The Dana-Farber Cancer Institute Case Study Essay Example for Free

The Dana-Farber Cancer Institute Case Study Essay 1. How did DFCI come about? The Dana-Faber, as it is commonly known, was originally established as the Children’s Cancer Research Foundation in 1947 by Dr. Sidney Farber, then a pathologist at Boston’s Children’s Hospital. In the 1940’s the only treatment for cancer were surgical removal of tumors and radiation therapy. Cancers that had metastasized were regarded as incurable. Dr. Farber’s vision was that children’s cancer, particularly systemic cancers such as leukemia, could be cured if researchers and clinicians worked as a team. He envisioned the union of research laboratories and patient care. As David Nathan, CEO of the Dana- Faber since 1995, explained, â€Å"The problems of the patients would be brought up to the labs and ideas from the labs would go down to the patients.† The history of the Dana-Faber is intimately tied to history of its funding. Initial funding for the Children’s Cancer Research Foundation came from the Variety Club of New England. In 1948, the Variety Club organized a radio broadcast from the bedside of a young patient with lymphoma known as â€Å"Jimmy† as he was visited by members of the Boston Braves baseball team. The donations that poured in to buy Jimmy a TV set on which to watch Braves’ games were the beginning of the subsequently became the official charity of the Boston Red Sox, Ted Williams and the Massachusetts Chiefs of Police Association. In 1974, the institution’s name was changed to the Sidney Faber Cancer Center to honor its founder, and in 1983, the name was changed to the Dana-Faber Cancer Institute to acknowledge the major contributions made over twenty years by the Charles A. Dana Foundation. The first Children’s Cancer Research Foundation facility, the Jimmy Fund building, was built in 1951 and housed research laboratories. It was expanded in the 1960s to include outpatient services, mostly for children. According to Dr. Faber’s original vision, the organization was to consist of research laboratories and outpatient clinics, but not inpatient beds. Inpatient care was provided at Children’s Hospital. However, as research and patient care grew to include adult patients, the doctors at the Dana-Faber were faced with the problem of where to admit adult patients. In particular, the new technique of bone marrow transplant (BMT) required the patient services of a general hospital. A joint program existed between the  Dana-Faber and the Hematology Department at the Brigham and Women’s Hospital. However when the BWH would not permit Dana-Faber physicians to admit patients and retain control of their clinical care, the Dana-Faber decided to open its own inpatient service, initially for BMT patients in 1979, and later, for general oncology patients. In fact, the system for hospital reimbursement in effect since 1983 favored the opening of inpatient beds at the Dana-Faber. General hospitals, such as the Brigham and Women’s, are reimbursed for all Medicare and many non-Medicare patients on a DRG basis. On the other hand, specialty hospitals, such as the Dana-Faber, were permitted to charge Medicare and other insurer’s full costs. This revenue allowed the Dana-Faber to finance its expansion. The institute roughly doubled in size between 1985 and 1995. In 1995, the Dana-Farber had 57 licensed beds, 2,088 inpatient admissions and 55,427 outpatient visits. 2.What was the hospital’s primary mission The Dana-Faber, as it is commonly known, was originally established as the Children’s Cancer Research Foundation in 1947 by Dr. Sidney Farber, then a pathologist at Boston’s Children’s Hospital. In the 1940’s the only treatment for cancer were surgical removal of tumors and radiation therapy. Cancers that had metastasized were regarded as incurable. Dr. Farber’s vision was that children’s cancer, particularly systemic cancers such as leukemia, could be cured if researchers and clinicians worked as a team. He envisioned the union of research laboratories and patient care. As David Nathan, CEO of the Dana- Faber since 1995, explained, â€Å"The problems of the patients would be brought up to the labs and ideas from the labs would go down to the patients.† 3.How did the mission evolve? 4.Explain Phase I II clinical research trials. Phase I and II trails are designed to understand the effects of a drug in the human body. They examine the toxicity and effectiveness of the drug and the way that the body metabolizes the drug. Phase I trails require that blood  samples be drawn as often as every few minutes for a period of several hours. Phase II trials are undertaken after a drug has been tested in a small group of people and the correct dosage has been established. They examine the efficacy of the treatment in a larger sample of patients. Phase II trails compare this drug treatment to patients who are receiving conventional therapy. All trails are implemented using a research protocol, a lengthy and detailed document that describes the following: 1.The objectives of the research and its rationale 2.The details of the drugs to be administered (dosage, frequency and route of administration), including the way in which the correct dose is to be calculated for any individual patient 3.The treatment to be administered (either investigational or conventional) 4.The criteria by which eligible patients are identified as potential candidates for the trail 5.The method of randomly assigning patients to the intervention and control arms of the trail 6.The endpoints being measured 7.The way in which the wellbeing of patients will be monitored over time (type and frequency of labs tests). 5.Explain how chemotherapy works. Cancers whose growth is restricted to a local area can be removed surgically. Those that are localized, such as malignancies of the blood and cancers that have already spread to distant sites are treated with chemotherapy. Most chemotherapeutic agents block essential process by which cells replicate, and therefore kills all replicating cells. Because cells in the cancer are replicating at a greater rate than noncancerous cells, the cancerous cells are killed preferentially. But chemotherapeutic agents are also harmful to normal cells, especially those with higher rates of turnover, such as the cells lining the intestines and white blood cells, a component of the immune system. Common side effects of chemotherapy include immune suppression, nausea and hair loss. The extent of these side effects is related to the dose of the drugs. Less common toxicities related to these drugs include heart and ling dysfunction. Chemotherapy is usually delivered in courses, each lasting several days, every few weeks. The time  off the drugs allows normal tissues time to recover. White blood cells numbers decrease after each course of chemotherapy and recover in the intervening days. Each course is preceded by blood test to check that the white blood cell numbers are back up to the normal range, and that heart, liver, and kidney function are not disturbed. The dose of chemotherapy s calculated based in the body surface area of the patient (milligrams per meter squared), which is calculated from the patient’s height and weight. Patients are weighed prior to each course of therapy. Doses of chemotherapy can be expressed by either daily of courses doses. The course doses are the sum of the daily doses. Because of the will known side effects of the chemotherapy, patients are given additional medications, such as anti- nausea drugs. 6.What is the process that the nurse goes through when a new patient arrives? Upon arriving at an inpatient unit, a patient met his primary nurse and was formally admitted to the unit. Each new patient was assigned a primary nurse and two or three associate nurses. The primary nurse was the patient’s first point of contact with this unit. The associate nurses cared for the patient when the primary nurse was off duty. The first thing that the primary nurse did, prior to administering chemotherapy, was to check the patient’s consent form. The original was kept in the patient’s medical record, and a copy was kept in the protocol binder in the physician’s dictation room. Next, the nurse determined whether or not the patient was being treated under a research protocol. The only way she could do that was to look at the physician orders that the patient often carried with him when he arrived on the unit. Medication order was also often written after the patient arrived on the unit. The nurse manager information or research protocols unless previously notified by the oncology fellow. If the research protocol was not with the physician’s orders in the patient’s record, the admitting nurse looked for a copy in the files on the unit or went to the Protocol Office. For common protocols, nurses frequently carried index cards listing the details of the treatment. If the protocol was new the nurse might have to look up additional information on the purpose and design of the protocol. Finally, in admitting a new  patient, the nurse measured the patient’s height and weight, and calculated the body surface area. With this she verified the calculations of the chemotherapy dosage. She also checked the dosage of the other agents, either by looking in the hospital formulary, other standard references, or the research protocol. Before beginning any therapy the nurse checked the results of the blood test that the patient had when he arrived at the Dana-Faber. When the nurse received the bag of the chemotherapeutic agent from the pharmacy she cross checked the label on the bag with the drug order sheet in the patient’s drug book. Having confirmed that the drug and dose written on the label of the bag matched the order in the drug book and that the patient’s name on the drug sheet and bag matched the name on the patient’s identification arm band, the nurse began infusing the solution of chemotherapy. The duration of the chemotherapy of ten spanned several nursing shifts. Each nurse coming on duty went through the same confirmation process just described. She checked the patient name, drug and dose on the label of the bag, the drug order book, and the patient’s consent form, and recalculated the dosage, but she did not necessarily check the original drug order. 7.What kinds of safeguards are present in the process of administering chemotherapy to patients? Chemotherapy is usually delivered in courses, each lasting several days, every few weeks. The time off the drugs allows normal tissues time to recover. White blood cells numbers decrease after each after each course of chemotherapy and recover in the intervening days. Each course is preceded by blood test to check that the white blood cell numbers are back up to the normal range, and that heart, liver, and kidney function are not disturbed. The dose of chemotherapy s calculated based in the body surface area of the patient (milligrams per meter squared), which is calculated from the patient’s height and weight. Patients are weighed prior to each course of therapy. Doses of chemotherapy can be expressed by either daily of courses doses. The course doses are the sum of the daily doses. Because of the will known side effects of the chemotherapy, patients are given additional medications, such as anti- nausea drugs. 8.Explain occurrence screens. Quality assurance (QA) activities were similar to many hospitals nationwide, largely because they are mandated by state agencies such as the Board of Registration in Medicine and the Commonwealth of Massachusetts Department of Public Health, as well as the JCAHO. Each department undertook quality monitoring and improvement activities. For clinical care, quality assurance information was collected in several ways. After discharge, medical records were reviewed manually by a medical technologist who was jointly employed by the QA and Infections Control departments. She screened the record for evidence of any one of 20 adverse events, such as death, re-admission, pneumothorax secondary to an invasive procedure, and central lines improperly placed. These events were called â€Å"occurrence screens.† In addition, adverse events were monitored through an â€Å"incident reporting† system. Nurses working in the patient care area would fill out a standard from whenever there was an unexpected incident or negative outcome, such as a patient fall or a medication error. Some incidents were reported by phone call. The supervisor of the area concerned had to complete a few questions about the response to the incident, sign the form and pass it on to the QA department. As Karen Nelson, Director of the QA department said â€Å"99% of these said ‘nurse was counseled’.† 9.What were some of the issues noted in the case study that might have led to this incident? She was admitted to the Dana-Faber for her third round of high dose chemotherapy on November 14th, 1994. Her treatment involved a bone marrow transplant. The purpose of high dose chemotherapy is to kill tumor cells, but it also kills healthy bone marrow. Therefore, healthy bone marrow was removed and held in reserve prior to high dose chemotherapy and then re-injected after the chemotherapy. The treatment used was a very high dose of a common chemotherapy agent, cyclophosphamide. The dose was so high that normal bone marrow would be killed. In addition to the common side effects of hair loss and gastrointestinal upset, high dose cyclophosphamide was known to be toxic to the heart. Lehman was participating in a clinical trail and so, in addition, received the anti- ulcer drug cimetidine, which had been shown in animal studies to boost the effect of cyclophosphamide. 10.If you were Dr. Sallen, how would you have addressed this incident initially and then ultimately?

Scarus opinion of Antony Essay Example for Free

Scarus opinion of Antony Essay Scarus explains that Antony left in the height of the battle to chase after Cleopatra. Scarus opinion of Antony is now that of a coward, we know this because he calls him a mallard; this is a wild duck that chases after the female, who in this case is Antony is going after Cleopatra.  Scarus then goes on to say that he had never seen such shame, which surprises him because it came from Antony, who has been described as a triple-pillar of the world. This is very significant because Antony shows how much love he has for Cleopatra. The fact that he would flea a battle at it most significant stage, to risk being called a coward, shows just how much he loves Cleopatra. And also, that he would leave a battle, and risk it being lost, just so he could go after Cleopatra, this shows how loyal he has become to both Cleopatra and Egypt.  Scarus says that the experience of great wars and battles, a mans pride and honour and a mans manhood, had never been violated in such a way before. The fact that he would leave a battle which Rome is fighting, a place that means so much to him, to chase after a woman, is so out of character, this shows his once great love for Rome is now a low priority compared to Cleopatra. Octavia, who is Antonys wife, is another main character of the play. She is associated with gentle, natural phenomena, which means crying in the play. It is also clear that Octavia highlights the nature and importance of the argument between Caesar. As Octavia is Antonys wife and naturally sees her goodness.  Also, Agrippa has an opinion of Octavia; it is that because she is so beautiful and elegant, she has managed to attract the best possible man. Agrippa also says:  Whose virtue and general graces speak.  Agrippa is saying that Octavia has qualities and virtues which no other woman has. Enobarbus also has an opinion of Octavia, he says;  Octavia is of a holy, cold, and still conversation.  He is saying that Octavia is boring and religious, which Enobarbus sees as being a downside to her personality. He says that she has still conversations, which means that she is quiet and does not speak much to others. Antony calls Octavia a swansdown feather, he is trying to imply that Octavia is like a feather on a river, and can not decide upon which way to go. Antony means that Octavia is weak against himself and she will agree or do anything that Antony says.  It is clear from Shakespeares play, that there are many opinions of Antony, some of which are good and in his favour and others that are bad and against him. However, there are characters in the play that have in one scene said nothing but good comments and later on in the play, say nothing but bad remarks about Antony, it may not always be clear what causes the characters to change their opinion, but it usually has something to do with Antonys love for Cleopatra. It is obvious that Antony is an excellent soldier and Roman, especially when it comes to wars and battles. But, when it comes to deciding upon Rome or his love life, he is not so certain, and is usually disliked for his decision by his fellow Roman soldiers.  Discuss the Importance of the Comments Made By Other Characters in the Presentation of Antony

Aristotle Quotes

Aristotle Quotes A constitution is the arrangement of magistracies in a state. A friend to all is a friend to none. A great city is not to be confounded with a populous one. A sense is what has the power of receiving into itself the sensible forms of things without the matter, in the way in which a piece of wax takes on the impress of a signet-ring without the iron or gold. A tragedy is a representation of an action that is whole and complete and of a certain magnitude. A whole is what has a beginning and middle and end. A true friend is one soul in two bodies. A tyrant must put on the appearance of uncommon devotion to religion. Subjects are less apprehensive of illegal treatment from a ruler whom they consider god-fearing and pious. On the other hand, they do less easily move against him, believing that he has the gods on his side. All human actions have one or more of these seven causes: chance, nature, compulsions, habit, reason, passion, desire. All men by nature desire knowledge. All paid jobs absorb and degrade the mind. All virtue is summed up in dealing justly. Anybody can become angry that is easy, but to be angry with the right person and to the right degree and at the right time and for the right purpose, and in the right way that is not within everybodys power and is not easy. At his best, man is the noblest of all animals; separated from law and justice he is the worst. Bad men are full of repentance. Bashfulness is an ornament to youth, but a reproach to old age. Both oligarch and tyrant mistrust the people, and therefore deprive them of their arms. Bring your desires down to your present means. Increase them only when your increased means permit. Change in all things is sweet. Character may almost be called the most effective means of persuasion. Courage is a mean with regard to fear and confidence. Courage is the first of human qualities because it is the quality which guarantees the others. Democracy arises out of the notion that those who are equal in any respect are equal in all respects; because men are equally free, they claim to be absolutely equal. Democracy is when the indigent, and not the men of property, are the rulers. Different men seek after happiness in different ways and by different means, and so make for themselves different modes of life and forms of government. Dignity does not consist in possessing honors, but in deserving them. Education is an ornament in prosperity and a refuge in adversity. Education is the best provision for old age. Even when laws have been written down, they ought not always to remain unaltered. Every art and every inquiry, and similarly every action and choice, is thought to aim at some good; and for this reason the good has rightly been declared to be that at which all things aim. Excellence is an art won by training and habituation. We do not act rightly because we have virtue or excellence, but we rather have those because we have acted rightly. We are what we repeatedly do. Excellence, then, is not an act but a habit. Excellence, then, is a state concerned with choice, lying in a mean, relative to us, this being determined by reason and in the way in which the man of practical wisdom would determine it. Fear is pain arising from the anticipation of evil. For as the eyes of bats are to the blaze of day, so is the reason in our soul to the things which are by nature most evident of all. For one swallow does not make a summer, nor does one day; and so too one day, or a short time, does not make a man blessed and happy. For though we love both the truth and our friends, piety requires us to honor the truth first. Friendship is a single soul dwelling in two bodies. Friendship is essentially a partnership. Good habits formed at youth make all the difference. Happiness depends upon ourselves. He who can be, and therefore is, anothers, and he who participates in reason enough to apprehend, but not to have, is a slave by nature. He who hath many friends hath none. He who is to be a good ruler must have first been ruled. He who is unable to live in society, or who has no need because he is sufficient for himself, must be either a beast or a god. Hence poetry is something more philosophic and of graver import than history, since its statements are rather of the nature of universals, whereas those of history are singulars. Homer has taught all other poets the art of telling lies skillfully. Hope is a waking dream. Hope is the dream of a waking man. I count him braver who overcomes his desires than him who conquers his enemies; for the hardest victory is over self. I have gained this from philosophy: that I do without being commanded what others do only from fear of the law. If liberty and equality, as is thought by some, are chiefly to be found in democracy, they will be best attained when all persons alike share in government to the utmost. If one way be better than another, that you may be sure is natures way. In a democracy the poor will have more power than the rich, because there are more of them, and the will of the majority is supreme. In all things of nature there is something of the marvelous. In making a speech one must study three points: first, the means of producing persuasion; second, the language; third the proper arrangement of the various parts of the speech. In nine cases out of ten, a woman had better show more affection than she feels. In poverty and other misfortunes of life, true friends are a sure refuge. The young they keep out of mischief; to the old they are a comfort and aid in their weakness, and those in the prime of life they incite to noble deeds. Inferiors revolt in order that they may be equal, and equals that they may be superior. Such is the state of mind which creates revolutions. It is best to rise from life as from a banquet, neither thirsty nor drunken. It is clearly better that property should be private, but the use of it common; and the special business of the legislator is to create in men this benevolent disposition. It is Homer who has chiefly taught other poets the art of telling lies skillfully. It is just that we should be grateful, not only to those with whose views we may agree, but also to those who have expressed more superficial views; for these also contributed something, by developing before us the powers of thought. It is not once nor twice but times without number that the same ideas make their appearance in the world. It is the mark of an educated mind to be able to entertain a thought without accepting it. It is unbecoming for young men to utter maxims. Jealousy is both reasonable and belongs to reasonable men, while envy is base and belongs to the base, for the one makes himself get good things by jealousy, while the other does not allow his neighbour to have them through envy. Love is composed of a single soul inhabiting two bodies. Man is by nature a political animal. Man is naturally a political animal. Men acquire a particular quality by constantly acting in a particular way. Men are swayed more by fear than by reverence. Men create gods after their own image, not only with regard to their form but with regard to their mode of life. Misfortune shows those who are not really friends. Moral excellence comes about as a result of habit. We become just by doing just acts, temperate by doing temperate acts, brave by doing brave acts. Most people would rather give than get affection. Mothers are fonder than fathers of their children because they are more certain they are their own. My best friend is the man who in wishing me well wishes it for my sake. Nature does nothing in vain. No excellent soul is exempt from a mixture of madness. No great genius has ever existed without some touch of madness. No notice is taken of a little evil, but when it increases it strikes the eye. No one loves the man whom he fears. No one would choose a friendless existence on condition of having all the other things in the world. Of all the varieties of virtues, liberalism is the most beloved. Perfect friendship is the friendship of men who are good, and alike in excellence; for these wish well alike to each other qua good, and they are good in themselves. Personal beauty is a greater recommendation than any letter of reference. Piety requires us to honor truth above our friends. Plato is dear to me, but dearer still is truth. Pleasure in the job puts perfection in the work. Poetry is finer and more philosophical than history; for poetry expresses the universal, and history only the particular. Politicians also have no leisure, because they are always aiming at something beyond political life itself, power and glory, or happiness. Probable impossibilities are to be preferred to improbable possibilities. Quality is not an act, it is a habit. Republics decline into democracies and democracies degenerate into despotisms. Suffering becomes beautiful when anyone bears great calamities with cheerfulness, not through insensibility but through greatness of mind. Temperance is a mean with regard to pleasures. The aim of art is to represent not the outward appearance of things, but their inward significance. The aim of the wise is not to secure pleasure, but to avoid pain. The beginning of reform is not so much to equalize property as to train the noble sort of natures not to desire more, and to prevent the lower from getting more. The best friend is the man who in wishing me well wishes it for my sake. The educated differ from the uneducated as much as the living from the dead. The end of labor is to gain leisure. The energy of the mind is the essence of life. The generality of men are naturally apt to be swayed by fear rather than reverence, and to refrain from evil rather because of the punishment that it brings than because of its own foulness. The gods too are fond of a joke. The greatest virtues are those which are most useful to other persons. The ideal man bears the accidents of life with dignity and grace, making the best of circumstances. The law is reason, free from passion. The least initial deviation from the truth is multiplied later a thousandfold. The moral virtues, then, are produced in us neither by nature nor against nature. Nature, indeed, prepares in us the ground for their reception, but their complete formation is the product of habit. The most perfect political community is one in which the middle class is in control, and outnumbers both of the other classes. The one exclusive sign of thorough knowledge is the power of teaching. The roots of education are bitter, but the fruit is sweet. The secret to humor is surprise. The soul never thinks without a picture. The state is a creation of nature and man is by nature a political animal. The ultimate value of life depends upon awareness and the power of contemplation rather than upon mere survival. The virtue of justice consists in moderation, as regulated by wisdom. The whole is more than the sum of its parts. The wise man does not expose himself needlessly to danger, since there are few things for which he cares sufficiently; but he is willing, in great crises, to give even his life knowing that under certain conditions it is not worthwhile to live. The worst form of inequality is to try to make unequal things equal. The young are permanently in a state resembling intoxication. There is no great genius without a mixture of madness. There was never a genius without a tincture of madness. Therefore, the good of man must be the end of the science of politics. This is the reason why mothers are more devoted to their children than fathers: it is that they suffer more in giving them birth and are more certain that they are their own. Those that know, do. Those that understand, teach. Those who educate children well are more to be honored than they who produce them; for these only gave them life, those the art of living well. Those who excel in virtue have the best right of all to rebel, but then they are of all men the least inclined to do so. Thou wilt find rest from vain fancies if thou doest every act in life as though it were thy last. To run away from trouble is a form of cowardice and, while it is true that the suicide braves death, he does it not for some noble object but to escape some ill. We are what we repeatedly do. Excellence, then, is not an act, but a habit. We become just by performing just action, temperate by performing temperate actions, brave by performing brave action. We make war that we may live in peace. We must no more ask whether the soul and body are one than ask whether the wax and the figure impressed on it are one. We praise a man who feels angry on the right grounds and against the right persons and also in the right manner at the right moment and for the right length of time. Well begun is half done. What is a friend? A single soul dwelling in two bodies. What it lies in our power to do, it lies in our power not to do. What the statesman is most anxious to produce is a certain moral character in his fellow citizens, namely a disposition to virtue and the performance of virtuous actions. Whosoever is delighted in solitude is either a wild beast or a god. Wishing to be friends is quick work, but friendship is a slow ripening fruit. Wit is educated insolence. Without friends no one would choose to live, though he had all other goods. You will never do anything in this world without courage. It is the greatest quality of the mind next to honor. Youth is easily deceived because it is quick to hope.

Freedom of Cyber-Speech -- Internet Censorship Essay

Freedom of Cyber-Speech      Ã‚  Ã‚  Ã‚   Freedom of speech has always been an important issue in American society.   With the advent of the Internet as a high-speed communication device, this issue has become even more prominent in recent years.   This paper will explore the issue of whether the Internet should be censored. Additionally, it will investigate possible methods for undertaking this censorship.      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   Since 1787, the Constitution has been integral part of American society.   The First Amendment to the Constitution, passed in 1791, reads: Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances. [1]    For two hundred years, this amendment has been tested in many different ways.   Over the years, the government passed many laws that did, in fact, "abridge the freedom of speech" for a variety of reasons.   Now, new technology appears to be giving the government another issue in which it must decide if it should go against the literal interpretation of the Constitution.  Ã‚   This paper will show how content on the Internet can be seen as dangerous, and if it should be censored.   It will then investigate what strategies are being used to censor it.      Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚  Ã‚   The Internet has provided a new and very powerful communication tool for Americans over the past several years.   With the Internet, ideas can be transferred faster than ever before.   Countless benefits have arisen with the development of the Internet, including powerful research resources, on-line shopping, and more.   However, with ... ...ier Foundation. 10/17/99.   http://www.eff.org/EFFdocs/about_eff.html#mission - An introduction to the EFF [6] First Amendment and Free Expression.   Center for Democratic Technology.   10/17/99.   http://www.cdt.org/speech/ An introduction to the CDT [7] The Freedom Forum Online.   The Freedom Forum.   10/19/99. http://www.freedomforum.org - An introduction to the Freedom Forum [8] The Free Expression Network The Free Expression Network.   .http://www.freeexpression.org   - An introduction to the Free Expression Network [9] United States Supreme Court.   Schenck v. United States.   1919. [10]United States Congress.   Title V - Broadcast Obscenity and Violence.   1995. [11] Baase, Sarah.   Gift of Fire. New Jersey:   Prentice-Hall, Inc.   1997. [12] GetNetWise.   GetNetWise.   10/17/99.   www.getnetwise.com - A tool for obtaining web-filtering software.

Dietary Assessment Essay -- Nutrition, Diet, Disease

A dietary assessment method is a critical component in many aspects of nutritional epidemiology such as evaluating energy and nutrient intake in free-living individuals (Taren, et al., 2002). The purpose of dietary assessment data collection is to establish the causal associations between diet and disease aetiology (Jain, et al., 1996). However, it is very difficult to measure exactly how much food people eat or to determine the nutrient content of the diet (Wild, et al., 2001). Therefore, the valid and precise techniques are required to estimate accurate and detailed information on food and nutrient intake as well as eating patterns for identification of the dietary influence on health and disease (Bingham, et al.,1994). Nutrition assessments include clinical and dietary assessment, anthropometrics, as well as biochemical, laboratory immunologic and functional indices of nutritional status (Gibney, 2005). In epidemiological studies, different dietary investigation tools were designed to assess the nutritional status in individuals and populations, nutrition monitoring and surveillance and diet-disease research (Friedenreich, et al., 1992, Taren, 2002). Choosing an appropriate dietary assessment method depends on the purpose for which it is needed. The majority of retrospective dietary assessment methods such as 24-hour recall is of limited validity because of dependence on subject memory and motivation, reliability of the respondent not to under /misreport and ability to estimate portion sizes of the items consumed (Thompson & Byers, 1994). Although the technique is inexpensive, low respondent burden and relatively easy to assess current nutrient intake of a group, it is not appropriate to use data from a single day to repr... ...., 2006). Furthermore, nutritional analysis of recording or reporting food intake data presents a main source of inaccuracy when determining habitual nutrient intake and it does not contain comprehensive information on the interpretation of results from dietary surveys (Macdiarmid, & Blundell, 1997). Therefore, biochemical markers of nutrient intake are now a valuable tool in validating dietary assessment methods (Bingham, 2002). For example, the double labelled water technique and 24-hour urine nitrogen and potassium are routinely used and potentially independent of the errors associated with dietary survey methods (Bingham, 2002). The aims of the study is to determine the intake of total energy, protein , carbohydrate, fat, iron, calcium and fiber within a group of students using the duplicate diet analysis, 24 hour recall and the 7 day weighed intake.

The 19th Century Aesthetic Movement Essay example -- Art History Essay

The 19th Century Aesthetic Movement The Arts and Crafts Movement is the main line of reform design in the 19th century that defines the period of its greatest development, roughly between 1875-1920. The Aesthetic Movement and Art Nouveau, whose roots were in the reaction to the Industrial Revolution in England in the middle of the 19th century, are the two major stylistic developments of this Movement’s philosophy (A Thing of Beauty 9). The term "Aesthetic Movement" refers to the introduction of principles that emphasized art in the production of furniture, metalwork, ceramics, stained glass, textiles, wallpapers, and books. The catalyst for its widespread popularity was the Philadelphia Centennial Exposition of 1876. There, in numerous displays, many Americans, artists and craftsmen as well as the general public, were exposed to art objects from a great variety of nations and periods (Bolger Burke et al. 19). Most writers on the Aesthetic Movement agree that its roots lie in the reaction to Industrialization in mid-19th century England The movement incorporated both exotic and historical sources of design generally, the Japanese influence became the strongest and best known. However, not all Aesthetic Movement design is in a Japanese style and vice versa. Today relatively little remains of the highest expressions of Aesthetic Movement design. Never inexpensive and therefore never plentiful, few objects and very few intact interiors, particularly the domestic interior, survive to suggest their richness and beauty (A Thing of Beauty 11-12). The Aesthetic movement in Britain began as a reform impulse. It was a part of a larger critique of the Industrial Revolution, which had radically altered Britain following the Napoleon... ... oriented away from ritual and visual symbols and more towards social and community ideals, it reinforced the social nature of the movement (A Thing of Beauty 9). Thus, although the Movement definitely had its stylistic expressions, it was not simply an art movement but had a rather complex structure of social, political and moral ideas of the British life in during that period. Works Cited A Thing of Beauty (Catalog of an exhibition at the High Museum of Art in Atlanta, Georgia, February 1-April 6, 1980). Atlanta: The High Museum of Art. 1980. Bolger Burke, et al. In Pursuit of Beauty. New York: Metropolitan Museum of Art. 1986. Kaplan, Wendy. The Art That Is Life: The Arts & Crafts Movement in America, 1875- 1920. New York: Little, Brown and Company. 1987. Klein, Dan. Aspects of the Aesthetic Movement. London: Gordon House/Hillingdon Press. 1978.

The Architecture Of Theatres Architecture Essay

Back to the first half of the twentieth century and it was in America that mass production was going of all time more efficient and ironss of theaters were blossoming all over the state. Architects commissioned to plan these theaters were no longer being briefed by the dramatists and directors but by the proprietors of the ironss with the exclusive purpose on increasing box office gross revenues. The aesthetics were clearly intended for the paying client and the money directed at the entryway anteroom and the of all time turning auditorium infinites and the less exhausted on the of all time smaller dressing suites. This job was less common in Britain around that clip as really few theaters were built during the war but a premier illustration for Britain did come about with the renovation of the Memorial Theatre in Stratford-upon-Avon in 1930. Designed by modernist designer Elizabeth Scott, after months of fundraising and commission meetings, was expressed by the manager of the theatr e William Bridge-Adam as holding, â€Å" Absolute flexibleness, a box of fast ones out of which the kid like head of the manufacturer may make whichever form it pleases. It should be able to offer Mr Poel an Elizabethan phase after his bosom ‘s desire. † The Architectural Review responded to it with critical acclamation. Sightline was an country singled out as being particularily good with no pillars blockading any positions and no boxes. Acousticss were besides mentioned, â€Å" the form of the theater resembles a elephantine horn and is so deigned that the participants can be herd from all parts of the phase and the sound distributed equally throughout the auditorium. The splays and the ceiling of the apron, together with the proscenium when in usage, act as reinforcment to the beginning of sound. † Finally the usage of stuffs and the manner where mentioned. â€Å" Though new theaters continue to look in changeless sequence throughout the state, each fledgling, with really occasional exclusion, represents no more than another measure along the boring way of motif decoration and nonmeaningful ornament. Since Palladio built his theater of Vicenza there has been no development other than an increasing inclination towards coarseness and over-elaborationaˆÂ ¦ in the new theater in Stratford-on-Avon stuffs are used with intelligence, choice and fittingness of intent and designed by the nature of the stuff. † It subsequently became clear that the histrions did non experience the same manner. Remarks were made over the distance from the phase and front row and the bare walls stretching from the apron to the circle. It was described in The Other Theatre, published in 1947, Word count: 294 as if â€Å" acting to Calais from the drops of Dover. † ( Baliol Holloway ) Clearly the designer had non achieved what she had wanted ( an confidant theater ) nor what the client desired. What had happened here was a deficiency of communicating and cooperation between the two professions. In the yesteryear there was an apprehension of what was required and small was said between either professions but back so the designers working on theatre edifices would hold specialised in Theatre design, most of them being builders themselves with several old ages of experience under their belts. The word specializer was non used in Britain until the mid-19th century, pervious to that an designer who designed theaters would merely be referred to as a Theatre Designer. Earlier instances have been recorded in other parts of the universe where renowned general designers have thought they could work out the jobs aroused by the old theater designs. At the terminal of the eighteenth century London had several theaters which had work done to them such as Benjamin Dean Wyatt ‘s Theatre Royal in Drury Lane which besides received architectural critical acclamation. Too frequently theatres built by celebrated Renaissance man designers are more excessive and stop up holding work done to the auditorium within and around a decennary. Fortunately for both designer and theater proprietor money had become available for rebuilds and amendments nevertheless huge. The theatre professions displeasure with the plants of Wyatt ‘s at Drury Lane and Elizabeth Scott at Stratford -upon-Avon are merely a twosome of illustrations of what happens when celebrated designers try and enforce a solution to and old and accustomed job. Their belief that they could rethink the nature of the auditorium ‘s issues upon their first effort can be seen as naA?ve and as the theater profession is more voluble than the architectural kingdom when provoked, the public tend accept the incrimination being placed on the designer.Word count: 385Fortunately there are a few first clip Architects, Theatre Designers and Consultants who do listen to their clients and are willing to pass the clip analyzing the codification for auditorium design every bit good as meet proficient demands. As a consequence there are many theaters in both Britain and America which function out of a healthy relationship between both theaters and architecture professions. The dislocation in communicating is what both sides have to be wary of and this can frequently be caused by the designers instinctive to offer slight resources to the external design. In some instances it may be the instance that the designer has taken a modernist mentality, strange to the theatrical precedency which is by and large that the exterior of the edifice should show what ‘s interior and besides the other manner around. Therefore in the name of architectural truthfulness as a whole, the particularization and form to the auditorium could be sacrificed by the designer under his pronunciamento. Looking at it the issue in item, the same result can be caused by the sentiment that the designer is non altering anything merely reorganizing the auditorium elements more efficaciously which is merely every bit unsafe as believing that they can alter the nature of the auditorium itself. Therefore by seeking to organize these cardinal constituents such as lighting, side seating and acoustic stuffs, and traveling them to the margin of the infinite the oculus of the spectator may be drawn to the exterior of the phase instead than inwards at the histrion. The attending would be drawn to the side walls and ceiling hence the histrion will hold to seek harder to derive the attending of the audience. The job with auditoriums in the yesteryear was the failure to pull the attending to the front 15ft of the phase which should â€Å" look to drift † . Some of the causes may hold been that the seating went excessively far back or was spread excessively broad. The root for this job maybe that some designers are taught and become house trusters that form follows map, therefore the functionality false belief. They work merely with statistics in making a design which is dictated strictly on Numberss. Areas of the design which could non be measured were frequently ignored or left to the designer to make up one's mind on the result unattended. This is a clear illustration of a deficiency of a existent philosophical treatment on the nature of how theatre maps, between the theatrical technician and the designer.Word count: 403To understand the designer Lashkar-e-Taiba ‘s expression at how the development of the proper attack to theatre design. First of all a squad needs to be formed dwelling of: an designer, applied scientist, acoustic adviser, cost adviser and theater adviser. An designer of course heads the squad as is in the designer ‘s office where he or she works alongside spouses, associates and has technicians underneath headin g different sections on the building drawings. There will be some younger members of the squad which would hold graduated high from their architectural schools desiring to work for an experient designer on high degree undertakings who spend their clip seeking to happen rational solutions through planing study strategies with the designer. These immature people are who the Theatre Consultants should intercede with. The Engineers on occasion have a inclination to take over a undertaking which can be unsafe for the place of the designer. The electrical applied scientist has the safest function in footings of illuming which can be overseen by the Theatre Consultant and more cardinal to the success of the undertaking is the mechanical applied scientist. The mechanical applied scientist takes charge of the warming and airing. Theatres require that the infinite be dry and cool whilst besides being soundless, something theater directors specify as being indispensable is the silence. Architecture Actor & A ; Audience states that â€Å" Quite merely there is nil more expensive and nil more necessary. † The overall occupation of the applied scientists be them electrical, structural or mechanical is to work out how the design is put together as opposed to the â€Å" what † and the â€Å" why † of the design. This leads us to the unsafe instances in which the applied scientists take over the function of interior decorator of theaters from the designers. 1950 ‘s America and applied scientists were emerging with legion makings in phase design and acoustic and scenic technology claiming they had solutions to sights and sounds. Fixed angles where determined for acceptable sightlines in the auditoriums. Ceilings hidden by illuming, antecedently referred to as â€Å" the celestial spheres † to capture the lifting human spirit and to maintain a cap on the theatre infinite to concentrate the attending back down to the histrion. The side walls which had been lined with humanity in the early old ages were besides now shaped for acoustic advantages. To make a theater that was confidant, it was suggested that the furthest seats from the phase had to be of a certain distance. Jo Melziner ‘s so called field trials in which he concluded that the furthest distance of: â€Å" 55ft ( 16.8m ) for Julie Harris in play, somewhat more for Gertrude Berg in a instead wide comedy and 100ft ( 30m ) for Ethel Merman in anything. † What had non seemed to be considered was the denseness of the infinite given to the single audience member or of the impact of the sum of people to be fitted into the full distance allocated. Merely to advert some of the theaters loved by the theatre profession ; the Old Vic in London, the Lyceum and the Booth in New York, all of which would be considered severely designed with positions obstructed with bad sightlines and countries with a deficiency of legroom but shows win in these theatersWord count: 331Nowadays this is realised as being a error in design as functionality really took away from the experience but in the 50s and 60s this confusion of the standards of what makes a good theater experience had non been realised. What differentiates the unrecorded theater is the sense of community and engagement non the accent on the ocular lines and sound quality. Possibly if we take a measure back and expression at what Marcus Vitruvius Pollio wrote in the early first century BC on theatre architecture, we could perchance happen another angle on design. Vitruvius holding been an designer and builder shared most if non all his cognition in his 10 books on architecture. He makes elaborate mention to bing edifices and gave recommendations on how to construct new 1s.Word count: 248The decision is that clients are looking to be progressively avaricious desiring larger seating volume with equal comfort. The designer must non fall for the naivete that they can work out the jobs which have been around for centuries. An designer ‘s certitude in his proficient accomplishments can easy do the failure of a production and non hold the endowment of the production or authors to fault. Many freshly emerging designers believe that theaters need modernization but at that place needs to be a greater apprehension of the thaumaturgy and illusionistic handli ng of the infinite of such a complex edifice type. It seems better so to lodge to old schemes which work and if there is an old theater in inquiry so maintain it if it works. Amendments can be made to the dressing room and saloon, perchance the anteroom but non to the infinites in which the audience interact with the performing artists. By looking to the yesteryear for replies we will happen that the bulk of successful theaters are based on the rules of the â€Å" sacred geometry † which should be considered as particular harmoniousness with the purpose to promote motion of energy non as a robust cyberspace of formations. Finally the sightline paradox. It seems the theaters which work good suffer from the occasional positions with obstructors but those theaters which have first-class sightlines all-round are universally disliked by histrions and audience.