetime, he had encounters with many leaders and statesmen such as Benjamin Franklin and King George   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The encounter with leaders and statesmen had a great impact on his artwork. He painted the portraits of these statesmen and of the Royal family which remain important up to date. He also made paintings at the state structures such as the paintings at St George’s hall at Windsor castle.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The passion for adventure is clearly portrayed when Benjamin goes to Italy and on his way back to America he visits England where he settles and never goes back to America. This adventure helps him advance his painting and artwork skills. He copies the artwork of Italians such as Titian and Raphael.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   In his lifetime, he demonstrated his interest in religion by doing religious painting and interacting with the members of the clergy. The artwork, Christ healing the sick, shows that he was a Christian and believed in the power of healing. He also made an artistic impression of the conversion of Paul at St Paul’s church. This religious nature made him do numerous religious paintings   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   His first religious work, Christ healing the sick, was originally intended to be a gift to a quacker hospital in Philadelphia. This shows that he was a charitable man, and this made him make gift paintings.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   It is also apparent that West was a historian who was studying history and recording history to be used in the future. He painted images of social, political and religious history. His painting, presentation of the queen of Sheba at the court of King Solomon, is from biblical history. He also painted William Penn’s treaty with the Indians. This was a historic treaty that was believed to have been signed many years back. This interest in history opened up areas in which he could draw paintings.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Benjamin was also a very social man. In his life, he interacted with so many people with whom he shared ideas and who helped him nurture and improved his painting skills. This can be traced right back from when he was a young boy, and he interacted with the Native Americans who taught him how to make paint. Later on in his life he interacted with people from all backgrounds. He met artists, clergymen, political leaders, traders such as gunsmiths and many more categories of people. This exposure not only earned him the knowledge in artwork, but it also opened up chances of creating a market for his painting skills. He painted portraits of the leaders he interacted with, made religious painting for the churches after interacting with the church leaders.   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Benjamin West’s paintings help us understand the American literature and the kind of life they lived before attaining independence. The fact that he made a painting and entitled it â€Å"Christ Healing the sick†, is enough to convince us that the Americans were Christians even during their pre-colonial period   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Benjamin West’s painting, William Penn’s treaty with the Indians, helps us understand that the American had interacted with the Indians even before America attained freedom. It also portrays the peaceful and the welcoming nature of the Americans during this time.It is also evident that America had not fully embraced formal education during the colonial period. People used to attend informal schools where they learnt technical skills such as painting. In his painting, Benjamin Franklin drawing electricity from the sky, painted in 1816, we learn that the American attempts to develop energy begun as early as the 19th century. This painting and others he did have proved to be of great importance in tracing the history and literature of America   Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   It is, therefore, clear that even in his grave; Benjamin West will always be remembered for his contribution in creating references for the American literature and political, social and religious history of the Americans (Dillen , John & Benjamin West, 1997). References Dillen Berger, John. Benjamin West: the context of his life and work, particular attention to his artwork with religious subject, including a correlated version of the nineteenth- century West’s paintings, exhibitions, and sales records, and alas. San Antonio: Trinity University Press, 1977. Helmut von, and Allen Staley. The paintings of Benjamin West. New Haven: Yale University Press, 1986. Meyer, Jerry D.. The religious paintings of Benjamin West: a study in late eighteenth and early nineteenth century moral sentiment. Austin: cy, 1973-1974. The life of Benjamin West. London: Wetton & Jarvis, 1821. West, Benjamin, and Charles H. Morgan. Benjamin West, his times and his influence: an exhibition, May 9-30, 1950. Source document

Answer to case Study Example | Topics and Well Written Essays - 750 words

Answer to - Case Study Example The Congress government wanted to impose regulatory measures on the derivative trading deals in order to avoid such losses in future. Unlike trading in New York Stock Exchange, most of the derivative transactions took place between private parties in U.S. The government wanted to make such trading through ‘clearinghouses’, where public intermediaries’ would inspect the dealings. According to the government, it was also necessary to implement the Dodd Frank Act that would oppose the banks from undergoing excessive risks in big dealings. At this juncture the commercial banks claimed for less government intervention. Jamie Dimon the chief of the company commented that, three high ranking executives left the company and this was the reason for the loss. Stakeholder Theory Approach The JPMorgan loss affected both the market and the non market stakeholders. Market Stakeholders Customers The customers are the depositors who keep their assets in the bank. The loss of JPMo rgan would make the customers feel unsafe to deposit their wealth in the bank. They would fear that the bank might collapse in such adverse crisis and thereby might withdraw their deposits. Employees The employees of the bank would lose confidence from the organization and might decide to leave their jobs and join elsewhere. They would do this in fear of losing their jobs in future. Suppliers The suppliers would also turn out to be non supportive to the bank. They would cease the major derivative dealings in fear that in such crisis the bank might not be able to pay back the returns to them. Non-Market Stakeholders Government The government would need to offer an implicit bail out to finance the loss making projects of the firm. The state would offer an implicit bail out only if the bank accepts to operate under its regulations. Communities The communities would expect the bank to recover its loss. This is because JPMorgan initiates certain social responsible schemes for the communi ties. They would encourage the employees, suppliers and customers not to loose confidence from the bank. Business Supporting Groups The business support groups would also support the views of the company chief. They would claim for less state intervention in the matters of the private banking. They would claim this because they are in favour of banking led business expansions. The Stakeholders Map High Stakeholders Salience Stakeholders Sailence Low Against Position of the issue For (Source: Authors Creation) As shown in the above map, the communities and business support group would take this loss to be a normal incident. They would comment that the loss has actually taken place because three important officials left JPMorgan bank at this juncture. Ina Drew was one of these three officials, who used to look into the risk in the firm’s derivative deals. On the other hand customers, government, suppliers and the employees would move against the views of the issue. They would l ose confidence from the bank in due course of this loss. However, since U.S. is a republican country the salience or power of the customers would be utmost influence the decisions of the banks. The government and the communities would have the minimum powers. Sample Stake holder Map Recommendations The power of the customers and suppliers are high in matters of private commercial bank. The scale of operations of a commercial bank depends on the trust and

Trusts and Equity Essay Example | Topics and Well Written Essays - 2000 words - 1

Trusts and Equity - Essay Example seems not entirely wrong, to say that lawyers and legal theorists tend to deal with the first option, a rule-bound jurisprudence of equity and literary practitioners with the second, a less formal, more allusive supplementary notion of equity. But the question as to whether equity does or does not â€Å"belong† to the law is not just an institutional one. The answer also depends on whether equity is associated with something general, such as a universal rational order of justice, or something particular, such as the judicial discretion to interpret the law according to rules and precedents that can change over time. Similarly, it depends on whether the law is associated with something general, such as the predictability and security of rules, or something particular, such as the alterability and flexibility of rules and precedents over time. Thus, what is general about equity is its concern with what is universal. Conversely, what is general about the law is its concern with w hat is predictable; what is particular, its concern with what is posited. Different conflicts between the general and the particular may emerge, therefore, depending on whether equity is or is not considered part of the law. If it is part of the law, then the security, validity, and accessibility of rules may conflict with the potential unpredictability, arbitrariness, and privacy of judicial discretion. If not, then different aspects of judicial discretion, such as a judge’s â€Å"genius† or â€Å"paternalism, † may conflict with non-judicial forms of discretion, such as the readiness of individual conscience to ascribe or accept guilt. (Polloczek, 1999, p. 9) Though since the Judicature Act came into force in 1875 the rules of Common Law and Equity are recognised and administered in the same court, yet they still remain distinct bodies of law, governed largely by different principles. Like the Common Law, the rules of Equity are judicial law, i.e. to find them we must look in the first

Econ Essay Example | Topics and Well Written Essays - 500 words - 4

Econ - Essay Example He is known for his works which include: A Discourse on the Commonwealth of this Realm of England (1549). Sir William Petty considered taxes, land and labor as the most important resources of the growth and acquisition of national income. He came up with several ways to optimize the collection and generation of taxes while being fair to every individual. He believed and recommended that the taxes collected should be just equal to the nation’s expenditure. Petty was against poll taxes and the unequal taxation of the poor excessively (Petty p30). He came up with strategies to raise taxes fairly. He suggested that imports should be taxed, but only in a way that they would be at the same level with the locally produced products. He also began turning his concerns towards income distribution and the relative value created by the contributions; He was talking of diminishing returns on land relative to their distance from the market (Petty p84). This was a result of the initiation of the idea that rent on land was a surplus above wage payments. He also initiated the â€Å"labor theory of value†. This stated that the value of goods produced should have been determined by the number amount of time the labor went into it. The Basic theme of The Discourse on the Commonwealth of this Realm of England was an attack on debasement which Sir Thomas Smith was openly against; this even led to his exile. He claimed that debasement was responsible for social unrest, high prices and inflation, and the biggest losers were fixed income earners. In his works he claimed that the King was one of the biggest losers from the high prices caused by debasement, since it adds immediately to the king’s revenue and before the rise of prices comes, contrarily the king is the prime beneficiary of monetary measures of inflation and debasement (Rothbard p67). Smith was a mercantilist as seen by his

Western Civilizations History Research Paper Example | Topics and Well Written Essays - 500 words - 1

Western Civilizations History - Research Paper Example Dictatorship is the opposite of the democracy, where the citizens are not allowed any freedoms. Hitler was a German leader who embraced the German People’s Party and later became an active member. When holding the party’s position of a spokesperson, he renamed the party the National Socialist German Workers’ party (NAZI). During this time, he was still employed by the army. Due to his excellent skills in speaking, he got the support of many people. Hitler was a great admirer of the Japanese leader Mussolini. When he rose to power in the early 1930s, both Hitler and Mussolini became allies. However, their friendship became a marriage of convenience and not that of sister states. Despite the earlier differences between the two countries, and those of the two leaders, they formed a formidable alliance. Germany under Hitler offered support to Rome during and after the Abyssinian crisis that the country was facing in the mid-1930s. The ambitions of Mussolini of building a new empire that would replicate the ancient Rome targeted Abyssinia. He invaded and occupied the state, and received a lot of criticism from the League of Nations. Hitler himself had pulled Germany out of the League of Nations in 21933. With the support of Hitler, he went ahead to carry out his plan. In 1936, Germany and Italy were involved in a civil with

What is the problem of communication with aliens, according to Peters Term Paper

What is the problem of communication with aliens, according to Peters - Term Paper Example Otherness is the condition in which an individual develops the belief of being different or possessing another form as compared to the majority around him/her. The notion of otherness in philosophy has been advanced since the debate on the existence of extraterrestrial beings and other unidentified objects within space. The feeling of otherness exists in a number of situations and depends on an individual state of being, experiences and level of knowledge and exposure (Peters 231). In the development of the otherness feeling, two classification of individuals arises which includes the 'us' versus 'them' feeling, one which is currently dominant in the discourse of aliens and terrestrial life. The out-group, which in this situation happens to be the aliens, is coherent as a group due to the opposition it receives from the in-groups, which are the human beings. One common example of the feeling of otherness arises from the western versus others feeling which is created by the strong bel ief that the west are more superior to the others. In this ethnic discourse, the feeling of otherness is strengthened by binary logic, which is more attached to the strong principle of self-identity. Within this set of argument, 'us' and 'them' hypothesis and reasoning is created from the grouping that exists in us and the distinctions from their groupings. For example, the division of one group into heterosexuals and homosexuals while the other group forms the male and female dichotomy forms the basis behind the advancement of this notion (Peters 243). The preoccupation with alien invasion and the need to develop communication means with the extraterrestrial beings has led to the establishment of the communication with extraterrestrial intelligence, which seeks to develop communication protocols. Just like the craze for developing human-animal communication processes, alien communication has grown since the 20th century. In case of any alien encounter, attempts to communicate will occur due to human instinct power but communication will not be the end of the problem. Just as human-animal communication has been described as one way communication, human-alien communication can also fall into this category. In an attempt to understand and discern the information from the aliens, human may be subjected to erroneous fabrication and interpretation of the message from the aliens. It is common knowledge that the desire to communicate with extraterrestrial beings is capped with dialectic enlightenment. Human have shown interest in communicating with the aliens and the number of studies that followed the telephone signal that was received from space demonstrates this. According to Peters in his speaking to the space discourse, there is no other kind of communication other than that with the aliens, a statement that he supports in his writing. Whenever we speak, we speak to the air and the aliens are the real occupants of space according to this discourse. The electroma gnetic communication that occurs from voice vibration results into the travel of sound into space, which incites the aliens. All communication, whether between ourselves may seem to be internal communication but it is all directed to the others who are not part of the ‘us’ (Peters 235). With communication, misunderstanding occurs from several avenues and this may be possible in instances where there is no otherness. However, miscommunication with aliens does not occur as a result of the semantics as words have the same meaning but from figuring out what is meant by otherness. Through this statement, Peters refers to the fact that without misrepresentation of the words from the aliens, it would be possible to understand each other’

Article Critique Essay Example | Topics and Well Written Essays - 1000 words

Article Critique - Essay Example It is vital to understand the methods implemented by single mothers to successfully cope with stress as mothers experiencing stress can be detrimental to the stressors of their children. Similarly, a link has been revealed that shows a correlation between the economic stress of a single mother, the way in which she responds to and raises her child, and the overall outcome of her child in regard to their own behaviors and future economic status. Understanding how economic pressure negatively influences a single mother will also help in gaining an understanding into how maternal optimism promotes positive parenting behaviors despite environmental adversity, thus promoting a positive life for the child. Another purpose that this article serves is to fill the gap of literature pertaining to dispositional optimism within minority ethnic groups, especially in relation to mother-headed homes. Very few studies have been undergone in regard to this; most studies have looked into the negative influences and outcomes of single-mother households, shunting aside the existence of maternal optimism in other families with similar structures. Methods The study began in the mid-1990s, using 889 African American children, their caregivers, and, when possible, an older sibling, all living in Iowa and Georgia. The participants of the study were taken on through telephone interviews. Data was collected between these families in four different waves, starting in 1997 and ending in 2006. Of the original 889 participants available during the first wave, only 86.7% were involved in wave two and three interviews. From this group, families run by single mothers, as opposed to caregivers, were chosen and the others were dismissed. The final sample group of the study consisted of 394 single mother families. During each interview, two two-hour home visits in a span of seven days were made to each family. The first visit involved the giving of consent, both of the mother and the children to p articipate in the study; name and locations of schools were also given, and children’s teachers were authorized to provide further information about the children’s functioning at school. The ages of the participating children varied from ten to fifteen years of age; the mean age of the mothers was thirty-five years of age. The mean education of the mothers was approximately twelve years, and the mean income was $20,689. The mean number of children per family varied between one and two. Various questions were asked of the mothers and children, each pertaining to certain economic situations or behavioral statuses. These variables would be used to measure the overall situations of the individual families. These variables are are follows: Mother’s childhood adversity, which asked eight questions to determine if the mother was subjected to specific adverse childhood advents such as a relative living at home having a serious drinking problem. Economic pressure, which measured four indicators (unmet material needs, cannot make ends meet, financial cutbacks, and no money), all dealing with the financial situation of the household. Mother’s dispositional optimism was then measured, offering yes/no questions to determine the mother’s level of optimism during times of hardship. Mother’s internalizing symptoms, which measured how depressed, discouraged,

The relationship between iron and zinc status and treatment of ADHD Essay

The relationship between iron and zinc status and treatment of ADHD (subject to modification) - Essay Example Diagnosis is therefore rather subjective and obtaining epidemiological data is cumbersome. Co-morbidities are often present and these make diagnosis even more difficult (Rowland, Lesesne et al. 2002). Despite these limitations, there are valid data that suggest that ADHD seems to have a higher rate of occurrence in white children than in black children in the USA (1.7% to 4.4% in 1997) according to treatment records obtained by physicians. (Olfson, Gameroff et al. 2003). Also, the national epidemiological survey in UK showed a lower prevalence of ADHD in black children than in white children (0.4% to 1.6%) (Meltzer, Gatward et al. 2000). There is the postulation that cases of ADHD in black children could possibly have been under-diagnosed in these societies simply because black families possibly lack access to health facilities due to poorer economic status. This argument may not be valid considering that even higher access to facilities by black families have not resulted in increas ed diagnosis of cases of ADHD in them. Moreover, the U.K epidemiological survey cuts across racial and socioeconomic barriers. ... The ADHD Help-Seeking model is a basis of understanding factors that are predictive of service access and utilization, with a view to using such understanding to break the barrier to service utilization in ADHD treatment (Eiraldi, Mazzuca et al. 2006). The model proposes that for effective treatment, there must first be problem identification on the part of the affected, and then the decision to seek help must follow. Also, service selection and service access by the affected are integral parts of the model pathway. It is believed that through its predictive nature, the model will provide answers to various questions regarding disparities in access to healthcare by various ethnic and racial groups. (Eiraldi, Mazzuca et al. 2006). The model however needs to be made stronger by reconstructing it on factors that are less general and are more specific for affected groups, so that individual needs could be more effectively met (Eiraldi, Mazzuca et al. 2006). Cultural influences could play a very significant role in the Teacher and Parent Ratings across cultural divides (Olfson, Gameroff et al. 2003). The prevalence rates for ADHD from 1997-2001 among African American, Hispanic and White children (6-11 years old) were obtained using a National Health Interview Survey. Information was obtained from parents about health and socio-demographic characteristics of their children. Drug therapy history was taken. Again, White children were found to have the highest rate of ADHD than any other ethnic group, though occurrence of learning disability was higher in the African American and Hispanic children. About 1% of Hispanic children were reported to have ADHD without LD, against 4% white children. Compared to white children, the percentage of

ENHANCED ACADEMIC WRITING AND PRACTICE ED2215 (Ass 2) Essay

ENHANCED ACADEMIC WRITING AND PRACTICE ED2215 (Ass 2) - Essay Example The issue for betterment of the school environment is intrinsically related to the social and cultural environment of the state and society. Further, such issues seen from a judicial and moral standpoint needs be addressed while generating social policies related to the educational environment. The policies generated by the social and educational leaders must generate positive outcomes to help the due achievement of such moral and social goals. The educational and social leaders must focus directly on the betterment of the pedagogical and courseware areas of the educational institutions rather than rendering more concentration on changing the organizational structure. Furthermore, the educational and social change must proceed in a spontaneous manner and must not be restricted in bettering up the educational atmosphere of any particular institution. Development brought about in a particular institution without catering to a holistic view disturbs the fragment of social equity in the state or region. In the context of United Kingdom, the Labor Party during the 1997 period took stance of bringing about a large-scale educational and social reform in the country. ... passing on of the first term the labor party failed to confer further more alterations in the educational atmosphere of the region for which the developments brought about started stagnated with the arrival of the second term. The external leadership imparted by political and social leaders to bring about a mass scale alteration of the educational and social sphere of the region fails to make a sustainable stand unless otherwise recognized by the educational institutions themselves. In other words, the educational institutions are required to perform in close cooperation with the social and cultural ideology of the region to judge their aspirations and aims. The external leadership on the other hand must help create an atmosphere that would promote development of the educational and pedagogical procedure of the institutions. Thus, an environment must be created which would help in the implementation of the policies framed at the national and state level in the educational organizatio ns (Hopkins, 2005, p. 4). Promoters of Educational Development Hopkins outlined four major areas that can help in bringing about a stream of reforms that would help in the formation of an ideal educational environment in a region or state. Hopkins states that an educational environment must focus in designing a personalized approach with the student community that would help in the betterment of the educational patterns. Further, the pattern of the teaching imparted by the educational institution must focus on incorporating professional ideas that would help the students to eke out a living in the future. In the process of bringing about a change in the educational environment, the educational organizations must not function in an isolated environment. Rather they must enthusiastically

Mr. Gascoignes company Essay Example for Free

Mr. Gascoignes company Essay I am going to create a macro that will allow Mr Gascoignes company, (Shoes n all) to insert a different response into a template letter, so that the letter will contain the necessary information appropriate for the use. I am going to create 4 different Macros. They will input a short paragraph that will tell the reader about their credit bill to the company. The 4 Macros will be: 1. To open the Master Letter 2. Telling the reader that their credit bill is up to date and that they hope that the customer will continue using the company to buy their shoes. 3. Telling the customer that their credit bill is slightly behind and that the require the credit bill as soon as possible 4. Telling the customer that they havent paid their bill for quite a while and that their credit account has been closed. 5. A slogan that will appear in the footer. I first created a simple letter and put in where information will be inserted. (See first of documents) On the same document but on a different page I created the responses that will eventually be the different macros. (See second of documents) I then saved the document as a . dot file, as this then becomes the master copy. Once they were created I had to start recording a macro. I went to, file- new and opened a blank document. New was the time to start recording. I wanted to record a macro that would open the master Document. To start to record the Macro I went to tools- Macros -Record new Macros (left) Once I had pressed it a new box came up, where I inputted the Name. I named it master and pressed OK (Below) Now that I had opened the file I pressed Stop on the Macro Tool bar. Now that the master had been created. I wanted to start recording the responses to go in the letter. So to record in the first response I first needed to load the master Macro because it contains the different responses and the blank letter. To load the Macro I went to Tools - Macro - Play Macro Now that the letter had been opened I wanted to start to record a new macro. I started it the same way as I did at point 1 and entered the name as Para. Again, like before the cursor turned into a picture of a tape, to signify that it is recording. When recording macros it is unadvisable to use the mouse to select text because it sometimes causes complications. So what I wanted to do was to select the paragraph, Copy it, Move up to the blank space in the letter and paste in the paragraph. So to do this all on keyboard I moved down the page to the paragraph by using the cursor keys. Once I got to the first paragraph I wanted to highlight it. To do this without the mouse I went to the point before the paragraph, held down shift and scrolled along the text using the cursor keys. I stopped scrolling at the end of the paragraph. This then highlighted the text. Now I wanted to copy it. The hotkey to copy it on a keyboard is Ctrl+C. This then saved the information to the clipboard. Now I wanted to paste the paragraph in the blank space. So I scrolled up to the space using the cursor keys. To paste the copied text in I just pressed Ctrl+V. This then pasted the paragraph in to the slot needed. I then used the mouse to stop recording the macro like I did at point 1. I recorded the other three macros like I did at point 2 and named each one Para 1, Para 2 and Para 3. Now I wanted to create a macro so that it will input a slogan into the footer. So I started off recording it and named the macro as Slogan. Using the mouse is necessary when creating a footer, but it is usually advisable to use the keyboard whenever possible. So I used the mouse and pressed View- Header and Footer (Bottom Left) Now That the actual bar was created I just wanted to insert the macros in to the toolbar. So I pressed the commands tab and dragged each of the macros into the toolbar. Once they had been dragged in, they looked like this. As you can see the icons are very wordy. So I decided to assign a picture to each of them so it would be easier select them and understand them. So, to do this I: 1. Selected the icon. 2. Press Modify Selection 3. Select Change Button Image 4. Select the picture So I selected a different picture for each icon. I tried to make it as appropriate as I could Master=Speak Para1=Happy Face Para2=Piggy Bank Para3=Unhappy Face Footer=Steps It is also possible to change the Macro in the actual code. To open the macro code I went to Tools- Macro-Macros I then selected the Macro I wanted to edit and Selected edit. The code then appeared. I then Edited it. See documents 6 7 Sam Flower Macros and Toolbars GNVQ IT Page 1.

Meaning of Jane Eyre as a Whole

Meaning of Jane Eyre as a Whole The whole of the work is a critique of Victorian Englands social hierarchy and inequality for women. Jane struggles against social class and gender inequality, both of which she considers great injustices. Free Response Question (Year and Paraphrase of Question) 1997. Novels and plays often include scenes of weddings, funerals, parties, and other social occasions. Such scenes may reveal the values of the characters and the society in which they live. Select a novel or play that includes such a scene and, in a focused essay, discuss the contribution the scene makes to the meaning of the work as a whole. You may choose a work from the list below or another novel or play of literary merit. Opening Sentence for (your) Essay (Be prepared to write an essay on this novel at any given time during the quarter!) In the novel, Jane Eyre, a certain scene depicts Victorian Englands social class hierarchy. This scene is of when Mr. Rochester brings a party of distinguished gentry and ladies to his home and they all converse and relax in his parlor. In the scene, they indulge in their own splendor and think nothing of those who are considered to be in a lower social class than they. Their treatment of Jane, whom they consider beneath them, reveals just how little the higher classes of the time regarded those of lower classes. This value of social class in the society where they life greatly adds to the meaning of the work as a whole. Key Plot Incidents Jane Eyre is an orphan living with her terrible aunt, Mrs. Reed. In that home she is treated cruelly and disliked by all but Bessie, a servant in the home. One day, Jane is hit by John Reed, and she loses it and attacks him. As punishment for starting the fight she is sent to the red room where she has a vision of her dead uncles ghost she screams and faints. She wakes up in the care of Bessie and Mr. Lloyd, who makes the suggestion of Jane attending school. Mrs. Reed does so after Jane goes on a spiteful tirade against her. At Lowood School, Jane finds a miserable situation. The school is in horrible condition with inadequate means for survival and stern rules installed by the hypocritical headmaster, Mr. Brocklehurst. Jane has a dear friend there, Helen Burns. This angelic friend dies of consumption when an epidemic of typhus sweeps Lowood. So many girls die, it attracts the attention of the public who discover the horrible living conditions. Brocklehurst is replaced by better men. Jane stays for six more years as a student and then two as a teacher. She soon desires new experience after her time there and after her idol, Miss Temple, marries and leaves. Jane puts out an advertisement and is soon employed as a governess at Thornfield Hall. She teaches an illegitimate little French girl named Adele and meets the housekeeper, Mrs. Fairfax, both of who she befriends. The gentleman at Thornfield is Mr. Rochester, a dark and moody man. He and Jane have deep conversations often and confine in each other. Jane sees his flaws but falls in love with Mr. Rochester. One night she saves his life from a fire which creates a mystery for Jane concerning Grace Poole, a servant. Jane concludes that she is unaware of all the facts. One day, Mr. Rochester brings home a party of gentry and fine ladies. They stay for a couple of weeks. Jane is in silent despair as she sees Mr. Rochester fancy a beautiful but vicious woman, Blanche Ingram, and expects them to me married soon. Jane begins to make arrangements to leave Thornfield but then Rochester confesses love for Jane and proposes to her. She joyfully accepts. Their wedding day is ruined by the announcement that Rochester is already married. Mr. Mason, when attaining knowledge of Mr. Rochesters intentions concerning Jane, made it known that Mr. Rochester is married to Bertha, Mr. Masons sister, who is insane and who Mr. Rochester has kept hidden in the third story of his house. Jane, a strong defender of morality, cannot stay with Mr. Rochester, who is a great temptation. In the night she flees from Thornfield. She has nothing and is reduced to begging and is received by no one. Finally, when she is on the verge of death, she is taken in by three siblings, Mary, Diana, and St. John Rivers, at their manner, Marsh End. She becomes very close to them, especially the sisters. St. John finds employment for Jane as the teacher in a school for poor girls. One night, St. John comes and tells Jane, after discovering her identity, that she has inherited a large fortune of 20,000 pounds from her uncle, John Eyre. She also learns that she and the Rivers are cousins and is thrilled. She splits her fortune with her beloved relatives. As she lives with the Rivers she studies with Mary and Diana until St. John entices her to do so with him. She does and he soon asks her to accompany him to India as a missionary and his wife. She will not go as his wife because she does not love him. One night when he as almost convinced her to marry him, she hears Mr. Rochester cry out her name and she returns the call. The next morning, she sets out for Thornfield and her love. Upon arrival she discovers that Thornfield has been burned to the ground by Bertha, who jumped off the roof, killing herself. Mr. Rochester was stricken blind and crippled (he lost his hand) in the fire will trying to save all the servants and Bertha. He now lived with only two of his trusted servants in a dark place, Ferndean. Jane goes to him and they love as they did before. They are soon married and the story end with Janes short recount of the next ten happy years. Key Characters (Who and Why) Jane Eyre- Intelligent, moral, and opposes the injustice of oppression and inequality. She is plain but engaging and seeks fulfillment. She maintains high values throughout the whole book. She is a metaphorical challenge against Victorian treatment of women and those who are poverty stricken Edward Rochester- Master of Thornfield and wealthy employer of Jane Eyre. He is passionate, dark, and secretive. Jane falls in love with him and he loves Jane. Despite societal norms, he marries her. Before Jane, his life was reckless and lost. He was moody and miserable. St. John Rivers- Janes benefactor when she had nothing. Also her cousin and deliverer of good news. He is devoted to God. He wishes to be a missionary in India and asks Jane to accompany him as his wife. He is cold and ambitious. He is handsome. There are many other characters, with smaller roles, who come in and out of Janes life. Setting(s) Gateshead- Mrs. Reeds home. Jane grew up there for ten years. Lowood-the miserable school Jane attended and taught at. She gained her education and values there. Thornfield- The home where Jane was a governess. She finds a place there and falls in love. Mr. Rochesters home. Marsh End- the home of Mary, Dianna, and St. John Rivers. Becomes Janes home after she inherits her fortune. Significance of Opening Scene The significance of the opening scene is to establish Janes first thoughts of injustice and the beginning of the development of her high morals and her sense of right and wrong. Significance of Closing Scene Jane is rewarded for her living of high values and morality with the love of her life. Her reward is just. Style of Narration/Point of View The point of view is first person. It is from Jane herself. She narrates as though she is telling her life story from far in her future. Theme(s) Love vs. Autonomy- Jane longs to be loved, not only romantically, but by family. She wants to belong but not enough that she will lose her autonomy. Her fear of losing her connection to God motivates her to flee from temptation (Rochester). Religion- Jane is very religious. She struggles, throughout her story, to balance her desire to serve her God and with her desire to serve herself. Jane is very strong in her faith and has high principles as a result. She meets three religious figures. Mr. Brocklehurst represents hypocrisy and the danger of the Evangelical religious movement. Helen Burns represents passive hope and trust in God. St. John Rivers represents finding glory in God and self-importance. Jane does not accept any of these. Symbols(s) Bertha- Serves as a symbol of Rochesters unhappiness, and tribulation for Jane. Bertha is Janes trial. Bertha is also a symbolic critique of Englands locking away of other inferior cultures. Bertha represents Victorian wives who are kept under tight leash. The Red Room- symbolic of struggles Jane must overcome. Jane recalls the Red Room every time she is struggling. Janes desire to find more fulfillment in her life is symbolic of all feminine unrest. Tone A slap in the face of injustices. Deep-rooted misery and search for fulfillment.

Pathophysiology of DORV and Surgical Management

Pathophysiology of DORV and Surgical Management Advances in genetic techniques and ability to detect the chromosomal abnormalities in the cellular structures; have had a great impact on the detection of congenital cardiac defects. Although in the past congenital heart diseases have long been recognised as a constituent of complex genetic syndromes, a genetic cause for specific congenital heart diseases has less been apparent; as the sources of these defects has been believed to be multifactoral. In addition, with the advancement of the molecular genetic studies, it has come to light that in many instances, congenital heart diseases exhibit classic Mendelian transmission. It is also possible to trace the direct involvement of a gene with a particular congenital cardiac defect. Tetrology of Fallot has been found to have genetic predisposition, it is estimated that offspring of a parent with tetrology of Fallot is more likely to suffer from the disease in comparison to offsprings whose parents do not suffer from congenital heart disease. Studies estimated that about 1.5% of live births will be affected by tetrology of Fallot if the parents suffer from the defect and about 0.1% will be affected by the presence of tetrology of Fallot if parents do not suffer from congenital heart disease. In comparison in DORV chromosomal abnormalities have only been identified in some cases. In the Baltimore-Washington infant study, DORV was diagnosed in a few patients with downs syndrome and in trisomies 13 and 18, although the incidence was quite low compared with that morphologically similar lesion, tetrology of Fallot. In addition the related conotruncal abnormality, complete transposition of the great arteries, was not found in any patient with trisomy in reported study, this suggests that DORV and transposition of great arteries may be etiologically similar and may be fundamentally different form tetrology of Fallot in terms if developmental mechanism. Also DORV and Transposition of Great arteries are rarely found in patients with CATCH 22 syndromes, although tetrology of Fallot is not uncommon. In a large sample study of patients with conotruncal abnormalities to evaluate the frequency of 22q11 deletions, only 1of 20 patients with DORV as compared to 15.9% of the patients with tetrology of Fallot. The studies have also reported that DORV may be a part of complex CHD in patients with DiGeorge, velocardiofacial and conotruncal anomaly-face syndrome. In a resent animal study it was reported that DORV occur in mouse embryos homozygous for the JMJ mutation, which affects the nuclear protein jmj coded by chamber-specific genes. Surgical Management Surgical management for the DORV and tetrology of Fallot is determined by the anatomy and physiology of the defect as well as the age at which the diagnosis is made and at which the need for surgical intervention arises. Indications for operation are similar to those for defects that lie on each side of the DORV spectrum (VSD, tetralogy of Fallot, and Transposition of great arteries). In addition the presence of associated cardiac defects may modify the approach. In DORV the position of VSD and the presence and severity of pulmonary stenosis are probably the most important considerations. In tetralogy of Fallot most patients have satisfactory systemic arterial oxygenation saturation at birth and require no treatment. However when the oxygen saturation drops below 75-80% operative intervention becomes imperative. Hypoxemic spells may occur from the transient reductions in pulmonary blood flow, due to sudden increase in right ventricular outflow tract obstruction and the decrease in systemic vascular resistance, so a surgical approach takes into consideration the number and location of ventricular septal defects, anatomy and severity of right outflow tract obstruction, coronary artery and aortic arch anatomy and the presence of other cardiac and non cardiac anomalies. Depending on the severity of the cyanosis two types of surgical streams are available. There are two basic possible types of surgical strategies for newborn infants with tetralogy of Fallot. One of the strategies consists of a staged repair; where initial palliation is followed by a complete repair and other one being a complete repair in the neonatal period. Palliative surgical correction, which often does not require the use of cardiopulmonary bypass, is the creation of systemic to pulmonary shunt. This correction is achieved by connecting systemic blood flow source to a the pulmonary blood flow, as already mentioned the main feature of this congenital defect is the reduced flow to the pulmonary system which is the basis of cyanosis. The palliative repair is done by fitting a tubular prosthesis between a systemic artery and a pulmonary artery as shown in the figure (?) (a, b and c). The commonest type of systemic-to-pulmonary arterial shunt is a modified Blalock-Taussig anastomosis which is a communication between a subclavian and pulmonary artery of the same side. Another form of palliative correction is done by creating a connection between ascending or descending aorta and the trunk of pulmonary artery. The connection which connects the posterior ascending aorta to anterior pulmonary trunk is called Waterston shunt and connection bet ween posterior pulmonary artery to anterior descending aorta is called potts shunt. Both of these techniques have there advantages and disadvantages (figure (S) e and f). Figure ( ? ) The most common types of palliative procedures for tetralogy of Fallot. The modified Blalock-Taussig shunt (MBTS) using a Gore-Tex graft either from the right subclavian artery (A) or the right innominate (INN) artery (B). C, A central aortopulmonary shunt using Gore-Tex. D, A right ventricular outflow patch without ventricular septal defect closure. Pathophysiology of DORV Once the anatomic variables of DORV are understood, the various physiologic manifestations become both logical and predictable, at the tetrology end of the DORV spectrum; pathophysiology is similar to that in the tetrology of Fallot. The most important variables determining the physiology of a given heart are the position of the VSD in relation to great arteries, the relation of the great arteries to each other and the presence of associated defects (in particular, outflow tract obstruction). In general patients with large VSD and no pulmonary stenosis or severe pulmonary vascular resistance are not clinically cyanotic. This is because Qp is high and the resultant mixture of blood in the right ventricle has a high enough oxygen saturation to prevent clinically evident cyanosis; however there is some arterial desaturation. Although both great arteries arise from the right ventricle, often incomplete mixing of oxygenated and unoxygenated blood occurs at the ventricular level because of streaming. This streaming of blood within RV is usually determined by the relationship of semilunar valves to the VSD and the position and presence of the infundibular septum. The blood in the great artery most closely related to the VSD and therefore most aligned with LV outflow tract tends to have the highest oxygen saturation. Likewise, the great artery that due to streming, preferentially receives systemic venous return, tends to have a lower saturation. This phenomema is somewhat different from true single ventricle physiology. In DORV with subaortic VSD and no pulmonary stenosis, pulmonary blood flow will be determined by the relationship of pulmonary to systemic vascular resistance. What is usually the case after the first few weeks of life pulmonary vascular resistance is less than systemic vascular resistance, pulmonary blood flow will be greater than systemic flow, resulting in higher than normal pulmonary arterial saturation and congestive heart failure. As the pulmonary vascular resistance increases in response to this abnormal volume load, pulmonary blood flow correspondingly decreases. Eventually, if left untreated, this usually results in pulmonary vascular obstruction disease with severely and irreversible elevated pulmonary vascular resistance, causing progressive cyanosis and early mortality. However if when the VSD is in subaortic position with pulmonary stenosis, whether valvular or subvalvular, obstruction to pulmonary blood flow is found. Conduction System In tetrology of Fallot the sinus and atrioventricular nodes are normal in location, and the bundle of His follows the same general course as in patients with isolated perimembraneous and juxtatricuspid VSDs. Thus it emerges through the right fibrous trigone at the base of the noncoronary cusp of the aortic valve and courses forward toward the papillary muscle of the conus along the inferior VSD margin or slightly to the left side of the defect edge. In addition, hearts which show marked clockwise rotation of the aortic root with overriding, the right trigone is carried more rightward and superiorly and directly into VSD margin. By contrast, the bundle of His does not lie on VSD margin when a muscle ridge is present, since the ridge projects superiorly above the right fibrous trigone. In DORV with concordant AV connections the AV node lies in the usual position in the muscular portion of the AV septum. The bundle of His penetrates the fibrous right trigone of the central body and lies along the posteroinferior margin of the VSD in lesions that are juxtatricuspid wheter the defect is subaortic, doubly committed, or sub-pulmonary. When muscle is interposed between the defect and the tricuspid valve, this muscle protects the bundle, which no longer runs along the posteroinferior free margin of the defect. Oxygenation Hemodynamic representation of Tetrology of Fallot (indicating right to left shunting) Supply of oxygen to the body Due to the mal-alignment and deviation from the normal physiology, the main issue of the patients with tetarology of Fallot is hypoxemia due to inadequate pulmonary blood flow caused by the inadequate pulmonary blood flow, which is determined by the right ventricular pressures and degree of obstruction. Since the right and left ventricular and aortic pressure is equalized, a drop in systemic arterial pressure will result in a reduction in pulmonary blood flow. Oxygen carrying capacity of blood depends mostly on haemoglobin concentration and greater the haemoglobin concentration in the blood that perfuses the lungs, the greater the amount of oxygen extracted per unit of blood flow. In neonates the haemoglobin concentration is relatively high (15 to 18 g/dL), however it drops to about 10 or 12g/dL by 3-4 months after birth. In neonates with tetralogy of Fallot there is an increase in blood level of erythropoietin due to hypoxemia. Iron is required to maintain or increase in haemoglobin levels; however suckling infants have very low stores of iron and food intake in early infancy provides little iron. Therefore there is a high incidence of anaemia in children with tetralogy of Fallot. On the other hand tetraology spectrum of DORV, where the great arteries lie side by side with aorta to the right of pulmonary artery and both semilunar valves lying in the same transverse and coronal plane the physiology is similar to tetralogy of Fallot. In these neonates the VSD is closer to aortic valve thus oxygenated blood form left ventricle is directed to the aorta and the deoxygenated blood is directed to pulmonary artery but the degree of pulmonary stenosis directs portion of deoxygenated blood into aorta. In addition due to the presence of large VSD both ventricles are subjected to similar pressures. Due to the pulmonary stenosis the blood flow to the lungs is restricted causing drop in the pulmonary systolic pressure, which in turn causes hypoxemia. The pulmonary stenosis is most often infundibular, but may be valvular, with or without a small pulmonary valve ring. In doubly committed VSD category of the DORV spectrum the conoventricular septal defect is both subaortic and sub-pulmonary owing significant conal septal mal-development and mal-position. The hemodynamics change in that case will also be determined by the presence or absence of subaortic or sub-pulmonary stenosis. Therefore cases with sub-pulmonary stenosis will have reduction in the pulmonary blood flow and will result in the hypoxemia and thereby cyanosis corresponding physiological characteristics of tetralogy of Fallot. Also in cases of non-committed DORV majority of great vessels arise form right ventricle thus right ventricle is subjected both pulmonary and aortic circulation resistance. Oxygenated blood form left ventricle gets mixed with non-oxygenated blood through VSD making systemic and pulmonary circulation equal. In addition due to left and right shunting right ventricle is volume overloaded and results in congestive heart failure. Additionally, the stimulation for the formation of red cells continues and very high counts of red cells are achieved, but the cells are microcytic and hypochromic, since the average corpuscle volume and average corpuscle haemoglobin are markedly reduced. Also the rise above 60% increases the blood viscosity. This raised viscosity of blood leads to greater resistance to flow through the tissues and ultimately capacity to transport oxygen vanishes. In transposition spectrum of DORV the physiology is different then described above, since the presence of large sub-pulmonary VSD and its commitment to the pulmonary artery; the course of circulation is dependent on the afterload on each ventricle, as shunting could occur in either direction. In this type of defect the oxygen saturation in the pulmonary artery is higher than in systemic circulation. The high oxygen saturation of pulmonary arterial blood will however decrease the pulmonary vascular resistance and consequently will result in right to left shunting during systole. This will result in some decrease in PO2 of blood distributed to the lungs as well as through ductus arteriosus. On the other hand during diastole a larger volume of blood will return from the pulmonary veins to the left atrium and ventricle and thus results in a left to right shunting. As a result, the oxygen saturation of the blood going to systemic circulation is increased and thus tends to limit the abnorm al decrease in the upper body PO2. A characteristic of this defect is the presence of a large unrestrictive VSD with which the mixing of pulmonary and systemic blood takes. This phenomena result in a relatively large pulmonary to systemic blood flow ratio and consequently high systemic oxygen concentrations; therefore limiting the tissue hypoxia. However the inability of the ventricles to maintain the physiological normal pressures cardiac failure is often associated in infants with transposition spectrum of DORV. Infants with this type of physiology usually appear with mild cyanosis and in congestive heart failure. In addition if there is effective mixing but pulmonary flow is reduced by the presence of pulmonary stenosis or increased pulmonary vascular resistance, pulmonary to systemic flow ratio decreases and arterial saturations will be lower and subsequently will result in tetrology of Fallot type pathophysiology. Right to Left Shunts. Now just for a moment let us consider a large VSD assocoiated with pulmonary valve stenosis which is severe enough to have a resistance greater than systemic vascular resistance. Just like the last case, this ratio of resistances results in reversal of the shunt. This is in fact an unusual combination, but the point here is that the situation mimics the haemodynamics of tetralogy of Fallot. Also it shows how associated pulmonary stenosis can have a great influence on cardiac malformations on many sorts. We will meet it again in the commom mixing situations. On the other hand with no pulmonary stenosis look at the difference Right to Left Shunts. I am making a morphological point here: tetralogy of Fallot is not a coincidence of pulmonary stenosis and VSD but the consequence of right ventricular outflow tract and central pulmonary artery hypoplasia. The diagram can be adjusted to accentuate this, as above. Tetralogy has a variable and sometimes spasmodic stenosis of the muscular right ventricular outflow tract. Sometimes, particularly early in life, the degree of obstruction is not great and the infant may present with signs of a VSD shunting left to right. Qp:Qs (Ratios Pulmonary to systemic Ratios) Double outlet Right ventricle hemodynamic representation (DORV -Common mixing) In many cases of complex congenital cardiac disease it can be quite difficult to understand how the degree of systemic desaturation reflects the flows in malformed heart. It helps to realise that many of them fall into this group of common mixing circulation, which is to say that all pulmonary and systemic venous blood streams are obliged to come together at some point in the circulation. They are: Totally anomalous pulmonary venous drainage. Univentricular heart. Double outlet right or left ventricle. All simple valve atresias. Fallot pulmonary atresia. Truncus arteriosus. And any of the above in combination with any other defect. If there is complete mixing of the systemic and pulmonary returns, it follows that pulmonary and systemic arterial saturation will be identical. Due to streaming effects, the mixing may not be quite complete but the saturations will still be nearly identical. This all means that some degree of systemic desaturation will be present. The degree of cyanosis is dictated by the ratio of pulmonary to systemic flow as shown in the figure above, in which Qp is pulmonary flow and Qs is systemic. Often, particularly in the univentricular heart and in the double outlet ventricles, it is asssociated pumonary stenosis which determines the ratio of Qp to Qs. Some patients with a Qp high enough to keep systemic saturation above 94% or so will not be clinically cyanosed. Time and space do not allow a full descrtiption of all the pathologies so we will take one example, double outlet right ventricle. Double outlet right ventricle is a good example of the haemodynamic variability of this group. The figure above shows the circulation in a case where there is a large ventricular septal defect, no pulmonary stenosis and no significant rise in the pulmonary vascular resistance. Pulmonary blood flow is elevated and the radiograph will show plethora. The high ratio between pulmonary and systemic venous return means that the saturation of the mixed flow, and therefore of the aortic blood, is 90%, which is barely detectable clinically as cyanosis INTRODUCTION  Ã‚  In 1888, Etienne-Louis Arthur Fallot described three cyanotic patients with four similar anatomic features [1]: Stenosis of the pulmonary artery Intraventricular communication Deviation of the origin of the aorta to the right Concentric right ventricular hypertrophy This constellation of findings has since become known as tetralogy of Fallot (TOF). The prevalence of TOF in the United States is about 3.9 per 10,000 live births [2]. This defect accounts for about 7 to 10 percent of cases of congenital heart disease and is one of the most common congenital heart lesions requiring intervention in the first year of life [3]. TOF occurs equally in males and females [4]. The pathophysiology, clinical features, and diagnosis of TOF will be reviewed here. An overview of the management of this disorder, including postoperative complications and issues related to pregnancy, are discussed separately. (See Overview of the management of tetralogy of Fallot.) ANATOMY  Ã‚  The exact embryologic abnormality that accounts for TOF is unknown. What is recognized is that during development, there is anterior and cephalad deviation of the infundibular septum. This results in a malaligned ventricular septal defect (VSD), with the aortic root overriding the defect and leading to subsequent right ventricular outflow obstruction (figure 1). The ensuing right ventricular hypertrophy is thought to be a response to the large VSD and right ventricular outflow obstruction with resultant systemic right ventricular systolic pressure. Ventricular septal defect  Ã‚  The VSD in TOF is most commonly a single large malaligned subaortic defect located in the perimembranous region of the septum (picture 1). The VSD can extend into the muscular septum. There are rarely other muscular ventricular septal defects. (See Pathophysiology and clinical features of isolated ventricular septal defects in infants and children.) Right ventricular outflow obstruction  Ã‚  The right ventricular outflow obstruction is often at multiple levels (picture 2): The anterior and cephalad deviation of the infundibular septum results in subvalvar obstruction Hypertrophy of muscular bands in this region can further accentuate subvalvar obstruction The pulmonary valve annulus is usually hypoplastic, although in some instances it is of normal size The pulmonary valve itself is frequently bicuspid and stenotic In addition, it is not uncommon to identify an area of supravalvar narrowing in the main pulmonary artery at the sinotubular ridge. There may also be further obstruction at the branch pulmonary arteries. These may be diffusely hypoplastic or have focal areas of stenosis, most commonly at the proximal branch pulmonary arteries. The proximal left pulmonary artery near the site of ductal insertion is a frequent location for stenosis (picture 3A-B). Overriding aorta  Ã‚  Overriding aorta is a congenital anomaly, in which the aorta is displaced to the right over the VSD rather than the left ventricle. This results in blood flow from both ventricles into the aorta. The degree of aortic override of the VSD can vary widely and is one of the major factors used by some groups to differentiate between TOF and double outlet right ventricle. If one defines double outlet right ventricle as the presence of aortic/mitral valve fibrous continuity, then the degree of override is not relevant to diagnosis. If, however, one defines double outlet right ventricle as a condition with greater than 50 percent aortic override, then, by definition, the degree of aortic override in TOF is limited. Associated cardiac features  Ã‚  There are a number of frequently associated anatomic features that are important to look for when evaluating a patient with TOF, since they affect therapy. Associated cardiac anomalies occur in about 40 percent of patients with TOF. Approximately 25 percent of patients have a right aortic arch. This is particularly important to identify if one is contemplating a palliative shunt. Abnormalities of the coronary arteries, such as the left anterior descending arising from the right coronary artery, are seen in about 9 percent of patients [5]. These are important to identify prior to complete repair, since the course of the artery may run directly across the right ventricular outflow tract; inadvertent transection could have catastrophic consequences. Occasionally, patients have significant aorticopulmonary collateral vessels that may require attention prior to or at the time of surgery. A patent ductus arteriosus, multiple ventricular defects, and complete atrioventricular septal defects may be present. Infrequently, aortic valve regurgitation is present due to aortic cusp prolapse. GENETIC FACTORS  Ã‚  Although TOF may present as part of a known syndrome, this lesion typically occurs sporadically without other anomalies. Surveys of patients with nonsyndromic TOF have reported the following genetic abnormalities: In one study of 114 patients with nonsyndromal TOF, 4 percent of patients had mutations in transcription factor NKX2.5., which appears to have a role in cardiac development [6]. In genome-wide surveys of patients with nonsyndromic TOF and their parents, de novo copy number variants were estimated to be present in about 10 percent of sporadic cases of TOF compared to less than 0.1 percent in controls at several chromosomal locations [7]. Tetralogy of Fallot has also been reported in association with mutations in TBX1 and ZFPM2 [8-10]. Further investigation is required to determine the role of these mutations in the evolution of Tetralogy of Fallot. Approximately 15 percent of patients with TOF present with associated syndromes, including Down syndrome (trisomy 21), Alagille syndrome (mutations in Jagged1), and DiGeorge and velocardiofacial syndromes (deletion on chromosome 22q11) [8,11-17]. There may be susceptibility genes for TOF within the latter region of chromosome 22q11 in children without extracardiac anomalies [16,18,19], and 22q11.2 deletion syndrome is unrecognized in many adult patients with TOF [20]. (See DiGeorge syndrome: Pathogenesis, epidemiology, and clinical manifestations  and Inherited disorders associated with conjugated hyperbilirubinemia, section on Alagille syndrome.) PATHOPHYSIOLOGY  Ã‚  The physiologic consequences of TOF are largely dependent upon the degree of right ventricular outflow obstruction. Since the VSD is typically large and unrestrictive, the pressure in the right ventricle reflects that of the left ventricle. As a result, the direction of blood flow across the VSD will be determined by the path of least resistance for blood flow, not by the size of the VSD. If the resistance to blood flow across the obstructed right ventricular outflow tract is less than the resistance to flow out of the aorta into the systemic circulation, blood will naturally shunt from the left ventricle to the right ventricle and into the pulmonary bed. In this situation, there is predominately a left-to-right shunt and the patient will be acyanotic. As the degree of right ventricular outflow obstruction increases, the resistance to blood flow into the pulmonary bed also increases. If the right ventricular obstruction is significant enough to increase resistance, it will be easier for blood to cross the VSD from the right ventricle into the left ventricle and go out the aorta, which now becomes the path of least resistance. This right-to-left shunt across the VSD will result in a large volume of desaturated blood entering the systemic circulation and cyanosis and polycythemia will ensue (figure 1). One of the physiologic characteristics of TOF is that the right ventricular outflow obstruction can fluctuate. An individual with minimal cyanosis can develop a dynamic increase in right ventricular outflow tract obstruction with a subsequent increase in right-to-left shunt and the development of cyanosis. In the most dramatic situation, there can be near occlusion of the right ventricular outflow tract with profound cyanosis. These episodes are often referred to as tet spells or hypercyanotic spells. The exact etiology of these episodes is unclear, although there have been a number of proposed mechanisms, including increased infundibular contractility, peripheral vasodilatation, hyperventilation, and stimulation of right ventricular mechanoreceptors [21]. CLINICAL PRESENTATION  Ã‚  The clinical presentation of the patient with TOF is dependent upon the degree of right ventricular outflow obstruction: Children with severe obstruction and inadequate pulmonary flow typically present in the immediate newborn period with profound cyanosis Children with moderate obstruction and balanced pulmonary and systemic flow may be noticed during elective evaluation for a murmur Children with minimal obstruction may present with pulmonary overcirculation and heart failure Most children with this lesion are symptomatic and cyanotic; there is a subgroup, however, with typical morphology and hemodynamics that remains clinically asymptomatic for a period of time (pink variant). In general, the earlier the onset of systemic hypoxemia, the more likely it is that severe pulmonary outflow tract stenosis or atresia is present. Physical examination  Ã‚  On inspection, individuals with TOF are usually comfortable and in no distress. However, during hypercyanotic spells, they will become hyperpneic, and infants will often become agitated. If cyanosis is present, it is most easily seen in the nail beds and lips. On palpation, one may appreciate a prominent right ventricular impulse and occasionally a systolic thrill. Hepatomegaly is uncommon. Peripheral pulses are usually normal, although the presence of prominent pulses may suggest the existence of a significant patent ductus arteriosus or aorticopulmonary collaterals. Cardiac auscultation  Ã‚  On auscultation, the first heart sound is normal, and the second heart sound is most commonly single because the pulmonic component is rarely audible. Third and fourth heart sounds are uncommon. An early systolic click along the left sternal border may be heard, which is thought to be due to flow into the dilated ascending aorta. (See Auscultation of heart sounds.) Murmur  Ã‚  The murmur in TOF is due primarily to the right ventricular outflow obstruction, not the VSD. The murmur is typically crescendo-decrescendo with a harsh systolic ejection quality; it is appreciated best along the left mid to upper sternal border with radiation posteriorly. It can, however, have a more regurgitant quality that can be easily mistaken for a VSD. (See Auscultation of cardiac murmurs.) The murmur is due both to the degree of obstruction and to the amount of flow across the obstruction. In TOF, unlike isolated valvar pulmonary stenosis, the amount of flow across the right ventricular outflow tract will decrease as the obstruction increases, due to the shunting of blood right-to-left across the VSD. Thus, as the obstruction increases, the murmur will become softer. During severe hypercyanotic spells, the murmur may actually disappear due to the markedly diminished flow across the obstruction.