Romeo and Juliet Courage Essay Example for Free

Romeo and Juliet Courage EssayRomeo and Juliet, a story of two families. A story approximately two lovers that are willing to die for each other. A story where courage plays a huge and historic role in. Life itself also involves a lot of courage Just to get by day to day. This essay will explain how courage plays an important role in belles-lettres and life. One example of how courage plays a role in literature is in shakespheres Romeo and Juliet. Romeo and Juliet both express their love for each other in a huge way. This shows a ton of courage because they would likely be killed or hated because they are with the other family.Romeo and Juliet are willing to die for each other with shows so much courage because they are very likely to be banished or killed for their actions. Another example of how courage plays an important role in literature is how much courage the agree in the play Romeo and Juliet shows. The nurse knows about Romeos love for Juliet and Juliets love for Ro meo. Yet the Nurse keeps it a secret from the Capulet family even though she could be fired and ruin Romeos change to be with Juliet if the Capulet family found out. The Nurse shows courage by doing this and it plays an important role in the play and in literature.An example of how courage plays an important role in life is when you make a new friend. Before you meet them you have no idea who they are or what kind of person they are. But instead of leaving them alone and neer getting a chance to make a new friend you talk to them. After talking to them you realize they are a good person. This is important because without courage you would never had the guts to go out and meet a new friend of learn about other people. In this essay I have showed you Courage, the ability to do something that frightens one, is important in life and also very important is literature.

The Daffodils by W.Wordsworth and Miracle on St.Davids Day by G.Clarke Essay Example for Free

The Daffodils by W.Wordsworth and Miracle on St.Davids Day by G.Clarke EssayForm and meaning of The Daffodils by W.Wordsworth and Miracle on St.Davids Day by G.Clarke. Pre and patch C20th Poetry Comparison.William Wordsworth wrote the poem The Daffodils in 1804, dickens years later after his hump with the Daffodils. The poem Miracle on St. Davids Day was written by Gillian Clarke full point fount-nigh 1980. Miracle on St. Davids Day was written one hundred and seventy- sise years after The Daffodils was. The poems atomic number 18 very similar in the way that they both fashion c are poems, having a regular structure. In Miracle on St. Davids Day apiece stanza apart from the stretch forth one has five gillyflowers that are alone close the same length.In The Daffodils each stanza has six-spot lines that are all much or less the same length. The poems are different in the way that Miracle on St. Davids Day was written like a story, sentences starting in one stanza a nd finishing in a nonher. Also this poem does not rhyme, it looks like a poem and sounds like prose. The Daffodils is written as a poem with a regular rhyming pattern. bourn one and line triad rhyme, line two and line four, and line five and six are a rhyming couplet. This is regular throughout the poem. Both poems are similar as they are true amazes of the writers, and they are written in raw English. Also the poems are both communicative poems.William Wordsworth was born in 1770, an octonaryeenth century ro military mantic poet. He described his song as emotion recollected in tranquillity, and that remembering is the make out. Gillian Clarke was born in the twentieth century and is still alive today. G. Clarke is modern contemporary poet. Wordsworths inspiration for The Daffodils was spring itself, the sense and feeling of spring around him with so many numerous daffodils. Wordsworth allowed himself to be inspired by the violator of nature and the magic of every year nature dying and freezing over and then coming to disembodied spirit and beingness re-born again. Wordsworth became caught up in the upshot of his real life experience and cute to savour and treasure it, so he wrote and feelings down on paper. In Wordsworths time you were either poor and hard working, or wealthy with not much to do.Wordsworth had not much to do, so he opened his imagination to write poetry to fill his spare time. With having spare time and no compulsion to be anywhere at a received time, he explored nature and learnt more about the happenings of nature, which as a poet he respected, and he recorded his discoveries and emotions on paper. Clarkes inspiration for written material Miracle on St. Davids Day, was her personal experience when visiting a intellectual institution.She was leading poetry to the insane, which happened to awaken a long, repressed recollection in one of the patients, whom recites a poem from the days of his youth, cardinal years ago i n a valley school, the class recited poetry by rote. This experience impressed so strongly on Clarkes judicial decision that she wanted to keep her depot of the experience alive, telling the story for ten years to people before writing it in a poem. Clarkes inspiration was the power of memory and the power of poetry. The sounds of her reading poetry to both(prenominal)one triggered a memory so hidden from long ago that I think she was shocked that it could energize happened, and inspired her to write it in a poem.Wordsworths purpose in The Daffodils is to express his emotion to the contri notwithstandingor, and make the commentator feel the daffodils and become lost in a wizardly world of the beauty of spring honorable like he himself did. Wordsworth appreciated nature already barely wanted to get it across to the reader the moment of tranquillity and peace of mind he had, surrounded by the pretty-pretty daffodils. Clarkes purpose in writing Miracle on St. Davids Day is t o tell people about the incident that she witnessed and to show the power of poetry and memory. Clarke wanted people to see that no matter how old the memory was or whether the person had a psychological illness or not, as long as at that place was no memory loss, a memory hidden deep in the back of the mind can be awoken. Any small insignificant thing such(prenominal) as touch, sight, smell, sound or taste can awake it, and that memory is a very powerful thing.Wordsworths The Daffodils has four stanzas in it. The content of stanza one tells us that Wordsworth is walking alone and how he comes across the daffodils and where. Beside the lake, beneath the trees, they were blowing in the wind.Stanza two is where Wordsworth makes a comparison of the handsome sparkling daffodils to the stars on the off-white Way, which government agency that there were too many daffodils to count like the millions of stars in the sky, And twinkle on the opaque Way, they stretched in never- determi nationing line.Stanza three explains how content a poet can be amongst these daffodils appreciating their natural sparkling beauty for a poet clearly respects natural beauty and The Daffodils being a true experience for Wordsworth made it a more significant experience in his life. Also Wordsworth describes how the daffodils stand out from anything around them and that totally the daffodils are in focus, stopping any thought of any other matter in his charge teacher. A poet could not but be gay, in such jocund company. Wordsworth did not realise what effect the sight of the daffodils had brought on him and I do not think he realised that he would be writing about them two years later. Obviously the daffodils stuck in his mind and frequently reminded him of his experience because he was writing about them two years later, and to write about them obviously satisfied his need to express to others the joy the daffodils brought to him.Stanza four is a memory of Wordsworth. He describes his situation of telling the reader in stanza one, two and three of the moment of the experience and stanza four is thinking about the impact of the experience. For oft, when on my couch I fabrication in vacant or pensive inclinationG. Clarkes Miracle on St. Davids Day, has nine stanzas in it. The content of stanza one is a quote from the daffodils by W. Wordsworth. At showtime glance the reader is confused and thinks that it is a literal on the poem, but then realises that is it connected with the poem in some later stage which makes the reader inquisitive and want to read on. They flash upon that interior eye, which is the bliss of solitude.Stanza two is an introduction to the mental institution but the reader does not know this yet, the reader just absorbs the information described to them in a detailed demonstrate which already mentions daffodils, giving a connection betwixt this poem and The Daffodils. An afternoon yellow and open-mouthed with daffodils. A picture is al ready in the readers head of a warm, sunny afternoon in spring somewhere in a forest where there is a lot of greenery and a prodigious rustic house hidden from view, pacific and graceful.Stanza three is the writer and the narrative utterance, Gillian Clarke, describing what she is doing. She tells the reader that she is reading poetry to insane, so we assume that she is in an innovation and not the beautiful, tranquil country house the reader first thought it was. Clarke in stanza three withal starts to describe a few of the patients there to the reader. A beautiful chestnut haired boy listensStanza four is an extension of stanza three. It carries on to describe another patient, a woman at the institution, who is not mad or disturbed as people might think you would be in a mental hospital. She is just mildly mentally take. She does not inhalation, or think, or feel, the woman is lacking(p) in mind but bounty physically. In her neat clothes, the woman is absent.Stanza five is similarly a continuation of stanza four these three stanzas are all connected. It goes into detail about a certain patient, described as a labouring man. By going into more detail about this patient, the reader thinks that he is a main character or will play quite a a large role in the rest of the poem. This poem interests the reader to read further.Stanza six tells us that this patient has never spoken. The consider qualified and mild man stands up to recite The Daffodils. This is where stanza one is linked with the poem. This stanza tells us about the miracle that happens. The miracle is that a man in a mental institution, who has not spoken for a long, long time, is suddenly forced to speak by the power of an awakened memory. To the staff it does not seem such a miracle, as they know that he is an elective mute.Stanza seven is about the nurses and the residents at the institution and the substantial of natures reactions. It withal describes the man who is reciting The Daf fodils and how well he recites it after years of not speaking. The nurses are frozen, active the patients seem to listen.Stanza eight is an explanation of how he came to know the poem The Daffodils and why he necessary to speak it. It is a trip back in time and a reason for his being in a mental institution. The man came to know the poem, cardinal years ago, in a Valleys school, the class recited poetry by rote. His reason for being in the asylum is, since the dumbness of misery fell he has remembered there was a music of speech and that once he had something to say. This also explains why he spoke. He had a memory woken inner(a) of him by the narrative office reading to the insane.Stanza nine finishes off the poem, as so does the man. There is a silent, still moment throughout nature and from the listeners at the mental institution, before the applause, we point out the flowers silence. There is a moment of silent appreciation throughout nature and humanity.The structure of The Daffodils by William Wordsworth is in four equal stanzas. They each have six lines of similar length. The stanzas all look like each other. This is a regular structure. Stanzas one and two have complete sentences but stanza three and four have lines linked with a break in the middle. The rhyming pattern of the Daffodils is that line one and line three rhyme and line two and line four rhyme, and line five and six are a rhyming couplet. This is the regular rhyming pattern that continues throughout the rest of the poem. The poem looks even and neat on the page and has straightforward pick uping looking language. The regular rhyming pattern fits in with the simplicity of the event and is a common experience shared by all. Wordsworth has shortened intelligence activitys to make to make them fit in with the flowing of the poem. This brings the structure together and neatens it to make it more readable. For oft, when on my couch I lie oft is the shortened version of often.The structu re of The Miracle on St. Davids Day by G. Clarke also has a regular structure but is quite different from the Daffodils. It has eight stanzas all equal in size. They all contain five lines all of similar length, apart from the very determination stanza that has only three lines containing the conclusion. When hes done, before the applause, we reveal The poem is non-rhyming but flows, by one sentence starting on one line and running onto finish on the next line, such as, A big, mild man is t depoterly ledto his chair.This pattern helps to reveal the stages of the miracle because it flows and looks like a poem but sound like prose. This poem is a narrative poem. The narrative go is Gillian Clarke as it is revealed to the reader that she is there herself telling the readers about her experience. I am reading poetry to the insane. The final stanza leads up to Clarkes final meaning of how a distant memory can be triggered by anything small or large, showing the power of memory. Forty years ago, in a Valleys school, the class recited poetry by rote. William Wordsworth is the narrative voice of The Daffodils as it is revealed to the reader instantly, I wandered lonely as a veil. This tells the reader that Worsworth is telling the reader about his experience.The style of The Daffodils is imperturbable and tranquil. The body fluid is set dreamily straight away with an image of floating. I wandered lonely as a cloud that floats on high oer vales and hills. It has a sentimentalist style for Wordsworth was a romantic poet, emotion recollected in tranquillity. Wordsworths words flow and run like a song with many images being displayed in nominal head of the readers eyes all at once. Beside the lake, beneath the trees, fluttering and dancing in the breeze.This rhyming style sounds like a song and creates a summer picture of sun glittering on a lake with a frail patch of shade over it from the trees that are gently waving about in the soft and warm breeze in the rea ders mind. The style of The Miracle on St. Davids Day is completely different to the one of The Daffodils. It changes rapidly. At first it is warm and welcoming, the setting of the poem. First the reader is outback(a) the building admiring the scenery, then the quickly moves to the inside of the building to discover the buildings true nature. The mood is then changed, slightly tense. The poem style is confusing, as there is a lot of a contrast used. Clarke contrasts the look of the patients to their mental illnesses. She has already referred to them as the insane.A beautiful chestnut-haired boy listens entirely absorbed. A schizophrenic. This contrast is quite strong and obvious. The reader imagines a beautiful boy in every way, a good child, normal, content and happy. Then it instantly changes, he is a schizophrenic which changes the readers perspective of the child, as on the outside he is a perfect boy, almost angelic, then we see the inside, corrupted and destroyed of any norm ality.The language of The Daffodils is in Modern English although some words have been shortened to fit in with the rest of the poem. For example Oer , means over. That floats on high oer vales and hills. Antiquated language is also used such as glee and jocund. The English is very straightforward, using both modern and antiquated vocabulary.Stanza one begins with a metaphor. Wordsworth likens himself to a cloud that is driven by the wind over which the cloud has no control. Here he is telling the reader about his mood and feelings and behaviour in that present moment. His mood is aimless as his feet were driving him in a directionless manner. He just felt a force taking him and a need to wander. I wandered lonely as a cloud. The simile creates a drifting mood. There is then a strong sense of immediacy, all at once. Wordsworth draws the reader in with at once and the readers attention is riveted. There is a great deal of imagery in the first stanza.Crowd and host, both convey a ve ry large number or a numerous amount. In the next line the reader discovers what the crowd is. It is described vividly to the reader with a rich, luxurious and vibrant feel, golden. There is also a unearthly quality in a host of golden daffodils. A picture is created in the readers head of the golden daffodils glowing and highlighted to stand out from the rest of the world, as if from the heavens. It is like a host of angels. There is a strong assonance in stanza one, the repeat of the vowel sounds ee creates a sense of movement beside, beneath, trees, breeze. The reader hears a beat, a rhythm creating a sense of the flow of movement and swaying of the daffodils. There is also an ing sound in stanza one that creates a more bouncing effect fluttering and dancing. This gives stanza one a song like quality.Stanza two opens with a simile and a comparison. Wordsworth compares the daffodils to stars, which stretch endlessly to the human eye. Wordsworth compares the numbers of the daffodi ls to the vast amount of stars. Continuous as the stars that shine, this means that the daffodils continued beyond the reach of his own sightedness so that there must have been thousands of daffodils or more. They stretched in never-ending line.This conveys an infinite number, enthralling the reader. Wordsworth then gives elevated imagery, stars that shine and twinkle on the Milky Way. This gives the imagery of the daffodils releasing a ray of golden light around them, giving a magical feel. Wordsworth then makes a personification, Tossing their heads in sprightly dance. moreover something that is alive could dance or toss their heads, so he points out the amount of life in these daffodils. He makes them full of life with vivid movement, sprightly. This is a lovely word to describe the behaviour of the daffodils, and conveys that they are full of movement and spring. The mood is warm, relaxed and light with a romantic atmosphere.In stanza three an image of the building block of N ature alive is presented to the reader, the waves beside them danced. This is the waves of the lake beside the daffodils, leaping about driven by the wind as if dancing to compete with the beauty of the daffodils. This is also a personification of the waves dancing. The mood then changes by the word but, making the reader expect something. After all the describing of the magical and romantic atmosphere, the reader feels pessimistic that something is going to change the building block mood of the poem. The reader then discovers that nothing terrible happens but the but was only to shame the waves, as the daffodils were more effective than the waves out-did the sparkling waves in glee. This means that the daffodils bettered the waves.The atmosphere is now light and fantastic again, glee meaning merriment and cheerfulness. There is a colon in the middle of stanza three indicating a pause, which continues with Wordsworth commenting on his feelings and actions at the present moment. I g azed- and gazed- but little thought. The hyphens slow the line down by breaking it up gradually, this gives the printing of thought to the reader. By doing this Wordsworth indicates the end of the description of the daffodils. There is also a metaphor in this stanza, what wealth to me the show had brought. The wealth in this stanza is a metaphor for the lasting measure of the experience gained by the sight of the daffodils and the emotions that they brought.Stanza four is at a later time, indicating that the poem was a memory flashback. The reader knows this from the first line of the stanza. For oft, when on my couch I lie. It is a reflection of the experience by saying oft which means frequently. The next line creates an empty mood, far away, drifting and dreaming. This tells the reader of Wordsworths longing to be back in that experience. The mood and atmosphere is quite strongly put forward to the reader with vacant or in pensive mood. This means absent and dreaming, inattentiv e and expressionless but with a thoughtful frame of mind. This shows Wordsworths mood of leaving the world far behind him and trying to enter an ageing memory of an uplifting experience. Stanza four has a special meaning. It is a time in Wordsworths life when he is having a retrospective view of his experience, which is so emotionally fire to him that it has created an extremely long lasting impression in his mind.Wordsworth sums up his feelings from the experience in the last stanza they flash upon that inward eye, here he is saying that the pile of the crowd of daffodils is branded on his imagination for the rest of his life. This brings great happiness to him, which is the bliss of solitude. By using the word bliss, Wordsworth expresses his emotion of complete happiness. It is a religious and holy sounding word making the experience sound even more unreal and magical. solitude, meaning being alone completely with no-one near you at all, tells the reader that this experience was completely personal to him and special, and only he will ever know the true wonder of it even if he describes is as high hat as he can to others and then my heart with pleasure fills.This is a personification as there is an image of a vase being filled to the brink with pure joy. Also there is another personification in the last stanza, and dances with the daffodils. It is a further personification of a lively person who dances. In this last line Wordsworth is saying that his heart is dancing with the daffodils. Daffodils do not dance, but to Wordsworth they exude life, joy and radiant beauty. Wordsworth is deeply moved by the sight of them and he feels that his heart has gained a clean lease of life and that he will look on everything about life and living in a new manner now. The last three lines of stanza four create an angelic and heavenly mood.In The Daffodils Wordsworth is trying to teach the reader to appreciate the beauty of nature and to understand the power of memory. I also think that he is trying to teach the reader about how the effect of just one experience in your life can be so strong and powerful that it can be remembered as vividly as it was the day of the experience many years later.From the prenomen Miracle on St. Davids Day it is revealed to the reader what this poem is about. It is obvious that a miracle is the main point of the poem, meaning something holy yet unexpected. We also find out that it happens on St.Davids Day, which might be of some sort of significance later on in the poem. Underneath the poem is an extract of a well-known poem. To the reader this is some sort of a misprint or mistake, but the author and title of the extract are given also, signifying no mistake. After a read through the reader finds out that it is linked with the fifth stanza, the labourers voice recites The Daffodils.The language of this poem is in Modern English. It is descriptive, non-antiquated, meaning more modernised and less formal, and contempo rary. It also has a narrative style. The vocabulary evokes spring, the asylum and re-birth. Examples of vocabulary evoking spring are used in the first stanza to set the scene. An afternoon yellow and open mouthed with daffodils, this gives the reader an impression of freshness, newness and spring, clear and open to the world. Growth and life is suggested in the description of a garden, among cedars and enormous oaks. Nursery shrubs, also suggests this.The vocabulary evoking the asylum is mainly in stanzas two, three, four and six. Immediately it is evoked in stanza two with the words insane and a schizophrenic. In stanza six the impression of the asylum is presented quite clearly with the nurses are frozen, alert the patients seem to listen. From this the reader learns that the place is some sort of hospital.The vocabulary that evokes rebirth is in stanzas one, five and eight with the reference to the daffodils, which are connected to spring and being reborn. The Miracle on St. Dav ids Day is in poetic prose to prove that it is a descriptive piece.In stanza one, line one, there is a personification, yellow and open-mouthed. This suggests that the sun creates an image of a bell shaped flower telling the reader of the afternoon speaking of spring. There is another personification in this stanza of sunlight appearing to walk along a path. the path treads the sun among cedars. A country setting where nature dominates is evoked in lines four and five. it might be a country house, guests strolling, the rumps of gardeners between nursery shrubs. The language and arrangement of it gives the reader an image of a place of contentment and relaxation. might be, strongly suggests that they are not guests strolling and it is not a country house setting. This interests the reader to read on further to discover the true nature of the guests.In stanza two images are created of the two characters presented to the reader. The first line of stanza two is a strong contrast to the harmonious setting created in stanza one I am reading poetry to the insane, is an extreme change of tone destroying the peaceful atmosphere. It is a short one line sentence, blunt and sharply in focus. It is what G. Clarke, the narrative voice is doing, proving that what she has written is from personal experience similarly to Wordsworth. G. Clarkes technique is contrast. She contrasts the look of the patients to their mental illnesses. In lines seven and eight an old woman is described as interrupting. Lines nine and ten describe a boy as beautiful and chestnut-haired and then further on as a schizophrenic.Stanza three describes a woman in her neat clothes but mentally absent. The womans description repeats the word not three times to emphasise her mental absence meaning her state of mind is not entirely there, sits not listening, not seeing, not feeling. It is key word emphasising the effect of the illness on the human psyche. There is a total lack of response to the poetry from t he woman. The next two lines describe a man as a big, mild man is tenderly led, suggesting he is either dumb or bovine or ox-like, lumbering but good-natured.Line eleven continues from line ten fitting in with G. Clarkes narrative purpose. By mentioning herself, the focus of the reader is brought back to the story telling mode. Line twelve contains a metaphor, in a cage of first March sun a woman. The woman is surrounded by a spotlight of sunlight. She is caught in a cage, which is the asylum and her mental illness. This is three different ways of being trapped emphasising her situation. In the last line of stanza three, the subject of the miracle is introduced although the reader does not know this yet. The sentence is unpainted naturally leading the reader on to stanza four and on with the story.Stanza four continues the sentence begun in stanza three. Imagery is created by the big, dumb labouring man as he rocks. A large imapct is presented to the reader with big and dumb is a l arge impact conveying contrast of his mental and physical state. In the first line of stanza four the reader discovers that this patient has never spoken, but later we find out that he can and is therefore an elective mute. Line cardinal has blunt, shorter words that describe him very well. His psychotic behaviour is presented to the reader with a rocking rhythm created throughout the stanza, repeated. He seems content with the rhythms of the poem, by the image of rocking. His labourers hands on his knees, he rocks. ..to the big, dumb labouring man as he rocks. Rocks is repeated twice in the stanza so that a movement is created in the stanza and to emphasise his mental condition. There is also an oxymoron in this stanza, I read to their presences, absences.It is two opposite things put together. Here the patients are there in physical state but not in a mental state.Stanza five introduces the beginnings of the miracle with an alliteration. He is suddenly standing, silently. These a re quiet but powerful words giving the thought to the readers head that something of extreme importance to the poem is going to happen. The reader has already heard of the man as big and mild but now he is huge and mild, now that he has stood up. He is quite a presence, but from the repeated word mild, we know that he is really a gentle giant. Although he sounds a gentle giant his presence is intimidating. The impact of him standing evokes a sense of fear in the poet, but I feel afraid. Huge and mild are straight forward language but give a large impact. There are two similes in stanza five, Like slow movement of spring water, creating the image of after winter, snow and ice have almost all melted and it is slow and heavy, trickling down a hill side. Images of light and biased are created with the first bird of the year in the breaking darkness. This tells the reader that the mans voice is coming out of the darkness. His voice is being reborn or regenerated symbolising the whole ne wness of spring.Stanza six is the response or reaction to the reaction of the poem, from the staff, the patients and the whole of nature. The nurses are frozen, the nurses are shocked and in amazement to the reaction that this man had to the poem. The nurses are also alert, because this is a very unusual occurrence and they have to be alert and ready to act in any medical capacity needed. The other patients also seem to listen for once, being attentive and showing recognition of the miracle. There are two halves to the poem from different sides of the reaction, the patients reaction and the staff. He is hoarse but word-perfect, this tells the reader that he has obviously not spoken for a very long time although there must be some reason for this. His voice is croaky from the lack of use of it, but his memory is very powerful and he has not yet forgotten any of it from his days of youth.Nature outside also seems to listen to the mans recital, outside the daffodils are as still as wax , they are awake, attentive and listening, but somehow they look like they have been carved, waking up daffodils from long ago. Their syllables unspoken, show that nature waits for the recital of the poem to end. The daffodils symbolise spring and rebirth, in many forms. The rebirth of the mans voice. There is one personification at the end of the stanza, their syllables unspoken, suggesting that the daffodils can speak. There is a reference to The Daffodils in stanza six ten thousand, stating the amount of daffodils outside there are, which are the exact words used in The Daffodils by Wordsworth.Stanza seven is a flashback of the mans youth and how he came to learn the poem that he recites. The flash back offers an insight or explanation of how he is able to stand up and recite the poetry. There is one metaphor in this stanza, a music of speech. A music of speech is a voice inside of him with a very strong force and the power of memory needing to get out and tell others of this fo rce. Music is symbolic for harmony and now once more the man is in harmony with himself, between his vocal chords and his intellect. The inner harmony within him shows the importance of poetry on the soul. This stanza emphasises the effect of nature on us all and the power of nature on the human psyche.Stanza eight is when the silence, stillness and attentiveness throughout stanza six, seven and eight, breaks. The man finishes the recital and the patients and the staff firstly postdate natures attentiveness and then the applause comes telling the reader that the change in nature during the recital did not go unnoticed.When hes done, before the applause, we observe the flowers silence. The end of this line is a personification of the flowers being able to listen and change their mood by choice, the flowers silence. A thrush sings, tells the reader of how the atmosphere changes and nature goes back to normal. It also suggests to the reader that this was the expected miracle, permanen tly changing the mans life for the better. It seems that the mans illness has either been taken away by some angel of nature or has taken a new extremely unexpected turn. The last line contains a metaphor, the daffodils are flame, giving the reader an image of heat, power, intensity and life. The daffodils are alive and have awoken from the dream or other life whilst they were listening, just like the mans mental state.Clarke was trying to teach the reader that the power of voice and poetry can be eer lasting in a strong memory, even if the memory is very distant it can be triggered. Learning a piece by heart, once engraved on the brain may never be lost. Many things can unlock this memory but in particular the power of nature, voice and poetry can recall it most strongly. Even if mentally ill a memory can be recovered and even sometimes a memory lost long ago with the help of nature, can even cure an illness bringing the person back with their mental and physical state.I have lear nt a lot from studying these two poems. The poems are completely different and contrast in many ways, but they also link with each other also. I had not heard of either of the two poems before, although The Daffodils by William Wordsworth is quite a well-known poem. Both poems being new to me they were fresh and interesting. examine these poems has taught me to appreciate the wonder of nature more and recognise the power of memory. I cannot say which poem I prefer as they are entirely different, but I probably enjoyed reading The Daffodils more, because it was light and dreamy with a bouncy rhythm to it. It also seemed more unrealistic which appeals to me more.My profound experience with nature happened last summer. I go out horse riding every weekend with a friend of mine in Brockenhurst. We spend the whole day physical exertion the horses and exploring the forest. One weekend we were walking along a track in the forest, we turned round to the right at the end of the track, into a clearing and we stop straight away. In front of us, at the bottom of a wide decreasing slope was a bevy of deer. Right at the front of the herd was a white stag. He was proud, wise, noble and valiant looking with the golden sun adoring him, giving him a halo effect.Everything seemed to be silent as if time had been stopped, we were in a moment all of our own. The sun was beating down on us from behind us, as if to illuminate the stag and his herd. We just stared at the stag and he seemed to stare back. The stag held our gazes, which seemed to last forever. He then proudly turned around and walked through the centre of the herd into the dark and shaded forest. He did not turn his head, but the rest of the herd walked behind him as if trying to match noble quality but none succeeded. I will never forget that, as I had never seen a white stag before and probably will never again.

Examination of the Cardiovascular System

Examination of the Cardiovascular SystemThe barbarian should be undressed befittingly to the waist. In the older boor, the examination easily performed with the patient academic term over the edge of the backside or even on a chair. Preferably, examine the younger child on the p arnts lap. Removing a toddler from his p arents is less promising to yield good clinical signs and more similarly to yield a screaming child. For examination of femoral metres, the child should be in the supine position. prompt your devotes by expungebing them against each other.STEPS OF THE delegateYou should use the middle three feels of your dominant overturn to experience the momentums against the underlying bone. The finger tips are used for palpation as they have maximum sensitivity. plot of ground palpating, the artery is stabilized by the proximal and distal fingers and the thrust of the twinkling is felt by the middle finger. Partial occlusion of the artery by the distal finger improv es the thrust of the pulse draw in on the middle finger.Palpate all the pulses listed on a small-scaleer floor first on the violentress and then on the go forth over(p) side. Always compare the respective pulses on both sides except the carotids. In case of carotids, palpitate both sides faecal matter induce cerebral ischemia and tin can cause the patient to faint.Carotid (dont palpate both sides simultaneously) Palpated at the level of thyroid gristle on the median border of the sternomastoid muscle either with finger tips or thumb ( leftfield thumb for the undecomposed side and vice versa)Brachial Palpated with the elbow flexed along the medial aspect of the lower end of the armRadial felt at the lower end of the radius on the anterior aspect of the wrist, medial to the styloid process with the patients forearm slightly pronated and wrist semiflexedFemoral (DO NOT FORGET FEMORALS) felt in the middle of the groin with the wooden leg slightly flexed and abducted a nd foot outwardly rotated.Dorsalis pedis can be felt on the dorsum of the foot craveance to the extensor hallucis tendon in the middle third of the footPosterior tibial felt posterior to the medial malleolus and anterior to the Achilles tendon.For assessing the pulse rate, use brachial pulse in an infant or toddler and radial pulse in older childrenWhile counting the pulse rate, count for 15 seconds and multiply by 4. But tell the examiner that ideally, you would like to count for one minute. However, if the pulse is irregular, then count for one adept minute and also count the heart rate by auscultation.Rhythm while looking for the rhythm, one looks for the perturbation between the pulse waves and comment on their regularity.VolumeThis is a highly subjective sign. It desc roastes the thrust (expansion) of the pulse wave and reflects the pulse storm.If high volume, always break-dance for collapsing nature. (Hold the right forearm of the patient by your fall in such a way a s the radial artery is under the head of the metacarpals of our go across. glom the patients entire velocity limb vertically by 90and feel for the sudden and exaggerated rise and fall of the pulsations of radial artery.)Character This describes the form of the wave and various types are decided by the rise, peak and waning of the wave. It is best appreciated in carotids.Radio femoral learn (femoral pulse appears next a time go over after radial suggests coarctation of aorta)POST- trade union movementMake sure you dont leave the child undecided.Thank the child/ parent for co act if no further examination is plannedVIGNETTECharacteristics of pulse should be described as followsRateRhythmVolumeCharacterSymme moveRadio-femoral delayRateComment on rate as normal, tachycardia or bradycardia based on term specialised heart. In general, for children over 3 years of while pulse rate 100 beats per minute is tachycardia and pulse rate Tachycardia has poor specificity and always m ake sure child is not anxious/ febrile before attributing significanceBradycardia in a child is usually point to underlying pathology once exercise (athletes), drug intake (Digoxin, beta blockers) is ruled out.Rhythm describe as regular, Regularly irregular and Irregularly irregularRegular there is a normal variation of heart rate on breathing fistula arrhythmia. It is present in most children.Regularly Irregular abnormal beats occur at regular intervals pulsus bigeminus, coupled extrasystoles (digoxin toxicity), Wenckebach PhenomenonIrregularly Irregular no specific gaps between the waves Extrasystoles are common in normal children and disappear with exercise. Atrial fibrillation is another common condition which causes an irregularly irregular pulse. Comment on the pulse deficit i.e. the difference between heart rate and pulse rateVolumeHigh volume anemia, carbon dioxide retention or thyrotoxicosis woeful volume pulse is seen in low cardiac output states.CharacterSlow risi ng and plateau (pulsus parvus et tardus) dreaded aortic stenosisCollapsing pulse e.g. aortic incompetencePulsus Paradoxus- pulse is weaker or disappears on inspiration e.g. Constrictive pericarditis, tamponade, status asthmaticusJerky pulse normal volume, rapidly rising and ill sustained.-suggestive of hypertrophic obstructive myocardiopathyPulsus bisferiens deuce peaks felt during systole, seen in the presence of moderate artic stenosis and severe aortic regurgitationPulsus alternans sp illumine second wave with alternate depleted and large waves seen in severe left ventricular failure and arrhythmiasSymmetryUnequal or absent pulses may be suggestive of previous surgery e.g. Blalock-Taussig shunt, repaired coarctation, cervical rib or absent radial pulseOSCE CHECKLISTPRIOR TO THE taxHand washing or using alcohol rubAsks the name and age of the child, if already not told by the examinerExplains the purpose of his/ her visit and what he/ she is going to do personates the pat ient appropriatelyTASKUses the middle three fingers of the dominant hand to palpate the pulsesPalpates all the pulses first on one side and then on the other sideCompares pulses bilaterallyDoes not palpate the carotids simultaneouslyCounts the pulse rate at least for 15 secondsIf pulse is irregular, then counts for one full minute and also counts heart rate lookings for Radio femoral delayWhile describing the pulse, comments on rate, rhythm, character, volume, symmetry and radio-femoral delayPOST- TASKMakes sure that the child is not left exposed give thanks the child / parent for co procedureTask MANUAL Measurement of occupation contractPRIOR TO THE TASKMercury sphygmomanometer should be used as aneroid sphygmomanometer loses accuracy on tell usage.Choose the appropriate size cuff the cuff bladder should cover at least 2/3 of the length of the arm and 3/4 of the circumference . Cuff size should always be documented.Make sure that the child is calm and not crying or agitatedCh ild can be either seated or in the supine positionAny clothing over the arm should be removedTHE TASKThe conclave is to measure BP in the right arm in a calm but awake subject. If conditions differ from this they should be documented with the reading.The elbow should be support and flexed and should be at the level of the heart.The cuff is wrapped around the upper arm with the bladder centered over the middle of the arm.Approximate estimation of the systolic blood pressure is done initially by inflating the cuff fully and then deflating slowly and smoothly while palpating the radial pulse. Systolic blood pressure is noted at the point when the radial pulse returns.Following this, the blood pressure is recorded by auscultatory method which is the more accurate measure. The s top offpage of the stethoscope is placed over the brachial artery along the medial aspect of the lower end of the arm below the edge of the cuff. The cuff should be lofty to 30 mm above the palpatory systolic blood pressure and then deflated slowly and smoothly at the rate of 2-3 mmHg per second. Systolic blood pressure is recorded at the point when clear, repetitive tapping heavys are just heard. Diastolic blood pressure is recorded when the rights disappear.In some children, instead of disappearing, the sounds put out first before disappearing. In this case, the value at which the sounds muffle should be recorded as the diastolic pressure if the difference between the point of muffling and fade of the sounds is greater than 10 mmHg.POST- TASKMake sure you do not leave the child exposed.Thank the child/ parent for co operation if no further examination is plannedWhile interpreting the readings, the state of the child should be taken into account. Values should be compared to normal values with reference to the age/height and sex of child.VIGNETTEIn infants, instead of radial, brachial pulse should be palpated. Sometimes, auscultation can be difficult in infants in which case systoli c pressure by palpation should be documented.If measuring a lower limb pressure, the same cuff can be app double-dealingd to the lower leg and a foot pulse palpated.It is advisable to measure the blood pressure in both upper and lower limbs. When coarctation is suspected, it is imperative that blood pressure is recorded in both arms and one leg. The same should be done is cases of hypertension and in those who have had shunt surgeries as in Blalock Shunt.While enter blood pressure in the lower limb, a larger appropriate size cuff should be used and auscultation is done over the popliteal artery.The sounds which are heard while auscultating are called as Korotkoffs sounds and has five phases. Phase 1 is the first heard clear, tapping sound, phase 2 is intermittent murmur like sound, phase 3 is the loud tapping sound, phase 4 is the muffling of sounds and phase 5 is disappearance of the sounds.Occasionally, the sound might disappear after the Korotkoff sound phase 1 before reappearin g later. This auscultatory gap can lead to either underestimation of the systolic blood pressure (if prior estimation of blood pressure by palpation is not done) or overestimation of diastolic blood pressure is the auscultation is not continued till the end.In atrial fibrillation, phase 4 of Korotkoff sound should be used for recoding diastolic blood pressure.Pulsus paradoxus is best appreciated while recording blood pressure by auscultation and is identified by recording the value at which the tapping sounds are heard only during expiration and the value at which the sounds are heard both during inspiration and expiration. When the difference between the two values is greater than 10 mmHg, pulsus paradoxus is said to be present.Pulse pressure is the difference between systolic blood pressure and diastolic blood pressure. A weak pulse is associated with narrow pulse pressure and is seen in cardiac failure, shock, aortic stenosis and constrictive pericarditis. Pulse pressure is wide in aortic regurgitation, hyperthyroidism, anemia and febrile states.OSCE CHECKLISTPRIOR TO THE TASKWashes pass on or uses alcohol rubExplains the purpose of his/ her visit and what he/ she is going to doPositions the patient appropriatelyChooses mercury sphygmomanometerChooses the appropriate size cuffRemoves any clothing over the armTASKSupports the elbow and keeps it at the level of the heart.Wraps the cuff around upper arm with the bladder centered over the middle of armEstimates systolic blood pressure by palpatory methodUses brachial pulse in infants for palpatory methodEstimates systolic blood pressure by auscultatory methodUses diaphragm of the stethoscope for auscultationPOST- TASKMakes sure that the child is not left exposedThanks the child / parent for co operationRecords blood pressure as estimated by palpatory and auscultatory method including the site and the position of the childInterprets the blood pressureTask Evaluation of jugular vein venous pulsePRIOR TO THE TAS KThe room should be adequately lit for the assessment of jugular venous pulseThe patient should be in semi-reclining position with the trunk at 45 to the bed.The head and the back should be soundly supported with a pillow under the head.The head should be positioned in the midlineTHE TASKStand on the right side of the patient and assess the jugular venous pulse.The torch should be shined from the left in an oblique direction and the jugular pulsation is observedJugular venous pulse is located just lateral to the clavicular head of the sternomastoid muscle.Pulsations of the jugular veins should be differentiated from the carotid pulsations as discussed below.The jugular venous pressure is assessed by measuring the vertical distance between the top of the jugular venous pulsations and the sternal angle (angle of Louis). In cases where the top of the jugular pulsations is not visible at 45, increasing the reclining angle up to 90 can make the top of the pulsations obvious. The assessm ent is done when the child is breathing quietlyLook for hepato-jugular reflex. This performed by exerting firm and sustained pressure on the right upper quadrant of the abdomen and looking for an elevation in the jugular venous pressure by 2-3 cm.POST- TASKMake sure you do not leave the child exposed.Thank the child/ parent for co operation if no further examination is plannedVIGNETTEAssessment of jugular venous pressure is rarely important in the younger child. It is also difficult to obtain an accurate reading because of the short neck in childrenIt can be generally measured easily if the child is greater than 10 yearsJugular Venous PulsationCarotid PulsationPulse lateral to sternomastoidPulse medial to sternomastoidBetter seenBetter feltMultiple waves seenSingle waveAbdominal pressure makes the pulsations prominentAbdominal pressure has no effectValsalva caper makes the pulsations prominentValsalva maneuver has no effectCan be obliterated with pressureCannot be obliterated with pressureThe right jugular vein is in a straight line with the right atrium and is more likely to show the pressure effects than the left jugular vein which has more tortuous pass over and is more likely to kinked. This can lead to false elevation of the jugular pressure.In patients with highly elevated JVP, the pulsation may be seen only below the angle of jaw. In such cases, increasing the reclining angle to 60 or more makes the pulsations more obvious.Turning the head slightly towards the contralateral side can make the pulsations prominent, if the pulsations are not obvious.JVP consists of a, c and v waves and x and y descent. a wave is due to right atrial contraction, c wave is due to bulging of the tricuspid valve and v wave is due to atrial filing. x descent is due to atrial relaxation and y descent results from ventricular alter and tricuspid valve opening.The sternal angle (angle of Louis) is taken as the reference point as it roughly corresponds to the middle of the righ t atrium.JVP is elevated in congestive cardiac failure, fluid overload, constrictive pericarditis, pericardial tamponade, tricuspid stenosis and tricuspid regurgitation.Non-pulsatile elevation of JVP is seen in superior vena cava obstruction.a wave are absent in atrial fibrillation.Large a waves are caused either by hypertrophied right atrium in response to decreased right ventricular compliance as in pulmonary hypertension and pulmonary stenosis or contraction of atrium against resistance as in tricuspid stenosis.Cannon a waves are ogre a waves seen in early systole and is caused by contraction of the atrium against a closed tricuspid valve. It is usually seen in complete heart block and ectopics.Large v waves are seen in tricuspid insufficiency.Sharp x and Sharp y descents are seen in constrictive pericarditis and restrictive cardiomyopathy.OSCE CHECKLISTPRIOR TO THE TASKWashes hands or uses alcohol rubExplains what he/ she is going to doMakes sure that the room is adequately lit Positions the patient in semi-reclining position with the trunk at 45 to the bedSupports the head with pillow to ensure relaxation of the neckPositions the head in midlineTASKStands on the right side of the patient and assesses the right jugular venous pulse.Locates the jugular pulse correctlyIf the jugular pulse is not obvious, then makes it obvious by turning the head slightly to the left and shines the torch from left obliquely if necessaryMeasures the jugular venous pressure correctlyLooks for hepato-jugular reflex.POST- TASKMakes sure that the child is not left exposedThanks the child / parent for co operationLists the differences between carotid pulse and jugular pulseTask general inspection of the body with reference to cardiovascular systemPRIOR TO THE TASKIntroduce yourself to the child and carer and ask for permission to examineFor inspection, the room should be well lit. Ensure that the lights are turned on and the windows are openThe child should be undressed appropriate ly to the waist.In older child, the examination is easiest to perform while they sit over the edge of the bed or even on a chair witness the younger child on the parents lap.STEPS OF THE TASKLOOK GENERALGeneral well being Well/ Ill looking childInterest in the surroundings Sick child will not be interested size of it of the child thin small, thin tall, well nourished and tall, well nourished and short.Degree of breathlessness classify as none, mild or severe environs (Equipment) oxygen mask, nasal cannula, intravenous catheter, pulse oximetry, feeding tube/ gastrostomy,LOOK SPECIFICHead look at the size (microcephaly or macrocephaly) and shape (dolichocephaly) lawsuit Normal or dysmorphic features, malar flushConjunctiva pallor, jaundice (refer chapter on general examination)Mouth Using the pen torch, take a quick look in the oral fissure and look for the presence of age appropriate teeth, abnormal teeth and caries. Ask the child to stick their vernacular outwards and upwards towards the nose and examine the tongue for central cyanosis.Hands and fingers pallor clubbing polydactyly and syndactyly Oslers nodes Janeway lesions splinter haemorrhages. Examine both the hands quickly.Difference in colour between limbsPOST- TASKMake sure that the child is not left exposedThank the child / parent for cooperationVIGNETTEAlways think whether the findings combine to form a recognizable clinical syndrome.It is preferable to inspect the child in sunlight than in artificial light.Children with chronic cardiac conditions are usually thin and small for age.Breathlessness is classified as mild when the child has only tit recession, and there is no contraction of sternocleidomastoid or nasal flaring and severe when all three are presentMicrocephaly can be associated with some of the intrauterine infections and genetic disorders like congenital rubella syndrome and Edwards syndromeDolichocephaly (increased antero-posterior diameter) is seen in ex-pretermsSyndrom es with dysmorphic facial nerve featuresDowns syndrome almond shaped eyes (due to epicanthal folds) Brushfield spots (light colored spots in the iris) small, flat nose small mouth with a protruding tongue small, low set ears round faces flat occiputTurners syndrome prominent, posteriorly rotated auricles with looped helices and attenuated tragus infraorbital skin creases mildly foreshortened mandibleWilliams syndrome broad forehead short nose with broad tip full cheeks wide mouth with full lipsNoonans syndrome downwards slanting eyes with arched eyebrows epicanthal folds broad forehead nose with wide base and bulbous tip pointed mentumMarfans syndrome long, thin face deep-set eyes down-slanting palpebral fissures receding chin dolichocephaly malar hypoplasia enophthalmosDiGeorge syndrome small ears asymmetric facies small mouth and chinMalar flush plum coloured malar eminencesHutchinson (conical) incisor is seen in congenital syphilis (patent ductus arteriosus) and enamel hy poplasia in Ellis-van Creveld Syndrome (atrioventricular canal, ventricular septal defect, atrial septal defect, and patent ductus arteriosus).Caries tooth may be a cause of infective endocarditis in congenital heart disease.In preaxial polydactyly, the extra digit is on the radial (thumb) side while in postaxial polydactyly, it is on the ulnar (little finger) side of the hand.Oslers nodes are painful, red, raised lesions found on the hands and feet and is seen in infective endocarditisJaneway lesions are nontender, macular lesions, most commonly involving the medallions and soles and seen in infective endocarditis.Splinter hemorrhages appear as narrow, red to reddish-brown lines of blood that run vertically under nails. Splinter hemorrhage can be associated with infectious endocarditis, systemic lupus erythematosus, and traumaOSCE CHECKLISTPRIOR TO THE TASKWashes hands or uses alcohol rubExplains what he/ she is going to do and ask for permission to examinePositions and exposes th e child appropriatelyMakes sure that the room is adequately litTASKLooks for the following general pointsGeneral well beingInterest in the surroundingsSize of the childDegree of breathlessnessEnvironment (Equipment)Looks for the following specific pointsHead size and shapeFaceConjunctivaMouthHands and fingersDifference in colour between limbsPOST- TASKMakes sure that the child is not left exposedThanks the child / parent for co operationTask INSPECTION OF THE CHESTPRIOR TO THE TASKIntroduce yourself to the child and carer and ask for permission to examineFor inspection, the room should be well lit. Ensure that the lights are turned on and the windows are openThe child should be undressed appropriately to the waist.In older child, the examination is easiest to perform while they sit over the edge of the bed or even on a chairExamine the younger child on the parents lap.STEPS OF THE TASKLook tangentially from foot end of the bed in supine patients and from the sides in sitting patien ts.Look for the following and commentShape of the Chest symmetrical or asymmetricalSymmetry of pectus expansionScarsPulsations Observe for apical impulse, parasternal, suprasternal, epigastric pulsations.Spine for scoliosisPOST- TASKMake sure that the child is not left exposedThank the child / parent for cooperationVIGNETTECommon asymmetrical chestsPectus carinatum also called pigeon chest, blot of the chest characterized by protrusion of the sternum and ribs. It may occur as congenital abnormality or in association with genetic disorders such as Marfans syndrome, Morquio syndrome, Noonan syndrome, Trisomy 18, Trisomy 21, homocystinuria, and osteogenesis imperfecta.Pectus Excavatum also called funnel chest, deformity of the anterior circumvent of the chest producing sunken appearance of the chest. It may occur in rickets, Marfans syndrome and spinomuscular atrophy.Harrisons sulcus horizontal indentation of the chest wall at the lower margin of the thorax where the diaphragm att aches to the ribs. It may occur in conditions with increased pulmonary blood flow or chronic asthma.Scars lateral thoracotomy scar results from closure of patent ductus arteriosus, tracheoesophageal fistula repair and Blalock Taussig shunt. Central sternotomy scar is seen after open heart surgery and lobectomy. Children can have waste pipe scars in epigastrium, subclavian/axillary scars from pacemakers and scars following cardiac catheterization in the groin and neck.Pulsationsapical impulse will be shifted peripherally due to cardiomegaly, collapse of left lung or fluid in the right pleural cavityParasternal pulsations can occur due to right ventricular enlargement or enlarged left atrium pushing the right ventricle.The most common cause of suprasternal pulsations is dilated aorta due to aneurysm or markedly increased blood flow.Epigastric pulsation may be seen in thin children, right ventricular hypertrophy and abdominal aneurysm.Scoliosis should be looked for in the standing and not in sitting positionOSCE CHECKLISTPRIOR TO THE TASKWashes hands or uses alcohol rubExplains what he/ she is going to do and ask for permission to examinePositions and exposes the child appropriatelyMakes sure that the room is adequately litTASKLooks tangentially from foot end of the bed in supine patients and from the sides in sitting patientsLooks for the following points and commentsShape of the ChestSymmetry of chest expansionScarsApical impulse, parasternal, suprasternal, epigastric pulsationsSpine for scoliosisPOST- TASKMakes sure that the child is not left exposedThanks the child / parent for co operationTask PALPATION OF THE CHESTPRIOR TO THE TASKIntroduce yourself to the child and carer and ask for permission to examineThe child should be undressed appropriately to the waist.Position the older child so that they sit over the edge of the bed or lie down on the couchExamine the younger child on the parents lap.Warm your hands for palpationSTEPS OF THE TASKBe gentle with pa lpationApical ImpulsePlace the palm of the whole hand flat over left chest wall to get a general impression of the point of maximal impulse.Next, lay the ulnar border of the hand on the chest parallel to rib home where the impulse was felt and try to locate the bloom.Finally palpate with the fingertip of the index or middle finger to localize the apical impulse and define its character.Use the left hand to palpate the carotid artery to time the apical impulse.With the finger of the right hand still in place over the apex beat, palpate the manubriosternal joint (angle of Louis) which is present just below the suprasternal notch and is felt as a intumescency with the left hand. It corresponds to the second intercostal space. Slide the index finger and count down the next few intercostal spaces until you locate the intercostals space that is level with the apex beat. Look at the position of the apex with reference to the midclavicular line.If the apical impulse is not readily palpab le in the supine position, ask the child to lie on their left side.If the apex beat is not still palpable, try on the right side in case of dextrocardia.Parasternal pulsation and heaveWith the fingertips, palpate over the left sternal edge to find the parasternal pulsations.With the child lying in supine position, place a pencil lateral to the left sternal edge and look tangentially for lifting of the pencil.Next, place the base of your hand just lateral to the left sternal edge and palpate for a parasternal heave.If parasternal heave is present, try suppress it by exerting pressure with base of the hand.Thrills are best felt with fingertips. Time the belt with carotid or brachial pulse. Palpate the following expanses. point of the heart3rd to 5th intercostal space along the left sternal borderPulmonary area (left second intercostal space)Aortic area (right second intercostal space)Suprasternal areaCarotidsPOST- TASKMake sure that the child is not left exposedThank the child / par ent for cooperationVIGNETTEApical impulse is the farthest inferior and lateral maximal cardiac impulse on the chest wall. It results from the heart rotating, moving forwards and striking against the chest wall during systole. Apical impulse is normally felt in the 4th left intercostal space on the midclavicular line. It may be difficult to palpate in obese children and in pericardial effusion.Displaced apexTension pneumothorax and pleural effusion (push apex away from the lesion)Pulmonary fibrosis and collapse (pull towards the side of the lesion)Left ventricular hypertrophy apex is displaced down and outRight ventricular hypertrophy apex is displaced outwardsSkeletal abnormalitiesQuality of apical impulse (normal apex lifts the palpating fingers briefly)Sustained (increased bounteousness and duration) pressure overload (aortic stenosis)Hyperdynamic or forceful (increased amplitude but not duration) volume overload (mitral incompetence and aortic incompetence)Tapping palpable first heart sound of mitral stenosisParasternal pulsationsPalpable 2nd heart sound reflects pulmonary hypertension.Parasternal heave is present in right ventricular hypertrophy or left atrial enlargement pushing the right ventricle.There are three grades of parasternal heaveGrade I heave identified by lifting of the pencil entirely and not the heel of the handGrade II easily identified, can be suppressed with pressureGrade III lifts the heel of the hand and cannot be suppressed with pressureThrill is a palpable murmur that felt like a purring cat. While describing the thrill, describe the site and phase of cardiac cycle. When thrill is present, the accompanying murmur is by definition at least 4/6 in intensity.OSCE CHECKLISTPRIOR TO THE TASKWashes hands or uses alcohol rubExplains what he/ she is going to do and ask for permission to examinePositions and exposes the child appropriatelyWarms hands beforeTASKPalpates gentlyApical ImpulsePlaces the palm flat over left chest wall to get a general impressionKeeps the ulnar border of the hand parallel to rib spacePalpates with the fingertip to locate the apical impulsePalpates the carotid artery

SWOT Analysis of Chile: Business and economic trends

SWOT Analysis of chili pepper work and economic trendsCountry Profile chilli 20142014 LATIN American BUSINESS ENVIRONMENT REPORTINTRODUCTION In 2014 the business environment in Latin America did non live up to expectations, and seems that it will not deliver significant results for 2014.Growth rate set protrudeped again, down in 13 of the 18 countries covered in the LABER analysis. Lower commodity prices and financial market volatility in Latin America Governments struggled to cope with growing economic imbalances and rising social discontent.The 14 countries adhering to the centrist social-market paradigm, in spite of these pressures, did not deviate from its more business-friendly policies. Should the economic slump deepen in 2014, it was not unreasonable to expect pressures for change to deepen.Country Profile ChilePolitical FactorsSWOT Analysis of ChileStrengthsChile experiences open economy and the bilateral, regional and multilateral trade agreements led to a increase i n foreign tradeInternational competitiveness has faced an change magnitude growth rate ascribable to the trade agreementsChile offers foreign investors some of the pieces most competitive business costsPrivatization and deregulation read created in the public eye(predicate) utility and telecommunications industriesCorporate taxes and labor costs argon relatively lowNo evidence of active terrorism in Chile feature of serious offences ashes relatively low, despite reports of increased crime levelsChile capital, Santiago is considered one of the safest countries in Latin AmericaEnjoys a stable classless political system, with strong institutionsComprehensive legal framework and independent judiciaryWeaknessesBinomial electoral system is ripe for reformChile is vulnerable to remote shocks due to overdependence on primary export industriesSupply shortages and potential power stoppages due to heavy dependence on imported sources of abilityReforms of Chiles institutions and labor market remain unlikely.Absence of reform exacerbate structural imbalances in the economyAbsence hales on economic growthOpportunitiesForeign investors are supported by the Government through three enthronization mechanismsThe mechanisms offer the rights of both the state and the investor throughout the implementation of projectSignificant opportunities for inbound investment in areas of power generation and deificationation, as well as grunter productionSince 1990, Chile has enjoyed an uninterrupted period of stable democracyVoting is overbearing for all voters older than 18.Government took important measures to increase efficiency of public administration by 2003 and ensuring a transparent authoritiesCongress also sanctioned a law to regulate the financing of political parties and election campaignsThreatsGrowing public protests among the poorer sections of societyHigh levels of income inequality and discontent with the cost of education weakening governments popularityChiles major(ip)(ip) ports and industrial mines suffer growing labour unrestBusiness environment in the rural areaBMI Business Environment Risk RatingsChile ranks 28th out of 191 countries in business environment rankings and scoring around 64.0. This makes Chile the outperformer of the neighboring countries by some outperform and places it higher than several developed industrial economies. In terms of market orientation, it ranks well ahead of many developed states including the US and the UK. Nonetheless, causes for concern remain. The arena has a sizeable infrastructure deficit, reflected in our relatively weak score for Chiles business infrastructure, a category in which Chile ranks except 55th globally.Chile is an open economy and practices bilateral, regional and multilateral trade agreements. This has led to a steady increase in foreign trade and the countrys international competitiveness. Chile offers foreign investors some of the worlds most competitive business costs. Priva tization and deregulation have created sophisticated telecommunications, healthcare and public utility industries. Chile at the same time has maintained a moderately low corporate taxes and labor costs.Environmental concomitantorsChile is a exceedingly Election dominated environment. It possesses the following features with regard to the environmentSolid economic performanceThroughout the region of Latin America growth softened, but the drop was not steep in Chile and the outlook was encouraging with average annual growth rates for the period 2004-12. The causes of s set out economic growth were lower export earnings, weaker investment and slower growth in the domestic demand. The local stock market has downgraded by 15% in dollar terms for the year, do it the worst performing of the major exchanges. This fall in the exchange rates made the economic scenario quite unfavorable for the foreign investment. The depreciating peso was accounted for the major fall in the economic perfor mance. (upto 521 to the dollar)Exports softened but FDI surgedChile is the worlds largest producers of copper. Being in its maximum height of production, the decline in world copper prices affected Chiles market negatively. Copper accounts for 60% of exports and 20% of gross domestic product. Chile drew its attention away from copper due to the long-term need to diversify the economy and such heavy dependence on a single commodity. As the Chinese economy relaxed, copper prices fell down by 12% in November affecting Chiles trade and exports, resulting in a fall in 2012. The CAD (current account deficit) and debt increased due to the exports slump. Chile has favorable access to bond markets and foreign investors due to its best managed economy and the highest credit rating in Latin America, and hence its environment remains very investor friendly. Resulting in a Net FDI tripled in 2012.Public protests broke out againChile was recognized as a world leader in the implementation of the market reforms that was responsible for the generation of growth and rising standards of living. Chile has proven unemployment rate that fell to a historical low of 5.7% in October. Despite the growth, Chile was the first country to face rising citizen discontent in the form of the street demonstrations, which are now common throughout Latin America. Chile experienced for the first time in 2013 students, unions and Mapuche Indians all conducted disruptive demonstrations.Election returned center-left coalition to powerAs expected, former President Michelle Bachelet easily frustrated Alianza por Chile, the candidate of the governing party, and her New Majority coalition won a majority in Congress. In many respects, the outcome was disappointing for Bachelet and her supporters. The disappointing fact was the low turnout , with voting was no longer mandatory, especially among first-time voters who were expected to deliver an easy first-round victory.Central Bank lowered interest rates to awake growthIn order to stimulate the growth in the face of weak domestic demand, the Central Bank cut interest rates. This will throw out enhance the growth of the economy and productivity.National strategies and public policiesChile follows the strategies to raise taxes, reform education and providing free tuition for university students. These reforms were mainly targeted in reducing inequality, thereby reducing the protests.Keys Progress on reform agenda price of copperIndustry structure and competitive dynamics in terms of Infrastructure mashInfrastructureChile has a well developed and efficient infrastructure network, which contributes to the governments export-driven development strategy. Since the adoption of build-operate transfer concessions the countrys physical infrastructure has improved substantially.Though gigantic damage was done to the existing countrys infrastructure network by the devastating 2010 earthquake, the ongoing focus of government attention ens ure the rebuilding of Chiles infrastructure. The Pan-American Highway is considered to be high international standards and backbone of Chiles road system. Chile also has world-class airport and seaport infrastructure.Chile is working to develop a network of transport corridors across the region, using rail and road infrastructure. This will uplift the Chiles exports to Argentina and Brazil, and also facilitate the use of Chilean ports for exports to Asia.EnergyEnergy supply in Chile is considered the Achilles heel. With its limited domestic energy supply, the country heavily relies on the bulk of its energy resources on Imports. It has to maintain sound relations with its neighbors to realize the precious energy supply. The reliance on energy imports, particularly on natural gas from Argentina (where 80% of gas imports originate), is a growing problem.The Chilean government has prioritized addressing the electricity issue.Intellectual Property RightsIn the International Property Ri ghts Index of 2013, Chile comes in 28th place out of 130 countries. This places Chile the highest class-conscious of all emerging markets. Chile approved legislation to bring the country into compliance with the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) signer obligations .As per the TRIPS signatory, Chile must meet the agreed standards pertaining to copyrights, including producer rights, industrial designs, patents and trademarks.The area in which Chile was most scrutinized is IPR in pharmaceutical products. This is due to the fact that Chile lacks a transparent system for protecting pharmaceutical patents. In 2005, the MOP established a system in protecting data related to pharmaceutical products.Business-government relationsChile is positioned with a stable political outlook and sound economic fundamentals for steady, albeit slower, economic progress. Due to its high reliance on copper exports and oil imports, Chile is posed to a high risk to e conomic progress. Diversification of the countrys economic drivers will be inseparable to ensuring sustainable growth to accept the high dependence on the copper exports and oil imports. But this diversification may drag the GDP of the country leading to a more consumer-driven economy.Moreover, the GDP per capita is envisioned to nearly double between 2013 and 2022, in line with President Sebastin Pieras goal of at least US$25,000 GDP per capita by 2020. This would give Chile de facto developed country status.Nevertheless, we will face two obstacles that would hamper Chiles economic growth over the upcoming age Despite the countrys vast reserves of hydroelectric power, periods of drought have exposed Chiles dependence on energy imports modernizing power generation and transmission will be highly essential to continued growth. capablenesss Risks and bottlenecks faced by Chile GovernmentChile faces few terrorist activity and regional security threats in comparison with neighboring countries. Other Potential risks are in the field of labor, education, healthcare, communication and transportation facilities.Strikes and public protests present a significant risk to business in Chile. In recent years these events have been concentrated in the areas of health, education, transportation, communication and civil service sectors. The real wages are slowly increasing in a less dismay way and high corporate profits have led to greater worker resentment. Strike action is becoming more widespread. It is not totally red carpet(prenominal) for labor tensions to develop into full-blown conflict. These labor conflicts largely affect the copper mines functioning. This leads to a significant amount of delays in certain large mining and energy projects.Mapuche political activists pose a growing threat to the foreign investments due to hindrances in the domestic security and the countrys business climate. These conflicts lead to a significant drag on the Chilean business envir onment if left unresolved. According to government statistics, crime rates are falling.Chile OUTLOOK in the face of lovely Business EnvironmentsIn the business environment analysis conducted by Business Monitor, only 9 nine countries emerged with the most business attractive environments in the Latin America region. Although there are differences among them, they all share significant positive strengthsSustained growth with moderate inflationFavorable external profilesDeclining poverty and growing middle classesStable, multiparty, centrist politicsSocial-market economic policiesSlowly improving legal systemsSeven of the nine ranked highest of the 18 LABER environments on the 2013 World Economic assemblages global competitiveness score as given below.Chile government supports business and related investments with its strong and efficient legal framework more or less accommodative in the regionGovernment continues to place attracting foreign investment high on its priority listInfra structure network is a major asset to the Chilean business climateOpen foreign trade regime, helps to maintain the countrys reputation as an attractive foreign direct investment (FDI) terminationCorruption and criminal activity remains a nuisancePiera government has struggled to produce results on these fronts

Rameshwaram,Tamilnadu

Rameshwaram,TamilnaduRameswaram town in Ramanathapuram district in the Indian state of Tamil Nadu is famous as Rameshwaram throughout the world.The holy island of Rameswaram called as ?Benaras of the southerly? is the only place worshipped by both Saivites and Vaishnavites as it is India?s most venerated and most visited shibah shrines and is also associated with the life of Lord Rama, the hero of the epos Ramayana. It is located on an island separated from mainland India by the Pamban channel. Kashi and Rameshwaram together are single of the holiest places in India to Hindus and part of the Char Dham pilgrimages.The Rameshwaram island is spread over 61.8 square kilometers and has shape of a conch. Rameswaram is one(a) of the 12 Jyothirlingas of India and considered one among four most set apart pilgrim centers of India namely Rameswaram in the South, Badrinath in the North, Puri in the East and Dwaraka in the West. Among these, Rameswaram is dedicated to Shiva, while the former (a) three are dedicated to lord Vishnu.The Ramanatha Swamy Temple is the main tabernacle of Rameshwaram and is very beautifully constructed.It can be considered as the masterpiece of Dravidian architecture.The temple has cardinal wells and surprisingly the taste of the water of each well is different and wells are believed to possess medicinal properties.Dr. Abdul Kalam,Ex-president of India,belongs to a small village,Dhanushkodi situated on the island.Legends says Lord Rama built a bridge Ram Setu across the sea at this place to reach Lanka to rescue godess Sita and also worshipped Lord Shiva after killing Ravana, who was the greatest worshipper of Lord Shiva and also blessed by lord shiva.According to the Puranas lord Rama along with Sita and Lakshmana installed and worshipped the Sivalinga here to revoke sins of killing Ravana,a brahmin.Sethu Karai is 22 km before the island of Rameswaram where lord Rama is believed to have built a Floating Stone Bridge Ramasethu till Rameswara m that further continued from Dhanushkodi in Rameswaram till Talaimannar in Sri Lanka.Rameswaram is an acclaimed Parihara Sthala, where it is believed all sins get absolved. Devotees take holy dips at Sethu Theertha, Agni Theertha and former(a) sacred waters, offer pujas to get progeny, perform Shraadha for their ancestors. Places to visit-Sri Ramanathaswamy Temple-This temple is directly cerebrate to lord Rama and believed to be the must visit place for hindus if one wants to attain nirvana from the cycle of birth and death.There are seven such places in India where one would like to offer prayers for achieving salvation in life and Rameshwaram temple is one of those.The temple has the longest corridor in unit of India. This place has great significance as it is believed that Whole Ramayan was conceived in this place.Gandhamadhana Parvatham-Gandhamadhana is most renowned and worshiped in the southern India having Lord ramas feet imprinted on the chakra placed in the temple.Gandha madhana is the deity of several communities in southern India. It is a holy place thronged by devotees from all parts of India.It has Rama tirtham constructed on the Gandamadhana Parvata hence th it is called Gandamadana.It is good Dhanushkodi,where Rama met Vibhishana and has its own historical importance. Agnitheertham-It is one of the 12 jyotirlings of India and is one of the holiest place to visit.It has a large lake whose water is considered holy and people believes that taking bath in the place washes away their sins and one attains salvation.It has 22 wells having waters of different taste. It is one visit place.Badrakaliamman Temple-It is the largest temple of Ma Kali in southern India who is the holy mother for devottes in southern India.The statue of Maa kali is of pure opulent and temple has different master pieces of different ages.Annai Indira Gandhi Road Bridge-It is the longest bridge in southern India connecting Rameswaram Island to the main land.It is also called the Pambam Bridge as it is located beside Pamban, the sacred place where Rama could quench the thirst of Sita by throwing an arrow in the place where they could actually retrieve cool water.It is 7kms long. Other temples-There are numerous other temple having religious as well as historical significance. Villondi tirtham is one of those temples located on a place where lord Rama buried his bow as villondi means a buried bow.It is about 7 kms from main Rameshwar temple and is considered to be a sacred place by most of the followers.It has a realise where drinking water is available in the midst of salty sea. Dhanushkodi Temple is other main temple on the southern tip of India located near the Bay of Bengal and Indian Ocean on the other side. The seas are in the shape of bow and arrow when viewed from the top.Lord Rama has his pious feet even in this temple and whole story of Ramayana revolves here as well. Five faceted Hanuman temple is other famous temple.The statues of lord Rama, Laxman, Sita and Hanuman are placed in the temple.The temple has a floating stone which was believed to be used to bulid the bridge on the sea.Nambu Nayagiamman Temple is other worth visiting templeHow to reach-By Air-Nearest airdrome is Madurai,163 km from Rameshwaram and has good road connection to it. By Train-The railway connects Rameshwaram to places like Chennai, Madurai, Coimbatore, Trichy and Thanjavur and 2 km long Indira Gandhi Bridge connects the island of Rameshwaram with the mainland of Mandapam. By Road-Rameshwaram is well connected by roads to all the major cities nearby, Kanyakumari, Trichy, Pondicherry, Tanjore and Chennai.

Citizen Kane: Exposing the Truth about William Randolph Hearst Essay

Citizen Kane Exposing the Truth about William Randolph HearstMany have c onlyed Citizen Kane the greatest cinematic achievement of all time. It is indeed a true masterpiece of acting, screen writing, and directing. Orson Welles, its young genius director, lead actor, and a co-writer, used the best talents and techniques of the day (Bordwell 103) to tell the story of a theme giant, Charles Kane, through the eyes of the people who loved and hated him. However, when it came out, it was scorned by Hollywood and viewed only in the private theaters of RKO, the producer. Nominated for nine academy Awards, it was practically booed off the stage, and only won one award, that for Best Screenplay, which Welles and Herman Mankiewicz shared (Mulvey 10). This was all due to the pressure applied by the greatest theme man of the time, one of the most powerful men in the nation, the man Citizen Kane portrayed as a corrupt power monger, namely William Randolph Hearst. One cannot switch off the str iking similarities between Hearst and Kane. In order to make clear at the outset exactly what he intended to do, Orson Welles included a a few(prenominal) details about the young Kane that, given even a rudimentary knowledge of Hearsts life, would have set one thinking about the life of that newspaper giant. Shortly after the film opens, a reporter is seen trying to discover the meaning of Kanes last word, Rosebud. He begins his search by going through the records of Kanes boyhood guardian, Thatcher. The painting comes to life in midwinter at the Kane boarding house. Kanes mother has come into one of the richest gold mines in the world through a defaulting boarder, and at age twenty-five, Kane testament inherit his sixty million dollars (Citizen Kane)... ...r himself by abusing the most potent weapon and shield of his day, the free press. If I hadnt been very rich, I might have been a really great man. (Orson Welles, Citizen Kane) Bibliography 1)Bordwell, David. Citizen Kane, Fo cus on Orson Welles. Prentice-Hall,1976. 2)Cowie, Peter. The Cinema of Orson Welles. De Capo Press, 1973. 3)Citizen Kane. dir. Orson Welles. With Orson Welles, Joseph Cotten, Dorothy Comingore. RKO, 1941. 4)Mulvey, Laura. Citizen Kane. BFI, 1992. 5)Reflections on Citizen Kane. dir. Unknown. Turner Home Entertainment,1991. 6)Robinson, Judith. The Hearsts an American Dynasty. Avon Books, 1991. 7)Swanberg, W.A. Citizen Hearst. Scribner, 1961. Bantam Matrix Edition, 1967. 8)Zinman, David. Fifty Classic Motion Pictures The immobilise that Dreams are Made Of. NY Crown Publishers, 1970. NY Limelight Editions, 1992.

Essay --

1.The development of the astrolabe was an important invention that helped measure altitude. Maps were also very important in determining location. The sailors understanding of wind patterns allowed them to determine pass and the most prompt way to reach their destinations. The improvement of the Spanish and Portuguese caravel sailing ship allowed them to be quicker on their expeditions. Combined, these technical developments allowed transoceanic cope and travel to be possible. 2.The Ming dynasty, in 1644 was taken over by the Manchu Qing Dynasty. Hongwu was the first emperor of the Ming Dynasty in 1368, when he drove out the mongols he then brought tolerate the sholar-gentry. The Chinese society began to be strict on education. They began giving the youth exam questions which was a reflection of what the Chinese values had become. 3.Columbian Exchangewell-educated effectsUnintentional effectsBrought in domesticated animalsBrought diseasesBrought in cropsContaminated landWeeds Wild animals4.Mining in Spain was the foundation of its power in the indies. Latin America was b...