Organic Food Industry Analysis Essay

The organic products industry has shown consistent growth over the last 25 years, growing 3,400% (Flynn, 2014). The organic industry earned $35 billion in 2014 up from $1 billion in 1990 (Flynn, 2014). Credited with being the primary market force drivers, food safety and health concerns have been driving the industry since the end of the 2009 recession. This research paper examines the organic products industry and identifies how supply and demand affects future prices of organic products. ORGANIC INDUSTRY ANALYSIS 3 Organic Industry Analysis This paper provides a succinct market analysis of the organic food and product industry. The paper provides background and description of the organic product market. The paper examines U. S. and global market trends of the organic food and product industry by examining demand and supply for organic products. This paper identifies key box store retailers and describes their roles in driving the organic food industry. Analyzing various studies from the USDA and its Economic Research Section (ERS) identified the driving market forces behind the popularity of the organic foods and products, which are the improvement of health and reduction of pesticides from individual diets. The purpose of this paper is to identify market trends and the driving forces behind the global organic food and product market. The driving forces behind the organic food market are health conscious millennials and new mothers who want to reduce chemicals from their diet. Background and Description The term organic has been the topic of controversy for academics and business leaders since the 1940s. The controversy involves several sub-topics such as lack of international standards for organics, cross contamination of organic products during transport, genetically modified organisms (GMO), chemicals and pesticides, and costs to produce organic goods. The definition of organic is: made or grown without the use of artificial chemicals (Organic, 2015). The premise of organic food is not new; however, the creation of national standards has objectively standardized what may be considered an organic product. As the global population grows, the demand for food has caused farmers to increase efficacy and reduce crop waste; however, the methodology utilized to preserve crops may be more of a detriment to human health resulting in the higher demand for uncontaminated food sources and products. ORGANIC INDUSTRY ANALYSIS 4 Demand The organic food market was supply driven for many years; however, demand now drives the organic market (Dimitri & Oberholtzer, 2009, p. 10). The demand for organic products is increasing every year as people use marginal analysis to justify the higher expense for organic products: Do the benefits out weight the costs? Consumer mistrust in conventional food producers, who add harmful dyes, trans-fats, and high fructose corn syrups to products, is another variable driving the organics market. Environmentalists are also another market force mechanism contributing to the demand for organic products because organic farming reduces environmental pollution. The emergence of organic food is directly linked to an amalgam of food safety and health concerns, which directly relate to ingestion of chemicals used to grow, treat, and preserve foods. The organic food industry has shown consistent global growth over the last two decades and is projected to continue to grow until 2018 (Research and markets adds report: ‘United States organic food market report 2013-2018, 2014). The organic food market has grown 3,400 % in the last 25 years (Flynn, 2014). Organics are divided into several categories such as, fruits and vegetables, dairy, meat, and packaged organic products. In 2014 annual organic food sales, mainly fruits and vegetables, reached $35 billion, $290 billion if packaged products are included, up from $1 billion in 1990s (Flynn, 2014). The United States and Europe have the highest demand for organic products compared to other nations (Lohr, n. d. p. 68). Identifying potential organic product consumers is a challenge, but some market research has shown consumers who choose to purchase organic products are generally well educated, millennials, higher income families, and households with children (Dimitri & Oberholtzer, 2009, ORGANIC INDUSTRY ANALYSIS 5 p. 4-5). The United States consumes approximately 44% of the global organics market followed by Europe at 41% (Aggarwal, 2014 p. 3). The remaining countries that contribute to the consumption and export of organic foods may have difficulty in exporting goods due to individual national standards and export acts (Aggarwal, 2014 p. 3). Demand for organic products is not central to one part of the world; many countries and cultures realize the importance of consuming foods free of harmful chemicals. Supply Demand has grown for organic products; however, there is a shortage of organic farming land, which may negatively impact supply. The organic industry is constrained by its supply chain; there are only so many farms to produce organic goods and organic goods can only be shipped so far. According to the 2012 U. S. Census of Agriculture, there are now around 17,000 organic farms in the U. S. out of an estimated 2. 1 million total farms; acreage used for organic agriculture accounts for just 0. 6 percent of all U. S. farmland, while organic food sales make up over 4 percent of the total annual food sales. (Young, 2014) The organic farm shortage is an important variable to the organic industry because consumers who tend to purchase organic products generally want to support local farmers in a grass roots type of movement; excluding climate specific food such as, bananas, coffee, limes, and pineapples (Greene, 2013). Contributing to the supply shortage in the United States are strict national standards set in place by the USDA and strict requirements for potential farmers looking to transition into the organic industry. Also contributing to the shortage in organic food and ORGANIC INDUSTRY ANALYSIS 6 products are large box retail stores, such as Whole Food Markets, Wal-Mart, Tesco, and Target. Wal-Mart is the United States’ largest grocer and is competing for organic goods to remain competitive against its competitors, such as Target, which has made agreements with organic producers to supply products for its stores (Hopkinson, 2014). Partnering with organic companies, large retail box stores have created their own brands of organic products to reduce costs associated with providing customers a wide range of product choice. Price Changes Due to Supply and Demand: Historically, organic food is more expensive than conventional food (Dimitri & Oberholtzer, 2009, p. 5). Organic food prices come with a premium due to costs involved in growing and harvesting crops. Prices are set through the suppliers because the organic standards restrict the certification of potential farmers. The certification process slows down potential farmers entering the industry, which reduces the number of producers available to farm the produce and make products. The reduction in organic products available reduces supply and increases demand. Market shelf placements of organic foods are fetching premiums and farmers are realizing the advantages of entering the market. As demand rises for organic products, the current producers are not able to sustain sufficient crop production compared to industry growth. In any competitive market, when demand rises so does opportunity. Due to the premium prices associated with producing products in the organic industry, many farmers may potentially conform to industry standards and convert their farms. The potential for commercial organic farms may also increase due to the undeniable growth of the industry. As more competition enters the organic industry, prices will drop. Large retail box stores, such as Whole Food Markets, Wal-Mart, Tesco, and Target may also have a significant effect on the price of organic ORGANIC INDUSTRY ANALYSIS 7 foods and products. Wal-Mart’s expansion into the organic market has the capability to reduce organic food prices alone due to the numbers of stores across the nation. In conclusion, the undeniable growth in the organic industry is a product of consumer mistrust of conventional growers, mainly due to toxic chemicals used in the production of food. The growth of the organic food industry is directly related to food safety and health conscious consumers who do not mind spending more money to consume uncontaminated products. Consumer demand has been the driving force of much of the organic industry since the end of the recession in 2009. The high consumer demand for organic food is part of an initiative from well-educated people, millennials, higher income families, and households with children, resulting in a 3,400% in the last 25 years creating a $35 billion industry (Flynn, 2014). With the high demand for organic goods, suppliers are unable to maintain sustainable level operations due to lack of organic farmland. Many of the problems associated with the organic food industry are centered on strict certifications that are necessary to maintain product integrity; the stringent certifications are creating supply shortages. The strict organic standards hinder potential farmers from entering into the organic industry. For example, farmers must be pesticide free for at least three years before being certified to produce organic food. Large retail box stores are recognizing the growth of the organic food industry and are currently adding more products annually, but even so, demand exceeds supplies. As the organic food industry continues to grow, prices for organic goods should reduce due to the increased competition in the market. ORGANIC INDUSTRY ANALYSIS 8. References Aggarwal, P. (2014). Supply chain management of locally grown organic food: A leap toward sustainable development. Retrieved from http://www. cognizant. com/InsightsWhitepapers/Supply-Chain-Management-of-Locally- grown-Organic-Food-A-Leap-Toward-Sustainable-Development-codex928. pd Dimitri, C. , & Oberholtzer, L. (2009). Marketing U. S. organic foods recent trends from farms to consumers. USDA, Economic Research Service, (58). Retrieved from http://www. ers. usda.gov/media/185272/eib58_1_. pdf Flynn, D. (2014). Report: Organic industry achieved 25 years of fast growth through fear and deception, Food Safety News. Retrieved from, http://www. foodsafetynews. com/2014/04/report-fast-growing-organics-industry-is- intentionally-deceptive/#. VL0ILWd0xjo Greene, C. (2013). Growth patterns in the U. S. organic industry. Retrieved from http://search. proquest. com/docview/1518534011? accountid=35796 Hopkinson, J. (2014). Will Wal-Mart gobble up organic food supply? Retrieved from http://www. politico. com/story/2014/04/walmart-organic-food-105631. html Lohr, L. (n.d. ). Factors affecting international demand and trade in organic food products. USDA, Economic Research Service. Retrieved from http://www. ers. usda. gov/media/293617/wrs011j_1_. pdf ORGANIC INDUSTRY ANALYSIS 9 Organic. (2015). In Merriam-Webster. com. Retrieved from http://www. merriam-webster. com/dictionary/organic Research and markets adds report: ‘United States organic food market report 2013-2018’. (2014). Manufacturing Close – Up, Retrieved from http://search. proquest. com/docview/1498350288? accountid=35796 Young, T. (2014). Organic check-off. Retrieved from https://ota. com/organic-check.

Foundation Certification †My Short Notes Essay

A team or group of people and the tools they use to carry out one or more processes or activities. Functions provide units of organization responsible for specific outcomes. Functions are logically isolated from each other. Definition – Process A set of coordinated activities combining and implementing resources and capabilities in order to produce an outcome and provide value to customers or stakeholders. Process has following attributes. Trigger, Activity, Dependency & Sequence Process should be measurable Process should produce specific output Process should meet customer expectation Definition – Process Owner The person/role responsible for ensuring that the process is fit for the desired purpose and is accountable for the outputs of that process. Definition – Service Owner The person/role accountable for the delivery of a specific IT Service. They are responsible for continual improvement and management of change affecting services under their care. The service owner is a primary stakeholder in all of the underlying IT processes that enable or support the service they own. Definition – Service A means of delivering value to customers by facilitating outcomes customers want to achieve without the ownership of specific costs or risks. Definition – RACI Model R – Responsibility (at least 1R per activity who is doing the actual work) A – Accountability (1 A per activity) C – Consult I – Inform Service Strategy The purpose is to define the perspective, position, plans, and patterns that a service provider needs to be able to execute to meet an organization’s business outcomes * Perspective – Defines the organization’s view of itself, generally communicated through the organization’s vision and direction. * Positions – Defines the distinctiveness of the organization in comparison to its competitive market and as identified through the minds of its customers. * Plans – The predefined details for supporting and enhancing the organization’s perspective and positions, usually identifying a potential future state for the organization and a strategic response to the state and level of investment required. * Patterns – Defines the conditions and actions that must be consistently in place and repeatable to achieve the objectives of the organization; patterns allow the organization to predict the future. Service strategy defines the role of serv ices and service provider in achieving the business objectives of the organization through management of IT. Value to Customer To enable a service provider to create value for a customer, a systematic approach has to be adopted. For ITIL, this approach is determining service utility and service warranty. Service Warranty (Fit for use) + Service Utility (Fit for propose) = Service Value Service utility and service warranty are present for every service provided to a customer. One cannot exist without the other. By describing both Service Utility and Service Warranty, it enables the provider to clearly establish the value of the service, differentiate themselves from the competition, and, when necessary, attach a meaningful price tag that has relevance to the customer and associated market space. Service Package = Enabling Services + Core Services + Enhancing Services Definition – Service Asset A Service Asset is any resource or capability used in the provision of services Definition – Business Case The business case is a detailed analysis of the benefits and impact of the business action in meeting the business objective and disrupting the delivery of other IT services. Attributes Introduction, Methods & Assumptions, Business Impact, Risk Service Strategy Processes Demand Management & Strategy Management for IT Services are out of scope for ITIL Foundation exam. 1. Financial Management * Responsible for securing the necessary fund to provide the service to the customer. * Maintain balance between cost of service and quality of the service * Maintain balance between supply and demand * Activities * Budgeting * IT Accounting * Chargeback * Service Valuation * Outputs * Service Valuation * Service Investment Analysis * Compliance (Align with rules & regulations) * Cost optimization * Support for BIA 2. Service Portfolio Management * Track services throughout whole service lifecycle * Link services to their business objectives/value * Ensure all other management processes are working to get expected business outcomes * Includes Service Pipeline, Service Catalog & Retired Service Catalog * Content : Description, Requirements/Business Cases, Value, Options, Price, Risk, Priority Investment Categories and Budget Allocations Phases/Activities of service portfolio management 3. Business Relationship Management * Maintain relationship between customer and service provider and understand customer needs * Ensure high level of customer satisfaction * Understand service packages and service level packages Service Design Benefits of Service Design * Reduction in total cost of ownership (TCO) * Improved quality of service * Improved consistency of service * Easier implementation of new or changed services * Improved service alignment * Improved service performance * Improved IT governance * Improved effectiveness of service management and IT processes * Improved information and decision-making * Improved alignment with customer values and strategies The Four Perspectives (Attributes) of ITSM * Partners/Suppliers * People * Product/Technology * Processes Major Aspects of Service Design * Service solutions for new or changed services * The management information systems and tools, especially the service portfolio * The technology architectures and management architectures * The processes required * The measurement methods and metrics Service Design Package (SDP) The contents of the service design package comprise four major sections with several smaller, but equally important, sub-sections. The four major sections are: †¢ Requirements †¢ Service Design †¢ Organizational readiness assessment †¢ Service Lifecycle Plan Service Design Processes 1. Design Coordination * Single point of coordination and control for all activities & processes in Service Design stage * Individual organizations decide whether they need Design Coordination process or not. Only major changes will require this process * Activities 2. Service Level Management * Focus on Service Warranty (performance, availability, and security) * The establishment, monitoring, and improvements in service levels and their achievement * Communication to Customers & Business managers on Service Levels. Will not conflict with Business Relationship Management process since this will only focus on Service Warranty * Manage, Negotiate & Document SLR & SLA * Develop & Review OLA * Review UC for ensure they are align with SLA * Influence improvement within SIP * Monitor service performance against SLA * Three types of SLA structures. Service Based, Customer Based & Multi Level/Hierarchical (Corporate, Customer & Service based agreements) 3. Supplier Management * UC (Underpinning Contracts) SCMIS (Suppliers & Contracts Management Information System) * Activities * Definition of new supplier and contract requirements * Evaluation of new suppliers and contracts * Supplier and contract categorization and maintenance of the * SCMIS * Establishment of new suppliers and contracts * Supplier, contract, and performance management * Contract renewal or termination * Supplier Categorization * Supplier Management process activities are span across all states except Service Strategy 4. Service Catalog Management * Include live service are services available for deployment (Customer-facing service and supportive services) * Service Catalog is a large part of the Service Portfolio. However, while the portfolio is focused on tracking the business requirements and the investments on a service, the Service Catalog is focused on the service solution and its delivery to the business * Service Catalog includes Business Service Catalog & Technical Service Catalog * Top – Down approach is used when defining service catalog. (Business -> Technical) 5. Capacity Management * Maintain balance between Resources/Capabilities Vs Demand * Business Capacity Management & Service Capacity Management * Sub-Process of capacity management * Business * Service * Components * Activities * Performance Monitoring * Demand Management – Short term reactive activity * Application Sizing – New or Changed service * Modeling – Predict future behaviors * Tuning * Capacity Planning * Capacity Management Information System 6. Availability Management * Ensure that the level of availability delivered to all IT services matches the agreed need for availability or defined service level targets * Includes Reactive Activities (Monitoring, Incidents) & Proactive Activities (Planning, Design) * Measurements * Mean Time Between Failures (MTBF) or Uptime * Mean Time to Restore Service (MTRS) or Downtime * Mean Time Between System Incidents (MTBSI) 7. IT Service Continuity Management * Known as disaster recover planning * Produce and maintain IT Service Continuity plan to support Business Continuity Plan * Business Impact Analysis (Quantify the loss) Risk Assessment (Identify possible failure points) are considered when implementing strategy * Ongoing activities to make people aware about the recovery plan. Trainings, Reviews 8. Information Security Management * Information security is a critical part of the warranty of a service * Ensuring that the agreed business needs regarding the confidentiality, integrity, and availability of the organization’s assets information, data, and IT services are matched * Develop and maintain information security policy align with business security requirements * Security test schedules and plans. * Information Security Management Perspectives * Organizational * Procedural * Physical * Technical * Framework for Managing Information Security * Plan * Implement * Control * Evaluate * Maintain Service Transition Service Transition Processes 1. Transition Planning and Support * Ensure proper attention is given to the overall planning for service transitions and to coordinate the resources required to implement the new or changed service * Provide clear and comprehensive plans that enable customer and business change projects to align their activities with the service transition plans * The scope of transition planning and support concentrates on the resources, schedules, and budgets required to move the IT service * To standardize methods and procedures used for efficient and prompt handling of all changes * A transition strategy will be constructed to define how all transitions will be managed within the organization based on the type and size of transitions expected in the environment 2. Knowledge Management * Maintain a Service Knowledge Management System (SKMS) that provides controlled access to knowledge, information, and data that is appropriate for each audience * DIKW Data-Information-Knowledge-Wisdom structure * Database to capture Data, Information and Knowledge but not Wisdom * Components of SKMS 3. Service Asset and Configuration Management * Ensure that assets under the control of the IT organization are identified, controlled, and properly cared for throughout their lifecycle * Identify, control, record, report, audit, and verify services and other configuration items (CIs), including versions, baselines, constituent components, their attributes, and relationships * Manage complete life cycle of CI * Activities * Planning – Strategy, Policy, Objectives, CMDB Design * Identification – What CI to be recorded & their relationships * Control * Status Accounting * Verification & Audit 4. Change Management * Ensure that all changes to configuration items are recorded in the configuration management system * Optimize overall business risk. It is often correct to minimize business risk, but sometimes it is appropriate to knowingly accept a risk because of the potential benefit. * Types of changes * Normal Changes – Need to go through all steps of change management process * Standard Changes – Pre approved changes. Should be possible via service request. No need of RFC * Emergency Change * Steps * The RFC is logged. * An initial review is performed (to filter RFCs). * The RFCs are assessed and may require involvement of CAB or ECAB. * Authorization of change builds and test by the Change Manager * Coordination of the build and test, e.g., work orders are issued for the * Build of the change (carried out by other groups) * Change Management authorizes deployment. * Change Management coordinates the deployment (with multiple checkpoints). * The change is reviewed (Post Implementation Review). * The change is closed. 5. Release and Deployment Management * Planning, scheduling, and controlling practices applied to the build, test, and deployment of releases * Define and agree Release and Deployment Management plans with customers and stakeholders * Four phases of release deployment management * Release & Deployment Planning * Release Build & Test * Deployment * Review & Close Service Operation Responsible for the ongoing management of the technology that is used to deliver and support the services. Service Operation accepts the new, modified, retiring, or retired services from Service Transition, once the test and acceptance criteria have been met. Functions Unique to Service Operations is the introduction of functions. While a defined function does have responsibilities in all stages of the Service Lifecycle, the majority of activities they performed are completed within the scope of Service operations. 1. Service Desk * Single point of contact between the services being provided and the users. A typical Service Desk will manage incidents and service requests as well as communication with the users. Thus, the Service Desk staff will execute the Incident Management and Request Fulfillment processes with the intent to restore normal-state service operation to users as quickly as possible * Minimize service outage day to day basis * Make sure that agreed services only provide to those who authorized * Structures * Local * Central * Virtual * Follow the Sun * Activities * Logging all request, prioritization, categorization and first level of investigation * Keep user informed about incident & outage * Customer satisfaction survey 2. Technical Management * Custodian of technical knowledge and expertise related to managing the IT Infrastructure. It provides detailed technical skills and resources needed to support the ongoing operation of the IT Infrastructure. * Plays an important role in providing the actual resources to support the IT Service Management lifecycle. It ensures that resources are effectively trained and deployed to design, build, and transition, operate, and improve the technology to deliver and support IT Services. 3. IT Operations Management * Ongoing management and maintenance of an organization’s IT infrastructure. IT operations is the set of activities used in the day-to-day running of the IT infrastructure to deliver IT services at agreed levels to meet stated business objectives.IT Operation Control * IT Operation Control * Job Scheduling, Backup, Restore and Monitoring * Facilities Management * Data Centers, Recovery Sites, Computer Rooms 4. Application Management * Application Management covers the entire ongoing lifecycle of an application, including requirements, design, build, deploy, operate, and optimize. Service Operation Processes 1. Event Management * Detecting Event, Understanding Event, Determining Appropriate Control Action * Three Types of events * Informational * Warning * Exception * Populate SKMS with event information and history 2. Incident Management * An unplanned interruption to an IT service or reduction in the quality of an IT service, or a failure of a CI that has not yet impacted an IT service * The purpose of Incident Management is not to prevent an incident, but to reduce its impact by restoring normal service operation as quickly as possible * Ensure that standardized methods and procedures are used for efficient and prompt response, analysis, documentation, ongoing management, and reporting of incidents * Incident Models – Steps and procedures that should be used to manage previously seen and documented incidents * Steps * Order of Steps * Responsibilities – Who should do what * Time scale/Threshold * Escalation Procedures * Any necessary evidence/prevention actions * Activities * Identification * Logging – All incidents regardless of source of that incident * Categorization * Prioritization * Impact + Urgency = Priority * Initial Diagnosis * Escalation * Functional * Hierarchical * Investigation and Diagnosis * Resolution * Closure 3. Problem Management * Concentrate on diagnosing the root cause of incidents and on determining the resolution to those problems. * Defines a problem as the underlying cause of one or more incidents 4. Request Fulfillment * Form of changes that are small in nature, low risk, and low cost in its execution, and are frequently performed * Activities * Menu Selection * Financial Approval – Optional * Other Approval – Optional * Fulfillment * Closure 5. Access Management * Effectively execute the policies in Information Security Management, enabling the organization to manage the confidentiality, availability, and integrity of the organization’s data and intellectual property. Continual Service Improvements * CSI is always seeking ways to improve service effectiveness, process effectiveness, and cost effectiveness * Review, analyze, prioritize, and make recommendations on improvement opportunities in each lifecycle stage * Periodically conducting internal audits verifying employee and process compliance * Periodically conducting customer satisfaction surveys * Continual Service Improvement Approach * CSI Register * Part of SKMS. And keep track of all improvements opportunities. * Anyone should be able to access and submit improvement points to CSI Register * IT Governance has three main areas * Enterprise, Corporate, IT Governance * Types of Metrics * Technology – Performance, Availability * Process – KPI, * Service * Tension Metrics : Resources, Features, Time Schedule The Deming Cycle * Plan: Design or revise business process components to improve results * Do: Implement the plan and measure its performance * Check: Assess the measurements and report the results to decision makers * Act: Decide on changes needed to improve the process Seven Steps Improvement Process 1. Identify Strategy for Improvements 2. Define What You Will Measure 3. Gather Data 4. Process Data 5. Analyze the information & data 6. Present and use the information 7. Implement Improvement

Research Investigation: commedia dell’arte masks Essay

According to italian theatre historians, such as Roberto Tessari, Ferdinando Taviani, and Luciano Pinto, Commedia dell’arte, which literally translated as improvised comedy, developed as a response to the political and economic crisis of the 16th century in Italy and, as a consequence, became the first entirely professional form of theatre [1]. It is believed that the use of mask in commedia dell’atre originated in 1570 with Andrea Calmo, the actor and author who was inspired by the venetian carnivals of the time. She created Pantaloon who is the one of the most famous characters of commedia dell’arte today. She went on to create the spanish captain ‘Il Capitano’. Although her characters were initially unmasked, Andrea wished that the spirit of the Italian carnival ( which celebrates the epiphany [2] ) would be represented in her plays and therefore she introduced the masks and thus created the commedia dell’arte that we know today. [3] The carnival of venice. [1] Records of commedia dell’arte performances date back as early as 1551, where they were acted by professionals outside on temporary stages with costumes and masks. But as it was so popular with the nobles, many performances were also done indoors at court for the amusement of nobles. [4] After it became famous with the nobles the troupes began to move to france where many play writes such as Moliere were inspired to move their written works towards comedy.[5] Commedia dell’arte started to become popular outside Italy in the beginning of the seventeenth century. As the ‘tipo fisso’ (fixed stereotypes) soon became satiric references to the Italian parliament and to the typical Italian person it became one of the most popular comic theatre genres in the 17th and 18th century. [6] There are several reasons for the use of masks in commedia dell’atre. Primarily, as this type of theatre has fixed characters but is essentially improvised, the masks are used so that the audience was able to identify the characters. As commedia dell’arte was performed by different travelling companies, this meant that they would have different costumes, yet the masks would retain all the information needed to recognise a specific character. [7] Also as these performances were mainly on the streets or by the road, there would not really be a stage nor seating for the audience this made it difficult for everyone to see everything from the same angle or height. With the masks, all the audience could observe the emotions or actions that were being portrayed.[8] Commedia dell’arte masks were traditionally made of leather and only covered half of the actor’s face. They were like this so that the actor was able to project his voice and made certain noises that he could not do with a full mask. The masks were made to fit the face of a given actor because he or she would generally act out the same character for his/her entire career. Commedia dell’arte masks tend to have large, broad feature which are distinct to each character. For example on the character Zanni, the nose is very large. It is said that the larger the nose is, the stupider the Zanni represented tends to be. Zanni [2] Zanni [3] As I have said before, commedia dell’arte characters were based on ‘tipo fisso’ (a certain stereotype). Some of them have changed there name or personality over time for example Zanni, who is characterised as short of wit and always without money. Zanni has several masks that represent him which have changed over time with the fashion. Which all mean different things for example the Brighella mask which represents that poor and starving and hopeless side of Zanni and the Pucinella mask which represents the side which is also poor but although he is stupid he is able to outwit many. Many of the characters had a stereotypical opposite for example the stereotypical opposite of Zanni is represented with the well known character Pantalone (Pantaloon) who is typically arrogant and rich and who is always dealing with people who are trying to take his money away from him. Pantalone [4] Although most of the commedia dell’arte characters wore masks, there were few that were never masked. For example Isabella. Who was most famously acted by the famous actress Isabella Andreini. Also the lovers who were mostly the daughters and sons of the old and rich such as Pantalone or The Captain did not wear masks. This is because they were just there to bring the satiric comedy of romance and love to the performance. They were there to make the performance more light. And therefore did not have a specific characteristic apart from being completely in love with their character. [10] Commedia dell’arte masks were useful in the sense that although the the costumes and stage changed in fashion over time, The masks stayed basically the same. In this way the audience could appreciate and recognise the character and still enjoy new ways of the typical story being presented. In many schools such as Jaques Lecoq’s international school of theatre in paris, commedia dell’arte masks are used as a learning instrument for aspiring actors. Jaques Lecoq, was born in 1921 started off as a sports teacher and then moved on to acting with his partner, Gabreielle Cousin. He moved to Italy for eight years in 1948 where he discovered Commedia dell’arte. Together with the sculptor, Amleto Sartori, they developed the neutral mask. When Lecoq moved back to Paris he devoted the remainder of his life to teaching at his school. Jaques Lecoq [5] His school offers several courses that work on understanding and working with the body through the use of masks. His philosophy was that in order to become a good actor, you needed to use the Neutral masks to discover your body, movement, balance and space. He also believed that the typical half masks of commedia dell’arte, played an important role in improvisation and to work on character types therefore he integrated both into his courses [11]. Words 1000 (not including bibliography, notes under images nor titles ) Bibliography: [1] – http://en.wikipedia.org/wiki/Commedia_dell’arte [2] – http://www.religionfacts.com/christianity/holidays/mardi_gras.htm [3] – http://italian.about.com/library/weekly/aa110800a.htm [4] -http://www.tutu-inc.com/thesis/THESIS.htm [5] -http://www.therudemechanicaltheatre.co.uk/talkarchive.htm [6] -http://www.tutu-inc.com/thesis/THESIS.htm [7] – http://www.usq.edu.au/artsworx/schoolresources/androclesandthelion/commedia#Mask [8] – http://wiki.answers.com/Q/What_are_masks_used_for [9] – http://italian.about.com/library/weekly/aa110800a.htm [10] -http://www.delpiano.com/carnival/html [11] – http://www.ecole-jacqueslecoq.com Bibliography of Images: [1] – http://travel.smart-guide.net/venice-carnival [2] – http://tombanwell.blogspot.com/2010/09/zanni-leather-mask.html [3] – http://www.theater-masks.com/commedia-masks/commedia-mask-zanni-1 [4] – http://www.clg-mignet.ac-aix-marseille.fr/mignet/spip.php?article440 [5] – http://www.maghress.com/fr/marochebdo/31832

A Situation Analysis of a primary school of UK Essay

A Situation Analysis of a primary school of UK - Essay Example The ecological notion of ‘limiting factors’ is a useful concept with much relevance to the interaction of factors so as to facilitate or discourage good-quality learning. A situation analysis carried and represented here deals with the identification of learning difficulties in a primary school in UK which involves consideration of how factors like the curriculum, teaching strategies and school routines and relationships all of which affect children in different ways over a period of time. The aim would be to understand and respond to the educationally relevant individual differences which can create persistent obstacles to children’s learning in different contexts. A key aspect of this process is to give due weight to the interpretation and intentions of the people involved i.e. how does the professional interacts in the class. The tool which was used to derive efficient results was SWOT analysis. It was devised to identify the extent to which the current strateg y of an organization and its more specific strengths and weaknesses are relevant to and capable of dealing with changes in the wider environment. SWOT is an acronym for Strengths, Weaknesses, Opportunities and Threats. The professional should identify the Opportunities and Threats provided by an external environment and Strengths and Weaknesses of the school as an institution.

How the World might change in the next 25 years Assignment

How the World might change in the next 25 years - Assignment Example Deforestation is increasing the global warming problem and is diminishing the capacity of earth to generate oxygen through its plants. The purpose of this paper is to discuss and predict how advances in the management of natural resources are going to change the reality of humanity by the year 2037. The two social problems correlated to natural resources that are going to be emphasized in this discussion are food and air. The changes that are going to occur will come from exploitation of existing technologies and the creation of new innovations. There are a lot of people suffering from hunger today. Approximately 13% of the world’s population suffers from hunger which represents about 925 million people (http://www.worldhunger.org/articles/Learn/world%20hunger%20facts%202002.htm). A lot of experts believe that the world’s current agricultural capacity has the ability to feed everyone on the planet, but hunger is still occurring. One of the problems with the spread of hunger is that certain regions such as Sub-Saharan Africa do not have the arable land and the basic infrastructure such as water and electricity to create food. In the future this constraint will be eliminated as new technologies will enable the planet to turn salt water into drinkable water. About 20 % of the world land is covered by the five major oceans (http://www.gdrc.org/oceans/world-oceans.htm). The second innovation that will revolutionized agriculture worldwide is the creation on synthetic terrain. This new form of land can be transported anywhere and by used to regenerate the soil in places that lack arable land such as Haiti. A second major problem that is going to be resolved is the elimination of deforestation. This will occur prior to 2037 due to the fact that the paper wood milling industry will seize to exist. The world will not longer accept humanity cutting down trees to create books, magazines, or any form of wood pulp paper. Luckily this transition

Critically analyze Walter Lees Perspectives of the American dream. Why Research Paper

Critically analyze Walter Lees Perspectives of the American dream. Why is Walter determined to achieve the American dream - Research Paper Example Loraine Hansberry, one of the eminent African-American writers, wrote the play ‘A Raisin in the Sun’ in the year 1959. With all the vow of equality since ages, America was not able to establish the term to its truest sense has been well depicted through the play. Experiences of the two generations of the Younger family and their struggles and challenges encountered owing to the laws pertaining to the labor and housing discriminations in America have been made very explicit in the play. The black populace in America genuinely suffered from a hollow vision of American Dream due to the discriminative policies taken by government in the areas of work and stay. The agendas are different for two generations but the oppression remains the same and the contrast of experience in the case of Big Walter Lee as evoked through Mama’s voice in the play with that of Walter Lee’s perspective of American dream as a younger generation definitely helps to build a coherent and concise panorama of American Dream in the Afro-American society of the United States. ‘A Raisin in the Sun’ tries to throw light on the racial issues and impact of those issues on the notion of American Dream covering the agony of almost two generations. This essay intends to present the conflict and contradiction of generations manifested through the comprehension of American Dream by Walter Lee. A close introspection into the plot of the play ‘ A Raisin in the Sun’ launches its readers into a plethora where they get the opportunity to comprehend the hardships and the challenges encountered and undertaken by the African–American labor class from 1920s to 1950s. One must definitely take into consideration about the fact that Loraine Hansberry has covered a great span of time in her play, ‘A Raisin in the Sun’. Walter Lee (younger) is present in the play and the readers are aware of

Assignment on Teaching and learning practice Essay

Assignment on Teaching and learning practice - Essay Example Boud and Hawke (2003) underlines that it is more important to make the emphasis on the assessment of outcomes and immediate competence, focuses learners’ attention on the present task and how they might address it, that is, in a way that will satisfy assessors (cited Chappell, 2003). Professional judgment is perhaps the most far-reaching and complex parameter of all. In order to check out the performance of a student, a teacher needs to understand precisely how decisions are made. Every educator and teacher should be responsible for his professional judgment she/he makes concerning students performance and their level of personal development. In this case, professional judgment is a very important activity which helps a teacher to assess a student and determine competency of a student. Professional judgment in teaching is a complex activity which requires careful analysis and evaluation of student’s achievements. The main problem is that it is impossible to teach educators how to make the right judgment in all the cases they are faced with, because every student is a unique individuality and personally influenced by social factors. For this reason, professional teachers learn how to make professional judgments on the job. Boud & Hawke create a concept â⠂¬Å"learning-how-to-learn† They explain that â€Å"currently in an outcomes-based framework, this capacity is not developed. Instead, the emphasis on the assessment of outcomes and immediate competence, focuses learners’ attention on the present task and how they might address it, that is, in a way that will satisfy assessors† (Chappell 2003). On the other hand, in order to improve their professional judgments, the educators record their comments which may include an evaluation of what they have done and/or what they are working towards. Gradually the comments become more in depth in some years of teaching practice and young teachers are able to make detailed and perceptive professional

Review paper for optical-Ct gel-dosimetry Article

Review paper for optical-Ct gel-dosimetry - Article Example This new system incorporates the use of both Optical Computer Tomography (CT) Scanning and Gel- Dosimetry which as shall be shown do deliver dose maps with high degrees of resolution, precision and accuracy. 2. Introduction One of the key elements in the world is the aspect of radiation treatment. This has come in handy in the fight against some of the world’s deadliest ailments which the scientific world has always grappled with to fix. A major part of radiation treatment is radiation dosimetry which has had an increased need for a system that has a high degree of accuracy, precision and efficiency in the measuring of dose and in full 3D and high resolution (INTERNATIONAL CONFERENCE ON 3D RADIATION DOSIMETRY, & OLDHAM, M 2010). A lot of work has gone into the traditional systems like the Fricke dosimetry and this has had a tremendous result which is manifested by the effectiveness of Gel-dosimetry. A further development has seen the incorporation of Optical Computer Tomograph y (CT) Scanning into the system of Gel-dosimetry and this complementary system has been observed to have a high degree of accuracy, precision and efficiency. The main objective of this paper is to manifest the authenticity of this statement. In an effort to prove the effectiveness of the newly developed system, an experimental setup was put in place which has delivered results that have received thumbs up from the scientific world. The setup makes use of some 2-dimensional images from defined planes in a gel-dosimeter that is well constructed from a perfect design. Moreover, the performance of Optical Computer Tomography (CT) Scanning is compared with that of a MR scanning with focus being on accuracy and sensitivity of imaging, calibration, resolution and noise in the images of dosimetry. Work has been done to eliminate the sources of geometric distortion and optical artifacts in optical Computer Tomography Scanning. The new design has mechanisms to compensate for refraction, refle ction, signal drift, water-bath imperfections amongst other factors that cause incorrect reconstructions of coefficients of absolute attenuation. It is also the objective of this paper to show that indeed for phantoms which are used in the validation of optical CT scanners used together with the polymerizing gel dosimeters that are radiation induced, stable gel materials are needed. Phantoms on which light dyes are added are the basis of the simulation used as gel dosimeters. More accurate simulations are done with the use of phantoms with light scattering suspensions of colloidal mixed with the gal. 3. Body An experimental setup to prove the effectiveness of the newly developed system involved filling up three identical flasks with 300cc MGS Research BANG3â„ ¢ gel. The flasks had their heads stopped with a threaded screw allowing vertical mounting of the flask into the desired optical scanner as well as head phantom. One of the flasks was used in the study of a complex radio sur gical delivery as a dosimeter while the other two were used to examine calibration issues of gel. The two gel-flasks of calibration were put in a birth of water upright and 6MV beams of radiosurgery used to irradiate them shooting through their flat bases vertically upward. The beams gave doses of 1.5, 0.75, and 0.25 Gy into the first flask and in the second one 1.25, 1.0 and 0.5 Gy. Before the end of 48 hours, these flasks were scanned using both imaging modalities. Data on calibration was gotten by taking the

Abortion comprehensive assignment Essay Example | Topics and Well Written Essays - 1500 words - 1

Abortion comprehensive assignment - Essay Example Some people from the section term abortion as murder, or killing of the innocent soul. According to the medical experts, â€Å"An abortion is when the pregnancy is ended so that it does not result in the birth of a child. Sometimes this is called termination of pregnancy.† Abortion in the United States has been going on for centuries; unwanted pregnancies have been in existence for very many years and in one way or the other such pregnancies were eliminated. Before the18th century women carried out abortion at will as there were no laws that restricted or barred the women from doing so. Due to the lack of any specific laws so many women carried out abortions that some states started coming up with laws to restrict abortions. The first law was the Connecticut statute 1821 the statute prohibited the use of â€Å"toxic substances to cause miscarriage.† Soon afterwards other states followed New York law in 1829. After the New York law various states came up with laws that punished the abortion providers, restricted abortions and at times punishing women seeking to carry out abortions. The first ever United States Federal law to be enacted was the Comstock Law of 1873. The law allowed a special postal agent to open mails suspected to contain abortion or contraceptive. The main aim for the law was to suppress the circulation of â€Å"obscene materials† From the year 1900 up to1960s, abortions were outlawed. As a result many women turned to unsafe abortion. In the year 1965 a total of 265 deaths were reported to have taken pace as a result of unsafe abortions. New York as well as California reported complications with 20% being as a result abortions. As a result of the numerous deaths associated with unsafe abortions, a series of cases were taken to the Supreme Court and some women were granted the right to carry out abortions (Solodnikov,  2011). During the great depression that took place in the

Nursing Application Essay Example | Topics and Well Written Essays - 500 words

Nursing Application - Essay Example Some times I felt the need to assist but I lacked the capacity to do so because I was only a child. However, these occurrences usually strengthened my desire to acquire the capability to assist other people to overcome problems. From that time up to now when I am a grown-up, I still yearn to accomplish my childhood desires of becoming an expert in promoting people’s health and general well-being of children, adults including the healthy, the ailing and the aged. I have the conviction that becoming a nurse will empower me to accomplish my goals. I settled on the decision to apply to Dorothea Hopfer School of nursing came as a result of careful analysis regarding the various institutions that offer the program. I have met with a number of professionals in nursing as well as in other fields who graduated from the institution, and the positions that they hold in the local, as well as international organizations, are admirable. The institution has a good reputation, and local organ izations usually give the first priority to graduates from the institution. I believe that the skills that I need in nursing will be acquired through studying in the institution. I have never felt so right about accomplishing my goals through a particular institution the way I do now. I am ready to sacrifice as much time as the program requires. I have strong leadership and team building skills that enable me to learn quickly through interactions with other students. I actively participate in class and intend to continue with this practice in order to accomplish the best in my nursing studies. I feel privileged to present my application to this reputable institution where I believe my professional goals will be accomplished. I am looking forward to cooperating with the administration as well as my instructors to enhance my performance in studies.

Nordstrom's Success Term Paper Example | Topics and Well Written Essays - 1000 words

Nordstrom's Success - Term Paper Example They have knowledgeable sales clerks and sales people who pay more attention to customers (Lamb, et. al, 2011). Nordstrom’s level of service is known to be high full service. Sales people are taught to always try to understand their customers. They should try to make their customers have the best shopping experience at any time they visit the store. Nordstrom is therefore at the full service continuum level since its employees would do whatever is possible to make their customers happy. Nordstrom aims at giving the best experience to its customers, whether they are shopping on- line, in their stores or through a mail order catalogue. A good example of a business that is on the other end of the continuum is Target. Although they have good customer service, it cannot be compared to that at Nordstrom. Customers will just be greeted at the door when going into the store and not much assistance will be given to them. Their sales people with focus on making sales rather than assisting customers fully. Target does not depend on high quality customer service. The store will just ensure that products are well displayed on the shelves and that the store processes are running smoothly. The self-service model is more important at target store since customers will just walk around the store and look for whatever they wish to buy by themselves. Nordstrom has knowledgeable sales people who provide quality services to their customers because they know that each customer would love to get a unique shopping experience. The highly trained employees will create personal interactions with each customer and this will ensure that their needs and wants are satisfied. Nordstrom also uses selective distribution as a method of retailing. The departments now manage inventories at its stores and website as one big entity. When a customer is shopping online and the product is

Farewell Party for Miss Pushpa Essay Example for Free

Farewell Party for Miss Pushpa Essay In fact, Nissim Ezekiel makes fun of the way in which semi-educated Indians speak or write the English language. He ridicules the errors in grammar, syntax, and idioms which many Indians commit while speaking the English language. In other words, he mimicks the Indian way of speaking English with so many faults, and the poem is highly amusing. The speaker says that their dear sister, Miss Pushpa is leaving for a foreign country, and they all wish her bon voyage. In his speech, he again and again uses the present continuous tense instead of the simple present, which creates a ridiculous effect. He says that they â€Å"are all knowing† the sweet nature of Miss Pushpa who â€Å"is smiling and smiling for no reason, but simply because she is feeling†. The speaker goes on to say that her father was a renowned advocate in Bulsar or Surat, and that he is â€Å"not remembering† the correct place. Then he suddenly remembers that the place is Surat. He seems to be a poor speaker when he points out the irrelevant fact that he stayed there once with his uncle’s very old friend whose â€Å"wife was cooking nicely. † Again, the speaker starts praising Miss Pushpa, and says that she is very popular with men and ladies also. Whenever he asked her to do anything, she said,† Just now only I will do it†. Clearly the speaker means Miss Pushpa’s readiness to do any work, and the unnecessary use of â€Å"just† and â€Å"only† exhibits the Indian speaker’s ignorance of the usage of English words, creating laughter and fun. The speaker’s frequent wrong use of the present continuous instead of the simple present is further revealed in his speech when he says that he is always appreciating Miss Pushpa’s good nature, and â€Å"she is always saying yes† when he or anybody â€Å"is asking† any help. The speaker concludes his amusing speech, saying that they are wishing Miss Pushpa bon voyage. He informs that Miss Pushpa ‘will do the summing up†, when the other speakers finish their talk. What he means is that Miss Pushpa will respond to their words of praise in the end. Thus the poet makes fun of the faulty Indian way talking English. THEME: bad and ungrammatical english spoken by people of india.. this poem is a mockery on indian english, not to indians or india

Long Bone Fractures in Children: IN Fentanyl Treatment

Long Bone Fractures in Children: IN Fentanyl Treatment Introduction The clichà © that states children are just small adults is certainly not true in the case of long bone fractures. A childs experience of long bone fractures is dramatically different from that of an adult on account of their rapidly developing physiology (Wood et al 2003). This rapid development results in biochemical and physiological differences between a childs and an adults skeleton, the mechanisms of fracture and healing, are an important component of their treatment needs and consequently crucial part of emergency care management (Bonadio et al 2001). In addition, children, from infancy through to adolescence, have common fracture patterns related to their stage of development. The structural differences between the bones of a child and an adult enable childrens bones to endure greater forces and to heal quicker a childs remodeling potential supports full recovery with limited or no long term side effects from long bone fractures (Lane et al 1998). Injuries of all types are the second leading cause of hospitalization among children younger than 15 years (Landin 1997). Musculoskeletal trauma, although rarely fatal, accounts for 10% to 25% of all childhood injuries (McDonnell 1997, Landin 1997, Lane et al 1998). Boys have a 40% risk and girls a 25% risk of incurring a fracture before the age of 16 years (Landin 1997, Ritsema et al 2007). The most common site of fracture is the distal forearm which accounts for 50% of paediatric fractures. The rates of fracture increases with age as children grow; peaking in early adolescence. Fortunately, most fractures in children are minor greenstick and torus fractures constitute approximately 50% of all fractures in children (Landin 1997, Lane et al 1998, Gasc Depalokos1999, Richards et al 2006) and only 20% require reduction. Thus, the management of paediatric fractures is often straightforward. Without exception children will experience pain at the time of injury, attending the accident and emergency department and during recovery. The most common pain management strategies involve a multi-modal approach that includes both pharmacological and non-pharmacological components delivered via the least invasive technique (Worlock et al 2000). In practice this includes oral medication, such as oramorph, paracetamol, and NSAIDs, inhaled entonox, intranasal diamorphine (IND) or intravenous opioid where necessary and distraction with age appropriate devices, such as interactive books, bubbles, music and computer games in older children. Notably, IND is currently embraced as the key route of opioid delivery for children attending AED with fracture pain in the UK British Association for Accident and Emergency Medicine (BAAM E 2002). Parents and guardians of children frequently seek care in AED for the relief of pain from traumatic injuries and as a result the field of emergency medicine has assumed a leadership role in paediatric pain management. However, despite this the literature suggests the provision of pain relief for children attending AED remains suboptimal when compared to adults with the same injuries. Further discrepancies are reported between paediatric accident and emergency departments (PAED) and district general accident and emergency departments (DGAED) (Emergency Triage 2004). One reason suggested for these differences is the geographic distribution of specialised services, which are predominantly located in large cities where they are affiliated with universities. However, a recent audit by the British Association for Emergency Medicine (BAAEM 2005) of their guideline for the management of pain in children shows inconsistencies in provision of analgesia particularly for fracture pain throughout the country with no measurable difference between PAED and DGAED. A key feature of this guideline is the algorithm which advocates the use of IN diamorphine for acute moderate to severe pain in children over the age of one year (see appendix 1). The whole topic of analgesia in the paediatric population is complex and still imperfect especially in acute moderate to severe pain requiring urgent treatment in the emergency department (Schechter et al 2002). The road to pain free suffering is still paved with impediments such as failure of pain recognition and methods of delivery of analgesia (Murat et al 2003). Oral administration can be inadequate in an emergency situation with particular limitations in potential choice of drug and delay in gastric absorption and gastric emptying. Intramuscular (IM) and intravenous (IV) administration can be distressing to children and have been shown to influence future response to painful procedures (Gidron et al 1995, McGrath et al 2000, Fitzgerald et al 2005, Walker et al 2007). Rectal administration has limited acceptability given unpredictability of onset together with occasional problems of consent (Mitchell et al. 1995). By contrast, the efficacy and safety of the IN route has been well documented for desmopression acetate (DDAVP), insulin, antihistamines, midazolam and calcitonin (Jewkes et al 2004, Loryman et al 2006). In contrast, intranasal administration has a number of advantages. It is technically straightforward, socially acceptable and demonstrably effective. The nasal mucosa is richly vascular and administration by this route avoids the first-pass metabolism phenomenon Summary Studies in the 1990s such as Yearly Ellis (1992) have also demonstrated the efficacy of administration of intranasal medication via a nasal spray rather than drops in adults, although the efficacy of this application in the paediatric population remains to be proven. Intranasal administration is possibly the ideal route of analgesic administration in children. Currently, within the accident and emergency department (AED) of Bristol Royal Hospital for Children (BRHC) intranasal diamorphine is used as the first rescue analgesia in the paediatric population presenting with acute moderate to severe pain, most frequently in patients with long bone fractures who do not require intravenous access for resuscitation. Diamorphine is a semi synthetic derivative of morphine with a number of properties that render it a desirable analgesic agent for administration via the nasal route. It is a weak base with a pKa of 7.83 and is water soluble allowing high concentration to be administered in small volume (Rook et al 2006). Unfortunately the legal use of diamorphine is limited to two European countries i.e. United Kingdom (UK) and Sweden. Furthermore periodic problems with its availability during the past few years (with further shortfalls in availability predicted by the NHS purchasing and supply agency) have resulted in an alternative efficacious analgesia being sought for this population. Fentanyl, however, is a short rapidly acting opiate has several qualities that render it useful as an IN analgesia and a potential candidate to replace IN diamorphine in the AED for acute facture pain management in children. It has a very high lipid solubility, potency and diffusion fraction, and unlike diamorphine it is not a prodrug and does not cause histamine release (Reynolds et al 1999). Assessment of a patients pain experience is not directly accessible to others, collecting and analyzing information about the processes of pain relief and pain prevention is not straightforward and presents significant challenges to health care professionals. In children, this task is further complicated by their varied stages of physical and cognitive development. Recent research by Bruce Frank (2004) however, has shown that the ability to measure pain in the paediatric population has improved dramatically and that today there now exists a plethora of age appropriate pain assessment tools for acute pain in children ranging from pre-term infants to adolescents, the majority claiming validity (strength and robustness) and reliability (consistency). However, most clinical research into pain management strategies continue to rely on the gold standard self report and visual analogy score tools (mostly 0-10) (Chalkiadis 2001, Walker et al 2007). Although these tools are reliable they are not always adapted appropriately for a childs stage of development. Childrens understanding of pain and their ability to describe pain change with increasing age in a developmental pattern consistent with the characteristics of Piagets preoperational, concrete operational and formal operational stages in cognitive development (Smith et al 2003). The quality or int ensity of the pain can be difficult to determine in children, as most tools rely upon a patients relative judgment between the intensity of present pain versus a patients worst pain experience (Murray et al 1996). These tools can therefore be unreliable where a childs age of development means they have limited or no memory of pain experience. Stevens et al (2002) recently described a conflict of understanding that resulted in a study bias and an insignificant reported power of (p=0.6). In the study an 8 year old boy had chosen the VAS (0-10) but frequently reported his score as 10, although he understood the increasing value of the scoring system further questioning identified he perceived 10 of 10 to be a good score and 0 of 10 to be poor. The boy was at a stage of development that limited his understanding of less is more. This case highlights the importance of utilizing a pain assessment technique that reliably accounts for a childs age of development. A preliminary search of literature suggests there is currently exists limited research to support for the use of intranasal diamorphine or intranasal fentanyl for the management of acute pain in long bone fracture in children as evidenced based medicine. Despite this lack of evidence it remains a key strategy within paediatric AED for the pain management of long bone fractures and is anecdotally reported as a gold standard for paediatric pain management. Therefore; its lack of availability could profoundly compromise pain management for this population. Thus, this extended literature review will examine the efficacy of intranasal fentanyl as an alternative to intranasal diamorphine for traumatic fracture pain in children attending accident and emergency departments. However, in these days of evidence based medicine, it clearly needs to be established beyond all reasonable doubt. In view of that only research into paediatrics will be included increasing the credibility of its applicat ion to practice. SEARCH STRATEGY A range of complimentary search techniques were used to capture key research including a systematic electronic literature search of the Cochrane library, Embase, CINAHL, Proquest, Medline, PubMed since 1990 up to 2009 (this has to be to year of submission). The scope of the search was extended beyond the recognised five years of current research so as to include the empirical work into the development of IN analgesia in children. Key words used included the following: pain, acute pain management, intranasal diamorphine, intranasal fentanyl, procedural, accident and emergency, emergency department, child, pediatric, paediatric, child and fracture pain, as well as various combinations. In addition, in order to ensure the completeness of the search, an internet search was completed using the Google search engine, IASP, Pain Journal, Paediatric Nursing, BAAEM, NICE, Medline, EBM; the RCN was also utilised. Backward chaining of references found was also performed to ensure all relevant papers were identified. Although this review identified twenty seven citations it should be noted that historically there are fewer Randomised Controlled Trials (RCT) in children compared to adults possibly due to problems gaining ethical approval and consent. Additionally even experienced researchers will be unable to find all relevant papers and much research is not submitted for publication. The studies identified were divided into the three modalities of IN route, IN diamorphine and IN fentanyl with the majority presenting evidence for the IN route. All papers were critiqued using a tool published by the Learning and Development Department within the Public Health Resource Unit of the NHS (www.phru.nhs.uk/casp). The tool facilitated critiquing different forms of quantitative research and is based on work by Sackett (1986), Sackett et al (1996) and Phillips et al (2008) (see appendix 2). The results of the critique process for each paper and level of evidence applied in line with the modalities they address informed understanding of current practice and development of a research proposal. STRUCTURE OF THE LITERATURE REVIEW This literature review will focus on determining whether IN fentanyl is an effective alternative to IN diamorphine for the management of long bone fracture pain in children attending an AED. The scope of the literature review considers literature from 1990 onwards although occasionally earlier research has been referenced. Given the limited available evidence on the topic the following review structure has been selected. Chapters 1, 2 3 will present the evidence sourced on each theme intranasal route, intranasal diamorphine and intranasal fentanyl with a short summary to conclude each chapter. Chapter 4 will present an in-depth discussion and conclusion on the utility of the evidence, its application to practice and the requirement for a multi-centred comparative randomised control trial to improve the credibility of the evidence base for this field of treatment. Finally chapter 5 will present a research proposal for a comparative study of these modalities. Intranasal (IN) route of medication delivery in children. Nasal administration of drugs has been reported as having several significant advantages over current practice which are predominately oral, IM, IV and rectal (Williams Rowbotham 1998). It is emerging as a low-tech, inexpensive and non-invasive first line method for managing either pain or other medical problems (Wolf et al 2006). Nasal medication delivery takes a middle path between slow onset oral medications and invasive, highly skilled delivery of intravenous medications. The nose has a very rich vascular supply, IN facilitates direct absorption to the systemic blood supply due to increased bio-availability of the drug by missing first pass metabolism, It avoids the potentially technically difficult of sterile intravenous access, is essentially painless and is considered acceptable to children when compared to other routes of administration (Shelly Paech 2006) (see table 1). a theory which will be considered when reviewing the studies within this chapter Therefore suggesting th e IN route will result in therapeutic drug levels, effective treatment of seizures and pain without the need to give an injection or a pill, furthermore; it is quite inexpensive, an advantage in this era of increasingly expensive medical technology (Shelly Paech 2006). Additionally given the complexity of the developing child and the known consequence of poorly managed pain on the future responses to pain the IN route does, if it is as efficacious and as safe as suggested offer one of the most acceptable, definitive forms of analgesia delivery in children. The degree of accuracy of the previous statements will be established within this chapter by critically reviewing the 16 studies identified on IN medications other than intranasal diamorphine or intranasal fentanyl in the paediatric population (see table 2) as these agents are considered individually in later chapters. The rigour of the studies will be addressed within this chapter and reflect the level of evidence applied according to Sackett (1986) criteria (see appendix 3). Most studies reviewed were randomised clinical trials and in some cases compared against a placebo Conversely, this does not concur with the trials discussed earlier (Lahat et al 1998, Al-rakaf et al 2001, Fisgin et al 2002, Mahmoudian and Zadeh 2004 and Holsti et al 2007) where significant dosing was applied or in Wilson et al (2004) who retrospectively studied 30 children age 2-16 years receiving 0.3mg/kg at 5mg/1ml INM and 13 patients receiving rectal 0.2mg/kg diazepam for seizures. The authors report equal efficacy for both routes. Success of these agents was considered on cessation of seizures, no reported complication and not needing to attend A+E. A total of 27/30 families who had used INM found it effective and easy to use. Although 20/24 (83%) who had previously used rectal diazepam still preferred it mostly due to the coughing and the volume of liquid administered via the IN route. Given it is generally considered that the optimum IN dose as stated above is 0.1- 0.2 ml per nostril, all but the studies discussed so far were using drug concentration and dosing regimes whic h resulted in large volumes of liquid being dripped in to the nasal cavity. This is particularly poignant in Wilson et al (2003) who compared buccal to IN midazolam in 53 children aged 3-12 years experiencing seizures lasting > 5 minutes attending AED. A key feature of this study is the mean age of the children (age 9 years), mean weight (24kg) the study drug concentration as with previous studies was of 5mg /ml. IN dosing was at a dose of 0.3mg/kg. Given these figure the average dose would have been 7.2mg = a volume of 1.4ml being administered. Since the comparative route of administration for this study was buccal there is a possibility that part of the IN dose was buccally absorbed therefore creating a flaw in this study methodology, raising questions over why this comparative route was chosen and suggesting the only real conclusion to be taken from this particular study is buccal midazolam is effective and safe in children. Furthermore although this is described as a blind RCT and the authors claim the time to cessation of seizure was quicker for the INM group 2.43 (SD 1.67) to 3.52 (SD 2.14) for buccal route there is little detail on the blinding process or data collection procedure suggesting the rigour of the study maybe flawed therefore the efficacy and safety claimed for the IN route should not be embraced without further study. On the other hand Fisgin et al (2002) and Hardord et al (2004) compared the INM with rectal diazepam. In Fisgin et al (2002) in an unblinded RCT equivalence study the authors compared INM with rectal Diazepam to ascertain the safety and efficacy of INM for the development of a clinical protocol in the management of prolonged seizure in children attending the AED. Forty five infants and children age 1 month -13years experiencing prolonged seizures > 10 minutes were either given INM 0.2mg/kg or rectal diazepam 0.3mg/kg. The authors report proven efficacy (p Intranasal Diamorphine (IND) The delivery of opioids via the IN route is perhaps one of the most valuable indications for IN medication delivery. Acute pain is a frequent experience for children whether attending an AED, hospital and hospice setting (Hamer et al 1997). Furthermore it is not unusual for them to experience frequent episodes of breakthrough pain which requires additional support from fast acting analgesic agents. Owing to the developmental and physiological difference in the paediatric population there is a need for a variety of effective treatment option from which to select and individualise the patients therapy to meet their needs. IN opioid is simply one such option available which may be useful in children. It has been suggested that the delivery of medications via the IN route results in rapid absorption with medication levels within the cerebral spinal fluid (CSF) being comparable with (IV) administration (Chien and Chang 1997). Diamorphine hydrochloride is a semi-synthetic derivative of morphine. It is extremely hydrophilic, which makes it ideal to use when preparing in high concentrations in solution, thus allowing high doses to be administered in smaller volumes via the intranasal route (Kendall Latter 2003). However, this route of administration can be a painful process as reported by adults (Henry et al 1998). Despite this the intranasal route is considered more acceptable to children and their parents and is thought to lessen the opioid side effect profile seen in IV administration (Stoker et al 2008). This concept has been well recognised throughout the UK and many centres already use intranasal diamorphine for acute pain in children, following the guidelines by the British Association for Accident and Emergency Medicine Clinical Effectiveness Committee (2002) (BAAEM). Although the administration of intranasal diamorphine is now a first line choice for moderate to severe acute pain for children atten ding AED, as is the case within our institution, there is very limited research to substantiate this practice although as noted above it has been readily accepted by the BAAEM for acute pain management in children and very successfully used within our institution A recent shortage of diamorphine evoked the search for an equally effective and acceptable alternative. Early research in animals and adults reported pharmacokinetics of nebulised inhalation and intranasal administration of diamorphine as detected morphine in plasma at six minutes (Masters et al 1988, Kendall 2001). Despite the age of this research and the fact that the later study was in adults, it is still quoted as creditable evidence to support this practice in paediatrics. However the legitimacy of this should be questioned, due to children not being just small adults but have physiological differences intrinsic to their age and stage of development which may affect the bodys absorption and level of toxicity in different ways to adults. The extensive literature search highlighted four randomized controlled trials (RCT) that demonstrate IND to be clinically superior to intramuscular morphine and inferior to IV morphine particularly in the management of acute pain in children, a case study of an 8 year old boy and clinical audit of IND for pain relief in children attending AED (see table 3). The key methodology in the RCTs by Wilson et al (1997), Kendall et al (2001), Brennan et al (2004) and Brennan et al (2005) suggest these are superiority studies where the authors hypothesised improved pain management with the IND when compared to a variety of routes. The rigour of the studies will be discussed later in the chapter. Although while the critiquing process takes place it is fundamentally accepted that RCT are considered level 1 or 2 evidence as opposed to case study or audits at Level 3b and therefore generally sourced to Latest published clinical evidence to support the use IND in the paediatric population is presented in an audit by Gahir Ranson (2006) of 54 children whose care was managed by the use of an integrated care pathway for acute pain management while attending the local AED. This integrated care pathway focused strongly on the use of IND. Data collection was on a one page performa and included consent, date, patient demographic, pain score and side effect profile. Data collection was retrospective and data analysis illustrated limited recording of side effect profile but improved pain scores. However only 60% of patients have this information documented so data collection was difficult. Despite this lack of hard evidence no clinical incident, including the side effect profiles, were reported. Thus suggesting the practice of IND for acute fracture pain management in children could be safe, effective and more acceptable to children than the more painful alternative of IM or IV administration. However there is limited strength in an audit, other than a review of practice (Bowling Ebrahim 2005) and in this case a key feature for review should be the documentation process in the department as there were facets in the care pathway administration documentation missing. Therefore this audit suggests that IND is safe and effective pain management for children, but this conclusion can not be categorically drawn from the limited data available. The potential outcome of this audit could be education on documentation, to do a more rigours prospective audit of practice. Unfortunately at this point it only offers an insight to their clinical practice which is favourable for this agent and route. Albeit as noted before IND has improved childrens pain management and over all experience of acute care in our PAED additionally as with the results of the audit we have experienced no side effects or complications, further highlighting the importance of seeking an alternative to IND which offers equally efficacy. Intranasal Fentanyl (INF) Monitoring of the usual observations and pain scoring in the child was recorded prior to the administration of fentanyl (20 micrograms for 3-7 year olds and 40 micrograms for 8-16 yrs) and continued at 5 minute intervals for the 30 minute period. Additional doses of fentanyl (20  µg) were available if required at 5 minute intervals. Pain assessment was achieved with two validated pain assessment tools, the visual analogue scale (VAS) in older children and the Wong-Baker Faces (WBF) for younger children. Both are reliable and known to support consistency in pain assessment. Though there was no mention of training for those assessing this primary end point using these tools in the paper therefore this should be considered in the overview of the standard of evidence produced by this study. Additionally although forty five patients were randomized following consent unfortunately no details on the randomization process was disclosed in the paper either. This may not be significant, but when reviewing the credibility of the authors claims these obvious omissions could be responsible for a flaw in this study and remains to be established. On the other hand, the methodology that has been disclosed in the paper appears sound as it addresses key areas of sample calculation (power of the study) as a superiority study with the sub groups size adequate to detect a significant difference (Greenhalgh 2004); demographics, blinding of the drugs, assessors and appropriate statistical analysis of the data therefore supporting the validity of the results claimed and the application of the results to the age of patient targeted that this literature review is aiming to find an analgesic alternative to IND for. The results concluded by Borland et al (2002), are a reduction in pain score at 10 minutes to 44.6 mm (95% confidence interval) 36.2-53.1 mm from 62.3 mm 53.2-69.4 mm (95% confidence interval) at assessment using the VAS and 2.2 (95% confidence interval 1.3-3.1) at 10 minutes from 4.0 (95% confidence interval 3.3-4.7) at assessment in 16 children using WBS. Visual analogue pain scores demonstrated clinically significant reductions in pain scores by 5 minutes that persisted throughout the entire study (up to 30 minutes) for both INF and IV morphine. The second primary end point of this study (side effect profile) showed no significant change in physiological parameter of the childrens pulse or respiratory rate, blood pressure or oxygen saturations, interestingly the side affect profile chosen for monitoring such as pulse and blood pressure are not considered to be one of the primary side affects of morphine, however nausea and vomiting which are was not assessed. Ultimately, there wer e no negative side-effects and the sizeable reduction in pain scores (compared to baseline assessments) was accomplished in children using INF by 10 minutes and maintained throughout the 30 minute period with the mean INF dose at 1.5 µg/kg and ranging from 0.5-3.4  µg/kg. Interestingly 35.5% of children in the INF group only required one dose. Given the clinical equivalency of these two agents and routes the authors conclusion that INF offers the benefits of a simple painless technique for treating acute pain is substantiated. These benefits suggest that the IN route could be a valuable technique not only in an AED but also for breakthrough pain by offering a fast onset of pain control in moderate to severe painful conditions. It could also provide pain relief and allow topical anaesthetics to take effect on the skin prior to IV establishment. Therefore this may be a suitable alternative to IND. A similar and more recent double blinded RCT trial by Saunders et al (2007) claimed efficacy of a larger dosing regimen with a mean dose of 2 µg/kg INF (50 µg/ml) for pain reductions in paediatric orthopaedic trauma compared with IVM at 0.1mg/kg in 60 3-12 year old children. This study reports positive outcome for INF following both patients and carers reporting very effective pain management and satisfaction using this treatment method. However there is little information in the paper of methodology and results are given in percentages rather than a P value or NTT which should be expected in a rigorous creditable RCT of two agents (Bowling Ebrahim 2005) reducing the level of evidence applied to the paper to L3. Even supposing the results are an accurate reflection of the efficacy and safety of INF, particularly the fact that no significant difference in pain score or side effect profile and INF is a way forward, the lack of detail the randomisation process and analysis of data in the study methodology merely implies that these results maybe flawed. Interestingly given the concentration of fentanyl 50 µg/ ml a dosing volume for a 25kg child would have required one ml = 0.5ml per-nostril therefore suggesting some of the administration may have been oral rather than IN and present the issues of bad taste which is put forward as a possible study limitation by the authors. Then again there are no complications or reports on taste presented in the results and the authors conclusion on the efficacy of INF for acute pain management in children may be founded. However, without sourcing more details from the authors it cannot be considered evidence to inform this dissertations aims but merely an ex ample of poor research or appropriate omission by publishers. Further suggesting there remains a requirement for more research on the topic within double blind, equivalence, RCT focused on INF efficacy and dosing with sound methodology that is transparent in publication to answer the dissertation question. Conversely an older and more rigorous study which also looked at dose related analgesic effect between routes of administration is by Manjushree et al (2002). The authors demonstrated the clinical efficacy of INF in a cohort of 32 children (aged 4-8 yrs) in a postoperative situation and with a double blind level 1 RCT. The study design gives the impression of sound methodology as blinding, assessment and analysis of data was appropriate and available for scrutiny in the paper, particularly the analysis of both nonparametric and nominal data. The only weakness is possibly the sample size of 32 patients. Although the authors performed a power calculation which identified 40 patients to show a significant affect, they only recruited 32 patients, furthermore, this appears to be an equivalency study where the authors hypothesised INF would be equal to and not inferior to IVF therefore would have needed a larger sample to de

Reflection On Residential Workshop And Positive Interrelationships Nursing Essay

Reflection On Residential Workshop And Positive Interrelationships Nursing Essay Recently I attended a 7 day residential workshop at Findhorn Foundation in Scotland. The two middle aged co-leaders were very experienced in running this workshop, but had never worked together before. Ineka was Dutch and Annis was from the UK. The twelve participants from varying professional backgrounds were of various ages from mid twenties to mid 60s, from all over the world and with several using English as their second language. Although clearly stated in the application form, this was NOT a therapy group however three people had slipped through the screening process and arrived with diagnosed mental illnesses. Two were on medication but the third, Barbara, was not. The higher the level of an individuals psychological pathology e.g. depression, anger, anxiety the less able he or she is to develop and maintain caring and enriching relationships (Johnson Johnson 2009). This was my second visit to Findhorn, the earlier visit being 34 years ago. The purpose of the workshop was to introduce the members to the work of the Community, a World Heritage Eco Village and a spiritual community which runs many human development courses in its college every year. There was a second purpose of which I was unaware to experience and work through a wide range of emotions to increase positive interrelations. I was strangely obtuse about this second purpose and concentrated only on the first. Entitativity is the perception that a group is cohesive with members bonded together. The stronger the joint goals, shared outcomes, interpsersonal bonds, the greater the apparent entitativity of a group (Welbourne, 1999). Our group had incomplete entitativity, I for one feeling detached throughout. The leaders appeared unaware of the dislike many participants had for Annis, who frequently exhibited unnecessary controlling behaviours. Her autocratic style of leadership was rejected, while Inekas equally autocratic style was acceptable because she was a more agreeable, more authentic person. This conflict was not brought into the open, instead being discussed within subgroups, during recreational times. Anniss controlling behaviour impacted on the groups cohesion; there was entitativity amongst the group AGAINST Annis. We found a bond in our mutual rejection of her though that bond, for me, was not sufficient to make me feel part of the group for many reasons. Socializing outside the group can increase the groups cohesion but we divided along age lines. I couldnt get interested in the younger ones, their beliefs, interests and stories. Counterproductive socializing did not happen, nobody feeling excluded from cliques. One detrimental aspect of our group was our refusing to challenge one another for fear of jeopardizing newly forming friendships, and relying on the group as the source of our current social life. We were a long way from home, in an unknown setting, and needed each other for emotional security. Communication was autonomous rather than allonomous in its style of interaction. We talked directly to each other, rather than via the leaders. There was much praising, supporting and offering of help from us all. We all took care to understand and be understood by those who did not speak English well even when this required considerable effort. Gibb, 1961, established that evaluation, superiority, certainty and control produce defensive communication. There was a defensive reaction to Anniss control and certainty. There was evaluation and superiority expressed by participants, but mostly the leaders, against the non-Findhorn world. We were enlightened insiders educating and influencing the ignorant outer world. These attitudes I rejected, which impacted on my commitment to the group. Much respect for each other and each others contributions to the group efforts were articulated. The more accepting and supportive participants were of each other, the more likely they were to reveal ideas, feelings and reactions. The more trustworthy our groups response to such disclosures, the deeper and more personal the thoughts a participant will share (Johnson et al, 2009). We had revelations of bisexuality, of partnering with a paedophile, of terror at failing to cope with motherhood, of being overwhelmed with the exposure of self revelation. Clearly the group was achieving its goals for some of us, but not for me. I revealed more than I ever have before, but my core emotional wounds I kept hidden. I was astonished by such revelations and wanted to rescue those in distress, lacking any other response to such pain. Corey, Corey Corey, (2010) explains that if someone finds it too difficult to witness anothers pain, the supportive individual attempts to offer pseudo support rather than a genuine expression of concern, and empathy. I felt helpless the first time Barbara howled with pain. I postulate that there may also be pseudo pain. The second time Barbara lay in foetal position and screamed in agony, I was astonished to see her sit back on her chair calmly, well satisfied with the attention she received. The third time she performed I felt a little exploited. Thus I remained an outside observer, wondering if I should feel guilty for not being more empathetic. Power may be directly or indirectly expressed through group norms and values. Norms are agreed modes of conduct and belief that guide the behaviour of group members (Johnson et al, 2009). Our group obeyed the direct power exercised by the leaders. We were also systematically educated in the norms expected of us by the Findhorn Community. This was done in discussion and by the leaders modelling expected behaviours. At one point Annis gave us a lecture on the rules of group sharing sessions, the only time I thought she was directly criticising us and I didnt agree with those rules, wanting to give feedback to the person who had just shared but this was not allowed. Sharing was to be received in silence. The first time Barbara broken into howls of anguish, and shared a nightmarish experience she had had while on a group nature walk, she concluded with Now I feel foolish. I believed she should have been reassured that we had not found her behaviour foolish. I too felt ridiculous after co mpleting a task to show a side of me that others havent seen yet and I demonstrated my three year old self having a tantrum. I needed feedback. I was aware that energy is tied up in withholding feeling. When released, people typically reported terrific physical and emotional relief called catharsis. Barbara appeared not to. While expressing emotions may be culturally inappropriate in some situations it was not at Findhorn but later I questioned whether she actually was experiencing the healing of catharsis. Catharsis alone is limited in regard to producing long-term change. Barbara needed to understand her experience by putting into words those intense emotions but this was forbidden by our group norm which made discussion taboo (Corey et al, 2010). Every individual and group uses a mixture of learning styles, namely experience, reflection, conceptualisation and active experimentation (King Kiely, 2004). Our programme used all these adult learning styles in its varied tasks. We played games, danced, walked in Nature, meditated, listened to lectures, drew, made collages, sang, watched films plus much more. However the programme used mainly structured rather than unstructured exercises, which King Kiely (2004) claim is predominantly used for psycho-educational groups. As our leaders were very experienced they had developed their own toolkit of creative exercises though one participant began to cry during the first mornings session of encounter games designed to bond the group and I felt uncomfortable, and quite disgruntled, at having to take part in these role plays as they were outside my expectations. They were too physical, too unpredictable, for me to feel safe in the group at this stage. Our group had no procedures to seek out dissenting opinions. Group think is the collective striving for unanimity so that there is no appraisal of alternatives. There is lack of reality testing, a weakening of rationality, judgemental thinking and the ignoring of inconsistent external information. Groupthink censors discussion of disagreements or arguments (Quinn Schlenker, 2002). Our group felt strong pressure to agree with one another, and failed to engage in effective discussion. If the leaders believe in members capacities to make important personal changes participants may consequently see the group as a valuable conduit to personal growth. If the leaders listen non-defensively and communicate that they value members subjective experience, members are likely to see the power in active listing. If the leaders are genuinely able to accept others for who they are, participants will learn to accept peoples rights be themselves and be different. Modelling behaviour in groups is one of the most effective ways to teach members how to relate to one another constructively and deeply (Corey et al, 2010). These were our leaders successes, with the exception of Anniss need for too much control. If members feel that they are deeply understood they are more likely to trust that others care about them. A misapprehension of invulnerability, indicated by unjustifiable optimism and too much risk taking was present (Keyton, 2006). The norms of the group meant we were above attack and reproach. One participant, Elka, learned that her lover committed suicide while she was with us, and as a diagnosed depressive herself who had attempted suicide 6 months before, was vulnerable after hearing such news. The leaders offered her no feedback, as per their norms, and welcomed the fact that she opened herself up to this challenge! They stressed that they were not a therapy group but I claimed Findhorn attracted damaged people and its leaders should be trained in crisis management. But there were no contingency plans available for when participants became unstable. Absence of disagreement is the primary cause of groupthink (Courright, 1978). I kept my criticisms to myself in group time but talked about them privately to some participants as similarly did others about Anniss controlling behaviour. Members learn how they function as a person in the world by looking at the patterns they use in the group session (Corey et al, 2010). I protected myself from vulnerability by taking on the role of critical assessor, probing for information, attempting to give advice and paying attention to the dynamics of individuals and the group. Instead of paying attention to how I may be affected in the group, I shifted the focus to others, thus I was left behind as the group developed (Corey et al, 2010). The leaders did not sensitively block this defensive behaviour. They could have pointed out to that I was depriving myself of the maximum benefit from the group by paying more attention to others. Schutz (1958) identifies 4 stages in group development. The first, inclusion, assesses individuals as pondering where they fit in, feeling vulnerable, excited and often fearful. The second stage, control, is the jockeying for leadership, control and power. Who is marginalised, who is threatened, who frustrated with authority problems, who projecting onto the leader? This is where I fitted in, as I became frustrated with the groups unwillingness to express negative thoughts or give personal feedback as per the censoring demands of the leaders. My defensive role of critical observer anchored me to this stage. The third stage, affection, is a time when participants feel a sense of belonging, happiness, love and harmony with each other. The others in the group were able to feel this with each other, but not with Annis. The last stage is termination. Creating an effective group requires an appropriate balance between support and challenge but our group lacked appropriate challenge. Our norms were supportive and several participants used that to take risks but that in-itself was not sufficient. Groups that use confrontation to strip away the defensive behaviour of members often consequently have increasingly defensive interaction. Leaders are best to refrain from highly confrontational involvement until they have developed a trusting relationship with participants. Once interpersonal trust is achieved group members are usually more accepting of challenge (Corey et al, 2010). Theasaurus to here: ie done above. I never gave up the safety of my defensive detachment nor did others in the older sub-group. Resistance is a normal process that can lead to productive exploration in the group. The defensive style may take various forms such as conflict, detachment, distrust or diverting but the underlying fear is of getting close and the vulnerability this implies. The most successful way to deal with difficult behaviours is for the leaders to simply describe to members what they are observing and let the members know how they are affected by what they see and hear. Showing a willingness to understand the members behaviour is the gentlest form of confrontation. Using such a strategy in our group would have been helpful (Corey et al, 2010). When feedback is given honestly and sensitively, members are able to understand the impact they have on others and decide, what, if anything, they want to change about their interpersonal style. Feedback has been associated with increased motivation for change to o (Morran Wilson, 1997). Group leaders need to teach participants how to give and receive feedback. Members are more likely to consider feedback that may be difficult to hear when there is a balance between positive or supportive feedback and corrective or challenging feedback. Members can benefit from both if the feedback is given in a clear, caring and personal way (Morran et al, 1997). Positive feedback should be emphasised during the early stages of the group. However positive and corrective feedback should be balanced during the middle and later stages (Moran et al, 1997). However this did not happen for us. Corrective feedback is more credible, useful and increasingly more accepted by members during the working and ending sages. Leaders need to assist in establishing appropriate norms that encourage the giving and receiving of corrective feedback. (Morran et al, 1997). Our leaders modelled positive feedback but not corrective feedback and the groups success was inhibited accordingly. Our final session involved tasks to put what has occurred in the group into a meaningful perspective and to plan ways to continue applying changes to situations in our daily lives. At this time members need to express what the group experience has meant to them and to state where they intend to go from here. Members need to face the reality of termination and learn how to say good-bye. The potential for learning permanent lessons may be lost if the leader does not provide a structure that helps members review and integrate what they have learned but our leaders did this (Corey et al, 2010). We exchanged email addresses and these emails became a valuable support system, particularly for Elka who returned home to find her lover had killed himself the day before. We all emailed her with our empathy and, in my case, good advice as to seeking help for herself. I remained a rescuer! Assisting members in creating a support system is a good way to help them deal with setbacks and keep focused on what they need to do to accomplish their goals (Corey et al, 2010). There was an evaluation sheet that allowed participants to say what was helpful and what was difficult about the group and ways that the sessions could have been improved. It asked for feedback on the leadership which I didnt give! Even at the very end I remained uncommitted to the group processes. This request for post workshop evaluation was a valid request but not sufficient. Evaluation should have been more frequent, with assessment of the groups needs occurring throughout the programme. Keyton (2006) explains that some members enjoy the group experience so much that they do not want it to end. This was particularly true of our younger members. They felt happiness and pleasure at having had a good group experience, but they also felt sadness and loss that the group was over (Rose, 1989). The final night saw us enjoying a celebratory dinner. Keyton, (2006) claims that celebrating success solidifies individuals connections to the group and helps members gain closure. I found such expressions of sorrow irrelevant, never having moved from the control stage of the group so for me, overall, the group did not achieve its second goal. It was, however, successful in regard to this goal for the younger ones. For us all, the goal of being introduced to aspects of living at Findhorn was achieved. 2726 words.