Freedom Caucus Definition and Membership

The Freedom Caucus is a voting bloc of about  three dozen Republican members of the House of Representatives who are among the most ideologically conservative in Congress. Many of the Freedom Caucus members are veterans of the  Tea Party  movement that took root following the bank bailouts of the Great Recession and the election of Barack Obama as president in 2008. The chairman of the Freedom Caucus is U.S. Rep. Mark Meadows of North Carolina. The Freedom Caucus was formed in January 2015 by nine members whose mission is to â€Å"advance an agenda of limited, constitutional government in Congress.† It has also argued for a more decentralized power structure in the House, one that allows rank-and-file members a greater voice in deliberations. The mission of the Freedom Caucus reads: â€Å"The House Freedom Caucus gives a voice to countless Americans who feel that Washington does not represent them. We support open, accountable and limited government, the Constitution and the rule of law, and policies that promote the liberty, safety and prosperity of all Americans.† The coalition has been described as a splinter group of the Republican Study Committee, the conservative group that serves as a watchdog on the partys leadership in Congress. Founding Members of the Freedom Caucus The nine founding members of the Freedom Caucus are: Rep. Justin Amash of MichiganRep. Ron DeSantis of FloridaRep. John Fleming of LouisianaRep. Scott Garrett of New Jersey  Rep. Jim Jordan of OhioRep. Raà ºl Labrador of IdahoRep. Mark Meadows of North CarolinaRep. Mick Mulvaney of South Carolina  Rep. Matt Salmon of Arizona   Jordan was elected the first chairman of the Freedom Caucus.   Members of the Freedom Caucus The Freedom Caucus does not publicize a membership list. But the following House members have also been identified in various news reports as being members of or affiliated with the Freedom Caucus. Rep. Brian Babin of TexasRep. Andy Biggs of AlabamaRep. Rod Blum of IowaRep. David Brat of VirginiaRep. Jim Bridenstine of OklahomaRep. Mo Brooks of AlabamaRep. Ken Buck of ColoradoRep. Warren Davidson of OhioRep.  Scott DesJarlais of TennesseeRep. Jeff Duncan of South CarolinaRep. Trent Franks of ArizonaRep. Paul Gosar of AlabamRep.  Morgan Griffith of VirginiaRep.  Andy Harris of MarylandRep.  Jody Hice of GeorgiaRep. Darrell Issa of CaliforniaRep. Barry Loudermilk of Georgia  Rep. Alex Mooney of West VirginiaRep. Gary Palmer of AlabamaRep.  Steve Pearce of New MexicoRep.  Scott Perry of PennsylvaniaRep. Ted Poe of TexasRep. Bill Posey of FloridaRep. David Schweikert of AlabamaRep. Mark Sanford of South CarolinaRep. Joe Barton of TexasRep. Randy Weber of TexasRep. Ted Yoho of Florida Why the Small Freedom Caucus Is a Big Deal The Freedom Caucus represents but a small fraction of the 435-member House. But as a voting bloc, they hold sway over the House Republican Conference, which seeks support from at least 80 percent of its members for any move to be considered binding.   â€Å"Choosing their fights carefully, the Freedom Caucus has certainly made an impact since its formation,† wrote the Pew Research Center’s Drew DeSilver. DeSilver explained in 2015: â€Å"How does such a small group get to have such a big say? Simple arithmetic: Currently, Republicans have 247 seats in the House to 188 for the Democrats, which would seem to be a comfortable majority. But if the 36 (or more) Freedom Caucus members vote as a bloc against the GOP leadership’s wishes, their effective strength falls to 211 or fewer—that is, less than the majority needed to elect a new speaker, pass bills and conduct most other business.† While the makeup of the House has changed since then, the strategy remains the same: to maintain a solid caucus of ultraconservative members who can block action on legislation they oppose even if their own party, the Republicans, control the House. Role in John Boehner Resignation The Freedom Caucus rose to prominence during the battle over Ohio Republican John Boehner’s future as speaker of the House in 2015. The caucus was pushing Boehner to defund Planned Parenthood even if it meant forcing a government shutdown. Boehner, tired of the infighting, announced he would abandon the post and quit Congress altogether. One member of the Freedom Caucus even suggested to Roll Call that a motion to vacate the chair would pass if all of the Democrats were to vote in favor of ousting Boehner. â€Å"If the Democrats were to file a motion to vacate the chair and were to vote for that motion unanimously, there probably are 218 votes for it to succeed,† the unnamed member said. Many in the Freedom Caucus later supported Paul Ryan’s bid for speaker. Ryan was to become one of the youngest speakers of the House in modern history. Controversy A handful of Freedom Caucus members defected because they were unhappy with the group’s tactics, including its willingness to side with Democrats on votes that would undermine mainstream or moderate Republicans, including the effort to oust Boehner through a Vacate the Chair motion. U.S. Rep. Reid Ribble of Wisconsin quit after the leadership coup. â€Å"I was a member of the Freedom Caucus in the very beginning because we were focused on making process reforms to get every Member’s voice heard and advance conservative policy,† Ribble said in a written statement provided to CQ Roll Call. â€Å"When the Speaker resigned and they pivoted to focusing on the leadership race, I withdrew.† U.S. Rep. Tom McClintock of California quit the Freedom Caucus nine months after it formed because, he wrote, of its â€Å"willingness—indeed, an eagerness—to strip the House Republican majority of its ability to set the House agenda by combining with House Democrats on procedural motions.† â€Å"As a result, it has thwarted vital conservative policy objectives and unwittingly become Nancy Pelosi’s tactical ally,† he wrote, adding that the Freedom Caucus’ â€Å"many missteps have made it counterproductive to its stated goals.†

Literary Genres In Oresteia - 1280 Words

A genre is defined as a specific set of characteristics used for works of literature, music, or films. There are many forms of genres that can be broad or narrow because they have certain characters and plots that makes them unique from others. Some broad literary genres include fiction and nonfiction, and other narrow literary genres include tragedy and poetry. Both fiction and nonfiction appeals to broad audiences because it deepens their understanding of worldviews. On the other hand, a tragedy portrays a series of tragic events that leads to the downfall of the protagonist. As for an epic, it tells a story poetically about the deeds and adventures of a hero during a particular time period. The tragedy, Oresteia consists of three plays†¦show more content†¦This reveals that Gilgamesh is a dominant leader because he has absolute control on all aspects, which restricts freedom for the people of Uruk on a daily basis. Gilgamesh develops a no-limit mindset, so he have no inte ntions of reflecting on his indecent behavior towards the victims and persecuting young men for no reason. As the story progresses, the narrator describes that Gilgamesh and Enkidu challenged themselves to a few tests for fame and honor. When the two approached the beast, Humbaba, phrases like â€Å"they stick out like tusks† (Mitchell, pg.120) and â€Å"he charges ahead like a raging torrent† (Mitchell, pg.120) allows the reader to picture what the creature looks like by giving a brief description. The attempts of killing Humbaba and the Bull of Heaven was a success, but an incurable illness befall Enkidu to repay for their sins. Gilgamesh goes on a journey to find the secret to living forever, but comes to understand that there is no such thing. When Gilgamesh comes to an end, the tone was appreciative because Gilgamesh learned to be value the things he had. Odyssey by Homer is another epic that describes the achievements of a hero throughout his adventures. The author introduces Odysseus as clever, faithful, and caring. The opening scene of Odyssey begins with the narrato r claiming that the protagonist â€Å"plundered the hallowed heights of Troy† (Homer, pg.77).Show MoreRelatedWhen It Comes To Adapting An Existing Story, We Must First1409 Words   |  6 PagesWhen it comes to adapting an existing story, we must first look at what literary adaptation is. Literary adaptation, is the adapting of a storybook source, such as a novel, short story or poem, to another genre or medium such as a film, stage play, or video game. It can also involve adapting the same literary work in the same genre or medium, just for different purposes. For instance, maybe to work with a smaller cast, in a smaller setting, or even for a different demographic group, such as adjustingRead More Comedic Violence in The Medea, The Oresteia, and Antigone Essay2353 Words   |  10 PagesComedic Violence in The Medea, The Oresteia, and Antigone      Ã‚  Ã‚   Almost no Greek tragedy escapes the use of violence. The Medea, The Oresteia, Antigone, and other classic works of Grecian tragoidia all involve huge components of violence in many prominent places, and for all of these stories, violent action is an integral part of the play. Medea, especially, is a character worthy of note in this regard; her tumultuous life can be plotted accurately along a path of aggression and passionate fitsRead MoreThe Tragedy Of The Greek Tragedy912 Words   |  4 PagesGreat Tragedy Results in Deeper thinking Throughout the history of ancient literature, tragedy was one of the most famous and significant literary forms. Especially, Greek tragedy literature was a popular and influential form of drama performed in theatres across ancient Greece from the late 6th century BCE, and formed the foundation upon which all modern theatre is based (Cartwright). I will look for not only the reasons why Greek writers composed such tragedy, but also focus on what made the audienceRead MoreA Summary On Tragedy 2914 Words   |  12 Pagesfind a chorus in a modern tragedy, however in modern cinema like (500) Days of Summer a soundtrack can fulfill the role of a classic tragic chorus. Often aspects of an ancient Greek tragedy can be found in a modern tragedy such as the Furies of the Oresteia can be seen in the psychological struggles of Mourning Becomes Electra. Despite many of the classic elements of tragedy no longer serving modern works tragedy still exists when classic elements are replaced modern transitions. Tragedy is certainlyRead MoreThe Role of the Artistic Director in a Theater Production2388 Words   |  10 Pages380 BCE and he was a general of the Athenian Army. He was also a playwright, for he wrote many plays, but only five of them survived. These plays are Birds, Clouds, Frogs, Wasps, and Lysistrata. Aristophanes’ plays were under the genre of comedy and they were also literary. The plays contained satire, sex, eating, drinking, and wealth. Christopher Marlowe: Christopher Marl owe was born in 1564 and died in 1593. He was a spy, a poet, and a playwright within the sixteenth century. One of his knownRead MoreThe Renaissance and It’s Affect on William Shakespeare’s Works2369 Words   |  10 PagesIt’s very easy to see William Shakespeare as an amazing literary genius who had a perspective on life that, to simply put it, no one else has ever had. However Shakespeare was the product of the English Renaissance. The English Renaissance was a cultural and artistic movement spanning from the later 15th century until the early 17th century, it is associated with the Italian Renaissance which started in the 14th century. Like most of northern Europe, England did not get the full effect of the RenaissanceRead MoreEssay British Poetry4052 Words   |  17 PagesEngland. The 1970s saw a fair amount of polemic concerning the discontinuities of the national traditions, most of it concerned with poetry, all o f it vulnerable to a blunt totalizing which demonstrated the triumphant ability of nation to organize literary study and judgment--as it does still, perhaps more than ever. It remains the case twenty years later that there is a strong hint of the majority of the english poets to rediscover their ‘Englishness’ as a poet, and at the same time the presenceRead Moretheme of alienation n no where man by kamala markandeya23279 Words   |  94 Pagesï » ¿ANTIGONE KEY LITERARY ELEMENTS SETTING This tragedy is set against the background of the Oedipus legend. It illustrates how the curse on the House of Labdacus (who is the grandson of Cadmus, founder of Thebes, and the father of Laius, whose son is Oedipus) brought about the deaths of Oedipus and his wife-mother, Jocasta, as well as the double fratricide of Eteocles and Polynices. Furthermore, Antigone dies after defying King Creon. The play is set in Thebes, a powerful city-state north of

Afghanistan and Turkic States Free Essays

Turkmenistan formerly also known as  Turkmenia  (Russian: ), is one of the  Turkic states  in  Central Asia. Until 1991, it was a constituent republic of the  Soviet Union, theTurkmen Soviet Socialist Republic  (Turkmen SSR). Turkmenistan is one of the six independent  Turkic states. We will write a custom essay sample on Afghanistan and Turkic States or any similar topic only for you Order Now It is bordered byAfghanistan  to the southeast,  Iran  to the south and southwest,  Uzbekistan  to the east and northeast,  Kazakhstan  to the north and northwest and the  Caspian Sea  to the west. Turkmenistan’s GDP growth rate of 11% in 2010  ranks 4th in the world, but these figures are subject to wide margins of error. 5]It possesses the world’s fourth largest reserves of natural gas resources. Although it is wealthy in natural resources in certain areas, most of the country is covered by the  Karakum (Black Sand) Desert. The Turkmen government operates as a  single-party system. [6]  Turkmenistan was ruled by  President for Life  Saparmurat Niyazov  (called â€Å"Turkmenbasy† — â€Å"leader of the Turkmens†) until his sudden death on 21 December 2006. Gurbanguly Berdymukhammedov  was elected the new president on 11 February 2007. The territory of Turkmenistan has a long history, as armies from one empire after another decamped there on their way to more prosperous territories. The region’s written history begins with its conquest by the  Achaemenid Empire  of ancient Persia, as the region was divided between the  satrapies  of  Margiana,  Khorezm  and  Parthia. [citation needed] Alexander the Great  conquered the territory in the 4th century  BC  on his way to  Central Asia, around the time that the  Silk Roadwas established as a major trading route between  Asia  and the  Mediterranean Region. citation needed] Approximately 80 years later, Persia’s  Parthian Kingdom  established its capital in  Nisa, now in the suburbs of the capital,Ashgabat. After replacement of the Parthian empire by Persian Sassanids, another native Iranian dynasty, the region remained territory of the Persian empire for several centuries. [7] In the 7th century AD,  Arabs  conquere d this region, introducing  Islam. The Turkmenistan region soon came to be known as the capital of  Greater Khorasan, when the caliph  Al-Ma’mun  moved his capital to  Merv. citation needed] In the middle of the 11th century, the  Turkoman-ruled  Seljuk Empire  concentrated its strength in the territory of modern Turkmenistan in an attempt to expand into  Khorasan  (modernAfghanistan). The empire broke down in the second half of the 12th century, and the Turkmen lost their independence when  Genghis Khan  took control of the eastern  Caspian Sea  region on his march west. For the next seven centuries, the Turkmen people lived under various empires and fought constant inter-tribal wars. Little is documented of Turkmen history prior to  Russian  engagement. How to cite Afghanistan and Turkic States, Essay examples

Condition Monitoring System for Gears

Question: Discuss the condition monitoring system for gears? Answer: Introduction Condition monitoring facilitates monitoring the current condition and predicting the future condition of machines in operation. According to Randall [Randall2010] the external information about the internal effects should be obtained and analyzed during the operation of the machines. While machines are in operation, they require methodologies which will make it possible to detect their internal condition. This technique presents the condition of operating machines ( many of them run for long durations like 12 month or more), and decide whether the machine requires maintenance or not. In order to gain the information from internal issues of the machines, there are two main types of techniques used normally, viz., vibration analysis and lubricant analysis [Randall2010]. Onsy [Onsy2013] stated that Gears are among the most important parts of any mechanical transmission system, and effective monitoring techniques must be employed in order to achieve reliable operation. In this project, t he focus will be on gears condition monitoring techniques used to measure vibration, speed and temperature. Furthermore, several signal condition methods including time and frequency analysis will be applied. According to Modeley [Mobley2002] mechanical system or machines consist of most plant equipment, vibration monitoring is considering as the key component for most predictive maintenance techniques. In addition, for electromechanical system, the essential predictive maintenance tool is the vibration monitoring [Keith1999][Mobley2002]. Moreover, all mechanical equipment are suitable for using vibration analysis. However, a common yet invalid said that vibration analysis is restricted to simple rotating machines with running speed above 600 revolution per minute [Mobley2002]. In order to achieve the best operation condition for machine system, vibration analysis system need to set up properly [Mobley2002][Keith1999]. Throughout the operation periods, it is highly recommended that for the manufacturer is needed to identify the reliability of the machine system, which will naturally lead to the best level of maintenance [Adjallah2007]. Aims and objectives The main aim of the project is to develop condition monitoring system based on vibration analysis, which will work on to meet several subsequent objectives. Aims 1. To develop a condition monitoring system to detect the gear condition which will later provide reasonable predictions for remaining life for machine.2. To develop an effective system which will detect the failures in advance.3. To produce a best quality dissertation in practical fulfilment of a master degree in maintenance engineering. Objectives 1. To Identify the characteristics of the current condition monitoring system with focus on gear monitoring system.2. To Identify gear failure mechanisms.3. To get familiarization with data acquisition techniques (Lab VIEW).4. To develop an online data acquisition system which can display the measured data.5. To collect the data on gears with the use of software measurement.6. To perfom analysis and evaluate the data.7. To perform analysis for predicting the failure.8. To report findings in the proper format Methodologies The strategy to approach this project will have the following steps:1. Designing gear test bench system, In this part system measurement will be done first and Secondly, the condition of the test bench operation will be performed to set up the main element.2. The second objective of the project is to identify the gear failure in order to meet this requirement vibration analysis will be performed on gears of different condition.3. Inorder to display the system measurement data, the online data acquisition system will require the development in terms of insulation of sensors with the design as well as the connections to measurement elements.4. Final step is testing the validation of the operation system by implementing the evaluated data cambered with different gear cases. (Compare the data for different gear loads). Project plan References Adjallah, Kondo H. Advances in Degradations Monitoring and Predictive Maintenance. Bradford, GBR: Emerald Group Publishing Ltd; June 2007. Mobley, R. Keith. Plant Engineering : An Introduction to Predictive Maintenance , 2nd ed. Burlington, MA, USA: Butterworth-Heinemann; September 2002. Mobley, R. Keith. Vibration Fundamentals. Burlington, MA, USA: Butterworth-Heinemann; March 1999. ONSY, A., BICKER, R. SHAW, B.A. Predictive Health Monitoring of Gear Surface Fatigue Failure Using Model-based Parametric Method Algorithms; An Experimental Validation. SAE International Journal Aerospace 2013; Volume 6(Issue 1): . Randall, Robert Bond. Vibration-Based Condition Monitoring : Industrial, Automotive and Aerospace Applications. Hoboken, NJ, USA: John Wiley Sons; December 2010.

A Response to Message to the Grassroots by Malcolm X Essay Example

A Response to Message to the Grassroots by Malcolm X Essay This is a public speech by the militant black leader Malcolm X, calling upon men of his race to unite in their efforts to fight white oppression. The speech is reminiscent of the more famous counterpart delivered by Martin Luther King Jr. But the methods advocated by the two speakers are contrasting. While the philosophy of King was one of non-violent activist organization, Malcolm X forwards a more militant approach to racial equality. Malcolm X’s agenda is also much broader than attaining political rights. He believes that unless Black Nationalism (with due territorial sovereignty) is achieved there is no scope for black liberation. Malcolm X thus condemns the pacifist and conciliatory strands of the Civil Rights Movement. He urges all the black brethren to unite in their claim for a separate black nationhood. If a bloody revolution is what it takes to achieve that end so may the black race incur is his central message. Though Malcolm X’s speech is powerful in t erms of rhetoric and public appeal, I personally do not find it acceptable. Malcolm X has a valid point in urging all factions of black social activists to unite. But his ready endorsement of violent means for achieving socio-political goals is problematic on two counts. Not only is Malcolm X’s stance pragmatically unviable, it is also morally questionable. Reference: Malcolm X, â€Å"Message to the Grass Roots†, delivered 10 November 1963 in Detroit, Michigan This is a public speech by the militant black leader Malcolm X, calling upon men of his race to unite in their efforts to fight white oppression. The speech is reminiscent of the more famous counterpart delivered by Martin Luther King Jr. But the methods advocated by the two speakers are contrasting. While the philosophy of King was one of non-violent activist organization, Malcolm X forwards a more militant approach to racial equality. Malcolm X’s agenda is also much broader than attaining political rights. He believes that unless Black Nationalism (with due territorial sovereignty) is achieved there is no scope for black liberation. Malcolm X thus condemns the pacifist and conciliatory strands of the Civil Rights Movement. He urges all the black brethren to unite in their claim for a separate black nationhood. If a bloody revolution is what it takes to achieve that end so may the black race incur is his central message. Though Malcolm X’s speech is powerful in . We will write a custom essay sample on A Response to Message to the Grassroots by Malcolm X specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on A Response to Message to the Grassroots by Malcolm X specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on A Response to Message to the Grassroots by Malcolm X specifically for you FOR ONLY $16.38 $13.9/page Hire Writer

Five Research-backed Tips to Supercharge Your Freelance Writing Income

Five Research-backed Tips to Supercharge Your Freelance Writing Income You read tons of tips on how to increase your income, but how do you decide which are worth your limited time? After all, there are only so many hours in the day, and bill collectors aren’t known for their patience. Its simple. You focus on the tips that have been proven to work. Here are five of them, garnered from the best practices of successful freelance writers and good old fashioned scientific studies: 1. Prospect in the right places Successful writers go where the money is. Freelance writers Mridu Khullar Relph  and  Tom Ewer , who both   net $100 per hour, don’t write for content mills or search for work in bargain basement bidding sites like Elance. Instead they focus on clients who pay writers a decent wage. Here are some links to get you started: makealivingwriting.com/140-websites-that-pay-writers-updated-2014/. writersincharge.com/more-websites-that-pay/ http://esmeenetwork.com/top-websites-paying-100-per-guest-post/ 2. Retain and gain Regular clients are the key to good, consistent income. It is 50% easier to sell to existing customers than to brand new leads (Marketing Metrics). Not only that, but a 5 percent increase in customer retention can increase a company’s profitability 3. Specialize to command higher rates As successful freelance blogger Marya Jan puts it, â€Å"You can demand higher rates if you are a subject matter expert.† This is a universal truth, and is echoed 4. Wow your clients Just doing your job is not enough to skyrocket your income. You must deliver superior customer service and superior writing. This will bring a flood of new business your way through enthusiastic referrals from your existing clients. According to AdAge, 20 to 50 percent of purchases are the result of a word-of-mouth recommendation. And a Nielson 2012 online survey found that 92 percent of consumers trust recommendations from friends and family above all other forms of advertising. The best part? Word of mouth advertising is free. 5. Increase your productivity Writers get paid to write, and the faster you can write the higher your income. If you get paid $100 an article and take two hours to write it, your hourly rate is $50. Reduce your writing time to one hour and your rate bumps up to $100 per hour, double your previous rate. How do you increase your writing speed? First avoid the time suck of over research. There is nothing wrong with being thorough but you don’t have to interview ten people for a 300-word blog post on the latest skin care breakthroughs! Do just enough to support the arguments in your article. Second, resist the urge to endlessly tinker with your piece. Edit and rewrite as necessary, but don’t let the perfectionist in you take over. Lastly, work on your typing speed - the faster you type, the faster you can write. You can learn how for free at typingclub.com/ and keybr.com/ You can make more money with your freelance writing. Implement some or all of the above tips and watch the difference it makes to your bottom line.

Profiling Australian TSM as a Foreign Direct Investment Prospect Assignment - 1

Profiling Australian TSM as a Foreign Direct Investment Prospect - Assignment Example The tourism industry in Australia is still faced with challenges which impede the maximization of returns. In order for the sector to realize its potential, increased investments in hotel capacity, tourism infrastructure, and labor supply are highly required. These challenges are present opportunities for potential foreign direct investors to do business in such areas, including the aviation infrastructure, recreation, arts, and accommodation.Be that as it may, the level of optimism for investing in the tourism sector in Australia has tremendously improved in the last two years (Australia Trade Commission, 2013). Market size and development potential are important factors that influence the tourism service industry and FDI inflows.Australia rests within the world’, best performing tourism region, as well as the biggest global aviation market.The Australian government launched Tourism 2020, a programme intended to raise Australia’s overnight tourism expenditure to Aus$140 billion by 2020.The high growth economies of Asia present an opportunity for the flourishing of the tourism industry in Australia. In May 2014, accommodation occupancy in the capital city of Australia reached new peaks, surpassing 80 percent in Adelaide, Sydney, Perth, and Melbourne. Demand for accommodation is still on the rise, thereby boosting the hotel sectors (Australia Trade Commission, 2013).  High demand from Asia plays an important role in attaining growth in the global visitation of Australia. The Asian continent is recognized as the world’s fastest-growing market for tourists. This is necessi tated by stable economic growth, a developing urban and wealthy middle class, as well as the fastest growing aviation industry in the world.

United States involvement in Afghanistan Research Paper

United States involvement in Afghanistan - Research Paper Example In their book, Myths, Illusions, and Peace: Finding a New Direction for America in the Middle East, authors Ross and Makovsky (2009) explore a range of myths and illusions that underpin the challenges that the United States has faced in dealing with the Arab world. The two authors trace the challenges of the United States policy on the Middle East from the Cold War era to the current age. Illustrations are made regarding on how faulty assumptions developed into wrong approaches regarding the interests, perspectives, and political objectives of the Middle East. For instance, the United States wrongly interpreted the response of the Middle East to the rise of Communism. The US policy makers were under the impression that the Middle East would automatically reject the Soviet ideologies because of their inconsistency with the faith of Islam. Understanding the complexities, successes, and challenges of the United States involvement in Afghanistan acquires clearer insights when analyzed together with the core arguments propounded by Ross and Makovsky (2009). The authors make general and specific claims and arguments about the nature of the US foreign policy in the Middle East and its ramifications in the aspects of peace, balance of power, democratization, and religious extremism. The impact of the US foreign policy on the Middle East can have either positive or negative results depending on its capacity to interpret, predict, and relate with the challenges in the Middle East. Policies that have tended to demonstrate preferential treatment towards the State of Israel as particularly cited as problematic (Duncan, 2004). According to the argument, regional interests, nationalism interests, and Islam are essentially dissimilar. As such, they tend to manifest themselves in region in different forms in accordance with multiple factors. Cases have been pointed out where the pursuit of Islamic interests appears to contradict established interests. Hierarchies of interests vary and manifest themselves in multiple forms in accordance with the stakes of the region’s governments, strategies of various groups, and cultural factors (Hudson, 1996). Rigid structures and frameworks that apply across time and space cannot be developed to assess the nature of realities in the region. Therefore, the existing policies cannot apply in the interpretation of the political and social realities of the Middle East. Lack of comprehension of these forces has led to futile strategies in the formulation of peace plans in the region (Hudson, 1996). The traditional American policy for the Middle East, according to the authors, anchored on the myth of Arab Unity. The United States handled the region as a homogenous entity that relied on common interests and goals. The authors single out the case of the poor handling of the re gion’s peace proposals by former Egyptian President Anwar Sadat by the administration of former President Carter as a case in point where the United States failed to capitalize on the opportunity of the moment. The mistake, according to the authors was the belief that Sadat could never act alone outside the bracket of the Arab worldview. Myths that control the Arab approaches on matters, according to the authors, lead the United States policy makers to make poor judgments of situations that often prove to be very costly. The authors argue that such approaches generate a mismatch between the guiding ideology and the methods applied in the practical terms. Ideologies are equally explored in the manner in which they cloud the judgments on matters of regional balance and other issues that appertain to the relationship between the United States and the Middle East. Ross and Makovsky (2009) contend that relationships that are more productive are possible and the pursuit of peace ac hievable if the United States reworks its policies in the region in ways that correspond with the fluid nature of Middle East politics, religion,

Business Capstone Assignment Example | Topics and Well Written Essays - 2000 words

Business Capstone - Assignment Example Tesco is therefore large grocery retail, with thousands of stores distributed in more than 13 countries Role of Tesco’s Vision, Mission and Stakeholders A firm’s vision and mission statements play an important role in developing consumer royalty (Besanko et al, 2009). Tesco’s vision statement reads â€Å"Our vision is for Tesco to be most highly valued by the customers we serve, the communities in which we operate, our loyal and committed staff and our shareholders; to be a growth company; a modern and innovative company and winning locally, applying our skills globally† while the vision statement reads â€Å"creating value for customers, to earn their lifetime loyalty.† Clearly, the vision and mission statements of Tesco focus more on the target market and not the products. They focus on the benefits that the customers are going to derive from the company and its products. Besanko et al (2009) argues that such statements highly touch on the emotion s of the consumers. Consequently, they contribute to building of loyalty among the consumers of the firm’s products. ... This helped the company to expand internationally. Also, the firm changed its strategies to focus on technology under Leahys leadership, which has marked a lot of success. The employees of this company have also contributed to the development of consumer loyalty by being hard working and always being positive to customers. Macro Environment The environmental or external factors that affect the decisions taken by Tesco are grouped into six categories as discussed below: Political factors The current political issue affecting Tesco are the changes in corporate tax rate. The government of UK announced in the 2012 budget that it would reduce corporate tax by 1% for two consecutive years (2012 and 2013) from 24% to 22% (Tesco, 2012a). This will save this company a lot of funds and make it more financially stable. Economic factors The major economic issues affecting Tesco currently are high unemployment causing a reduction in aggregate consumption. This has further restricted the growth of this company in UK (Tesco, 2012a). Social factors The main social issue affecting Tesco currently is the change in consumers’ lifestyle, leading to a change in tastes and preferences. Tesco has responded to this by developing a new product range called â€Å"Clubcard† in order to suit different customer groups with different preferences (Tesco, 2012a). Technological Technology has a huge impact on the way business enterprises in all industries operate in the recent years. It has been playing as big role in shaping consumer spending habits. The internet, in particular, has opened a channel through which enterprises in the food retail industry distribute their products to customers (Tesco, 2012a). The new technology has also led to the introduction of self-service checkouts in the food

Chronic Pain Management: An Insight Into Neuropathic Pain

Chronic Pain Management: An Insight Into Neuropathic Pain Many people suffer from chronic pain. In these patients, the most common wish is to be pain free. Even though modern Medicine has advanced at an unprecedented rate over the past century, approaches to chronic pain management is still not completely satisfactory. I have recently seen a patient who has been living with neuropathic pain for many years. Neuropathic pain is a type of chronic pain that is considered to be the most difficult to treat and manage, due to its complex nature in etiology and clinical manifestations. Despite the improvement in scientific understanding of pathogenesis of neuropathic pain, and utilization of newer pharmacological, surgical and cognitive approaches, diagnosing and treating neuropathic pain still poses a challenge clinically. This essay will be presenting a case history of a patient with neuropathic pain being treated at the Kent and Canterbury Hospital and this case will form the basis of discussion on the current understanding of neuropathic pain m echanisms and its management. Patient case Mrs L is a 58 years old medically retired office worker who has a 25-year history of multiple sclerosis. She has been coping well until 8yrs ago when her left foot suddenly experienced a shooting pain on weight bearing. At first, she was maintained on paracetamol and nurofen by her GP with limited pain relief and then referred to the podiatrist, where an ultrasound scan revealed the presence of Mortons neuroma (a benign swelling of the intermetatarsal plantar nerve causing neuropathic pain), which was causing intense pain with a severity 10/10 across her left forefoot. To help alleviate the pain, it was initially decided that surgically removing the neuroma could achieve adequate pain relief, but this was proven to be an unrealistic goal. During the surgical intervention period, she had altogether three neuromas removed on separate occasions, with additional shaving off the bones to reduce compression on the nerve and resultant inflammation. She was then referred to be managed at the pain clinic. While Mrs L has been under the care of the pain physicians, she was given local anaesthetics steroid infiltration into her forefoot, cryotherapy (ice cold packs applied to tibial nerve), guanethedine block, lumbar chemical sympathectomy (with midazolam fentanyl), acupuncture, lidocaine patches, capsaicin cream, duloxetine and co-codamol. Despite temporary pain relief provided by these therapies, there was not a long-lasting effect that allowed Mrs L to stay pain-free. Understandably, living with an excruciating pain chronically can severely damage an individuals psychological as well as physical health. She could no longer enjoy her hobbies, such as dancing and going to antic fairs; even daily activities such as shower would make her scream in pain. As a result, she became extremely depressed and suicidal. Currently, she is receiving a multidisciplinary input from her GP, the specialist pain physician, specialist pain nurse, clinical psychologist, and physiotherapists and is maintained on gabapentin and diclofenac for her neuropathic pain, citalopram for her slowly recovering depression and baclofen for controlling her ongoing multiple sclerosis symptoms. She is also regularly attending chronic pain management programs, through which she believes that she gains better appreciation for her condition and is in a better position to be in charge of her own symptoms. This case nicely demonstrates the difficulties encountered in clinical practice in treating chronic pain. First of all, neuropathic pain is exceptionally difficult to treat, with unpredictable outcomes; secondly, most methods of pain management can only provide symptomatic relieve of pain temporarily, rather than offering a permanent cure; thirdly, chronic pain is an extremely debilitating condition to live with and its psychological impact should not be underestimated; and finally, to enable the best pain management a multidisciplinary approach is evidently the most successful and gives the patient most control over their symptoms. What is pain? We are all familiar with the term pain. The International Association for the Study of Pain (IASP) defines pain as: An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. (IASP 2007). It is important to note that pain is a very subjective experience, which varies enormously from one individual to the next. To emphasize on the subjectivity of pain perception and the need for individualized approach to pain management, Margo McCaffery who specialized in pain management nursing in 1968 described pain as whatever the experiencing person says it is, existing whenever the experiencing person says it does (Rosdahl Kowalski, 2007). It is undeniable that psychology and physiology are interwoven in the perception of pain. To understand pain, it is helpful to know what causes pain; as mentioned above, normally our perception of pain is triggered by a specific stimulus, such as hot, cold, or sharp objects, which could cause potential tissue irritation or injury. It is obviously advantageous in evolutionary terms to be able to sense the potential cause of injury and act via spinal reflexes to achieve self-protection, e.g. withdrawal of fingers from hot pan. This form of pain is called nociceptive pain, where the stimulus is known to be harmful in nature. This type of pain warns us of impending damage; therefore, it is regarded as the good type of pain. Of course, most of the long-term pains are certainly not good or friendly. What distinguishes between friend and foe in the field of pain is determined by the time-course, the intensity, the cause of and the social and economic consequences of the pain. An excellent example of a bad pain is neuropathic pain (Figure 1): Figure 1. Diagram showing the mechanisms behind the processing and perception of three different types of pain. Phase 1= nociceptive pain; Phase 2= inflammatory pain; Phase 3= neuropathic pain. (Cervero F, 2009) Neuropathic pains are resulted from disease or trauma to the central or peripheral nervous system; common causes include stroke, spinal cord injury, multiple sclerosis, surgery, diabetic neuropathy, and herpes zoster virus (Jensen et al., 2007). The Neuropathic Pain Special Interest Group (NeuPSIG) of the IASP has recently redefined neuropathic pain as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system (Treede et al., 2008). As a result, neuropathic pain produces very unusual pain sensations beyond the range produced by the normal nociceptive system; these include spontaneous pain, reduced pain thresholds, and mechanical allodynia (Cervero F, 2009). As illustrated in figure 1, abnormal sensory processing is one of the landmarks for diagnosing neuropathic pains; patients often experience pain in the absence of any noxious stimuli (allodynia) and additionally produces an abnormally heightened sensory input, changing a non-noxious stimulus int o a painful stimulus, producing a state called hyperalgesia. Therefore, the main characteristic is the nearly complete lack of correlation between peripheral noxious stimuli and pain sensations perceived. There are many types of neuropathic pain (Table 1), which can be broadly classified into four groups based on their aetiology and anatomy: peripheral nervous system focal and multifocal lesions, peripheral nervous system generalized polyneuropathies, central nervous system lesions, and complex neuropathic disorders (Freynhagen Bennett, 2009). It is outside the scope of this essay to discuss these different types of neuropathic pain in further detail; rather, neuropathic pain as a distinct group of pain will be explored. Table 1. Examples of neuropathic pain syndromes (Freynhagen Bennett, 2009). How is neuropathic pain diagnosed? Despite its frequent occurrence, neuropathic pain still constitutes as a major diagnostic problem in clinical practice because it can present with a variety of signs and symptoms, which vary greatly even within one particular disease entity (e.g. in postherpetic neuralgia) (Geber et al, 2009). Clinical examination and expert judgment is still the best way to make a clinical diagnosis of neuropathic pain, despite the recent development of various screening tools, such as the LANSS questionnaire (Bennette, 2001) and the Neuropathic Pain Scale (Galer and Jensen, 1997) that assist in making a diagnosis. Bedside examinations for hyperalgesia and dysthesia include assessing the effect of the same stimuli on painful areas compared to the contralateral side or an unaffected site. Allodynia is demonstrated by the experience of pain when performing light touch with cotton wool; exaggerated painful response to pin prick suggests hyperalgesia, therefore lowered pin-prick threshold. These are the typical components that define a pain as neuropathic type. Patients are most likely to present with a mixture of pain types with a neuropathic component to it. It is important to identify the presence of such a component as the treatment recommendations are different for these. With the introduction of the new grading system for neuropathic pain by NeuPSIG group (Treede et al 2008), it is becoming increasingly recognized that chronic pain is often presented as a combination of different types of pains, rather than a clear-cut nociceptive or neuropathic type of pain. In Treede and colleagues new recommendation for the diagnosis of neuropathic pain, options of definite, probable or possible are available for the diagnosis of a component of neuropathic pain in the disease presentations in the clinical setting, which aims to aid more accurate diagnosis of neuropathic pain (Figure 2). Figure 2. Flow chart of grading system for neuropathic pain. The grading system is based on four criteria: pain distribution (criterion 1), the link between pain distribution and the patients history (criterion 2), confirmatory tests of neurologic status demonstrating positive or negative sensory signs confined to the innervation territory of the lesioned nervous structure (criterion 3), and further confirmatory diagnostic tests to identify the lesion or disease entity underlying the neuropathic pain (criterion 4). Criteria 1 and 2 must be met to initiate the working hypothesis of possible neuropathic pain. *Patient requires follow-up and/or additional confirmatory tests. à ¢Ã¢â€š ¬Ã‚  The point at which the diagnosis of possible neuropathic pain should be abandoned has not been defined (Treede et al 2008). Mechanisms of neuropathic pain Broadly speaking, neuropathic pain arises from the peripheral nervous system (ectopic impulse generation due to abnormal sodium channel expression), or from the central nervous system (central sensitization, disinhibition and plasticity) (Scadding, 2003). The key behind the generation of neuropathic pain is the abnormal neurological changes to the sensory system resulting in an abnormal hyperalgesic state, achieved through three processes: 1) the activation and sensitization of peripheral nociceptors, which are responsible for sensing peripheral noxious stimuli; 2) the abnormal amplification, rather than the suppression as in the normal states, of the central nervous system, known as central sensitization, caused by the strengthening of the synaptic connections between the peripheral and central nervous systems, producing a persistent pain state; 3) the change in the central actions of the undamaged afferents, so that a non-noxious tactile stimulus sensed by these receptors are converted into nociceptive information and processed as pain, rather than a light touch (Cervero F, 2009). This also further leads to secondary hyperalgesia, which means that instead of relieving the nociceptive pain by rubbing on the painful area (tactile stim ulus), the tactile movement of rubbing will actually produce the opposite effect of enhancing the existing pain. Figure 3. The pain signaling and modulation pathways. F Cx: frontal cortex; SS Cx: somatosensory cortex; Hyo: hypothalamus. (Ro Chang, 2005) As shown in Figure 3, the physiological pain mechanisms include the pain signaling pathway from nociceptors to peripheral nervous system to spinal dorsal horn cells to thalamus and finally to the cortex, and the pain control system from the cortext to periaqueductal grey to raphe nucleus to spinal dorsal horn (Ro Chang, 2005). In normal circumstances, there is a balance between signal transduction and pain modulation, therefore the individual recovers from that episode of pain. However, when this balance is disturbed, i.e. when there is a lesion within the primary somatosensory system, then the individual experiences neuropathic pain. The lesion may occur anywhere along the pathways of the somatosensory system, and it could be as a result of compression, inflammation, ischaemia, trauma, tumour invasion, nutritional deficits, or degenerative processes to the neurons (Ro Chang, 2005). Some of these important mechanisms will be discussed individually below. Local nerve injuries After the occurance of local nerve damage, in an attempt to repair, a neuroma forms at the proximal stump of the damaged nerve. A neuroma is a tangled mass of regenerating axons embedded in connective tissues. The axons within a neuroma not only fail to regenerate properly, but also develop abnormal electrical activities (England et al, 1996). This neuroma sprout then begins to fire abnormal signals with a heightened excitability, which stimulates regenerating C-fibers. After a period in the growth of these fibers, erratic impulse generator will develop, which sends abnormal signals into the central nervous system, perceived as dysthesia, parasthesia, itching or electrifying sensations (Liu et al, 2002). Sodium channel accumulation Sodium channel density is increased in areas of axons proximal to the injury site, as shown by England et al (1996) when the excised neuromas were studied from patients who suffered from painful traumatic neuromas (Figure 4). This specific type of sodium channel accumulated have a faster recovery time after inactivation, therefore, they are able to conduct ectopic impulses in neuropathic states. The ectopic activity then maintains the central sensitization process, resulting in great amplification of peripheral afferent signals. In neuropathic pain, there is a change in ionic channels composition and functions, such an accumulation of sodium channels which leads to hyperexcitability of these nerve terminals. These are found to be accumulating in neuropathic damaged areas of the nerve, such as in neuromas and demyelinated areas (Devor, 2006). In a normal axon, the transportation of sodium ion channels is preprogrammed via endoplasmic vesicles along the axons to be distributed in the n odes of Ranvier and peripheral sensory endings; there is a low density of sodium channels on the myelinated axonlemma. However, as a consequence to neuropathic damage, the set program of ionic channel settlement is disturbed, and these ion channels end up being located at a high concentration at the areas of neuromas, demyelination and sprouting (Aurilio et al, 2008). Such important roles played by sodium channels means that by blocking these channels, neuropathic pains could be reduced. Indeed, sodium channel blockers open up a major therapeutic channel for neuropathic pain treatment. Figure 4. Sodium channel immunocytochemistry of neuromas. (a, b, c) Sodium channel-specific immunoreactivity is present throughout the axons of th these neuromas. (d) Control showing the nonspecific immunofluorescence. Scale bar = 10 micrometer (England et al, 1996). Calcium channels and signaling in injury Calcium channels are also involved in contributing to neuropathic pains, as intracellular calcium determines the phosphorylation of the membrane proteins (Aurilio et al, 2008). The inflammatory neuropeptides, calcitonin gene-related peptides (CGRP), are released from injured nerve endings. They have a role in acting as co-transmitters in the spinal cord, therefore are involved in the central sensitization and hyperalgesic states found in neuropathic pain. An in vitro study identified that the release of CGRP entirely depended on the presence of extracellular calcium ions; this process involves particularly the N- and L-type calcium channels (Kress et al, 2001). Selective calcium channel blockers, such as gabapentin and lamotrigine may have significant potential in treating neuropathic pain. Cytokines in neuropathic pain Cytokines such as interleukins and tumour necrosis factors are well known mediators of inflammatory responses. Additionally, they are involved in neurogenic inflammations and are thought to play a role in the generation of neuropathic pains. In an established experimental model of neurogenic hyperalgesia and allodynia, mice with chronic constrictive injury to one sciatic nerve, the usage of interleukin-1 antagonist has been found to significantly yield in a reduction in the pain responses (Sommer et al, 1999) (Figure 5). Since TNF- Ã‚ ¡ immunoreactivitiy is found to be higher in nerve biopsies from patients with neuropathic pain, directing treatments to reducing the level of cytokines in the nervous system may also be helpful in relieving neuropathic pains (Empl et al, 2001). Indeed, combined neutralizing therapies against IL-1 and TNF- Ã‚ ¡ produced additive effects in experimental models (Schafers et al, 2001). Figure 5. Hyperalgesia to thermal stimuli following unilateral sciatic nerve injury in six groups of mice. a negative difference score is an indicator of hyperalgesia in the experimental/treatment limb. Hyperalgesia is present throughout the experimental period in the sham-treated group of mice. Treatment with anti-IL1 reduces hyperalgesia in a dose dependent manner (Sommer et al, 1999). Central inhibition inefficiency and sensitization The pain transmission system is under continuous inhibitory control from the brainstem centers, such as periaqueductal grey and locus coeruleus. Many studies have been conducted in laboratory animals for studying the pain mechanisms in neuropathic pain. It is found that in animals with neuropathic pain their central descending inhibition is nearly 50% lower than normal (Zimmermann 2001). Additionally, there is a hypersensitized central nervous system in neuropathic pain. Normally central sensitisation process would return back to baseline level when the tissue heals and inflammation subsides (Dworkin et al, 2003), but in neuropathic pain states this is not the case. The plasticity and sensitisation following peripheral nerve injury was thought to be caused by the long-term potentiation mechanism (Liu Sandkuhler, 1995). It is thought that after local nerve damage peripherally, growth factors such as nerve growth factors (NGF) can no longer be taken up into the dorsal ganglion neurons; this alters the nervous system at the transcription and protein synthesis level. NGF is a trophic molecule essential in the development maturation of the nervous system, and it is found to be elevated in conditions which pain is a predominant feature. This change to the composition to the nervous system also results in changes in the activities of aspartate and NMDA, which leads to an i nflux of calcium ions that indirectly contributes to the sensitisation and hyperalgesia of the spinal cord dorsal ganglion cells (Ro Chang, 2005). Peripheral inhibition inefficiency In addition, there also is a reduction in the response to endorphin molecules in patients with neuropathic pain than other pain mechanisms (Terenius 1979); therefore, there is a reduction in the sensation of pain relief centrally. Peripheral nerve lesion was simulated in rats by rhizotomy, a technique which severs the spinal roots, and this has demonstrated a decreased opioid receptor binding in the spinal cord (Zajac et al, 1989). Living with neuropathic pain From a patents perspective, pain is something they have to learn to live with, however bad it is. Patients who suffer from chronic pain not only have to go through the physical anguish exerted by the pain, but being in pain also hinders them from normal day to day functioning; from not being able to stay independent or taking care of themselves, to losing jobs, family and friends, lack of support and results in social isolation. A patient has once told me that: because what Im going through (pain) is not readily recognized by others, the way other people acted towards me put me under lots of frustration and made me socially unaccepted. It is crucial to bear in mind the wider impact of living with neuropathic pain when formulating a management plan for that individual. Not surprisingly, neuropathic pain is linked to significant reduction in the patients health-related quality of life (HRQoL) as well as creating substantial costs to the health service. It is reported that generally, patients with neuropathic pain have higher pain rating scores and lower HRQoL (Jenson et al, 2007). In a cross-sectional evaluation of the impact of neuropathic pain on patients and their quality of life conducted in the Spanish population, it was found that pain substantially interfered with work and family life in these patients. Over 95% of the 1519 patients recruited for this study had either neuropathic pain or a mixed neuropathic and nociceptive pain. Younger patients tend to report a lower quality of life than that of the elderly population in both the physical and mental components of life (Figures 6a 6b); possibly due to having fewer comorbidities in younger patients helps to exaggerate the perceived deleterious effects of neuropathic pain on their daily functioning. Using the Sheehans disability scale, the younger patients are also shown to have generally a higher perceived stress compared to the older patients (Galvez et al, 2007). It is important to analyse the effects that neuropathic pain exerts upon its sufferer, not only because we start to appreciate the level of impairment on the quality of life this chronic illness can cause to the patients, but also to further explore areas that could be perhaps better dealt with in terms of treatment (Jenson et al, 2007). As was reflected by the outcome of the Spanish study, 43% of patient had extreme disability; these included disability for work (51%), 47% for social life, 42% for family life. 38% of the patients also reported extreme stress and 19% perceived that they received little or no social support (Galvez et al, 2007). This shows that living with neuropathic pain is not just leading to physical disability, but also psychological and social dysfunctioning. Having known this nature of neuropathic pain, it important to consider both a pharmacological and psychosocial approach when prescribing treatment and formulating management plans. Figure 6. Scatter graph showing the linear relationship between age (years) and quality of life of the patient; physical (6a) and mental (6b) components, given as a standardised score relative to the reference Spanish population (SDS). SDS score is shown for each patient adjusted for type of neuropathic pain, center, and present pain intensity, age, and sex. SD, standard deviation; 95% CI, 95% confidence interval. (Galvez et al, 2007) b. a. Management of neuropathic pain The management of neuropathic pain involves a number of well-established pharmacological therapies, as well as utilizing the psychosocial aspects of the neuropathic pain nature fully to best control the patients pain symptoms. Non-Pharmacological approaches As the symptoms of pain are not just derived purely from a physical entity, psychotherapy should be considered as part of the management program for neuropathic pain. At an early stage, patients should be educated on the nature of the condition and to have realistic expectations with regards to treatment options; especially the current management for neuropathic pain is still mainly palliative in nature, with main aims to reduce symptomatic complaints of pain, but not a curative fix. To be able to alleviate the pain and achieve symptomatic relieve, even if only temporarily, may be the only attainable goal (CREST, 2008). Since non-pharmacological treatments have the lowest risks of adverse side effects these must be offered early. These include a combination of physiotherapy, occupational therapy, psychotherapy and pain management programs that are adjusted to the individuals psychological and physical needs. The main aims for physiotherapy is to provide pain relieve wherever possible, but also focuses on the restoration of normal functioning and helping the patient to return to normal physical activities, such as going back employment (Serpell et al, 2008). The low risk physiotherapy modalities include TENS (transcutaneous electrical nerve stimulation) and acupuncture are offered, along with appropriate education, advice and exercise. Functional difficulties in areas of personal care, work and leisure could be managed best by the input of occupational therapists, who may work around the needs of the individual in adjusting the arrangements at home/work to best allow the patient to function despite t he pain. In Mrs Ls case, she had shower rails and hand-held tools to pick up distant objects without exerting strain on her back/affected limbs; these were extremely helpful to her. Of course, to maximize the outcome of pharmacological treatment, psychological therapy is essential in addressing the disability, emotional impacts and general life interruptions that are consequences of neuropathic pain. Apart from pharmacotherapy, psychotherapy is the best evidence-based therapy for the treatment of chronic pains like neuropathic pain (Morley et al, 2000). Additionally, patients living with chronic pain often suffer from other comorbidities. Frequently these are not treated alongside the treatment for the chronic pain, therefore, a limited effect of the pain treatment may be observed. Behavioral and psychiatric conditions are especially common in patients with neuropathic pain; recognizing and treating these will aid in improved quality of life and better pain relief overall (Fishbain, 1999). An recent eight-week study of the effects of cognitive behavioural therapy (CBT) on chronic pain-induced insomnia has found that patients who received CBT exhibited significant reductions in sleep latency, number of awakenings during sleep and overall quality of sleep (Jungquist et al, 2010). This offers further hope for patients who suffer from pain-related insomnias. Finally, the Pain Management Program is a multi-disciplinary approach to pain control that is tailored to each patients individual needs. Patients are typically referred to this program if they have been living with chronic pain for a number of years and suffer from significant physical, social and psychological functional difficulties. Many have become dependent on medications and acquired a number of side effects from these medications which are slowly eroding the quality of their lives. In the pain management programs, the goals are to reduce the subjective experience of pain, learning new coping strategies to control pain and improve physical and emotional functioning. Indeed, the pain management programs have been found to achieve a reduction in medication and enhanced rates of returning to work (CREST 2008 NRH 2009). Pharmacological therapies for neuropathic pain In most cases, patients with neuropathic pain will need to be started on analgesic medication after failure to respond to non-pharmacological treatments. Although opioid and non-opioid analgesics, such as codeine and diclofenac respectively, have a role in dampening pain transmission in within the CNS in neuropathic pain states, it is far more effective to target the sodium, calcium and NMDA receptors, which are altered during nerve injury. Generally speaking, the clinical effectiveness of these drugs is limited by their narrow therapeutic indexes, i.e. the difference between the number needed to treat (NNT) and the number needed to harm (NNH) is very small (Rice Hill, 2006). Neuropathic pain is appreciably a very complex condition and treatment for this can be a real challenge, as most patients do not respond to conventional analgesics. The main problems lie within the inadequate diagnosis, lack of understanding of the pain mechanisms, inappropriate selection of therapies, and insufficient management of comorbidities that could delay the response to neuropathic pain therapies (Ro Chang, 2005). Recently a review of the guidelines by OConnior Dworkin has resulted in the formulation of a stepwise approach to neuropathic pain management in primary care (Table 2). It is important to highlight that the first step of the management plan includes the identification of comorbidities, and relevant patient education as discussed above in the non-pharmacological managements of neuropathic pain to fully prepare the patient for adequate treatment. Table 2. Stepwise pharmacologic management of neuropathic pain (OConnor Dworkin, 2009) According to a recent review and recommendation by Dworkin et al, three lines of pharmacological treatment have been advised for neuropathic pain treatment. The first line treatments include tricyclic antidepressants (TCA), selective serotonin noradrenaline reuptake inhibitors (SSNRI), Ca2+ channel ligands (e.g. gabapentin pregabalin) and topically applied 5% lidocaine; second line treatments including opioid analgesics tramadol; and third line treatments are the other antiepileptics (e.g. Carbamazepine, lamortigine), other antidepressants (e.g. citalopram), N-methyl-D-aspartate (NMDA) antagonists and topically applied capsaicin (Dworkin et al, 2007 and OConnor Dworkin, 2009). TCAs The administration of TCAs such as amytriptyline and nortriptyline will benefit patients with neuropathic pain as TCAs have been shown consistently to be more efficacious than placebos in a number of randomized controlled trials (Saarto Wiffen 2007), and especially beneficial for patients who have a comorbidity of depression. They act via histaminic, muscarinic and serotoninergic receptors both peripherally and centrally. However, one should note that the possibility of cardiac toxicity hinders its administration in patients with pre-existing cardiac conditions, especially arrhythmias; they should also be avoided in patients who have suicide risk or poor impulse control (Serpell et al, 2008). A large, retrospective cohort study reported that there was an increased risk to sudden cardiac death at dosages higher than 100mg/day (Ray et al, 2004). Because the recommended dose of TCA can range from 25mg at the starting dose to 150mg/day as the maximum dose (Dworkin et al, 2007), administ ering TCA should be a cautious exercise. In general, TCAs should be started at low dosages, administered at night to minimize sedative effects, and titrated up slowly to be continued for 6-8 weeks to allow analgesic effects (OConnor Dworkin, 2009). SSRNIs SSNRIs such as duloxetine and venlafaxin are less effective than TCAs, but have a better safety profile. Duloxetine has consistently demonstrated efficiency in treating painful diabetic peripheral neuropathy (Dworkin et al, 2007), although its effects in other types of neuropathic pain have not been studies extensively, therefore its efficacy in those types of pain are still uncertain. Calcium channel ligands Calcium channel ligands, e.g. gabapentin and pregabalin, bind to the voltage-gated calcium channels at the ÃŽÂ ±2- Ã‚ ¤ subunit to modulate neurotransmitter release from presynaptic nerve terminals (Figure 7). Both drugs have been shown to be efficacious South Africa: Language and Culture South Africa: Language and Culture What is South African Culture? South Africa is known as the rainbow nation as it has complex and diverse cultures. (South African Languages and Cultures. It is a melting pot of culture; here are a few cultural aspects to admire about South Africa: Mapungubwe, Limpopo Province, is one of the richest archaeological sites in Africa. Two globally important battles namely, The Anglo Boer War and the Anglo Zulu War were both fought on South African soil. Since the freedom from Apartheid, dance has become a prime means of artistic expression. The Magaliesberg mountain range is said to be the oldest mountain range on earth. The Drakensberg mountain range runs the length of the country and is a Unesco World Heritage site. The Vredefort Dome is the oldest and largest visible meteorite impact site in the world. South Africa has a celebration for every event, place, art form, food, drink and agricultural commodity. South Africa has a wide variety of arts and crafts, as well as a wide range of craftwork styles; tribal designs, Afro-French wirework, wood carvings, world-class pottery and bronze casting, stained glass, basket weaving, clay and stone sculpting, dung paper and waste ornaments. The Drakensberg mountain range is the worlds largest art gallery and is a monument to the San Bushmen. Jukskei, a game which involves a player throwing a wooden pin at a peg in the ground. It has been identified as one of the seven indigenous games that should be encouraged and developed. After the Apartheid era, the youth of South Africa started to find their own voice in a style of music called Kwaito. Nguni cattle, they are indigenous to South Africa and might possibly be the most beautiful cattle in the world with their variously patterned and multicoloured hides. The Owl House, Nieu Bethesda, is a fascinating world of sculptures made from concrete and glass. The Cradle of Humankind has one of the worlds richest concentrations of hominid fossils. The Quagga, was extinct but has been rebred. It is a zebra-like animal but only has stripes on the front half of its body. Mark Shuttleworth was the first African in space. South Africa is home to seven Unesco World Heritage sites. South African cultural villages allow visitor to experience firsthand the cultures and traditions of our country, including food, drink and accommodation. South Africa produces 3.1% of the worlds wine and ranks number nine in overall volume production. The above text was referenced from: The A to Z of South African Culture 2010:1 During the Apartheid era, the government divided this diverse country into four population groups, namely white, black, coloured and Asian. (South African culture is impossible to capture in a nutshell, as the country is home to a rich variety of cultural groups of diverse ethnic and national origins. [sa]) These population groups were grouped as follows: White: English, Afrikaans, Jewish, Portuguese, Greek and Lebanese. Black: tribal groups, namely Xhosa, Zulu, Ndebele, Swazi, Tswana and Sotho. Coloured: people of mixed origin, mainly Afrikaans speaking and also a lot closer to the white cultural trends. Asian: people of Indian decent. The above text was referenced from: South African culture is impossible to capture in a nutshell, as the country is home to a rich variety of cultural groups of diverse ethnic and national origins. [sa] South Africa has eleven official languages, namely English, Afrikaans, Tsonga, Zulu, Tswana, Xhosa, Venda, Swazi, Southern Sotho, Ndebele and Sepedi. (South African Languages and Cultures [sa]) South Africas language distribution is as follows: Figure: Language distribution chart (South Africa Info) Xhosa Language: The word Xhosa is derived from the Khoisan language, which means angry men. South African Languages and Cultures [sa] There are about eighteen percent of Xhosa speaking people in South Africa, and are mainly found in the Eastern Cape. (South African Languages and Cultures [sa]) This makes Xhosa the second most spoken language in South Africa. (Languages of South Africa 2010:1) There are nine Xhosa speaking groups, some chiefdoms are larger than others, but there is conformity among them, the conformity can be seen in the homestead layouts. (Magubane 1998:10) Culture: The Xhosa speaking people were one of the first chiefdoms to be exposed to European explorers, hunters, traders, missionaries, soldiers and colonial administrators. (Magubane 1998:12) This exposure therefore altered the culture of the Xhosa people. Xhosa marriage is a polygynous affair as the chiefs and wealthy men, who had lots of cattle married more than one woman and in some instanced has as many as four wives. (Magubane 1998:20) These wives were distinguished in rank according to different houses. (Magubane 1998:20) The Great Wife was responsible in bearing a son, and of course heir who would eventually take over his fathers possessions, i.e. cattle. (Magubane 1998:24) Labola is a big part of the Xhosa culture, labola also meant that different groups could forge alliances as marriage within a clan is prohibited. (Magubane 1998:28) In a modern day Xhosa marriage negotiation it is common that money instead of cattle will be accepted. (Magubane 1998:25) Traditional rituals are performed throughout the life-cycle of the Xhosa people, from birth to puberty, marriage to menopause and filly to death. (Magubane 1998:32) One of these rituals is that of male initiation through circumcision. This ritual came about as men had to be circumcised to become a warrior, and had to be a warrior before he could marry. (Magubane 1998:33) Architecture: Dwellings consisted of a circular frame of poles and saplings, which were bent and bound in the shape of a beehive and thatched from top to bottom with grass. (Magubane 1998:18) this structure was then plastered with a mixture of mud and dug to provide adequate insulation. (Magubane 1998:18) screened off cooking areas, had an earthen oven for baking. (Magubane 1998:18) Zulu Language: Zulu people form the largest ethnic group in South Africa (Languages of South Africa 2010:1) and therefore Zulu is one of the most spoken languages in South Africa and is also understood by half of the South African inhabitants. (South African Languages and Cultures [sa]) South African English has adapted and was also inspired by many of the Zulu words, and therefore incorporate it into the English language. (South African Languages and Cultures [sa]) Culture: The Zulu nation arose in the 16th century; the Zulu warrior Shaka raised the nation to prominence in the 19th century. (Languages of South Africa 2010:1) The classic novel Chaka, by Thomas Mofolo, reinvents king Shaka into a heroic figure. (Languages of South Africa 2010:1) The current monarch is King Goodwill Zwelithini. (Languages of South Africa 2010:1) the present kings powers are essentially symboliche carries a sacred axe on important state occasions and he presides over key rituals, (Magubane 1998:37) Zulu children are exposed to nature at an early age which encompasses a deep understanding and empathy for the environment they live in. (Magubane 1998:45) Traditional foods include amasi (curds of milk) which is eaten either with maize meal or vegetables. Maize meal is either boiled into a thick porridge or eaten with vegetables. Meat was only eaten on special occasions, such as a wedding. (Magubane 1998:47) The Zulus are very crafty. The women are responsible for mat-making, beadwork and pottery. The men do woodwork and specialise in spoons, meat trays and milk pails which are crafted out of one piece of wood. (Magubane 1998:47) Traditional medicines in the Zulu culture are ancient, these medicines are divided into two parts, the Traditional Herbalist who administers medicine made from plants and animals, and the Diviner who smells out the complaints using bones, shells, seeds or other artefacts. (Magubane 1998:61) A category in the Diviners is the isangoma, who is a medium that makes contact with the ancestral spirits and prescribes medicine according to their dictates. (Magubane 1998:62) Music, song and dance have always been important in Zulu culture as it helps maintain a sense of group solidity especially in times of strees, joy and change. (Magubane 1998:62) The Zulu society had many stringed instruments, such as the uGubu which stringed bow with a calabash attached to the end. (Magubane 1998:62) Architecture: The extended homestead was roughly circular in form and was build on sloping ground facing east wherever possible, with the slope falling away to the main entrance, so that the chief dwelling would be on the highest ground. (Magubane 1998:40) In the centre of this homestead would be the cattle byre which is also linked to the temple, which is where traditional rituals would take place. (Magubane 1998:40) The building of these dwellings were the mens job and would often be a social event where the women would brew beer and neighbours, even passers-by, would come and lend a hand in erecting these dwellings. (Magubane 1998:43) The dwellings were either beehive or dome shaped. Saplings would be embedded into a circular dug trench; the saplings were then bent over and tied down to create framework which would then be tightly thatched. (Magubane 1998:43) There were no windows but the door was very low, people had to entre on their hands and knees. This door was then closed at night by means of a wicker door that was fastened with a cross-stick. (Magubane 1998:43) Afrikaans Language: Afrikaans is spoken by a majority of South Africans, either as a first or second language. Afrikaans is a rich cultural languages with much heritage from the Dutch, Afrikaans even means Africa in Dutch. (South African Languages and Cultures [sa]) Afrikaans is mainly spoken by white Afrikaners, coloured South Africans and a section of the black population. (Languages of South Africa 2010:1) Venda Language: Venda is also known as Luvenda or Tshivenda and is mostly spoken in the Northern parts of South Africa. (South African Languages and Cultures [sa]) The people who speak Venda have a Royal Family and show women great respect, therefore women are allowed to become Queens and Chiefs of their own tribes (South African Languages and Cultures [sa]) Culture: For a Venda person, music is one of the most important aspects to their culture, especially drum beats. (South African Languages and Cultures [sa]) They are hard working people but after working all day on a field, there is always music, a few drinks and dancing. (South African Languages and Cultures [sa]) A drum, named Ngoma Lungundu, is the centural feature in Venda culture. (Magubane 1998:82) Status and power are expressed through music, dance, and song. (Magubane 1998:87) Venda people use many musical instruments, even instruments that have vanished from other cultures in Africa; they use xylophones, thumb pianos, reed flutes, and three different types of drums. (Magubane 1998:87) The Venda pottery style was established in the 14th and 15th Century. (Magubane 1998:82) The young Venda men and old Venda men were highly regarded, as the Venda people believe that the young men are still close to the ancestors, while the old men are about to rejoin the ancestors. (Magubane 1998:84) Initiation played a big role in Venda culture, as with most South African cultures. (Magubane 1998:84) Initiation ceremonies were held for the many stages in life and would be made possible through external forces such as the ancestors, good and bad spirits, as well as witches. (Magubane 1998:84) A python, in Venda culture, is associated with fertility and the movements of a baby in the womb. (Magubane 1998:87) Venda women were held in much regard, unlike most African women. (Magubane 1998:89) venda women were in absolute control if in her courtyard, and elderly women played an important role in Venda society by telling the children traditional stories. (Magubane 1998:89) Venda women are able to own property and can become ruler of a clan if there was no male heir. (Magubane 1998:89) Architecture: Traditional Venda villages are surrounded by stone walls, which can still be seen near/under cliffs. (Magubane 1998:84) These villages are laid out so that the King is on the highest part of the land, with his wives and children around him, who are then surrounded by the rest of the inhabitants, who will protect the King and his family if there were to be a threat. (Magubane 1998:84) Ndebele Language: Ndebele language is split into two chief dialects namely, Southern Ndebele and Northern Ndebele, but the more common spoken dialect is Southern Ndebele. (South African Languages and Cultures [sa]) Ndebele is only spoken at home, and therefore only moves through generations, therefore it is thought to be a vanishing language. (South African Languages and Cultures [sa]) Culture: To tourists, the Ndebele culture is best known for their vibrant geometric patterns which decorate their houses, clothes and can also be seen in their beadwork. (Languages of South Africa 2010:1) These vibrant patterns embrace a variety of forms and symbols, such as natural objects, geometric forms and now days letters of the alphabet, numbers, representations of urban buildins, windmills and aeroplanes. (Magubane 1998:76) Ndebele life is characterized, life many other African groups, by the spirit world. (Magubane 1998:67) The spirit world is made up of the Ndebele ancestors who require constant sacrificing to keep them placid. (Magubane 1998:67) The Ndebele society is patriarchal; this was intensified by the white farmers who looked to Ndebele family labour where the men had to work for the white farmer. (Magubane 1998:70) The Ndebele man then moved away from the white farms and started their own businesses as taxi drivers or builders. (Magubane 1998:70) The Ndebele women would work as domestic servants in Pretoria but always returned home to look after the children and set up the homestead. (Magubane 1998:70) While the women were at the homestead, they would be supported by their husbands as well as making and selling beadwork, mats and dolls. (Magubane 1998:70) There is much deliberation on if the adornments worn by the Ndebele women are strictly for their own sensuality or whether their husbands want their wealth to be shown on their wives. (Magubane 1998:76) The most popular adornemnts worn by Ndebele women are the beaded wire hoops and/or copper or brass rings that they wear around their necks, arms, legs and stomach. (Magubane 1998:77) Sepedi Language: Sepedi is also known as Sesotho or Northern Sotho. (South African Languages and Cultures [sa]) But this language is best known for their wedding ceremonies. (South African Languages and Cultures [sa]) Culture: In the Sepedi culture, it is well known that the brides father ask the groom for lebola. Lebola is item/s exchanged for their daughter, for example money or livestock. (South African Languages and Cultures [sa]) The wedding is held at the brides or grooms home, but before the ceremony, the bride (dressed in a cows hide dress) has to go down to the river and collect water and wood for the ceremony. (South African Languages and Cultures [sa]) Once the ceremony is done, a sheep is then slaughtered in the back yard and the meat is equally divided between both families. (South African Languages and Cultures [sa]) Setswana Language: Setswana is commonly known as Tswana, which is related to the other Sotho languages. (South African Languages and Cultures [sa]) Setswana was mostly spoken in Botswana, but migrated into North Western South Africa. (Languages of South Africa 2010:1) Dr. Robert Moffat built the first school in Botswana and realised that he needed to use and write Setswana in his teachings, therefore Setswana was the first Sotho language to be in a written format. (Languages of South Africa 2010:1) Culture: Setswana is part of the Sotho-Tswana division, which use totems to contact their ancestors and these totems symbolise the sacred creature which is not to be hunted, the Setswana totem is a fish. (Magubane 1998:11) In the Setswana culture, wealth is measured by how many cattle they have in their possession; this is then ranked and put into a document called the Setswana Forbes, which lists all the names of the wealthy Setswana people. (South African Languages and Cultures [sa]) Setswana culture is also widely known for their Traditional healers, or sangomas, which play an important role in their culture. (South African Languages and Cultures [sa]) Southern Sesotho Language: Southern Sotho is spoken by more than five million South African inhabitants. (South African Languages and Cultures [sa]) It is a very complicated language, but once you get to understand it, it is a beautiful language. (South African Languages and Cultures [sa]) Sesotho originally was spoken in Lesotho, but moved into South Africa. It was also one of the first African languages, along with Setswana and Zulu, to be put into a written form as well as into literature. (Languages of South Africa 2010:1) Culture: Southern Sotho is part of the Sotho-Tswana division, which use totems to contact their ancestors and these totems symbolise the sacred creature which is not to be hunted, the Southern Sotho totem is a crocodile. (Magubane 1998:10-11) The Southern Sotho culture is one that believes strongly that Children benefit from serving their elders. (South African Languages and Cultures [sa]) Marriages are more often than not pre-arranged but in todays day and age, this has become less of normality as they are now able to pick their life partners. (South African Languages and Cultures [sa]) Swati Language: The Swati language is also known as the Swazi language. (South African Languages and Cultures [sa]) It is a very similar language to the Ndebele, Xhosa and Zulu language, and often gets confused with these languages. (South African Languages and Cultures [sa]) The language and culture of the Swati was highly influenced by the Zulus. (South African Languages and Cultures [sa]) Culture: The Swatis have many traditional events and the culture is one of colourful outfits with red feathers, carrying shields and wearing multicoloured necklaces. (South African Languages and Cultures [sa]) The Reed dance festival is one of their great festivals. (South African Languages and Cultures [sa]) The ceremony is held for eight days which runs through the end of August till the beginning of September. (South African Languages and Cultures [sa]) This ceremony is for all unmarried women and is to protect the womens chastity (South African Languages and Cultures [sa]) Tsonga Language: The Tsonga language is spoken throughout southern Africa. (South African Languages and Cultures [sa]) Tsonga is a language that does not use the English alphabet, but instead the Latin alphabet. (South African Languages and Cultures [sa]) Therefore it is a difficult language to learn or understand. Culture: The first Tsonga speaking people were traders of cloth and beads for ivory, copper and salt that was eventually joined by co-linguists pushed from the coast by Nguni raiders. Magubane 1998:90 The birth of a child is a great time for all Tsonga speaking people. (Magubane 1998:95) Babies are doctored with medicines and decorated with charms and beaded bangles. Magubane 1998:95 A Tsonga marriage is not just a relationship of two individuals, but an agreement and new relationship between the two families. (Magubane 1998:96) There is a sacrifice before the bride leaves her family and her ancestors to join her new family, her new family will now take her in as one of them and she will have to learn their etiquette and rules of behaviour. (Magubane 1998:96) Most of the agricultural work was done by women, but the harvesting was done in collaboration with the surrounding communities, with the owner/host of the land providing beer and refreshments therefore making it a festive occasion. (Magubane 1998:98) Venison was a vital part in Tsonga diet, so was fish as fishing was an important community activity. (Magubane 1998:98) Tsonga men have through the ages started working in the South African mines and send money home to their families. (Magubane 1998:99) They have to spend copious amounts of time on busses and trains, and have to live in hostels near to the mining towns. (Magubane 1998:99) The Tsonga people are able to play wind, stringed and percussion instruments, the string instruments being the most important. (Magubane 1998:99) The two other instruments they are able to play, but fall out of the mentioned catagories is the hand piano and the xylophone. (Magubane 1998:99) The stringed instruments they are able to play: Vibrating Bow Stringed bow attached to a calabash Hollow reed bow Wire stringed bow with a thickened handle plucked with a flat piece of wire The above text was reference from: (Magubane 1998:99) The wind instruments they are able to play: Cross flute Shepherds pipe Antelope horn trumpet The above text was reference from: (Magubane 1998:99) The percussion instruments they are able to play: Tambourines Drums The above text was referenced from: (Magubane 1998:99) Architecture: A Tsonga homestead comprises of the man, his wife/wives, their children and their sons families. (Magubane 1998:94) The houses are cylindrical with earthen walls and conical thatched or reed roofs. Magubane 1998:94 The homestead is generally circular with a central cattle byre and a main entrance on the eastern side, there may also be sub-entrances on the side of the water and fields. (Magubane 1998:94) English Language: South African English is rich and peculiar as it is influenced by most of the other ten languages. (Languages of South Africa 2010:1) For example: ..cars stop at robots, not traffic lights. A pickup truck is a bakkie, sneakers are takkies, a hangover is a babbelas, (Languages of South Africa 2010:1) English is understood across South Africa and is generally the chosen language in business, politics and media. (Languages of South Africa 2010:1) English is only spoken by 10% of South Africans, but is the primary language tought at primary, secondary and tertiary educational centres. (Languages of South Africa 2010:1) What artefacts are unique to each culture? Archaeology is important as it is able to tell us when and where people settled and how they lived. Archaeology is also able to link different cultural groups through the artefacts they leave behind. (Magubane 1998:8) Archaeological time periods and artefacts found from each period: Early Stone Age stone artefacts such as hand axes and cleavers. Middle Stone Age stone artefacts such as points and scrapers, as well as grindstones. Later Stone Age new technologies made way for the bow and arrow, and traps and snares. Early Iron Age new technology made way for hoes, axes, decorative pots and bowls, ornate metal work and complex terracotta sculptures. The above text was referenced from: Magubane 1998:8 The Bantu-speaking people have been thought to emerge from the Iron Age communities; the bantu-speaking people are divided into two groups, the Nguni speaking and the Sotho-Tswana speaking people. (Magubane 1998:10) These two groups are linguistically and culturally distinct (Magubane 1998:10) What is a Boutique Hotel? There are a number of characteristics and attributes that constitute a Boutique Hotel. Firstly a Boutique hotel is much smaller than a chain-hotel as the maximum amount of rooms a Boutique Hotel has is one-hundred. (Nobles Thompson 2001:1) Atmosphere is very important in a Boutique Hotel as it creates a memorable experience. (Nobles Thompson 2001:1) Management and staff need to anticipate guests needs and wants, knowing what a guest wants, when they want it and how they want it. (Nobles Thompson 2001:1) Unique and interesting themes, design and architecture. (What is a Boutique Hotel? 2003 2010) Stylish appearance (What is a Boutique Hotel? 2003 2010) Equally appropriate for business, honeymoon or vacation. (What is a Boutique Hotel? 2003 2010) Target market for Boutique Hotels is 25 55 age range and middle to upper income level. (What is a Boutique Hotel? 2003 2010) Boutique hotels offer a completely unique experience. Boutique Hotels can be hip and happening or historic in theme. (What is a Boutique Hotel? 2003 2010) Boutique Hotels offer comforts, such as bathrobes and fireplaces; spa-like services, such as healthy food choices, mind and body cleansing; the latest technology, as well as on-site dining, bar and lounge areas that are open to the public. (What is a Boutique Hotel? 2003 2010) How do you reuse an old building to create a new exciting interior? By preserving historic buildings and by updating the building and its interior for a new use (Bijelic 2006:1), the population and generations to come will be able to understand and appreciate South African heritage and culture. (The WBDG Historic Preservation Subcommittee 2010:1) By reusing existing buildings and transforming them into a new purpose, the architects and designers are in essence being environmentally responsible. (The WBDG Historic Preservation Subcommittee 2010:1) Existing buildings are in essence energy efficient as they already exist and therefore there is no need to create new building materials, which leave a carbon footprint behind. (The WBDG Historic Preservation Subcommittee 2010:1) Minor modification to the exterior or interior of these historical/existing buildings are possible and plausible as this will then create a new use for these buildings as well as upgrade these buildings in order to meet the modern building requirements and codes. (The WBDG Historic Preservation Subcommittee 2010:1) Converting historical buildings to meet modern demands might be a challenge, but there are advantages as clients will eventually realise the potential financial, cultural and marketing advantages of preserving architectural history. (Bijelic 2006:1) Practical benefits of preserving existing/historical buildings: Preservation of the history and authenticity. Increases the commercial value of the building and its ornaments/material which are more often than not high quality and not affordable. Sustainable building practice as there is less construction and demolition, and less need for new building materials as the existing infrastructure will be used. Energy efficient as there will be no energy waste on demolition and new construction. The above text was referenced from: The WBDG Historic Preservation Subcommittee 2010:1 Identify, Investigate, Develop, Execute and Educate are the five basic steps of preserving a historical building. (The WBDG Historic Preservation Subcommittee 2010:1) The four treatment approaches for historic buildings are: Preservation maintenance, stabilisation and repair of existing historic materials. Rehabilitation to alter or add to historic property. Restoration depicting the property at a particular period of time while erasing the evidence of other eras. Reconstruction re-creates non-surviving parts of the property. The above text was referenced from: The WBDG Historic Preservation Subcommittee 2010:1 Before preserving or reusing an existing building, the architect and/or designer needs to make sure that the original function of the building and the proposed new function of the building coincide and/or are compatible in order to reduce the deconstruction of the historic materials and ornaments. (The WBDG Historic Preservation Subcommittee 2010:1) In order to maintain the integrity of the historical building, the following preservation design goals need to be implemented: Update building systems this requires striking a balance between original building features and accommodating the new technologies and equipment. Life safety and security needs accommodate new functions, changes in technology and improved standards of protection. Comply with accessibility requirements provide access for persons with disabilities while meeting preservation goals. The above text was referenced from: The WBDG Historic Preservation Subcommittee 2010:1 Relevant Codes and Standards Previous research that has been done on the topic Field Research Data capturing I have sent out questionnaires to a number of architectural firms and travel agencies, as well as the Department of Tourism, Department of Home Affairs, The City Council of Johannesburg and the City Council of Tshwane. Explain in detail who, what, where, how and why The above mentioned parties will be able to advise me on (1) if there is a need for Boutique hotels in South Africa and (2) how to go about reusing/renovating existing buildings in order to preserve the environment as well as create a new, fresh Boutique hotel with the correct regulations.

Critique of Kane and Abel :: Free Essay Writer

Critique of Kane and Abel Jeffrey Archer’s epic novel Kane And Abel could just as easily be two novels; one named Kane and the other Abel, such is the difference between the two characters. From the outset, we are aware of William Lowell Kane’s privilege and of Abel Rosnovski’s poverty. Both are born 15th April, 1905 as male members of the human race. These are the most obvious similarities shared by the two. Their contrasted births introduce us to two different personalities and two different histories, which fate is to overlap at critical moments. Abel is born in a forest in Poland. A young hunter, alert to the sound of screaming, rushes to the mother and child. Mother is dead and the hunter feels responsible for this child: â€Å"Suddenly the young hunter saw the woman, with her dress above her waist, her bare legs sprayed wide apart. He had never seen a woman like that before. He ran quickly to her side and stared down at her belly, quite frightened to touch. There, lying beneath the woman's legs, was the body of a small, damp, pink animal, attached only by something that looked like a rope......† Observe the difference of William’s birth: â€Å".....It never occurred to him, not even for a moment, that the baby might be a girl. He turned to the financial pages and checked the stock market: it had dropped a few points; that damned earthquake had taken $100,000 off the value of his own holdings at the bank, but as his personal fortune remained comfortably over $16 million, it was going to take more than a California earthquake to move him ..."Congratulations, Sir, you have a son, a fine-looking little boy." What silly remarks people make when a child is born, the father thought; how could it be anything but little? The news hadn't yet dawned on him - a son. He almost thanked God. The obstetrician ventured a question to break the silence. "Have you decided what you will name him?" The father answered without hesitation: "William Lowell Kane.....† Abel is born into a world which thereafter conspired to take his mother. William’s father is so unconcerned with the labour that it fails to stir him from his daily routine of studying the â€Å"financial pages†. The pressure for each baby is different. Abel is surrounded by the unconcealed despair and uncertainty which represent being poor.