Hypoglycaemia in a Term Infant Form Diabetic Mother

Hypoglycaemia in a Term Infant Form Diabetic Mother Hypoglycaemia in a term infant form diabetic mother ASSIGNMENT TITLE: Critically analyse the care provided to an infant from a diabetic mother and family The following assignment will discuss the care of an infant within a special care baby unit, the care provided will be critically analysed and local, national guidelines and recent research associated with the care of the infant will be discussed. In order to ensure confidentiality and in accordance with Nursing and Midwifery Council (2015) the infant being discussed will be referred as Infant B. for the purposes of this assignment the nursing framework Casey, A. (1988), will be used. Casey model includes child, family, health, environment and nurse however to personalize the care provided the main focus within this assignment will be concerning blood glucose control though, temperature control, minimized pain, maintaining a safe environment, establishing feeds, communication and family centred care will be discussed as well in relation to blood glucose control. The rationale supporting the use of Casey model is said to focus on family centred care that is redefining the relationships in health care, increasing and becoming one of the main goals on the neonatal units across the world (Staniszewska et al., 2012). Casey, A. (1988) acknowledges the vital role of the parents and family and ensures the everyday care of the child through a partnership and negotiation between parents and family and the nurse (Casey and Mobbs, 1988; Patient- and Family-Centered Care and the Pediatricians Role, 2012). This assignment is focused on the care of infant B, born at term at 41 weeks and two days gestational age within an antenatal diagnosis of maternal diabetes mellitus type I with a birth weight of 3140 grams, over two consecutive night shifts. Admitted to special care with one day of life with diagnosis of hypoglycemia one of the most frequent causes of admission in this sector (NHS Improvement, 2016). The assessment of infant B. was performed at the moment of admission on the first day after transferred from post-natal unit as per Trust policy. An adequate assessment is a crucial component of nursing practice, mandatory for planning and provision of patient and family centred care (Staniszewska et al., 2012) fundamental for their professional accountability and responsibility RCN (2014.) IDM according with UNICEF (2013) are at risk and need to be correctly identified and managed appropriately. The definition of hypoglycemia in the newborn infant has remained controversial because of a lack of significant correlation among plasma glucose concentration, clinical signs, and long-term sequelae (WRIGHT and MARINELLI, 2014; Hay, et al 2009; UNICEF, 2013) Bulbul and Uslu (2016) concluded that there has been no substantial evidence-based progress in defining what constitutes clinically important neonatal hypoglycemia, particularly regarding how it relates to brain injury. However they consider clear the definition of transient and persistent hypoglycemia and their differences (Cornblath et al.,2000). Many authors have suggested a numeric definitions of hypoglycemia that are variable in postnatal age (Cornblath and Ichord, 2000; Harris at al, 2012; Hawdon 2013; Arya at al, 2013; Stomnaroska-Damcevski, 2015; Adamkin, 2016). The value 2.6mmol/l was adopted by many clinicians and by the Trust as well, however there is no scientific justification for this value (Wright and Marinelli, 2014). On admission infant B. presented with a low blood glucose level (BGL) of 1.3mmol/L, In order to increase blood glucose level, a peripheral venous line (PVL) was inserted in right foot as per Trust policy (2012) (NICE,2015), 10% Dextrose bolus administered, started intra venous fluids of 10% Dextrose and a nasogastric tube inserted. Blood glucose level checked 30mins after (NICE, 2015), level increased to 3.1 mmol/l. IV fluids started (60ml/kg/day) (NICE, 2015; BNF, 2015) and BGL checked 1-2 hours after. Frequency was based on infant B condition (Stomnaroska-Damcevski et al, 2015). Dextrose 10% is given to restore blood glucose levels and provide calories minimizing liver glycogen depletion (BNF, 2014). Administration of a 10%Dextrose is protocoled but this value, once more, it is not consensual in literature (BNF, 2010; Arya at al 2013; Adamkin, 2016). A bolus was given first, with higher concentration that infusion, to increase quicker the values and followed by the infusion to stabilize the levels (Adamkin, 2011). The goal is to achieve a blood glucose level of 2.6 to 9mmol/L (Rennie and Kendall, 2013). Frequent Dextrose bolus are not recommended (WHO, 1997) per risk of hyperosmolar cerebral oedema. A study developed by Heagarty (2016) showed significant benefits of oral dextrose gel as an option for treatment of symptomatic hypoglycemia. Shows that is most effective, well tolerated and reduce 50% the incidence of neonatal hypoglycemia in high risk infants, but just for newborn babies in postnatal unit, not indicated for NICU admissions due to severity conditions (BNF, 2015). Hawdon et al (1994) describe a persistent effect and side-effects, and high doses can stimulate insulin release, that can be a reason why oral glucose gel it is not used in NICU. Other option is glucose water however studies (Wight and Marinelli, 2014) indicate that has insufficient energy and lack of protein. At delivery, glucose supply from mother to the infant stops, and consequently glucose concentrations decrease rapidly, until a exogenous source of glucose is available, the infant depends on his hepatic glucose production to face metabolic needs and maintain the homeostasis during the first few days (Boissieu et al. 1995; de Rooy and Hawdon, 2002). The pediatric endocrine society considers the first 48h of a health newborn infant a normal period of transitional hypoglycemia (Cornblath and Ichord, 2000; Merenstein and Gardner, 2011). Low ketones levels, inappropriate preservation of glycogen, and low glucose levels, are characteristics of this period and may activate mechanisms for brain protection (Adamkin, 2016; Standley, et al, 2016). Acute neurophysiological changes occur when human neonates are low in BGL and the long-term significance of these acute changes is not clear (Cornblath and Ichord, 2000). The presence of risks factors, as an infant from a diabetic mother (Rennie and Roberton, 2013) predisposing an infant to hypoglycemia, and increase the risk of persistent hypoglycemia (Thornton et al., 2015). Highlighting the risk factors may determine an appropriate management and a proper planning since the delivery (Lang, 2014) and according with UNICEF (2013) IDM are at risk and need to be correctly identified and managed appropriately. Based on this we can consider infant B a high risk baby to develop hypoglycemia with risk for persistent hypoglycemia. As an IDM, infant B. developed in postnatal period a hypoglycemia episode, this can be considering a transitional hypoglycemia that is caused by hyperinsulinemia (Stanley at, 2015). A study developed by Isles, Dickson and Farquhar (1968) suggests IDM removes glucose quicker than babies from a non-diabetic mother, and that comes from the ability to produce more insulin based on memory of levels experienced in utero. Hyperinsulinism is the most common cause of increased utilization of glucose, and can be temporary, for example when the fetus has been in contact with a hyperglycemic environment by poorly controlled maternal diabetes, (Rennie and Roberton, 2013). In this stage is important to screen for transient and persistent hypoglycemia, the last one with high risk to develop permanent hypoglycemia and consequently induced brain injury (Adamkin, 2011). Neonatal hypoglycemia is commonly asymptomatic but non-specific and extremely variable signs can be presented (Merenstein and Gardner, 2011). In the Trust we apply N-PASS scale to assess pain, agitation and sedation (Hummel et al, 2004) Neurological manifestation as irritability, jitteriness, lethargy, seizure and cardiorespiratory manifestations like cyanosis, pallor, apnea, irregular respirations, tachypnea and cardiac arrest can be presented. Infant B on admission had an appropriate crying not irritable, appropriate behavior, relaxed facial expression, normal tone and with vital signs in normal range. N-PASS scale was applied every three hours when vital signs evaluated, on every procedure and every time that was appropriate. Hypoglycemia cannot be defined only based on single BGL, has to contextualize with infant and mother history (Cornblath and Ichord, 2000). A study developed by Eidelman and Samueloff (2002) associate directly physiopathology of an IDM with metabolic processes including fetal hyperglycemia and fetal hyperinsulinemia, this fetal hypermetabolic state promote somatic growth, obesity, and metabolic disturbance in short and long-term consequences. Diabetic control early in pregnancy is associated with normal neurodevelopment outcome, but according with Schwartz and Teramo, (2000), blood glucose control increases their importance during the pregnancy and especially during the labor and delivery. IDM according with WHO (1997) as high risk for hypoglycemia however, Hawdon (2015) and NICE (2015) says if prenatal and intrapartum are followed by a specialist and monitored this babies should be treated in a first approach as a low risk infant, and the baby can stay with the mother after birth to monitor BGL for 24h or 12h if stable (Adamkin, 2011). IDM is not an indication to be admitted in the neonatal unit. Managing a baby asymptomatic with confirmed hypoglycemia relies on continuing breastfeeding but now more frequently (Amended, 2015), feed 1-3ml/kg (up to 5ml/kg if needed) of expressed breastmilk (EBM) or substitute nutrition (formula, donor human milk) (NICE, 2013; Hegarty, 2016). Increasing frequency will provide more colostrum for the baby, will stimulate the breast to produce more milk, its a moment to practice skin-to-skin, provides a relaxing healthy moment for both encouraging bounding (Adamkin, 2016) Infant B. developed hypoglycemia in post-natal unit and formula milk was started, to receive proper neonatal care had to be separated from mom. This fact interfered with breastfeeding, production of breast milk and bonding between mother and newborn (Sparshott, M., 1997). Mother B didn ´t have any milk production and that was a trigger for a stressful situation. Assessment of knowledge of all situation was done; emotional support was given, educated and encouraged to continuing breastfeeding, explained importance of breastmilk. Colostrum is the first milk produced by a mother, as a high concentration of nutrient and sugar and ideal to help blood glucose level to reach acceptable values (Wight and Marinelli, 2014). Breastmilk is preferred to formula for association with increase of ketones production (Hawdon et al 1992) and lower blood glucose values in term babies fed with formula, related with insulinogenic effect of protein in formula (Lucas et al, 1981). In partnership with mother B. was planned to stop formula milk when possible and all the EBM expressed was given to infant B. Encourage skin-to-skin contact and unlimited access to breast. (Wight and Marinelli, 2014) It is extensively documented in the literature (Tessier, (1998); Almeida et al., 2010; Heidarzadeh et al., 2013; Blackman, 2013) that kangaroo care provides health benefits not only for the infant but also for parents. A study performed by Heidarzadeh et al. (2013) conclude 62.5% of the mothers that provide kangaroo care to their babies were discharged from the hospital exclusively breastfeeding their babies, comparing with 37.5% of the group that didnt provide kangaroo care. Almeida et al. (2010) in a similar study concludes 82% on discharge go home exclusive breastfeeding. Blackman in 2013 performed a study where one of the subjects evaluated was blood glucose level when provided kangaroo care and results were significantly higher comparing with infants that didnt rece ived. Tessier in 1998 cit by Poppy Steering Group (2009) conclude kangaroo care reduce maternal anxiety, and increase a mothers sense of competence and sensitivity towards her infant. After birth, one of the most important changes is related with metabolism energy and thermoregulation. Infant B. is a term baby however, is a newborn and the risk of disturbance of the thermoregulation is present (Arya at al 2013). A newborn after birth, loses heat immediately by evaporation, convection, conduction and radiation, dependent on the ambient air pressure, temperature and humidity and the temperature of surrounding surfaces (Waldron and Mackinnon, 2007) The newborn has an ability to control and balance temperature, glucose and oxygen perfusion constitute the energy triangle (Aylott, 2005) Variations in this gradual transition can result in disturbances of the neonate regulation such as neonatal hypoglycemia or hyperglycemia. Infant B. had initially presented with an axilla temperature of 37.1 °C, normothermic according with World Health Organization (2006), whilst nursed in an open cot. To prevent variations in temperature infant B. was dressed with a vest and Babygro, a hat and wrapped with a shawl and a light blanket on top NHS (2015) and nursed away from draughts and windows to reduce heat loss by convection (Vilinsky and Sheridan, 2014). Furthermore, care was taken to reduce over exposure of the infant due to procedures, as minimize handling and promoting kangaroo care. World Health Organization (1997) describes kangaroo care as a method to keep babies warm and improve the experience during painful procedures as heel pricks (Johnson, 2007). In order to avoid overheat, as Trust policy, temperature was monitored every three hours by use of a tempadot placed under the axilla for 3minutes and room temperature was set at 24-26 °C. It is essential that neonates are nursed within their neutral thermal environment, defined as a temperature where a baby with normal body temperature has a minimal metabolic rate and minimal oxygen consumption (Waldron and Mackinnon, 2007). Hypothermia can lead harmful effects as hypoglycemia, respiratory distress, hypoxia, metabolic acidosis and failure to gain weight (McCall et al, 2010). During this two night shift, Infant B. was able to maintain his temperature. Detect pain in a neonate it ´s a challenge for multiple factors, a complete and efficient evaluation results in an adequate plan of interventions. As referred previously, N-PASS scale it is adopted by the Trust as a tool to assess pain in neonates. Infant B is exposed to frequent acute pain for heel pricks for evaluation of BGG and cannula in left foot. On admission pain score 0 but during the procedures pain score 1 with consolable crying, tachypneic, tachycardic and clenched Non-nutritional sucking with and without sucrose, swaddling or facilitated tucking and kangaroo care are non-pharmacological techniques adopted to minimize pain to infant B. (2016). Non-nutritional sucking demonstrates to be effective to calm and decrease, particularly mild and moderate pain experienced by the neonate and behaviour responses to pain (Liaw et al., 2010). Baby regulates and organizes himself and relief pain through sucking with no nutritional intake objective. Sucrose effect is mediated by endogenous opioid pathways activated by sweet taste (Gibbins and Stevens, 2001). Beyond non-nutritional sucking, others interventions can be applied, and most of them in partnership with family and parents. Individualised developmental care to include family, explained how to reposition the baby in a comfortable way, swaddling and nesting, and during the procedure containment holding. Encourage parents to touch the neonate and talk with him. If the procedure allowed, do kangaroo care. Minimize painful procedures and clustering, discuss with parents schedules and develop a plan with team. Manipulate the environment decreasing noise and light (Sparshott, 1997). An approach based in recognition and appreciation of parents roles, siblings and other family member allow the nurse to recognise critical steps on the care pathway (Staniszewska et al., 2012) Maximising opportunities for communication with parents/ family increasing confidence in role as a parent and supporting parents-infant relationship. Within the special care unit family-centred care is essential as is advocated by the unit in which the care was being received. During this episode infant B. was placed in a normal cot, because he is a term infant and able to maintain his temperature. This fact allowed his mother as well to be more closed, with no physical barriers. The poppy Steering group (2009) indicate through the needs of parents with an infant requiring neonatal support, the findings show that parents need to have the opportunity to get to know their babies, emotional support, involvement in care and decision making and to establish effective communication with health care staff. When mother B. was able to attend the unit she appeared worried and anxious about not being with infant B. in port-natal ward. It was clear that she saw the change to a different place as a barrier. Explained that she can stay all day and night with infant B. only in handover time, she need to leave for 30 mins, was discussed the bette r time for cares and handling the baby for procedures. Infant B. father was not in the unit during the night, went home to rest, nursing staff were the only support available to her. A study developed by the poppy steering group (2009), showed evidence that improved communication and involvement in their baby ´s care promotes positive parent-child interaction and attachment. It is important for them to have the opportunity to spend time with their baby and know them in partnership with the nurse that is responsible to provide emotional support and provide involvement in care being open to discuss decisions to be made and stablishing effective communication. Mother B. referred that the possibility to do skin-to-skin when it is appropriate for her and for her baby, helped her to cope with sensation of losing control of her baby. Create opportunities for the mom to feel participative in the care, especially during feeding time, like helping with nasogastric feeding encourage bounding and promote attachment in situations of separation between mother and infant. (Bliss, 2011) In second night shift Infant B. remains on IV fluids, intravenous infusion rate was increased to 90ml/kg/day, as per Trust policy. Infant B was able to maintain blood glucose levels between 3.1-4.2mmol/L. Following Trust guidelines supported by NICE (2015), glucose measurements are now twice a day after two consecutive measurements above 2.6mmol/L if infant B developed symptoms of hypoglycemia frequency will be increased. Stablishing breastfeeding but followed by top up ´s through nasogastric tube (2mls every 2 hours) (Wight and Marinelli, 2014) given all EBM available and formula milk to achieve amount of milk that infant B needs. Intravenous fluids as decreased as feeds increased, titrating, to meet infant B intake requirements. Infant B was tolerating well his feeds, abdominal not distended and soft, minimal milky aspirates the plan is normalizing baby, decreasing amout of fluid given by intravenous line and increase feeds hoping baby can return to post-natal unit in the next day. Screening high risk babies is other controversial intervention. A utilization of a tool to screen universally IDM after birth will allow more accurate assessments. NICE, 2013 preconize a standard approach, considering IDM healthy babies until any underling condition appears. However Stomnaroska-Damcevski et al (2015) thinks that assessment is important and. Tools like CRIBS and SNAPPE both based in specific criteria but different between should be used. BGL checked by test-strips provides a estimative value, vary 0.5-1mmol/l (Hay et al, 2009) laboratory enzymatic methods is the most accurate method, but results not quick enough for rapid diagnosis, delaying potential interventions and treatment. A Test-strips is important but must be confirmed by a laboratory testing, however the treatment shouldnt be delayed in order to wait for the values, preventing neurologic damage. (Polin, Yoder and Burg, 2001, Adamkin, 2011) All literature consensual in therapeutic through IV dextrose bolus, and IV dextrose continuing infusion, increasing to 12.5% dextrose if values not stable (NICE,2013; Stomnaroska-Damcevski et al ;2015) but when start therapeutic interventions remains not clear. Need more research about oral glucose gel, and more studies about hypoglycaemia to try to understand values of reference and what is dangerous for infant. NICE, 2013, recommends an individualized approach to management with treatment personalized to the specific disorder, taking in mind patient safety and family preferences. Ungraded best practice statement. The available studies are inconclusive and ambivalent about the subject of hypoglycaemia. Primary studies about blood glucose levels are old, and that fact can compromised the conclusion of the case study for up to date resources. Flexibility of sources becomes easy to get lost in the main questions. A case study it ´s about a particular subject and become individualized losing the relevance. However the context of the phenomenon subject of study is explored in its context with is significance and understanding (Gerrish, K. and Lacey, 2006). This subject is something that we expect to see improving and more reflexion about practice. Diversity of literature helps contextualize diferent prespective through the time. Explain to women with insulin-treated pre-existing diabetes that they are at increased risk of hypoglycaemia in the postnatal period, especially when breastfeeding, and advise them to have a meal or snack available before or during feeds. [2008] To test BGL, in the Trust, it is used Bedside glucose reagent test strips, according with Akalay et al (2001) this are inexpensive and practical but are not with significant variance from true blood glucose levels, especially at low glucose concentrations. Ho et al (2004) preformed a study with five different glucometers, concluding that alone they are not sensitive enough to do a diagnose, just for initial assessment, advising a laboratory analysis to be more accurate. Tools para haver tools tinham de diferentes para cada grupo de risco (Harris, 2012) References AACN., NANN., AWHONN., and Watson, R. (2014). Certification and Core Review for Neonatal Intensive Care Nursing. 1st ed. Elsevier Health Sciences. Adamkin, D.H. (2016) Neonatal hypoglycemia, Seminars in Fetal and Neonatal Medicine, . doi: 10.1016/j.siny.2016.08.007 Adamkin, D.H. and Polin, R.A. 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Recommendations from the Pediatric Endocrine Society for Evaluation and Management of Persistent Hypoglycemia in Neonates, Infants, and Children. The Journal of Pediatrics, 167(2), pp.238-245. Thureen, P. and Hay, W. (2006). Neonatal nutrition and metabolism. Cambridge, UK: New York. Wielandt, H, Schà ¸nemann-Rigel, H, Holst, C, Fenger-Grà ¸n, J 2015, High risk of neonatal complications in children of mothers with gestational diabetes mellitus in their first pregnancy, Danish Medical Journal, 62, 6, MEDLINE, EBSCOhost, viewed 9 October 2016.

Black Sox Trial Essay -- essays research papers

The Black Sox Trial – 1921   Ã‚  Ã‚  Ã‚  Ã‚  The Black Sox scandal was a baseball betting scheme involving a group of baseball players and gamblers which led to the Chicago White Sox intentionally losing in the 1919 World Series. As a result this scandal led to the banning of eight players from the 1919 Chicago White Sox team, Joe Jackson (better known as Shoeless Joe Jackson), Eddie Cicotte, Chick Gandil, Oscar Felsch, Fred McMullin, Swede Risberg, Buck Weaver, and Claude Williams. This event also introduced a new commissioner and strict rules prohibiting gambling in baseball.   Ã‚  Ã‚  Ã‚  Ã‚  This conspiracy was the innovation of the White Sox’s first baseman Chick Gandil and Joseph â€Å"Sport† Sullivan, who was a professional gambler among his friend circle. During the 1919 baseball season, the Chicago White Sox had proven themselves to the world that they were the best team in the baseball league and, having clinched the American League pennant, were installed as the bookmarker’s favorites to defeat the Cincinnati Reds in the Series. At the time, gambling on baseball games was widespread and there were numerous stories about rigged ball games during the regular season but they were generally ignored by the team managers and owners.   Ã‚  Ã‚  Ã‚  Ã‚  Gandil, the first baseman, recruited seven of his teammates, to instigate â€Å"the fix,† all which was motivated by the mixed feelings of the dislike of the club owner Charles Comiskey along with greed. The seven players were the starting pitchers Eddie Cicotte and Cluade â€Å"Lefty† Williams, outfielders Shoeless Joe Jackson and Oscar â€Å"Happy† Felsch, and infielders Swede Risberg, Buck Weaver, and Fred McMullin. Sullivan and his two acquaintances Bill Burns and Billy Maharg contacted a wealthy New York gambler by the name of Arnold Rothstein to supply the money for the 8 players, who were told that they would get a total of $100,000. Even before the infamous Series started on October 1st there were whispers all over amongst the gambling population that things were a little weird, and the flood of money showed the odds of Cincinnati decline rapidly. These rumors also reached the press box where a number of reporters, including Hugh Fulle rton from the Chicago Herald along with Examiner and ex-player and manager Christy Mathewson, got down to compare notes on any plays and or players... ...ear. As it turned out the 1917 win in the World Series was the last championship the Chicago White Sox ever came across; changing the American pastime history forever! This Black Sox Scandal trial was a very interesting trial I had wanted to know about for the longest time. In writing this paper I mainly referred to the site,  Ã‚  Ã‚  Ã‚  Ã‚  http://www.law.umkc.edu/faculty/projects/ftrials/blacksox/blacksox.html This site consisted of many useful links and was very informative and broke down the events leading up to the trial and gave the entire sequence of events in a brief. Furthermore, to my surprise this site provided the court documents like the confessions of Joe Jackson, which seemed to be lost for a while and then mysteriously surfaced out of the blues later on, the trial testimonies, and many more. What really helped me out was the chronology of events along with the diagram of â€Å"the fix†. It was a lot easier to follow the diagram in my opinion. Another link on the website I found quite useful was â€Å"The Eight Men Out† link. It appropriately gives the ages, positions, salaries, and comments Gandil made for the eight players which were accused of the scandal.

Mending the Transatlantic Rift Essay -- Essays Papers

Mending the Transatlantic Rift The terrorist attacks of September 11, 2001 ushered in an era of dramatic change for foreign policy and the international system. Most obviously, the United States’ sense of invulnerability eroded as an acute awareness to the perils of terrorism gripped the American public. In American foreign policy, the dominant paradigms evolved. Whereas the Cold War notion of the centrality of powerful nation-states had helped order the Bush administration’s outlook before the attacks, the new paradigms explicitly accounted for the importance of non-state actors and rogue regimes as the salient elements of American foreign policy. In emphasizing rogue states, President George W. Bush focused on regime change in Iraq and ultimately decided to invade Iraq despite the opposition of important allies and the lack of authorization from the United Nations Security Council. The war in Iraq, along with an array of diplomatic and policy differences between the United States and its Eur opean allies, ultimately produced notable divisions in the transatlantic relationship. An analysis of the events and conceptual divergences that contributed to this rift renders a portrait of U.S.-European relations in which real rather than cosmetic differences separate the two sides of the Atlantic Ocean. Nonetheless, enduring commonalities and the realities of the present geopolitical situation leave hope for improvements in the relationship. In the end, mending the transatlantic rift will require the United States to exhibit a genuine commitment to diplomacy with Europe and engagement with the world’s most pressing issues. THE RELATIONSHIP Historically, the relationship between the United States and its European allie... ...ember/October 2002. Kagan, Robert. â€Å"America’s Crisis of Legitimacy,† Foreign Affairs, March/April 2004. Mandelbaum, Michael. â€Å"The Inadequacy of American Power,† Foreign Affairs, September/October 2002. The National Security Strategy of the United States of America, September 2002. < http://www.whitehouse.gov/nsc/nss.html> Nye, Jr., Joseph S. â€Å"U.S. Power and Strategy After Iraq,† Foreign Affairs, July/August 2003. O’Hehir, Andrew. â€Å"Welcome to the New Cold War,† Salon.com, November 15, 2004. Pond, Elizabeth. â€Å"European Shock and Awe,† Washington Quarterly, Summer 2003. Project for the New American Century World Press Review. â€Å"We Are All Americans,† November 2001. < http://www.worldpress.org/1101we_are_all_americans.htm>

A Student Commentary on Big Medias Attack on Fan Websites :: Sell Websites Buy Websites

A Student Commentary on Big Media's Attack on Fan Websites The fight between legal departments at major movie and TV studios and producers of fan websites has reached a fever pitch. The legal department of Fox TV sent out notices to cease and desist to two webmasters of fan "King Of The Hill" websites. Fox Primetime has cracked down on fan sites before, most notably those saluting "The X-Files." It boggles the mind why fan sites pose such a threat to the studios. It would seem that for a fan to take the time and spend the money to build a website without any hope of financial reward would be the supreme compliment to a given show. I know of no fan site which makes money. Usually, unless the webmaster has a free account through their College or University, their Internet access and web space costs money. And if not always a money sink, sites like these are always a time sink. These fans are taking time out of their busy educational and/or work schedules to give these shows free publicity. Still photographs from movies and TV shows used for reviews and/or given away, with or without autographs, to fans has been a traditional means of promoting a studio's wares. When fans offer stills for other fans to collect on the Internet, they are conducting a type of trade which has for decades existed via the mail and in face to face memorabilia swaps. There is more controversy about audio and video clips, but the fact remains that 10% of a copyrighted work of art can be duplicated for "fair use" purposes according to the Berne Convention, the current standard of law on copyrights for most of the world. Current audio techniques for the Internet like .AU, .AIFF, and .WAV get very, very large unless the audio snippet is only a matter of seconds long. And Real Audio .RAM files and Shockwave Streaming Audio files both play as they pass by and are not stored on a person's computer. We are not talking about piracy here. We are talking about a sample that's only a few seconds long, which the people who painstakingly make the sample slave over without any hope of recompense, and which takes up frightfully large chunks of server space. This goes double for the most controversial element of fan sites -- video clips. AVI Video For Windows and QuickTime video files are extremely largely sized.

Segmentation – a Brief Analysis of Facial Creams

The creative brief c. Look at the Sepals ad ND formulate backwards the positioning. Task 4: Debriefing: Take the case of the client brief of ANT (National Authority for Tourism) and imagine that you are an account person and put all the questions that you would put to a client within a debriefing session in order to clarify yourself so that you can come up with a creative brief. Task 5: Communication channels – Identify relevant communication channels for Avoidance Passport service and define what would be the role of each one in a communication campaign aiming to increase subscription of this service.Task 1 – Sony Triton- Formulate the Position Backwards [Target/need] To mime, entertainment. _Sony_Trillion_ people that watch TV as a means of Information. Spending is the brand of TV sets competitive framework] competing designed by Sony [perceptual mostly with other brands counterclaiming TV sets, as well as with other image- sharing equipment (videophone's, recorders, computers). That best satisfies your need [brand benefit] for brightness and clarity of the portrayed image The reason why is 1 .ART crystal-clear image at an affordable price 2. ROW it is based on a technological innovation – â€Å"triton† which is used specifically for a clearer and brighter image. I en Drank contracted Is reality. Brighter, clearer image , more vivid and resembling Competition a. Formulate the positioning of top 5 players on anti-aging face cream market as you can understand it from their communication in 2008 / 2009. B. Draw up 3: Briefing: Look at the ad named Maxillae and imagine backwards the following: a.Task 2 – Anti-Aging Cream – Formulate the Position Backwards The 5 brands which I will be discussing are: ; Naive QUOI Plus – anti-aging cream, based on commence QUOI for daily or night time usage. This is an anti-aging product, used by both males(Naive Men) and women, with both day and night time editions based on the same key ingredient – commence QUOI, at an affordable price. Product Pop: contains commence QUOI ; Given Power Youth – cream designed for the first signs of aging , based on natural ingredients and for a smoother, more hydrated effect of the skin. This is a cream which most women use regularly, during day time.Consumer Pop: natural ingredients ; La Prairie Anti-Aging Complex Cellular Intervention Cream – advanced anti-aging cream, includes collagen in addition to retinal and hydroxyl acids to reduce the appearance of lines. A more luxurious product, with an estimated price of 200$/ ounce. Product Pop: collagen addition, retinal and hydroxyl acids Task 2 – Anti-Aging Cream – Formulate the Position Backwards ;Erne Laszlo Timeless Skin Age – anti-aging cream appropriate for all skin types. Minimizes under-eye disconsolation, reduces appearance of fine lines and wrinkles, eliminates cow's feet and fine dry lines in eye zone.Formulated with Marine Co llagen Complex and vitamins to reduce lines and signs of fatigue. A cream for mass- consumption. Consumer Pop: marine natural ingredients to reduce lines caused by fatigue ; Clique Anti-Gravity Firming Lift Cream – the cream lifts and firms up skin. Helps erase the looks of lines as it tightens. Renews elasticity by rebuilding natural collagen. Adds cushion into thinning skin through patent-pending technology. This is a cream witch women use mostly during night-time, at an affordable price. Product pop: contains a self-registered formula designed to create a special cushion into skin tangling Ana telling.Task 2 – Anti-Aging Cream – Naive QUOI Plus [Target/need] To modern, dynamic and always on the move women that seek a youthful and Jovial aspect in their skin tone and texture, approximately from 35-4 years old. Is the brand of skin-care, anti-wrinkles cream [perceptual competitive framework] omitting mostly with other brands counterclaiming skin _Naive QUOI Plu s _ care products (creams, serums) , as well as with other products which aim at reducing the signs of aging – natural or chemical substances, medical interventions, additional ways of achieving the same result (massage, a particular diet).

List of Poetry Group

List of poetry groups and movements From Wikipedia, the free encyclopedia Jump to: navigation, search | The examples and perspective in this article may not represent a worldwide view of the subject. Please improve this article and discuss the issue on the talk page. (November 2011) | Poetry groups and movements or schools may be self-identified by the poets that form them or defined by critics who see unifying characteristics of a body of work by more than one poet. To be a ‘school' a group of poets must share a common style or a common ethos.A commonality of form is not in itself sufficient to define a school; for example, Edward Lear, George du Maurier and Ogden Nash do not form a school simply because they all wrote limericks. There are many different ‘schools' of poetry. Some of them are described below in approximate chronological sequence. The subheadings indicate broadly the century in which a style arose. Contents * 1 Prehistoric * 2 Sixteenth century * 3 Sevente enth century * 4 Eighteenth century * 5 Nineteenth century * 6 Twentieth century * 7 Alphabetic list * 8 References| PrehistoricThe Oral tradition is too broad to be a strict school but it is a useful grouping of works whose origins either predate writing, or belong to cultures without writing. Sixteenth century The Castalian Band. Seventeenth century The Metaphysical poets The Cavalier poets The Danrin school Eighteenth century Classical poetry echoes the forms and values of classical antiquity. Favouring formal, restrained forms, it has recurred in various Neoclassical schools since the eighteenth century Augustan poets such as Alexander Pope.The most recent resurgence of Neoclassicism is religious and politically reactionary work of the likes of T. S. Eliot. Romanticism started in late 18th century Western Europe. Wordsworth's and Coleridge's 1798 publication of Lyrical Ballads is considered by some as the first important publication in the movement. Romanticism stressed strong e motion, imagination, freedom within or even from classical notions of form in art, and the rejection of established social conventions. It stressed the importance of â€Å"nature† in language and celebrated the achievements of those perceived as heroic individuals and artists.Romantic poets include William Blake, William Wordsworth, Samuel Taylor Coleridge, Lord Byron, Percy Bysshe Shelley, and John Keats (those previous six sometimes referred to as the Big Six, or the Big Five without Blake); other Romantic poets include James Macpherson,Robert Southey, and Emily Bronte. Nineteenth century Pastoralism was originally a Hellenistic form, that romanticized rural subjects to the point of unreality. Later pastoral poets, such as Edmund Spenser, Christopher Marlowe, and William Wordsworth, were inspired by the classical pastoral poets.The Parnassians were a group of late 19th-century French poets, named after their journal, the Parnasse contemporain. They included Charles Leconte de Lisle, Theodore de Banville, Sully-Prudhomme, Paul Verlaine, Francois Coppee, and Jose Maria de Heredia. In reaction to the looser forms of romantic poetry, they strove for exact and faultless workmanship, selecting exotic and classical subjects, which they treated with rigidity of form and emotional detachment. Symbolism started in the late nineteenth century in France and Belgium.It included Paul Verlaine, Tristan Corbiere, Arthur Rimbaud, and Stephane Mallarme. Symbolists believed that art should aim to capture more absolute truths which could be accessed only by indirect methods. They used extensive metaphor, endowing particular images or objects with symbolic meaning. They were hostile to â€Å"plain meanings, declamations, false sentimentality and matter-of-fact description†. Modernist poetry is a broad term for poetry written between 1890 and 1970 in the tradition of Modernism. Schools within it include Imagism and the British Poetry Revival.The Fireside Poets (also known as the Schoolroom or Household Poets) were a group of 19th-century American poets from New England. The group is usually described as comprising Henry Wadsworth Longfellow, William Cullen Bryant, John Greenleaf Whittier, James Russell Lowell, and Oliver Wendell Holmes, Sr.. Twentieth century The Imagists were (predominantly young) poets working in England and America in the early 20th century, including F. S. Flint, T. E. Hulme, and Hilda Doolittle (known primarily by her initials, H. D. ).They rejected Romantic and Victorian conventions, favoring precise imagery and clear, non-elevated language. Ezra Pound formulated and promoted many precepts and ideas of Imagism. His â€Å"In a Station of the Metro† (Roberts & Jacobs, 717), written in 1916, is often used as an example of Imagist poetry: The apparition of these faces in the crowd; Petals on a wet, black bough. The Objectivists were a loose-knit group of second-generation Modernists from the 1930s. They include Louis Zukofsky, Lorine Niedecker, Charles Reznikoff, George Oppen, Carl Rakosi, and Basil Bunting.Objectivists treated the poem as an object; they emphasised sincerity, intelligence, and the clarity of the poet's vision. The Harlem Renaissance was a cultural movement in the 1920s involving many African-American writers from the New York Neighbourhood of Harlem. The Beat generation poets met in New York in the 1940s. The core group were Jack Kerouac, Allen Ginsberg, and William S. Burroughs, who were joined later by Gregory Corso. The Confessionalists were American poets that emerged in the 1950s. They drew on personal history for their artistic inspiration.Poets in this group include Sylvia Plath, Anne Sexton, John Berryman, and Robert Lowell. The New York School was an informal group of poets active in 1950s New York City whose work was said to be a reaction to the Confessionalists. Some major figures include John Ashbery, Frank O'Hara, James Schuyler, Kenneth Koch, Barbara Guest, Joe Br ainard, Ron Padgett, Ted Berrigan and Bill Berkson. The Black Mountain poets (also known as the Projectivists) were a group of mid 20th century postmodern poets associated with Black Mountain College in the United States.The San Francisco Renaissance was initiated by Kenneth Rexroth and Madeline Gleason in Berkeley in the late 1940s. It included Robert Duncan, Jack Spicer, and Robin Blaser. They were consciously experimental and had close links to the Black Mountain and Beat poets. The Movement was a group of English writers including Kingsley Amis, Philip Larkin, Donald Alfred Davie, D. J. Enright, John Wain, Elizabeth Jennings and Robert Conquest. Their tone is anti-romantic and rational. The connection between the poets was described as â€Å"little more than a negative determination to avoid bad principles. The British Poetry Revival was a loose movement during the 1960s and 1970s. It was a Modernist reaction to the conservative Movement. The Hungry generation was a group of ab out 40 poets in West Bengal, India during 1961–1965 who revolted against the colonial canons in Bengali poetry and wanted to go back to their roots. The movement was spearheaded by Shakti Chattopadhyay, Malay Roy Choudhury, Samir Roychoudhury, and Subimal Basak. The Martian poets were English poets of the 1970s and early 1980s, including Craig Raine and Christopher Reid.Through the heavy use of curious, exotic, and humorous metaphors, Martian poetry aimed to break the grip of â€Å"the familiar† in English poetry, by describing ordinary things as if through the eyes of a Martian. The Language poets were avant garde poets from the last quarter of the 20th century. Their approach started with the modernist emphasis on method. They were reacting to the poetry of the Black Mountain and Beat poets. The poets included: Leslie Scalapino, Bruce Andrews, Charles Bernstein, Ron Silliman, Barrett Watten, Lyn Hejinian, Bob Perelman, Rae Armantrout, Carla Harryman, Clark Coolidge, Hannah Weiner, Susan Howe, and Tina Darragh.The New Formalism is a late-twentieth and early twenty-first century movement in American poetry that promotes a return to metrical and rhymed verse. Rather than looking to the Confessionalists, they look to Robert Frost, Richard Wilbur, James Merrill, Anthony Hecht, and Donald Justice for poetic influence. These poets are associated with the West Chester University Poetry Conference, and with literary journals like The New Criterion and The Hudson Review. Associated poets include Dana Gioia, Timothy Steele, Mark Jarman, Rachel Hadas, R. S.Gwynn, Charles Martin, Phillis Levin, Kay Ryan, Brad Leithauser. Alphabetic list This is a list of poetry groups and movements. * Absurdism * Aestheticism * Black Arts Movement * Cairo poets * Chhayavaad * Classical Chinese poetry * Crescent Moon Society * Cyclic Poets * Dadaism * Danrin school * Deep image * Della Cruscans * Dymock poets * Fugitives (poets) * Generation of '27| * Georgian poets * Goliar d * Graveyard poets * The Group (literature) * Harlem Renaissance * Harvard Aesthetes * Heptanese School (literature) * LakePoets * La Pleiade * Los Contemporaneos * Misty Poets * Modern Chinese poetry * Negritude * Net-poetry * New Apocalyptics| * Nijo poetic school * Others (art group) * Oulipo * Poetic transrealism * Rhymers' Club * Rochester Poets * Scottish Renaissance * Sicilian School * Poetry Slam * Sons of Ben * Southern Agrarians * Spasmodic poets * Spectrism * Surrealist poets * The poets of Elan * Uranian poetry| References This article does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (May 2010) | [hide] * v * t * eSchools of poetry| | | Akhmatova's Orphans * Auden Group * The Beats * Black Arts Movement * Black Mountain poets * British Poetry Revival * Cairo poets * Castalian Band * Cavalier poets * Chhayavaad * Churchyard poets * Confessionalists * Creoli te * Cyclic poets * Dadaism * Deep image * Della Cruscans * Dolce Stil Novo * Dymock poets * Ecopoetry * The poets of Elan * Flarf * Fugitives * Garip * Gay Saber * Generation of '98 * Generation of '27 * Georgian poets * Goliard * The Group * Harlem Renaissance * Harvard Aesthetes * Hungry generation * Imagism * Informationist poetry * Jindyworobak * Lake Poets * Language poets * Martian poetry * Metaphysical poets * Misty Poets * Modernist poetry * The Movement * Negritude * New American Poetry * New Apocalyptics * New Formalism * New York School * Objectivists * Others group of artists * Parnassian poets * La Pleiade * Rhymers' Club * San Francisco Renaissance * Scottish Renaissance * Sicilian School * Sons of Ben * Southern Agrarians * Spasmodic poets * Sung poetry * Surrealism * Symbolism * Uranian poetry| | Categories: * Poetry movements Navigation menu * Create account * Log in * Article * Talk * Read * Edit * View history ——————†”————————— Top of Form Bottom of Form * Main page * Contents * Featured content * Current events * Random article * Donate to Wikipedia Interaction * Help * About Wikipedia * Community portal * Recent changes * Contact Wikipedia Toolbox Print/export Languages * Deutsch * Edit links * This page was last modified on 21 February 2013 at 05:54. * Text is available under the Creative Commons Attribution-ShareAlike License; additional terms may apply. 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The success of A Tale of Two Cities

The art of historical fiction requires from its creator the scrupulosity of selection. This relates to the selection of theme, characters and their roles, pace of narration and time sequence supported by the language embodied into certain literary devices to make a story unique and popular through centuries. This requirement is perfectly achieved by Charles Dickens in his novel A Tale of Two Cities.The success of A Tale of Two Cities can be attributed to Dickens's artful setting of a touching human story against the background of the world-shaking events of the French Revolution, and to the themes related with these events. Among these themes, one of the most important is the theme of sacrifice, as the way to self-fulfillment.An accompanying are the themes of retribution and human loyalty – kind and sympathetic in the case of the Manettes, father and daughter, and Miss Pross; appalling though understandable in the case of Madame Defarge, who can never forget what the Evrà ©mo ndes did to her family. Another theme is the resemblances and parallels Dickens wants us to see between London and Paris. The two cities represent opposed mindsets that are personified by contrasting female characters.Dickens refers first to the London carts and coaches, in which â€Å"pale travellers set out continually on a violent passage into the other world† from the criminal court and prison of Old Bailey (Dickens, ii 2). Later, before he depicts the mob in Paris, he gives us a London crowd, which â€Å"in those times stopped at nothing, and was a monster much dreade† (Dickens, ii 14).Dickens’s most memorable characters tend to be the eccentrics, the droll fellows. In A Tale of Two Cities there are few of these: Miss Pross and Jerry Cruncher are the two most notable. As a contrast to them there is the pushing Stryver; he is not really entertaining.The rest of Dickens’s characters do not hold much of the reader's interest. Thus, Sydney Carton, Charle s Darnay, Lucie Manette, the good Doctor Manette, and Jarvis Lorry all seem relatively normal people, who in other circumstances would not be very interesting.The same might even be true of the Defarges, husband and wife. Had they not had a revolution to fight, their lives might have been routine, and not worth investigating. But in this novel, the driving force is an impersonal one. Its impact on character is felt most strongly when we consider the two principal antagonists: Sydney Carton and Madame Defarge.Sydney Carton is a case of a spoiled man who has somehow lost his nerve and his self-respect and bitterly knows it. He gets the chance to do a noble thing and, in doing it, redeems his wasted life. But, had there been no such opportunity, we must suspect that he would have gone on in his downward track, drinking more and enjoying it less, and at some point being cast off by the now affluent Stryver – the man who has used him to his own great benefit – when he needs him no longer.