Recreation, Leisure and Play Essay Example for Free

Recreation, Leisure and Play Essay The idea of leisure has been in existence for many centuries and has come to have many different meanings depending on the period in history or the civilization that it originated from. From as early as Ancient Greece, Rome or Babylonia, the term we now know as leisure has existed in some form or another. As has been widely noted in introductory recreation texts, schole was both the ancient Greek word for leisure meaning, â€Å"serious activity without the pressure of necessity† and is the root of the English word for school (Godbey, 2003). To the ancient Greeks, leisure, education, and culture were intertwined. In other words, learning was available only for the rich, people with the wealth to afford free time. Leisure, as we know it today, has changed from the original meaning of the word. From what I have read and found in various books and articles, Leisure can be defined in 3 different ways: leisure defined as a state of being or a state of mind, leisure defined as an activity, and leisure defined as time. I will discuss the various definitions of leisure today and then discuss my issues with each definition. Leisure Defined as a State of Mind Leisure defined as a state of mind is, in my mind, the least often used definition of the word. The way to understand this concept would be use it in the context such as â€Å"someone who is at leisure†; meaning freedom from anxiety, obligation, or constraint or having an internal locus of control. Locus of Control refers to an individuals perception of main causes of events in life. More simply, having an internal locus of control means that you believe that you are the master of your own destiny. John Neulinger (1974) states: Leisure has one and only one essential criterion, and that is the condition of perceived freedom. Any activity carried out freely, without constraint or compulsion, may be considered to be leisure. â€Å"To leisure† implies being engaged in any activity as a free agent and of one’s own choice. (p. 12) Now I want you to keep in mind this idea of leisure as any activity of one’s own free willed decision because I am going to touch on it again during the leisure defined as time. Leisure Defined as an Activity Leisure defined as an activity is used widely as well. Most people would agree that leisure activity is something that is fun and enjoyable during a non-working time. This idea makes it difficult to pinpoint a leisure activity though. Understanding if the activity is performed for intrinsic or extrinsic purposes may be the deciding factor whether the activity is leisure or not. The distinction between intrinsic and extrinsic properties plays an essential role in stating several interesting philosophical problems. Why am I performing this action? If you are doing the activity because you enjoy it, then you are performing it for its intrinsic value. If you do not want to participate in an activity, but you know that you will benefit from the activity, you are performing it for its extrinsic value. An example would be a person who practices on the piano because they like to play, versus a person who practices piano because they want to win a music contest. Who of the two is experiencing leisure as an activity? Most people would agree that the first person is definitely experiencing leisure as an activity. The second person is where the debate lays. It is the same exact activity as the first person, but the motivation for performing the activity is different. I feel that as long as you, as a free willed individual, choose to perform any activity then you are experiencing leisure as an activity because you are fulfilling your desires. I feel that the only time when you are may not experience leisure is when you are dying. If you have lived a long life and eventually die from old age, I do not believe that you made the decision out of free will to pass away. Although, if a person commits suicide, does that persons free willed decision make the act of dying a leisure activity? Some good questions to ask: If your career is your passion, are you always at leisure? Conversely, is a person without a job always at leisure? Musicians, professional athletes, and the homeless are all specific examples of situations that may help answer these questions. Leisure Defined as Time Leisure defined as time may be the most commonly understood meaning of the word today because of its positive connotations (Martin, 1975). People often use the word leisure and the term free time interchangeably. On the surface this definition seems fine, but as you delve deeper and ask difficult questions, it starts to become less clear. What is free time? Free time is defined as time free of obligations or responsibilities, or time to do with what you please. As Neulinger stated his definition of leisure, performing the activity out of free will is the deciding factor for whether it is leisure or not. This idea brings this thought to mind. All human beings have been blessed with the gift of free will; a consciousness of who we are and of the decisions we make. Without consciousness we would still be aware of what is going on around us, but we would react to it in a reflexive, instinctive way. With consciousness, we can deliberately weigh what the senses tell us, and respond accordingly. If this definition holds true, shouldn’t all of life be considered leisure? Every decision, every action, comes from our decisions of our own free will. If we continue with this thought, some questions arise: †¢ Are there any instances in life that would prevent you from experiencing free will? †¢ Do we always make decisions based on our desires? †¢ Do having priorities that are not in sync with our desires negate our free will? These questions came after having a conversation with my friend. She told me that when you are a parent, you have obligations to your children that may interfere with your free time. This is where the damn breaks open and it is up to the individual to decide. Her question was, â€Å"What if my needs as a parent cannot be fulfilled because I have work to make sure my kids are fed and clothed? † I feel that even though you have the responsibility as a parent to provide for your children, you made the decision to have a child knowing full well the obligations and responsibilities that would ultimately come with that decision. Free time, who would have thought two little words, would bring up so many questions? My Definition of Leisure After contemplating on the various definitions of the term leisure I propose the following: Leisure is the phenomenon experienced by all self aware beings whose decisions are based out of free will, whether those decisions are made in the conscious or subconscious mind of the individual. Recreation Recreation is any activity which is relaxing to humans or provides diversions from their normal routine, and in many ways is also a therapeutic refreshment of ones body or mind. Any activity can potentially be a recreational one. Vacations to exotic islands, sporting events, meditation, watching television, or playing monopoly are all forms of recreation. A key factor to the activity being considered a recreational activity is whether or not it is pleasurable. If the activity is not pleasurable then the activity cannot be considered recreational because it is not rejuvenating to the body or mind. For example, a couple travels to the Caribbean for a second honeymoon. They have planned the vacation far in advance and the tickets and reservations are non-refundable. Upon arriving, the weather is awful and the couple is unable to participate in any of the activities they had planned for the trip. Even though the fact they were engaging in a commercial recreational activity, the weather prevented them from having an enjoyable time and therefore the vacation was not recreating to oneself or another. With the information provided, this vacation would not be classified as recreation. Fairchild defined recreation as â€Å"any activity pursued during leisure, either individual or collective, that is free and pleasurable, having its own immediate appeal, not impelled by a delayed reward beyond itself† (Fairchild, 1944). Another aspect of recreation was presented by Gray and Greben (1974) as: an emotional condition within an individual human being that flows from a feeling of well-being and self-satisfaction. It is characterized by feeling of mastery, achievement, exhilaration, acceptance, success, personal worth, and pleasure. It reinforces positive self-image. Recreation is a response to aesthetic experience, achievement of personal goals, or positive feedback from others. It is independent of activity, leisure, or personal acceptance. (p. 23) This definition is not focused on the activity itself, but on the individual’s reaction to the activity; the individuals state of mind. I would agree that this definition touches the heart of the subject much better. I stated earlier that any activity has the potential of being a recreational activity. This is true because it depends on how the individual feels about the activity. Most people experience pleasure during activities like exercise, sports, relaxing, and vacationing. If you think along these lines then it is easy to understand why some activities are generalized as recreational and why some are not. Although some people consider work pleasurable, most people do not love their job. This is why I believe that work is not universally accepted as recreational. My Definition of Recreation After contemplating on the various definitions of the term recreation I propose the following: Recreation is a positive state of mind achieved during any physical or non-physical activities characterized by feelings which are rejuvenating and recreating to the body and spirit. Play Leisure and recreation as I discussed them are states of mind experienced by an individual. Play, although related to these concepts, is different in the fact that it is a means to achieve this positive state of mind which all living beings desire. Play has existed since the beginning of time. Johan Huizinga (1950) described the characteristics of play as: †¢ Voluntary behavior †¢ Stepping outside of â€Å"ordinary life† †¢ Secluded and limited in time and space †¢ Not serious but absorbs the player intensely †¢ Bounded by rules †¢ Promoting formation of social groups that surround themselves with secrecy As you read the characteristics, you realize that they appear in all forms of play. Although play is a common occurrence within all ages of life, it is a concept that it liked to immaturity in today’s society. The Instinctual Aspect of Play. Play is a puzzle to scientists. Why do animals spend so much time and energy doing such silly things that seem to have no purpose? The struggle for survival in nature is deadly serious. What place is there for activities that dont help animals eat, grow, and reproduce? Play is also very risky. Animals can break bones, pull muscles, or get bitten too hard. In a study of 14 Siberian ibexes (wild goats), more than one-third were hurt badly enough during play to cause limps-a serious concern in the race for survival. And animals can become so wrapped up in play that they are unaware of danger. One study showed that 80 percent of the deaths among young fur seals occurred because the playing pups didnt see predators coming! (Braaf 2003,  ¶ 4) Why is play worth the risk? Many scientists believe its essential for survival-as important as food or sleep. Why Play? Most scientists believe that when animals play, they are practicing skills theyll need later in life. This is why different kinds of animals play in different ways. Young predators, such as wolves, lions, and bears, play by stalking, pouncing, biting, and shaking their heads from side to side. Theyre honing their skills for when they will run down, catch, and kill prey. When a wolf pup chases its own tail, bites it, and yanks it back and forth, the pup is rehearsing skills itll need one day as a hunter. Research shows that smarter animals spend more time playing. Elephants play more than horses. Chimps play more than macaques. Wolves play more than rabbits. And parrots play more than either ducks or sparrows. Smarter animals also play in more creative and complex ways. Not surprisingly, humans and chimpanzees are among the most playful species. (Braaf 2003,  ¶ 9) Here are three questions to start with: Why do humans play? Is play something that is learned, or is it instinctual? And what purpose does it serve in humans? To answer the first question, Godbey (2003) presents the following: If you put a person in a dark tank of water heated to same temperature as their body in a dark room devoid of sound, their need for stimulation will be so great that they will usually start to hallucinate. If you are walking down the street with nothing much absorbing your attention, you may start to notice cracks in the sidewalk and make up a game in which you have to avoid stepping on them. (p. 46) In conclusion, humans need stimulation. If the mind is idle then the person will seek out the stimulation in his or her surroundings. Whether or play is instinctual or learned, I believe that it is both. Most games that we play are learned, such as baseball, hide and seek, or even make believe games such as house. Obviously, not all forms of play are taught though. As in the example from Godbey, a person will make up a form of play if there are no other options for stimulation. Finally to understand the purpose of play in humans we must first discuss the four forms of play developed by Caillois (1958). †¢ The pursuit of vertigo in which one tries to momentarily destroy the stability of perception, escaping reality for the moment. †¢ Games of chance †¢ Make Believe †¢ Contests which require appropriate training, the application of skill, and the desire to win As in animals in the wild, play is used to hone a person’s skill for later in life. Some examples of this are interacting with other children on the playground, which will increase social skills, hitting rocks with a stick, which will increase hand-eye coordination, and cloud watching, which will develop a persons imagination. My Definition of Play After contemplating on the various definitions of the term play I propose the following: Play is voluntary behavior, bounded by rules, experienced by both human and non-human beings, which stimulates the mind and body, prepares an individual for similar future situations, and allows for personal growth within the individual. How Leisure, Recreation, and Play Relate Now that I have discussed my definitions of leisure, recreation, and play, I will explain how my definitions are related to one another. As I stated earlier, Leisure is the phenomenon experienced by all self aware beings whose decisions are based out of free will, whether those decisions are made in the conscious or subconscious mind of the individual. Life, to me, is leisure because of our ability to act out of free will. The question should not be, â€Å"Is this activity a leisure activity? †, but rather, â€Å"Is this activity considered good or bad leisure? † Recreation, I feel, is a subset of leisure. All of recreation can be considered leisure, but not the converse. Recreation is a positive state of mind achieved during any physical or non-physical activities characterized by feelings which are rejuvenating and recreating to the body and spirit. The reason that not all of leisure can be considered recreation is because not all of life is recreating to the mind and spirit. Play is a subset of recreation. Similar to leisure and Recreation, all of play is recreation, but not the converse. Play is voluntary behavior, bounded by rules, experienced by both human and non-human beings, which stimulates the mind and body, prepares an individual for similar future situations, and allows for personal growth within the individual. The main difference is that play is bounded by rules where recreation is not. Some examples of recreation that are not considered play would be meditation, reading, or watching TV. If you look at the following diagram, I think it makes it easier to understand the relationship between all three of the concepts. [pic] Leisure is all encompassing. Within it lays recreation and play. Although they are both within leisure there are still some aspects of leisure that are not considered recreation. This blue arrow points to this area. The red arrow points to the area that is recreational but does not classify as play. Quality of Life The well-being or quality of life of a person is an important concern when trying to understand leisure, recreation, and play in an individual’s life. Understanding quality of life is today particularly important in health care, where monetary measures do not readily apply. Decisions on what research or treatments to invest the most in are closely related to their effect of a patients quality of life. There are many components to well-being. A large part is standard of living, the amount of money and access to goods and services that a person has; these numbers are fairly easily measured. Others components like freedom, happiness, art, environmental health, and innovation are far harder to measure and are generally considered to be more important. There are two main strategies we can adopt to improve the quality of life in our everyday lives. The first is to try making external conditions match our goals. The second is to change how we experience external conditions to make them fit our goals better. Neither of the strategies is effective when used alone. Changing external conditions might seem to work at first, but if a person is not in control of his or her consciousness, the old fears or desires will soon return, reviving previous anxieties. (Csikszentmihalyi, 1990, p. 89) For instance, feeling secure is an important component of happiness. The sense of security can be improved by purchasing a gun for home protection, placing security locks on the front door, having an alarm unit installed, or moving to a safer neighborhood. All of these actions would fall under making our external conditions fit our goals better. One also has to understand that perfect safety is, in all reality, not possible and risks are inevitable. Once a person understands this then the threat of insecurity will not have as great of a chance of having a person live in fear; ultimately ruining ones quality of life. In society today, wealth, status and power have become symbols of happiness. People often assume that the rich and famous have very rewarding lives just because of their status. We often assume that life would be better if we were in other peoples shoes. The reality of the situation is that quality of life does not depend directly on what others think about us or what we own, but rather how we feel about ourselves and what happens to us in our everyday lives. Some people today suffer from affluenza, the bloated, sluggish and unfulfilled feeling that results from efforts to keep up with the Joneses. It is an epidemic of stress, overwork, waste and indebtedness caused by dogged pursuit of the American Dream. In layman’s terms, affluenza is experienced when people have the mentality that their possessions is what defines them as an individual. This is not to say that having nice things, being famous, or being is peak physical condition are irrelevant to happiness. These things can be genuine blessings but only if they make us feel better without having to sacrifice other important aspects of our life. Research on happiness suggests that in general, there is a mild correlation between wealth and well-being. Given these observations, instead of worrying about how to make a million dollars or how to win friends and influence people, it seems more beneficial to find out how everyday life can be made more harmonious and more satisfying, and thus achieve by a direct route what cannot be reached through the pursuit of symbolic goals (Csikszentmihalyi, 1990, p. 91). How Leisure, Recreation and Play Affect Quality of Life Everyone is familiar with stress. We experience it in varying forms and degrees every day. In small doses, stress can actually be beneficial to us. It is only when the stress becomes too great, affecting our physical or mental functioning, that it becomes a problem. The stress response of the body is meant to protect and support us. To maintain stability or homeostasis, the body is constantly adjusting to its surroundings. When a physical or mental event threatens this equilibrium, we react to it. This process is often referred to as the fight or flight response. We prepare for physical action in order to confront or flee a threat. When it is part of a natural reaction to challenge or danger, the body’s response is called positive stress. However, when you feel out of control or under intense pressure, you may experience the physical, emotional, or relational symptoms brought on by negative stress. Stress can cause both physical and emotional in an individual’s life. Stress adversely affects reproduction, sexual behavior, and growth. Stress inhibits the immune system, making you more vulnerable to colds, flu, fatigue and infections. Leisure, recreation and play are natural ways to reduce negative stress that builds up in the body therefore improving ones quality of life. The human body is like any other system in nature. If we don’t have ways to vent our stress from everyday life through activities that are pleasurable, we will start to experience the negative side effects of stress. Final Thoughts My thoughts on the subject of leisure, recreation, and play before this paper could not be further from where my thoughts are now. I feel that too much emphasis is placed on unimportant things today. Society, more so than ever, has gotten into the habit of treating the symptoms of people, instead of treating the individual. I feel that having a better understanding of the concepts of recreation, leisure, and play and the role they play in your life will ultimately lead to a happier and hopefully longer life. Refrences Braaf, E. (2003). Why animals love to play. Retrieved September 20, 2006, from Find Articles Website: http://www. findarticles. com/p/articles/mi_qa4128/ is_200311/ai_n9307508/pg_1 Caillois, R. (1958). Man, play and games. Glencoe, IL: The Free press. Csikszentmihalyi, M. (1990). Flow The Psychology of Optimal Experience. New York, NY. Harper and Row. Fairchild, H. (1944). Dictionary of sociology (pp. 251-252). New York, NY: Philosophical Library. Godbey, G. (2003). Leisure in your life: An exploration. State College, PA: Venture Publishing. Gray, D. and Greben, S. (1974, July). Future Perspectives. Parks and recreation, 61, 49 Hiuzinga, J. (1950). Homo ludens: A study of the play element in culture. Boston, MA: Beacon Press Martin, A. (1975, March). Leisure and our inner resources. Parks and Recreation, 69. 1-16 Neulinger, J. (1974). The psychology of leisure: Research approaches to the study of leisure. Springfield, IL: Charles Thomas Publishers.

Necrotizing Fasciitis (NF): Causes and Treatment

Necrotizing Fasciitis (NF): Causes and Treatment Abstract Necrotizing Fasciitis (NF) is a rare but severe type of bacterial infection that affects the soft tissue and fascia. Because of how rapidly the infection spreads it has a high mortality rate and the key to a successful recovery is early diagnosis and treatment. Since the discovery of this disease, little progress has been made to decrease the mortality rate, further emphasizing the importance of healthcare providers ability to detect and treat the infection early so that the patient will have a fighting chance. This article will discuss the history, pathophisiology, clinical manifestations, diagnostics and treatments, and interventions as it relates to the Nurse practitioners role in caring for a patient with NF. History and Background Necrotizing Fasciitis (NF) is a rare but rapidly progressing inflammatory infection that results in the extensive destruction of soft tissue and fascia. In the earlier stages of the infection muscle and skin are not affected (Ruth-Sahd Gonzalez, 2006). NF involves the superficial fascia, subcutaneous fat (which has nerves and vascular structures) and deep fascia (Green, Dafoe, Raffin, 1996). Thrombosis of the microvasculature occurs but there is an absence of myonecrosis (Giuliano, Lewis, Hadsley, Blaisdel, 1977). NF was first described as a complication of erysipelas by Hippocrates in the 5th century B.C. (Descamps, Aithen, Lee, 1994). During the civil war confederate army surgeon Joseph Jones described it as hospital gangrene in which 46% of the 2,642 soldiers who were infected died from NF complications. The cause of the disease was identified as a bacterial infection in 1915. It wasnt until 1952 that the soft tissue infection was named necrotic Fasciitis by Wilson (Wilson, 19 52). Cases of NF were sporadically occurring throughout the 19th and 20th century but remained restricted to military hospitals during the war with a few outbreaks occurring in civilian populations. Epidemiology The centers for Disease control and Prevention (CDC) reported that rates of NF increased worldwide from the mid 1980s to early 1990s. According to the CDC the increases in the rate and severity of NF are correlated with increase in the prevalence of toxin producing strains of S. Pyogenes (M-1 and M-3 serotypes). The CDC reported approximately 600 cases of NF in the U.S. in 1999 (Hu, 2002). Disease progression NF develops when bacteria enters the body usually through a minor trauma for example a laceration, bruise, or bug bite. Some cases occur after surgeries for example abdominal surgeries; the bacterium enters the surgical incision. The bacteria attacks the soft subcutaneous tissue releasing toxins that kill the tissue and affect blood flow to the infected area causing it to become gangrenous. If left untreated the skin, fat, muscle sheath, and later the muscle become involved. The infection spreads unseen moving up the affected body part at a rate of 3 centimeters per hour up to 1 inch of tissue per hour (Ruth-Sahd and Gonzales, 2006). Once necrosis of the tissue occurs that area has to be surgically removed. The bacteria can also cause the patient to go into systemic shock, which can lead to hypotension, respiratory failure, renal failure, and heart failure. If the infection is severe death can occur within 18 hours (Astorino, Genrich, MacGregor, Victor, Eckhouse, Barbour Barbour, 20 09) Pathophysiology Tissue destruction is possible once the bacterium has been introduced under the skin via a cut or penetrable wound. The pathogens begin to rapidly multiply spreading from the subcutaneous tissue along fascial planes, and then invading the blood vessels and lymphatic system. The bacteria release toxins that decrease the protective tissue factors in order to inhibit the immune systems ability to combat the bacteria. In the bodies attempt to combat the bacteria at the tissue level. The blood vessels in the area begin to leak due to the effects of the bacteria in the tissue, the immune response becomes hyperactive, which results in blood vessel dilation in order to facilitate the immune response to the area affected. Unfortunately the cells in the tissue begin to die as the blood vessels leak and decrease the oxygen supply to the cells due to the increase in permeability. Since there is a decrease in blood flow and oxygen supply to the tissue from the infection, tissue necrosis and ische mia occur. As tissue necrosis worsens, nerve damage takes place, which can be seen, as the patient will report the decrease or absence of pain at the area affected. As the infection progresses septicemia will also develop (Astorino, et al. 2009). Causative factors NF is caused by a bacterium named Streptococcus pyogenes or Group A streptococcus (GAS). GAS can be found in peoples throats or on their skin and they will be asymptomatic. S. pogenes is a cause for non-invasive GAS diseases for example rheumatic fever, strep throat, and skin infections like impetigo. When GAS travels to areas of the body where bacteria isnt found it is called invasive GAS disease example would be blood or lungs. More than 10 million non-invasive GAS cases occur annually. A rare but most severe case of invasive GAS is NF. These bacterium evolve quickly and scientist believe that GAS makes proteins that cause the immune system to attack the tissue directly thus the body destroys itself (Hu, 2002). NF has been classified into two types based upon the bacterium identified upon culture. Type 1 in a polymicroial infection including both gram-positive and gram- negative bacteria that can be anaerobic or aerobic. Type 1 is the most common, making up 90% of all the cases, st riking abdominal or peritoneal tissue. Underlying risk factors include postoperative, advanced age, or diabetes (McGee, 2005). Type 2 also known as the Flesh eating Bacteria is the rarest out of the two making up about 10% of the cases. It is the most dangerous of the infections usually affecting the arms or legs and involves the Group A (beta)- hemolytic streptococcus with or without staphylococcus aureus. Type 2 does not discriminate on age, race, or sex (Astorino, et al. 2009). Signs and Symptoms Early detection of NF is crucial it can be the difference between life and death. Health care providers need to be knowledgeable about the signs and symptoms of NF so that treatment can be started right away. Initial signs may be vague and are often confused with cellulitis, signs include pain, edema, erythema, and fever. A definitive diagnosis can be made by visualization and dissection of the necrotic fascia. A key factor of NF is pain, which is disproportionate to the amount of redness. If suspected cellulitis fails to respond to antibiotics within 24-48 hours NF should be considered (Varma and Stashower, 2006). Early symptoms including pain, malaise, fever, and thirst occur within the first 24 hours of invasion of bacteria. This is the time NF is usually misdiagnosed because progression of the disease is not visible until tissue destruction has already stated (McGee, 2005). Walter (2004) states that the hallmark of NF is erythema that spreads quickly with a margin of redness that extends to normal skin and is not raised. Advance symptoms occur 48-72 hours later and are characterized by significant pain at the wound site, increasing erythema, edema, and warmth. The skin tissue then becomes discolored and deteriorates further. The redness turns to dusky or blue and bullae (vesicles) appear. These bullae enlarge and then rupture leaking out dishwater pus a foul smelling, thin dirty gray liquid (Kessenich, 2004); (Ruth-Sahd and Gonzales, 2008). 4-5 days after appearance of the first symptoms patients can begin to demonstrate critical symptoms ranging from numbness and hypotension to toxic shock and unconsciousness. From there the patient can develop gangrene, sepsis, and then death may occur (McGee, 2005). When the initial symptoms are found it can be difficult to differentiate between NF and celluitis thus it is important to remember the hallmark of NF. After 3-5 days of onset when there is skin breakdown, bullae, and cutaneous gangrene present which are defin itive signs of NF and the involved area is usually not painful due to the are becoming anesthetic secondary to thrombosis of small vessels and nerve destruction located in the necrotic subcutaneous tissue Mandell, Bennett, and Dolin, 2005). Laboratory and Imaging Studies Common laboratory studies used in diagnosing NF include complete blood cell count with differential (CBC), Electrolytes, Blood urea nitrogen (BUN), Creatinine phoshokinase (CPK), rapid streptococcus test, and a culture and sensitivity. CBC may show an increase in WBC greater than 14,000/ul and the electrolytes may show a sodium level less than 135 mmol/L, which are both indicative of NF (Schwartz, 2006). The BUN may also be elevated to 15 mg/ml and the CPK may be elevated, indicating the presence of tissue breakdown. A C S with a Gram stain can determine whether the infection is Type 1 or Type 2, which will help to determine what antibiotics to prescribe. Computed tomography (CT) scan and magnetic resonance imaging (MRI) can be used to help diagnose NF. Ct scans can visualize the subcutaneous air and find the anatomic site of involvement by detecting necrosis with asymmetric fascial thickening (Maynor, 2006). MRI is helpful with guided rapid debridement of the wounds. Treatment In order to prevent significant disfigurement and/or death in the patient with NF is a quick diagnosis and very aggressive treatment is needed from the start. Broad spectrum antibiotics that treat gram-positive and negative aerobes and anaerobes are prescribed around the clock until the specific strain of the bacteria can be identified and treated appropriately. Due to the amount of antibiotics being administered and possible toxicity involved, Kidney and Liver function should be monitored during therapy. The patient will also need intravenous fluids, pain management, and possibly TPN. All necrotic tissue on the patient needs to be debrided with diligence in removing fascia, skin and subcutaneous tissue involved as early as possible, which may need to be performed multiple times to effectively remove all necrotic tissue. Hyperbaric therapy may be prescribed as an additional therapy. Role of the NP The NP needs to be able to recognize the early symptoms of NF so that he or she will be able to begin treatment quickly. A collaborative multidisciplinary care approach needs to be used for the care of this type of patient. The care team will need to include Critical/Acute care, Dietitian, Physical therapy, and Wound care Nurse. The patient will need a lot of education and psychological support as well. Conclusion Necrotizing Fasciitis is a very aggressive and debilitating disease that has a very rapid progression. Since the disease is very easily transmitted into the body with the potential of detection not until later stages due to the similarities to cellulitis. Rapid diagnosis and treatment is essential to prevent severe dismemberment and or death. So this makes the Nurse Practitioner working in ambulatory care the first line of defense against this rapidly debilitating disease.

The Power of Sin in Nathaniel Hawthornes The Scarlet Letter :: Scarlet Letter essays

The Power of Sin in The Scarlet Letter Sin is the main theme in the Scarlet Letter. All of the characters in the book were somehow affected by the main sin, which was adultery. The three main characters were the most widely affected, and their whole lives were molded by the way they dealt with the sin. The sin surrounds, encloses, and strangles them. There was no escaping from its harsh consequences. Hester Prynne's sin was as an adulteress, and the result of this was that she had to wear the scarlet letter "A." She feels that her sin has taken away everything she had, and given her one thing in return; her baby. Although she had dignity and pride when she first stepped out of the prison and when she stood upon the scaffold this "A" unfamilarized and seperated her from the community, and she stood alone with her child as she does for the most part of her life following this event. From then on, she was to live away from the community with her baby, Pearl, and was shunned by everyone. The sin she has committed has made her think that death would be an easy way out and that she deserves little, for she says, "I have thought of death, have wished for it, would have even prayed for it, were it fit that such as I should pray for anything." Throughout the next years, the sin Hester committed changes her personality and identity. Once a beautiful woman, Hester now looks plain and drab. Once passionate, she is now somber and serious. She had contained a precious quality of womanhood that has now faded away. Her plain gray clothes symbolize her temperament and disposition. There are also good effects that the sin has on her. She becomes more giving and caring, and is endlessly helping the poor and sick and doing neighbors favors. Hester feels that she owes it to the community, and is also forcing herself into a life of service to others. The sin stays with her throughout her life, and even when she leaves her town, she feels obligated to come back and fullfill her punishment. The sin made her lifestyle worse, but it changed her

Marketing Plan for Kathon MWX :: Business Marketing Case Study Essays, solution

Marketing Plan for Kathon MWX 1. EXECUTIVE SUMMARY Rohm & Haas is a diversified chemicals company. Its industrial chemicals division manufactures maintenance biocide products to the metal working industry. The company enjoys a healthy 30% market share with its Kathon 886 MW in the Central Systems segment. Rohm & Haas has recently launched Kathon MWX to target 150,000 customers in the Individual systems segment where the market for biocides is underdeveloped and has little competition. A large part of the customers use substitute products such as deodorants and bleaches with little effect on microorganisms. The company estimates the market size for the individual segment to be at $20 million and aims to achieve $0.2 Million revenues from this segment in the first year. Despite a superior product, the sales of Kathon MWX reached a meager 6 % of the annual plan in first five months. Rohm and Haas wishes to re-evaluate its strategy in order to tap this huge segment to significantly increase sales volume and market share of Kathon MWX. Rohm and Haas plans to enhance its allocation for distribution and marketing spend of the Kathon MWX. This would result in additional revenue of 0.1 million. This target would be achieved by a combination of a revamped distribution network for Kathon MWX, focused promotion campaign and sampling. 2. PROBLEM STATEMENT Can Rohm & Haas increase its market share and revenues in the maintenance biocide market with its current product line? The sales of Kathon MWX have barely touched 6% of the annual targeted sales for 1984. Is this the right product to target the Individual Systems segment? Can the current marketing strategy for this product help achieve the company?s objectives in the long run? 3. SITUATION ANALYSIS 3.1. Context The product sales of the company?s newly launched product Kathon MWX are well below the target set in the marketing plan for 1984. Despite its superior quality, the consumers have shown little inclination to adopt this product. 3.2. Company Rohm and Haas is a strong player in the maintenance biocide market for Central systems. The product Kathon 886 MW has a 30% share of the 18 million market. The company enjoys 70-80% market share in the non-ferrous metals segment and about 20% share in the ferrous metals market. The company has launched its new product Kathon MWX, a biocide targeted at Individual systems consumers.

Techniques and Outcomes of Germ-line Gene Therapy Essay -- Biology Med

The Relative Positives and Negatives Behind the Techniques and Outcomes of Germ-line Gene Therapy Abstract: Ever since the idea of altering the human genome was created through the research of germ-line gene therapy, advocates and protestors entered into contention with one another. Supporters of the new technology argue about the benefits of germ-line therapy. Humans have the right to scientific inquiry, especially if it is beneficial to mankind. However, their counterparts claim that the difficulty and unknown side effects (coupled with a few unsuccessful and fatal trials) will cause damage greater than any potential good. Furthermore, some even argue with the ethical issues resultant of a possible eugenics movement. Despite level of intellect or personal opinion about the issue, the new, viable chance for germ-line genetic therapy has quickly become a major issue of controversy. Since the dawn of time, man has striven to postpone death while increasing his quality of life. In 1991, human medicine opened an entire new horizon when Ashanti DeSilva became the first person in the world to receive gene therapy for her illness (Gene Therapy Turns 10, 2001). Doctors managed to add a critical gene that allowed her to produce the then absent (and essential) adenosine deaminase (ADA) enzyme. However, because only somatic cells are effected, this practice only has partial success, as DeSilva still needs to take weekly injections of the DNA. Thus, the idea of germ-line gene therapy was born. Germ-line therapy, the altering of embryonic and sex cells of the body, allows all of the new cells in the body to contain DNA along with all future offspring produced by that individual. With the notion that germ-line altering could soon become a... ... Human Gene Therapy, (volume 5). 151-152. Kittredge, Clare. (2005). Gene therapy†¦under the microscope again: some investors show new interest in gene therapy, despite the latest scare. The Scientist, (volume 19). Page 14. McLaren, Anne. (1998). Problems of germline therapy. Nature, (volume 392). 645. Wadman, Meredith. (26 March 1998). Germline Gene Therapy ‘must be spared excessive regulation’. Nature. 30 July 2005: http://www.nature.com/cgi- taf/DynaPage.taf?file=/nature/journal/v392/n6674/full/392317a0_r.html&filetype=&dynoptions= Willgoos, Christine. (2001). FDA regulation: an answer to the questions of human cloning and germline gene therapy. American Journal of Law & Medicine, (volume 27), page 101. Wivel, Nelson A. et al. (1993). Germ-Line Gene Modification and Disease Prevention: Some Medical and Ethical Perspectives. Sciences, (volume 262). Pages 533-538.

Money Laundering : Global Problem Case Presentation Essay

MONEY LAUNDERING : GLOBAL PROBLEM CASE PRESENTATION AS PART OF LEGAL ASPECTS OF BUSINESS , MBA Money laundering is the process of concealing illicit sources of money or in simple language it is the process of washing dirty money (money earned through illegal activities) to make it appear to be legitimate. Now question arises that who launders the money? No doubt, it is always launder by criminals. And who helps the criminals to launders the money is also a money launder. Money laundering is the dynamic that enables criminal activity of all descriptions to grow and expand. INTRODUCTION Money laundering is the process of concealing illicit sources of money or in simple language it is the process of washing dirty money (money earned through illegal activities) to make it appear to be legitimate. Now question arises that who launders the money? No doubt, it is always launder by criminals. And who helps the criminals to launders the money is also a money launder. Money laundering is the dynamic that enables criminal activity of all descriptions to grow and expand. As per Cambridge Dictionary, definition of money laundering is â€Å"The crime of moving money that has been obtained illegally through banks and other businesses to make it seem as if the money has been obtained legally.† If we look at historical aspect of money laundering it is not a new concept. There are historical evidences that in China, merchants would hide their wealth from rulers (4000 BC). Many regulatory and governmental authorities quote estimates each year for the amount of money laundered, either worldwide or within their national economy. In 1996, the International Monetary Fund estimated that two to five percent of the worldwide global economy involved laundered money. However, the Financial Action Task Force on Money Laundering (FATF), an intergovernmental body set up to combat money laundering, stated that â€Å"overall it is absolutely impossible to produce a reliable estimate of the amount of money laundered and therefore the FATF does not publish any figures in this regard†. Academic commentators have likewise been unable to estimate the volume of money with any degree of assurance. Mechanism of Money Laundering: There are 3 stages of money laundering: 1. Placement Stage: At this stage launderer introduces the illegal money into the legal financial system. It could be done to deposit money into financial institutions by various methods. 2. Layering stage: At this stage launderer engages in movements of funds to distance them from their source. Various financial instruments are purchased and resale many times especially through Shell companies and financial institutions. 3. The Integration Stage: At this stage, the funds re-enter the legitimate economy. Then launderer may choose to invest the funds into real estate, luxury assets, or business ventures. Methods of money laundering: The methods by which money may be laundered are varied and can range in sophistication 1. Hawala 2. Shell Corporation and co. 3. Structuring 4. Bulk cash smuggling 5. Trade based laundering 6. Round tripping 7. Bank capture 8. Casinos 9. Real estate 10. Black salaries 11. Fictional loans 12. Tax amnesties REGULATORY FRAMEWORK: premble: The prevention of Money Laundering Act, 2002 (PMLA) was enacted in 2003 and brought in to force with effect from 1st July 2005 to prevent money laundering and to provide for attachment, seizure and confiscation of property obtained or derived, directly or indirectly, from or involved in money laundering and for matters connected therewith or incidental thereto. Necessary Notifications/Rules under the said Act were published in the Gazette of India on July 01, 2005. Pursuant to the recommendations made the Financial Action Task Force on anti- money laundering standards, SEBI has issued a master circular No. CIR/ISD/AML/3/2010 dated December 31, 2010 on anti-money laundering/ Combating the Financing of Terrorism (CFT) in line with the FATF recommendations and PMLA Act, 2002. As per the Guidelines on Anti Money Laundering standards notified by SEBI, All registered intermediaries have been advised to ensure that proper policy frameworks are put in place. The objective is to ensure that we identify and discourage any money laundering or terrorist financing activities and that the measures taken by us are adequate enough to follow the spirit of the Act and guidelines As per the provisions of the PMLA, Intermediary includes a stockbroker, sub-broker, share transfer Agent, banker to an issue, trustee to a trust deed, registrar to an issue, asset management company, depository participant, merchant banker, underwriter, portfolio manager, investment adviser and any other intermediary associated with the Securities market and registered under section 12 of the Securities and Exchange Board of India Act,1992(SEBI Act) shall have to adhere to client account opening procedures and maintain records of such transactions as prescribed by the PMLA and Rules notified there under. SEBI has issued necessary directives vide circulars from time to time, covering issues related to Know your Client (KYC) norms, Anti- Money Laundering(AML), Client Due Diligence(CDD) and combating Financing of Terrorism (CFT). The directives lay down the minimum requirements and it is emphasized that the intermediaries may, according to their requirements, specify additional disclosures to be made by clients to address concerns of money laundering and suspicious transactions undertaken by clients. Obligations under Prevention of Money Laundering [PML] Act 2002 Section 12 of PML Act 2002 places certain obligations on every Financial Institution/Intermediary/ banking company which include: (i) Maintaining a record of prescribed transactions. (ii) Furnishing information of prescribed transactions to the specified Authority (iii) Verifying and maintaining records of the identity of the investors/customers (iv) Preserving records in respect of (i), (ii), (iii) above for a period of 10 years from the date of cessation of transactions i.e, the date of termination of account or business relationship between the client/ investor and the intermediary Legal highlights of PML Act 2002: * Special courts: The trial for the offences mentioned in the act are conducted by a special court, also called â€Å"PMLA Court†. The Central Government (in consultation with the Chief Justice of the High Court), designates a Sessions Court as Special Court. Any appeal against order passed by PMLA court can directly be filed in the High Court. * Punishment: Punishable with rigorous imprisonment from three years to seven years. He could also be liable to fine of upto 5 lakh. * Burden of proof: A person, who is accused of having committed the offence of money laundering, has to prove that alleged proceeds of crime are in fact lawful property OBJECTIVE OF PML Act 2002: The main objectives of the PMLA are as follows: 1. To have a proper Customer Due Diligence (CDD) process before registering clients. 2. To monitor/maintain records of all cash transactions of the value of more than Rs.10 lakhs. 3. To maintain records of all series of integrally connected cash transactions within one calendar month. 4. To monitor and report suspicious transactions. 5. To discourage and identify money laundering or terrorist financing activities. 6. To take adequate and appropriate measures to follow the spirit of the PMLAct 2002. Current Issue of money laundering by Indian banks: The on-camera sting carried out by website cobrapost.com has not only brought into focusthe presence of black money in our economy but also the methods used to convert it into white. Estimates of black money circulating in the system range between 10-30% of the actual size of the economy: Rs 88 lakh crore. As holding large chunks of cash is cumbersome, the search is always on for ways to convert it into mainstream assets. From the expose carried by cobrapost, it looks like even Indian banks are being used to launder cash of their prospective clients, taking advantage of the lax know-your-client(KYC) procedures. Video-clippings showed some employees of select branches of ICICI Bank, HDFC Bank and Axis Bank offering full support to bringing cash into the mainstream. Analysis: A person with black money is told by the customer relations executives to deposit cash in any bank and prepare demand draft (DD) in favor of single-premium insurance products. KYC norms are generally flouted while making DDs. Or clients were advised to make deposits in small amounts, generally below Rs 50000, for which KYC norms are less stringent or the compliance is ignored. Then this investment is routed in products with a horizon of seven or more years as tax authorities have statute limitations of asking assesses to produce documents going back beyond six years. The insuranceproducts chosen are such that the proceeds are tax-free in the hands of the investor. Thus, a person can easily get away without paying any tax on his black moneyand convert it into white. Second, investors can also use the recent window of investing an amount of Rs 20000 per fund house per year. On the face of it, Rs 20000 may look small. But considering there are 40 asset management companies (AMCs) in India, an investor can put in as much as Rs 8 lakh a year in mutual funds and hold the investment beyond six years to escape the tax authorities. A family with five heads can invest Rs 40 lakh in mutual funds in bits of Rs 20000 to conveniently convert the cash into white seven years down the line. As the amount per investment is low, the transaction may skip the taxman’s lenses. Also, those investing up to Rs 50000 per year through the systematic investment plan have been kept out of the KYC net. Such loopholes are being used for money laundering. Current norms state that investors can become KYC-compliant while making investment. The investment is accepted even if the KYC information is incomplete. Thus, a person can deliberately give wrong information so that the application is rejected. But this does not affect his investment. The form will have the remark ‘KYC not OK’, which hardly matters as he can still redeem the proceeds. An investor can repeat the procedure by submitting wrong KYC for each of his investment. Bank officials are interested in such clients as these investors have few options and tend to invest in insurance products where banks earn hefty commissions. Also, a large portion of the commissions come back to the employees as performance incentives. The staff are under constant pressure to meet sales quotas as their jobs and career growth are at stake. Thus, they resort to mis-selling and money laundering to achieve their internal targets. Many private banks are also focusing on non-core areas like sales of financial instruments to boost their non-core banking income. Very often a bank’s strength is judged by the fee-based income as it is unaffected by the interest-rate cycle. On the face of it, the KYC rules for transactions in financial instruments put in place by regulators like the Reserve Bank of India (RBI) and the Securities and Exchange Board of India (SEBI) may look quite stringent. But the cobrapost investigation has revealed the loopholes. Thus, Sebi and the RBI should take the incident seriously and see how KYC can be made leak-proof. Punishment for flouting norms should be stricter for all financial intermediaries. References: 1. Dirty Dealing, the untold truth about global money laundering: Peter Lilley 2. Money laundering, An insight into the dark world of financial frauds :BuhreLal 3. Capital Market : April 1-14 2013 4. PML Act 2002 5. Cambridge dictionary

Directors Use of Techniques in “Chocolat”

Individuality versus conformity is a fine line that people in society walk along. This has been shown in Chocolat, released in 2000 and directed by Lasse Hallstrom. Where Vianne and her chocolate shop represent individuality and the Comte represents conformity. Hallstrom uses various film and dramatic techniques to convey this idea to the audience. In Chocolat, the Comte has a big influence on how the townspeople feel and what they feel they should be doing. This means that the Comte is the pinnacle of control in the town and he feels that everyone should conform to the long standing traditions.The Comtes’ control over the town is quite strong as shown in the opening scene, where all of the townspeople are shown to be conforming to each other. In this scene the costumes of the townspeople are all dark colours and similar as including the Comte. This shows that the townspeople are conforming all the time, even in what they are wearing. There is a voice over narration in the fir st part of the opening scene and this line; â€Å"If you lived in this town you knew what was expected of you†, shows how controlling the Comte is and that the townspeople did not want to break conformity.There is a camera shot in this scene that is from Anouks point of view looking up at the Comte. This shows his powerful figure and his control over the townspeople. These techniques show that Comte is a very controlling figure and he likes to impose his feelings and thoughts on to the townspeople. Viannes presence in the town has the opposite effect to that of the Comte. Vianne is a very individual person and this starts to rub off on to the townspeople.She has her own way of doing things, for example not attending church, which is against the values that the Comte has instilled in the townspeople. Viannes individuality is shown in scene four where she is setting up her shop. There are close up shots of the traditional sculptures that Vianne is placing in her shop. These con trast greatly against the statue shown in the town square and show how different Vianne is to the rest of the town. Vianne is always wearing a piece of clothing that is red whichstands out from the clothing of the townspeople. When she takes in Josephine, she also starts to wearing bright colours. These costumes show Viannes effect on the townspeople and her individuality. In this scene, the images of townspeople peering round at her shop or looking through the cracks in the newspaper into the shop show their curiosity towards Vianne and the idea of individuality that she presents to them. Viannes influences the town through her presence in their lives and her knowledge of individuality that she displays towards them.The Comtes control is fighting against the effect of Vianne just the same as conformity is against individuality. Both characters want the townspeople to see the world their way. This is shown in scene six where Vianne opens her shop for the first time. In this scene th e Comtes house is shown and it has very dark lighting and they style of it is very old fashioned. This shows that the Comte is trying to set an example of what he feels the town should be like and that it should conform to his ideals.The Comtes control over the town is shown in the reactions of the townspeople when they discover that Vianne is running a chocolate shop. Their reactions include â€Å"This certainly is different†, which reveals information that the town has no other shops like this one and that it is new and individual. The music that plays while the townspeople are looking at or entering the shop is bright and tempting. This is a presentation of what is happening and of what is to come from the influence of Viannes individuality on the townspeople.The Comte and Vianne have opposite effects on the townspeople, trying to make them conform or affecting their individuality. The line between conformity and individuality is very fine. The Comte and Vianne represent d ifferent extremes of this line. Their influence on the townspeople is very strong and affects all of the townspeople differently. The Comte wants the townspeople to conform as one and he uses his authority to try and achieve this, but Viannes presence and her individuality drives a change in the thoughts of the townspeople and eventually the Comte.