Charlottes Web, by E. B. White | Summary and Analysis

Charlottes Web, by E. B. White | Summary and Analysis Relationships in Charlottes Web I chose to read Charlottes Web because it has always been one of my favorite stories. I instantly knew this would be the perfect story to write about human and animal interrelationships. There are many different relationships between the people and the animals throughout this book. Along with those relationships, there are also various interrelationships between the animals as well. I loved reading this book again, and found it the perfect book for this type of essay. The story begins with a litter of pigs being born at the Arables farm. There were a total of eleven pigs, including the runt. Normally, Mr. Arable kills the runt because it usually dies anyway. However, Fern, the Arable daughter, became very upset when she heard her Papa was going to kill the baby pig. She begged and pleaded with him until he finally gave in and told her that he would not kill the runt if she took care of it. Fern was so ecstatic to have her very own baby pig. She named her new pig Wilbur. Wilbur loved Fern, and would follow her wherever she went. After Wilbur was two weeks old, he had to live outside in a little wooden box under the apple tree. Fern would go outside everyday to feed, walk, and play with Wilbur. They both really loved each others company. Unfortunately, when Wilbur was five weeks old, Fern had to sell him to her Uncle Homer Zuckerman. The Zuckermans farm was close to Ferns house, so she could go and visit Wilbur whenever she pleased. The farm had horses, cows, geese, chickens, sheep, dogs, cats, and now Wilbur. Wilbur became very bored on the farm; he no longer got to go on walks or swims with Fern. He was always stuck in his little pig pen. One sunny day, Wilbur was just walking around his pen talking to himself about how bored he was, when a goose overheard. The goose told Wilbur that there was a board loose on his pen and he could get out and do whatever he wanted. Since Wilbur was so bored he decided that he would like to leave the pen and see whats out there. While walking around the farm with complete freedom, Mrs. Zuckerman saw him. She yelled out to her husband and Lurvy, the hired man to go and catch him. News like this spread fast throughout the farm. All the animals were talking about Wilburs freedom. Then Mr. Zuckerman, Lurvy, and the dog surrounded Wilbur. All the animals started yelling for Wilbur to run away. However, the sweet smell of slope soon came over Wilburs nose, and he was quickly lured back into his pen. There is a lot of human and animal interrelationship in these first three paragraphs. Mr. Arable doesnt really care about the pigs, he just uses them to make money. He doesnt see them as actual living things that have feelings just like him. However, his daughter Fern makes a real connection with Wilbur. She saves his life, and takes care of him just as she would her own child. They become each others best friend. If Ferns is not at school, she is with Wilbur. They do everything, and go everywhere with each other. They become true companions. Fern also develops a relationship with the rest of the animals on the farm. They all get to know her, and start to trust her. They allow her to sit in their pens and watch Wilbur. In the next three chapters, many things happen at the Zuckerman farm. Wilbur becomes very, very lonely. He had planned his whole day out. He planned when he would eat, when he would sleep, and when it would just sit there doing absolutely nothing. Unfortunately, when he awoke all his plans went out the window due to the rain. So he then asked the goose to play with him, but she was sitting on her eggs. Next he asked a sheep to play with him but the sheep said no and called him less than nothing. Not even Templeton the rat would take time out of his day to play with poor Wilbur. Wilbur then became extremely depressed, and started to weep. Right before Wilbur was about to go to bed he heard a little voice that said, Do you want a friend, Wilbur? Ill be a friend to you (White 31). Hearing this excited Wilbur, but he was confused because he couldnt see where this little friendly voice was coming from. The voice then told Wilbur to go to sleep, and that they will meet in the morning. Wilbur did as he was told, and in the morning he discovered his new friend was a spider named Charlotte A. Cavatica. At first, Wilbur was disgusted by his new friend Charlotte. She showed him how she caught her food in her web, and sucked out their blood. Wilbur didnt know what to think about her because he really wanted a friend, but he thought that what she did was very cruel. In these three chapters there werent any human and animal interrelationships because there werent any humans mentioned. However, there were a lot of animal relationships between Wilbur and the other animals. The goose doesnt even give Wilbur the time of day, and just sort of sees him as a distraction. The sheep say they consider pigs less than nothing, which is odd to me because what do the sheep do that make them that great? Hearing this just devastates poor Wilbur, as it would anyone. Wilbur then turns to Templeton who has no interest in Wilbur, just Wilburs food. After hearing that no one cares about him Wilbur becomes very depressed. He feels that he doesnt have any friends on the farm, which makes him sad because he was so used to having a friend all the time when he lived with Fern. Then Charlotte comes into the picture, but Wilbur isnt so sure if he really wants to be her friend because she is so bloodthirsty. In the next couple of chapters Wilbur gets extremely stressed. One of the sheep tells him that the Zuckermans are just fattening him up to kill him at Christmas time. Naturally, Wilbur freaks out and starts running around saying Save me, I dont want to die!(50). Charlotte overheard the conversation between the sheep and Wilbur, and told Wilbur to calm down. Charlotte said that she would come up with a plan to save Wilbur. The next morning Fern tells her family all about the animals at the barn. She tells her parents exactly what the animals were saying, which implies that she can understand animal talk. Her mom gets very concerned, and says she is going to call Ferns doctor. Ferns dad just blows off the whole conversation like it wasnt a big deal. Later the next afternoon, Wilbur starts admiring Charlottes Web. He tells Charlotte that he thinks he could build a web just like hers if he wanted to do so. Charlotte knows that this is impossible and tells Wilbur to try. So Wilbur then climbs to the top of the manure pile, and jumps off hoping a string will come out of his butt and catch him. Naturally, this does not happen, and Wilbur lands flat on his face in the ground. His next brilliant idea is to tie a string that Templeton gave him to his tail, and then try the same thing again. Just like the first attempt, this one failed too. Wilbur finally gives up, and everyone including Fern laughs at him. Charlotte then cheers him up, and tells him to just lie down and relax. After a while of silence, Wilbur asks Charlotte how she plans on saving him from being Christmas dinner. Charlotte says she has not thoroughly thought of the plan yet, but she will think of one that will work. Wilbur is still very curious of how this is going to w ork, and keeps asking Charlotte many questions. Finally, Charlotte tells him not to worry, and just to do as hes told. She then tells him to eat well, stay healthy, and to get a lot of rest. Wilbur does as he is told, and falls asleep. In these last three paragraphs, the first human and animal interrelationship is between the Zuckermans and Wilbur. The Zuckermans just see Wilbur as a Christmas dinner. The reason they feed him and take care of him is not because they actually care about him; it is because they want a nice, big Christmas dinner. To me, this is so sad. I dont know how people could raise a pig and then just kill it and eat it! I know this is what happens in real life, and it is how everyone gets their bacon and ham, but it is just so sad to me. The other human and animal interrelationship is between Fern and all the animals on the farm. Fern can understand the animals when they talk to one another. She knows what all of them are saying, but I dont think the animals know she has this special gift. Ferns mom just thinks she is going crazy, but Ferns dad just blows it off like its nothing. I think this is probably one of the most important human and animal interrelationships throughout the story. During the next three chapters many events take place. First, Charlotte figures out a way that she can trick the Zuckermans into not killing Wilbur. However, she knows she has to work fast because there isnt a lot of time. That day, Fern and Avery come down to the Zuckermans house for some blueberry pie. Avery brings a frog with him, which causes a disaster in the Zuckermans house. After the frog incident the two of them decide to go swing on the rope in the Zuckermans barn. After they got tired of swinging they went and picked some raspberries. While doing this, Avery found a little candy box to put his frog in. Fern then wants to go and visit Wilbur, so they both walk over to the pig pen. Avery discovers Charlotte and her web. He then tries to knock Charlotte out of her web and kill her. Luckily, Avery tripped and happened to break Templetons rotten egg. The nauseating smell lures Avery and Fern away from the pig pen, and Charlotte. The next day was very foggy, which made it easier to see Charlottes web. When everyone awoke they discovered that Charlotte had written the words some pig, in her web. The Zuckermans were so startled by this message, and started believe they truly had an amazing pig. Mr. Zuckerman then went and told a fellow priest, who of coarse told the whole town. By the next day people were lined up in front of Wilburs pen to see him, as well as Charlottes web. With all this excitement, Charlotte knew her plan to save Wilburs life was working. But she knew that in order to keep Wilbur alive she would need to do more, and change the words. So Charlotte then called a group meeting where they decided the new word would be terrific. However, Charlotte wanted more words as well, so she then convinced Templeton to go to the dumpster and collect magazine clips with more words on them that would continue impressing the people. The first human and animal interrelationship demonstrated in these chapters was between Avery and Charlotte. Avery saw Charlotte and her web and automatically wanted to swat her down and kill her. Even though Charlotte wasnt bothering Avery one bit, his natural instincts were to just kill her. This shows that not all human and animal interrelationships are good, or fair in this case. Another human and animal interrelationship shown in these chapters was between all the people and their reactions to Charlotte, Wilbur, and Charlottes web. The people were so astonished by the sight of the writing in Charlottes web. They could not believe that a spider could spin the letters so clearly in her web. The words some pig, completely changed everyones views of Wilbur. Before, he was just an ordinary pig that one day would be made into dinner, but now he is so good looking and perfect in their eyes. Its really interesting how the animals can change the views of the people so easily. During the next three chapters many events occur. After the words some pig, started to get old, Charlotte decided to reconstruct her web, and write in the word terrific. Once again, everyone came down to the Zuckermans farm to see the new web. Wilbur loved all of the attention, and started to believe that he was a terrific pig. Mr. Zuckerman also loved all of this attention. He started giving Wilbur all sorts of special treatment, and decided that he will enter him in the Country Fair. Templeton searched through the dumpster to look for new words that Charlotte could carve into her web. His first couple trips werent very successful; however he finally found the perfect word, radiant. Wilbur loved the new word, and started doing flips and turns to prove that he was a radiant pig. After a long day of flipping, Wilbur lay down, and asked Charlotte to tell him some stories. She went on telling him about her cousin who actually caught a fish in her web, and how another one of her cousins was a balloonist. The next day Fern told her mom all the stories about Charlottes cousins. Her mom began to worry about Fern, and how she thinks she can understand animals. Her mom decided to go see Dr. Dorian to talk about Ferns strange behaviors. Dr. Dorian didnt see anything wrong in what Fern was doing, and he actually found it quite enchanting. Mrs. Arable then goes on to ask if he has heard about the words written in Charlottes web. He says he has heard about them, and that it is a miracle that a spider could spin a web in the first place. So the fact that Charlotte could write something in it does not surprise him. Mrs. Arable then felt relieved after Dr. Dorian told her that he thinks Fern is perfectly fine. Wilbur started thinking about the County Fair, and what was going to happen to him. He asked Charlotte if she was going to come with him but she said she wouldnt be able to. Charlotte needs to stay at the farm and lay her eggs during that time. Wilbur pleads and pleads with her until she finally says she will try her best to be there. However, she knew she wasnt going to be able to help Wilbur much longer because she needs to start building her sac for the eggs. There are quite a few human and animal interrelationships during these couple of chapters. The first one is between Mr. Zuckerman and Wilbur. Mr. Zuckerman now sees Wilbur as something more than food. Wilbur has a chance to win the County Fair, and become useful to Mr. Zuckerman. In reality, Wilbur is still the same old pig, but because of Charlottes words in the web, Wilbur all of a sudden becomes a prized possession, as well as a very important asset to Mr. Zuckermans farm. Wilbur loves all the attention the people give him, as well. He now sees himself as terrific and radiant, instead of just a normal old pig. So here, both Wilbur and Mr. Zuckerman help each other out. Another human and animal interrelationship that is shown in this chapter is through Dr. Dorian. Dr. Dorian explains to Ferns mother that it is perfectly fine that Fern spends all of her time at the Zuckerman barn. He goes on to tell her that animals are very amazing creatures, especially spiders. Dr. Dorian says tha t he is not surprised by the miracle that Charlotte could spin letter in her web, because he thinks its an even greater miracle that a spider can spin a web in the first place. To me this shows that Dr. Dorian really respects animals, and all the amazing things they can do. During the next three chapters they take Wilbur to the County Fair. Mrs. Zuckerman wanted Wilbur to look extra clean, so she bathed him in buttermilk. The buttermilk worked very well, making Wilbur white as can be. After Wilbur was all clean, everyone went and changed into their best clothes to go to the fair in. When they were all done they met at Wilburs pen to help load him in his crate. When Mr. Arable saw Wilbur, he made a remark that the Zuckermans will get some extra good ham and bacon from him when they kill him in the winter. When Wilbur heard this he immediately passed out. Fern ran over to him with tears in her eyes, and Lurvy ran over with a bucket of cold water to splash on him. When Wilbur regained consciousness, they all helped load him into the car, and took off to the fair. Wilbur felt a lot better now that Charlotte and Templeton were coming with him as well. When they arrived at the fair many people gathered around to see Wilbur. Charlotte soon became worried because she noticed that the pig next to Wilbur was much bigger than Wilbur. However, when Charlotte went down to meet the large pig she was not impressed with his personality. His name was Uncle, and according to Charlotte he is too familiar, too noisy, and cracks weak jokes. This made Wilbur feel a little better because he knew that he could win over the crowd with his radiant personality. The next night Charlotte set Templeton out to find a new word for her web. She told him to make it a good word because it will be the last one she will ever create. Templeton found the word humble written on a piece of newspaper and brought it back to Charlotte. He said humble describes Wilbur perfectly because it means two things: not proud and near the ground. Charlotte agreed that it was a good word for the web, and quickly got to work. Later that night when the web was complete, Wilbur could not see Charlotte. She told him that she was in a different corner creating a masterpiece. Wilbur wanted to know what this masterpiece was, but Charlotte told him to get some rest and she will show him in the morning. In these few chapters there werent very many interrelationships between the humans and the animals. The time that there was any interaction between the two was when they were all at the Zuckermans farm talking about Wilbur. Mr. Arable made a remark about killing Wilbur, which shows that he has not changed his views on Wilbur from the beginning of the story. He is a farmer who sees pigs as food and nothing else. Fern on the other hand sees Wilbur as a companion, and would never do anything to hurt him. She shows her affection for Wilbur by running over to him and holding him when he passed out. They have a very close bond just like anyone would have with someone or something they loved. During the last chapters of the book many events occur. The first event was that Charlotte laid an egg sac with five hundred and fourteen eggs in it. Wilbur becomes ecstatic that Charlotte is going to become a mom, and that he will have a whole lot of new friends. However, Charlotte has horrible news for Wilbur. She tells him that she has become very ill. But she doesnt want to focus on the negative, so she changes the subject and points out how beautiful her web looks with the new word in it. It was the best web out of all the ones she had created before. But then of course, Templeton returns from a night of ravishing around the fair grounds with some unfortunate news. Templeton tells Charlotte and Wilbur that he noticed that Uncle, the pig next door has a blue ribbon placed on his pen. He then went on to tell Wilbur that this meant that Wilbur will soon be forgotten by everyone, and eventually end up as the Zuckermans Christmas dinner. This hit Wilbur really hard, but he tried to stay strong and listen to Charlotte. Charlotte told him not to worry, and everything will be fine. Within a couple of minutes the whole gang returned to see Wilbur. Fern pointed out the new web, and everyone stood admiring it with astonishment. Then Mrs. Zuckerman began to cry because Avery pointed out that Uncle had already won first prized. Everyone became very upset, except for Mr. Zuckerman. Mr. Zuckerman took control and told everyone to help him bathe Wilbur, and make him look his best. Everyone did as they were told. Suddenly, there was an announcement over the loud speakers that Wilbur had won a special prize, and everyone was to report to the judges booth. Excite ment rushed through the whole fair as everyone raced over to the booth. Once everyone was there, the announcer presented Mr. Zuckerman a prize of $25, and a bronze medal for Wilbur. Wilbur had won this award because he and the words in the web had brought many spectators to the fair from all around. Everyone cheered, and Wilbur felt so proud. Then as things wound down, the Zuckermans took Wilbur back to his pen before loading up the car. Wilbur noticed that Charlotte was a lot quieter than normal. Charlotte then told Wilbur that she would not be returning to the farm with him because she would only live for one more day. This news hit Wilbur hard, and began to weep. He did not know what he would do without Charlotte, his best friend. Then Wilbur came up with an idea to bring Charlottes egg sac back to the barn with him so Charlotte would at least know her children would be safe. So Wilbur called over Templeton to run up and get the sac. However, Templeton would not do it unless Wilbur agreed to give Templeton first pick of his food from that day forward. Wilbur instantly agreed. As Wilbur was being loaded back into his crate, he had Charlottes egg sac safe in his mouth. He could not talk, so he looked up and gave Charlotte a wink. Charlotte knew that he was saying goodbye and quietly said goodbye back. The next day Charlotte died alone. Wilbur, Templeton, and her eggs were all back at the barn with the other animals. They all made it through the cold winter, and patiently awaited the little spiders arrivals. Then one warm morning they finally hatched. They all said hi to Wilbur, but then made little balloons with their strings from their butts, and flew away. Wilbur began to cry because they were all leaving him and he thought he would be all alone again. Then he heard three little voices coming from the corners of the doorway. Wilbur looked up and saw that three of Charlottes daughters decided to stay, their names where Joy, Aranea, and Nellie. They became Wilburs close friends because now that Fern was growing up she didnt stop by to visit as often. As the years went on Wilbur became friends with Charlottes daughters, granddaughters and even great granddaughters. However, none of them could ever take the place of Charlotte in Wilburs heart. In these chapters the Zuckermans and the Arables all fall in love with Wilbur and his achievement. Wilbur essentially becomes their hero, and the highlight of their lives. However, Fern who was Wilburs best friend, didnt even want to stay to see Wilbur win his prize. She was to busy running around after a boy on the ferris wheel. This shows that the human and animal interrelationship changes a lot throughout the story. In the beginning of the story all Fern cared about is Wilbur and his health. Her parents, along with the Zuckermans didnt care about Wilbur; they just saw him as a good Christmas dinner. However, as the story develops, the tables turn, and it seems that Fern out grows Wilbur in a sense. Fern still loves Wilbur, and always will, but she has found other loves in her life now as well. Whereas the Zuckermans find a whole new love in Wilbur, and now see him as their pet. I thought the interrelationships in the last few chapters were very interesting. However, the true relat ionship in the last chapters was between Charlotte and Wilbur. Charlotte succeeds in saving Wilburs life, and in return Wilbur protects Charlottes eggs for her. They both would do anything for one another, whether it meant giving up their own lives or just always being there for the other. Charlottes Web was a great book to read for this essay. Not only did it show human and animal interrelationships, but it also showed animal relationships as well. It demonstrated the many ways people perceive and value certain animals, along with how their views can change. Fern saves Wilburs life and develops a very close connection with him. They become best friends, and would do everything together. However, no one else saw Wilbur in the way that Fern did. They saw Wilbur as a pig that would be used for food. Poor Wilbur then got sent away to the Zuckermans farm where their intentions were to kill him come summertime. There was no interrelationship between them and Wilbur. Eventually, Wilbur develops a close relationship with the animals on the farm, especially Charlotte. As time goes on, Charlotte and Wilbur become extremely close, and Charlotte also saves Wilburs life. The Zuckermans and Arables also start to develop a close relationship with Wilbur when he becomes famous. They end up seeing Wilbur as their pet, as well as part of the family. However, it took words in a web for them to realize how great of a pig Wilbur actually was.

Dementias Effect on the Visual System

Dementias Effect on the Visual System Abstract Recent evidence indicates that memory impairment and visual dysfunction are clearly linked in dementia, and that special testing for visual dysfunction can improve the early diagnosis and treatment of dementia. Visual function is divided in terms of anatomic, functional and cognitive areas respectively. Under normal circumstances these functions perform seamlessly together to produce a visual reality of what we call the external world. Alzheimers disease is the most common form of dementia and past research into this area has shown that sufferers show visual deficits in several key areas. Namely contrast sensitivity, motion, colour, depth perception as well as visual hallucinations. Thus by approaching the patient in a appropriate manor with regards to dementia, clinical professionals can detect visual dysfunction and memory impairment whilst also providing a vital role in secondary and tertiary preventative measures. Furthermore clinical professionals can provide aid in the treatmen t of dementia linked visual disorders. With current demographic trends, dementia is becoming increasingly prevalent due in the ageing population. Consequently there is an increased need for practitioners to have a sound knowledge of such dementia conditions. Improving the sufferers quality of life should be the practitioners main concern. By providing thorough treatments and suggestions on patient tailored environmental modifications this can be achieved. (1) Introduction Dementia is a loss of mental function in two or more areas such as language, memory, visual and spatial abilities, or judgment severe enough to interfere with daily life1. Dementia is not a disease itself, sufferers show a broader set of symptoms that accompany certain diseases or physical conditions1. Well known diseases that cause dementia include Alzheimers disease, Creutzfeldt-Jakob disease and multi-infarct dementia1. Dementia is an acquired and progressive problem that affects cognitive functions, behavior, thinking processes and the ability to carry out normal activities. Vision is one of the most important primary senses, therefore serious or complete sight loss has a major impact on a individuals ability to communicate effectively and function independently. Individuals who suffer from both dementia and serious vision loss will inevitably be subject to profound emotional, practical, psychological and financial problems. These factors will also influence others around the sufferer and will extend to the family and the greater society. As we get older both dementia and visual problems inevitably become much more prevalent. Current demographic trends show the increase of the number of very old in our population. Therefore it is inevitable that dementia and serious sight loss either alone or together, will have important consequences for all of us1. The vast majority of people are aware that dementia affects the memory. However it is the impact it has on the ability to carry out daily tasks and problems with behavior that cause particular problems, and in severe cases can lead to institutionalization. In the primary stages of dementia, the patient can be helped by friends and family through ‘reminders. As progression occurs the individual will loose the skills needed for everyday tasks and may eventually fail to recognize family members, a condition known as prospagnosia. The result of such progression is that the individual becomes totally dependent on others. Dementia not only affects the lives of the individual, but also the family2. Dementia can present itself in varying forms. The most common form of dementia in the old is Alzheimers disease, affecting millions of people. It is a degenerative condition that attacks the brain. Progression is gradual and at a variable rate. Symptoms of Alzheimers disease are impaired memory, thinking and changes in behaviour. Dementia with Lewy bodies and dementias linked to Parkinsons disease are responsible for around 10-20% of all dementias. Dementia with Lewy bodies is of particular interest as individuals3 with this condition not only present confusion and varying cognition, but also present symptoms of visual hallucinations2. Another common condition that causes dementia is multi-infarct dementia, also known as vascular dementia. It is the second most common form of dementia after Alzheimers disease in the elderly. Multi infarct dementia is caused by multiple strokes in the brain. These series of strokes can affect some intellectual abilities, impair motor skills and also c ause individuals to experience visual hallucinations. Individuals with multi infarct dementia are prone to risk factors for stroke, such as high BP, heart disease and diabetes. Multi infarct dementia cannot be treated, once nerve cells die they cannot be replaced1. In most cases the symptoms of dementia and serious sight loss develop independently. However some conditions can cause both visual and cognitive impairments, for example Down syndrome, Multiple sclerosis and diabetes. Dementia is most prevalent in the elderly, as is sight loss. Therefore it is inevitable that a number of people will present dementia together with serious sight loss. There have been many studies into the prevalence of dementia in the UK. An estimate for the prevalence of dementia in people over 75 years of age is 15% of the population2. The Alzheimers society suggest that 775,200 people in the UK suffer from dementia (figures taken 2001). The Alzheimers society also calculates that the prevalence of dementia in the 65-75 years age group is 1 in 50, for 70-80 years 1 in 20 and for over 80 years of age 1 in 5. Estimates suggest that by 2010 approximately 840,000 people will become dementia sufferers in the UK. Estimates suggest that around 40% of dementia sufferers are in residential institutions. One study from 1996 showed that dementia sufferers are 30 times more likely to live in an institution than people without dementia. At 65 years of age men are 3 times more likely than women to live in an institution and at 86 men and women are equally likely to be institutionalized4. Visual impairments are not associated general diagnostic features of dementia. However recent research has shown the change in visual function and visual processing may be relevant. Alzheimers disease patients often present problems with visual acuity, contrast sensitivity, stereo-acuity and color vision. These problems are believed to be more true of cognitive dysfunction rather than any specific problems in the eye or optic nerve9. Early diagnosis is essential to both dementia and sight loss patients, as drug treatments are becoming more and more available. Therefore maximizing the treatment and care for the individual. On the other hand early diagnosis of visual conditions is also essential, so that progression is slowed and treatment is commenced, therefore further progression is prevented if plausible2. The Mini-Mental State examination MMSE, is the most commonly used cognitive test for the diagnosis of dementia. It involves the patient to undertake tests of memory and cognition. It takes the form of a series of questions/answers and uses written, verbal and visual material. Poor vision or blindness is the most common cause of poor performance on this test other than dementia itself2. Visual deterioration can occur simultaneously with memory loss in most dementia sufferers. Therefore early recognition of dementia through vision tests has become of importance. Table 1 shows few possible tests that might be useful for such purpose Table 1 : Vision tests for possible early detection and monitoring of Alzheimers disease Use Benton visual retention test Might be able to predict risk for AD 10-15 years before the onset of the disease Tests visual memory Contrast sensitivity AD patients have selectively reduced CS for distinguishing large objects and faces Useful field of view Tests processing speed, divided attention and selective attention Facilitates detection of â€Å"attentional dysfunction†; patients suffering from this problem complain of poor vision and inability to identify someone in a group or an object on a patterned background Could be useful to assess fitness to drive Facial recognition AD patients do not recognize faces with large features and low contrast AD patients do not recognize familiar faces (due to impaired memory) Tests that use facial expressions with progressively diminished degree of contrast The aim of this paper is to provide information about current knowledge on the topic of visual function dementia. With regards to Alzheimers disease, there will be an inclination to several main foci of research. Namely anatomical/structural changes, functional visual changes, cognitive brain changes and other changes such as the effects of diagnostic drugs on Alzheimers disease patients. (2) Alzheimers disease Alzheimers disease is the most common cause of dementia amongst older adults. The Alzheimers research trust estimates that 700,000 individuals in the UK currently are afflicted. This number will inevitably increase exponentially in the near future with the trend of an increasingly aging UK population. Therefore it must be of the utmost of importance worldwide to have an understanding all behavioral, anatomical and physiological aspects of this disease. Alzheimers disease is a degenerative disease that attacks the brain, it begins gradually and progresses at a variable rate. Common signs are impaired thinking, memory and behavior. Health professionals and care givers agree that the memory deficit is usually the initial sign of the disease. However researchers have long known that Alzheimers disease is characterized by impairments of several additional domains, including visual function5. However these findings have not yet appeared in the diagnostic guides consulted by healthcare professionals, for example the most recent addition of the Diagnostic Statistical manual of mental disorders states that few sensory signs occur in early Alzheimers disease2. Therefore we still have a limited understanding of the true extent to which visual impairments affect Alzheimers disease sufferers. The current web site of the Alzheimers association1 and National Institute of Aging6 make no mention of the topic of sensory changes in Alzheimers disease. It has even been said that patients with Alzheimers disease report visual problems to their healthcare professionals less frequently than do healthy elderly individuals7. Nevertheless visual function is impaired in Alzheimers disease8. In terms of cognitive changes, the neuropathology of this disorder affects several other brain areas which are dedicated to processing low level visual functions, as well as higher level visual cognition and attention5.These neuropathological cognitive changes are more dominant however in the visual variant of Alzheimers disease known as posterior cortical atrophy. However visual problems are also present in the more common Alzheimers disease. Alzheimers disease begins when there are deposits of abnormal proteins outside nerve cells located in the brain in the form of amyloid. These are known as diffuse plaques, and the amyloid also forms the central part of further structured plaques known as senile or neurotic plaques1. Buildup of anomalous filaments of protein inside nerve cells in the brain can also take place. This protein accumulates as masses of filaments known as neurofibril tangles. Atrophy of the affected areas of the brain can also occur as well as the enlargement of the ventricles1. There is also a loss of the neuro transmitter Serotonin, Acetylcholine, Norepinephrine and Somatostatin. Attempts have been made to try to slow the development of the disease by replacing the neurotransmitters with cholinesterase inhibitors, such as donepezil (Aricept), rivastigmine (excelon), galantamine (Reminyl) and memantine (Namenda)1. These drugs work by increasing the levels of transmitters between cells, which otherwise beco me lacking in Alzheimers disease. The National Institute for Clinical Excellence NICE conducted a review of these drugs in March 2005 and concluded that none of these drugs provided sufficient enough advantages to the patient in order to justify their cost. They recommended against the use of such drugs in the Nhs, though the Department of Health later overturned this ruling. (3) Visual Changes in Alzheimers Patients Loss of vision is a key healthcare dilemma amongst the elderly. By the age of 65 approximately one in three people have a vision reducing eye disease. Dementia, Alzheimers disease patients and elderly patients, consequently have many visual conditions in common. Alzheimers disease impairs visual function early in the course of the disease and functional losses correlate with cognitive losses. There are several common visual functional deficits that are frequently identified in Alzheimers disease. There is evidence for deficits in Motion perception9,10 contrast sensitivity11 colour discrimination of blue short wavelength hues34 and performance on backward masking tests31.In Alzheimers disease the secondary point of damage is usually the visual association cortex and other higher cortical areas, as well as the primary visual cortex 13,14. (3.1) Some of the main changes that occur in the eye with aging include: The crystalline lens increases in thickness, therefore decreasing its transparency and elasticity; therefore there is a tendency for cataracts to appear. The conjunctiva can become thicker and wrinkled, therefore is subject to deposits such as pinguecela. The iris can atrophy, therefore pupils become constricted and their response to light becomes sluggish. The eyes ability to dark/light adapt is affected. Refractive index of the cornea decreases and it becomes less transparent. Arcus senilis can appear. The ocular globe and eyelids can shrink leading to conditions such as entropian, ectropian and trichiasis. Also while the lachrymal production is reduced the puncta lachrymalis can become stenosed and provide less drainage which gives rise to chronic watering of the eyes Anterior chamber usually becomes more shallow and the sclera more rigid, increasing the prospects of glaucoma. (3.2) Visual changes due to Alzheimers disease reported in literature are outlined below: (3.2) Anatomic Abnormal nerve fiber layer and retinal ganglion cells (Blanks et al, 1989); (Tsai et al, 1991); (Hedges et al, 1996 Imaging of the nerve fibre layer can be conducted via three techniques. These include Optical coherence topography (OCT), Scanning laser polarimetry and Confocal laser topography. Parisi et al16 conducted research upon the optic nerve fibre layer thickness using OCT. 17 Alzheimers disease individuals and 14 age matched healthy individuals were used. The findings of this study showed a definite relationship between the thickness of the nerve fiber layer and the prevalence of Alzheimers disease. There was a significant decrease in the nerve fiber layer thickness in Alzheimers individuals when compared to healthy age matched particpants. Macular cell loss (Blanks et al, 1990) Research has shown a definite decrease of the number of retinal ganglion cells located in the maculae of Alzheimers disease sufferers in comparison to age matched control individuals. It was found that the loss of retinal ganglion cells varied with eccentricity from the central macula17. Results obtained by Blanks et al, 1990 showed a 28% loss of neurons from retinal ganglion cells at 0-0.5mm from the foveola, 24% loss at 0.5-1.0mm and 47% loss at 1.0mm to1.5mm from the foveola. These losses of retinal ganglion cells were constantly greater than those seen in age matched healthy individuals. Supranuclear cataract (Goldstein et al, 2003) Cataract removal could improve not only the visual acuity but may be an important tool in helping those patients suffering from visual hallucinations (Chapman et al, 1999); however, no prospective study has been carried out to prove the role of vision improvement through cataract surgery on the well-being of patients suffering from AD; Exfoliation (Janciauskien and Krakau, 2001) Abnormal pupillary innervation [109-113] Glaucomatous optic nerve cupping (Bayer et al, 2002) (3.3) Functional Decreased visual acuity (Holroyd and Shepherd, 2001) Rapid loss of visual field in patients with AD and glaucoma (Bayer and Ferrari, 2002) Visual field loss (inferior) (Trick et al, 1995) Reduced contrast sensitivity (Holroyd and Shepherd, 2001) Abnormal colour discrimination (blue, short-wavelength hues) (Cronin-Golomb et al, 1991) Abnormal flash visual evoked potentials (VEPs) (Holroyd and Shepherd, 2001) Delayed saccadic eye movements (Holroyd and Shepherd, 2001) (3.4) Cognitive Abnormal visual sustained/divided/selective attention and visual processing speed (Rizzo et al, 2000) Inability to recognize depth (Holroyd and Shepherd, 2001) Impaired face recognition (van Rhijin et al, 2004) (3.5) Other Excessive pharmacological mydriasis/miosis [109-113] These changes summed together not only diminish the quality of vision, but many of them also make the examination of the eye much more complicated. In conjunction with the general visual symptoms of aging, Alzheimers patients can also experience visual disturbances caused by the brain rather than the visual system alone. This means that they can have problems and difficulties perceiving what they see rather than how clearly they see it3. Difficulties are usually experienced in the areas mentioned earlier, namely depth, motion, color, and contrast sensitivity. Visual hallucinations are also a common problem linked to loss of vision in Alzheimers disease patients18. Another common disorder linked to patients with Alzheimers disease is a variant of motion blindness. The patient can appear to be confused and lost; the individual will see the world as a series of still frames19. Visual changes in Alzheimers disease may also be dependent upon which brain hemisphere is more severely damaged; this factor can often be overlooked. An individual with Alzheimers disease could have damage to a greater extent on their left brain hemisphere from plaques and tangles. This would therefore cause subsequent retinal changes in only the left hemi-retinas of each eye i.e. the right visual fields. The right eye visual field would be affected in the temporal side (right) and the left eye visual field would be affected nasally (right)20. When only half the retina is impacted, smaller regions of the optic nerve and nerve fiber layer show losses. The left eye with affected temporal retina would show optic nerve damage in differing regions of the nerve than the right eye with nasal retinal damage20. Alzheimers patients commonly show selective degeneration of large ganglion cell axons located in the optic nerves. This suggests that there would be impairment of broadband channel visual function. Conversely studies have shown that broadband visual capabilities are not selectively impaired in Alzheimers disease. The magnocellular and parvocellular neurons are greatly affected in Alzheimers patients, this has been proved by studies of the dorsal Lateral geniculate nucleus(LGN)1. The geniculostirate projection system is split both functionally and anatomically into two sections. They include the parvocellular layers of the Lateral geniculate body and also incorporates the magnocellular layers. These systems are mainly divided in the primary visual cortex and go through further segregation in the visual association cortex. They conclude in the temporal and paritetal lobes1. The parvocellular layers contain smaller, centrally located receptive fields that account for high spatial frequencies (acuity), they also respond well to color. On the other hand these cells do not respond well to rapid motion or high flicker rates. The magnocellular cells have larger receptive fields and respond superiorly to motion and flicker. They are however comparatively insensitive to color differences. The magnocellular neurons generally show poor spatial resolution, although they seem to respond better at low luminance contrasts. To summarize the parvocellular system is superior at detecting small, slow moving, colored targets placed in the centre of the visual field. Meanwhile the magnocellular system has the ability to process rapidly moving and optically degraded stimuli across larger areas of the visual field1. The parvocellular system projects ventrally to the inferior temporal areas, which are involved in visual research, pattern recognition and visual object memory. The magnocellular system projects dorsally to the posterior parietal and superior temporal areas. These are specialized for motion information processing. The cerebral cortical areas to which the parvocelluar system projects receives virtually no vestibular afferents. Alternatively the cerebral areas to which the magnocelullar system projects receives significant vestibular and other sensory inputs. These are believed to be involved in maintaining spatial orientation. Research shows shows that the magnocellular system is more involved in Alzheimers disease1 Oddly, many individuals experience difficulties at low spatial frequencies instead of high frequencies as in old age. This suggests that areas controlling the low spatial frequency processing in the primary visual cortex would be affected more than those for higher frequencies processing21 After neuropathilogical studies in 1997 by Hof et al were carried out on brains with visual impairments they concluded that cortical atrophy dominated on the posterior parietal cortex and occipital lobe22. Glaucoma is also a neurodegenerative disease that has similar effects on the visual system. Lower spatial frequencies in the contrast sensitivity, deficits in the blue short wavelength color range as well as reductions in motion perception are all linked to glaucomatous patients23. When patients diagnosed with Alzheimers disease also have glaucoma, the deterioration of vision related to glaucoma is much more rapid and progression is more aggressive than in people with glaucoma solely and not Alzheimers disease as well24.Glaucoma is different from Alzheimers disease in that it affects the visual function at the early sites of neural activity, namely, the retinal ganglion cells. Glaucoma destroys the afferent axons at the nerve fiber layer in the retina. This loss of axons ultimately leads to added atrophy further up the visual pathway due to decreased neuronal input. Alternatively Alzheimers disease impacts the cells that are located terminally or intermediary in the visual pathway of the brain. The result is again reduced neuronal input due to loss of nerve fibre connections and atrophy along the visual pathway. When the two diseases exist in the same individual together it can be seen that there is likely to be a greater disruption to the visual system25. One key difference between the two diseases is that they affect the visual pathway at different points. Glaucoma is a degenerative disease starting at the beginning of the visual pathway, whereas Alzheimers disease is a degenerative process starting relatively late in the visual pathway. When the two diseases coexist then the neuronal and functional losses of vision are cumulative. (4) Optometric examination of dementia patients Dementia patients present special problems for optometrists. A standard eye test can be an audile to even the best of us. The patient is placed in an unfamiliar environment surrounded by unusual equipment, machinery and is subjected to probing questions about their medical history which will without doubt tax their already flawed memory. Dementia patients are most likely to be from the elderly. Therefore several difficulties are presented while conducting an ocular examination. The patient is required to sustain a position and has to maintain concentration throughout the testing procedures, which can be very difficult. Subjective examination requires responses from the patient, they are expected to remember and follow complex instructions given to them by the optometrist as well as make many precise discriminatory judgments in a short space of time. The multiple tasks required to be completed during the examination are often beyond dementia patients as they are limited by the disease . Therefore it is common that patients with even a minor degree of dementia fail to provide valid answers, provide unpredictable responses to the subjective examination and retreat into an apathetic state1,2. During the visual examination of Alzheimers disease patients, several key visual problems can be detected. Moderate dementia patients will often experience problems such as topographic agnosia, alexia without agraphia, visual agnosia and prospagnosia1. Such patients often cannot describe individual components of photos and routinely fail to recognize family members. The degree to which such problems are experienced is consistent with the level of cytochrome oxidase deficits in the associated cortical area. In conjunction with these problems dementia patients often have problems with texture discrimination and blue violet discrimination1. Throughout the examination of the elderly dementia patients there are two contradictory requirements, firstly is ‘assurance. The patients responses will be delayed and the patient may feel anxious in such an unfamiliar situation. Thus constant reassurance is required and they cannot be rushed. Alternatively time constraints are important, a dementia/elderly patient is likely to have a short attention span. Consequently the two factors above much be considered and balanced. The examination must be thorough yet carried out as quickly as possible. Often when examining a dementia patient a family member of the carer must be present in order to aid the communication between optometrist and patient, for example difficulties are likely to occur when recording history and symptoms without a carer present. All factors need to be considered such as family history, medication, eye treatment and knowledge of any medical conditions and if so how long they have suffered from them. In terms of an external examination firstly, gross observations should be recorded for example does the patient have an abnormal head position or is there any lid tosis. Many external observations can also be detected with the aid of pupil reflexes. Upon carrying out the external examination the optometrist must be carful to explain exactly what each procedure will involve so as not to intimidate the patient. (4.1) Internal ocular health examination Internal examination of an elderly patient often presents many problems. Older patients tend to have constricted pupils and often opacities in the media such as cataract. All of which make opthalmoscopy a much more complex task for the optometrist. Patients with dementia also show poor fixation as well as lack of concentration. Pupil dilation is often used to aid external examination however many older patients can have a poor response to the insertion of mydriatic eye drops. fddfdffdg There have been many studies into the affects of diagnostic mydriatic and miotic drugs. Many studies have shown excessive mydriatic pupil response to trompicamide (a pupil dilating drug) in patients with Alzheimers disease when compared to control individuals26-30. On the other hand studies into the use of Miotic drops, particularly Pilocarpine have shown an increased response of pupil constriction in Alzheimers disease patients upon comparison to normal control patients. These findings suggest a defect in pupillary innervation with Alzheimers disease individuals. Studies of post mortem individuals with exaggerated mydriatic pupil responses to Tropicamide found a definte disruption to the Edinger-Westphal nucleus. The Edinger-Westphal nucleus is one of the key structures of the brain involved in the autonomic nervous system, it mediates the sympathetic and para-sympathetic pupil responses. Research by Scinto et al found amyloid plaques and neurofibrillary tangles in all individuals t ested with excessive mydriatic pupil responses. The conclusion was that the Edinger-Westphal nucleus is targeted early in the progression of Alzheimers disease. In terms of intraocular pressures use of the goldman an Perkins tonometers will be limited for the elderly dementia patients, due to health and safety reasons. Sudden movements whilst carrying out pressure tests on such equipment may be dangerous. Therefore this can be overcome to a degree by the use of handheld instruments such as the pulseair. However even with the pulseair problems can still be faced with uncooperative patients. (4.2) Objective Refraction examination With uncooperative and awkward patients objective refraction through retinosopy may be difficult. Factors such as opacified media, miotic pupils, and poor fixation will influence the accuracy of the refraction. The recent introduction of hand held optometers has contributed to somewhat overcoming such problems. Instruments such as thee Nikon Retinomax are excellent for obtaining an objective refraction of the elderly patient with miotic pupils and cloudy media. When presenting the Snellen chart to a patient, the quality of their response will inevitably depend upon the degree of their dementia. Depending on which stage of dementia they are suff Dementias Effect on the Visual System Dementias Effect on the Visual System Abstract Recent evidence indicates that memory impairment and visual dysfunction are clearly linked in dementia, and that special testing for visual dysfunction can improve the early diagnosis and treatment of dementia. Visual function is divided in terms of anatomic, functional and cognitive areas respectively. Under normal circumstances these functions perform seamlessly together to produce a visual reality of what we call the external world. Alzheimers disease is the most common form of dementia and past research into this area has shown that sufferers show visual deficits in several key areas. Namely contrast sensitivity, motion, colour, depth perception as well as visual hallucinations. Thus by approaching the patient in a appropriate manor with regards to dementia, clinical professionals can detect visual dysfunction and memory impairment whilst also providing a vital role in secondary and tertiary preventative measures. Furthermore clinical professionals can provide aid in the treatmen t of dementia linked visual disorders. With current demographic trends, dementia is becoming increasingly prevalent due in the ageing population. Consequently there is an increased need for practitioners to have a sound knowledge of such dementia conditions. Improving the sufferers quality of life should be the practitioners main concern. By providing thorough treatments and suggestions on patient tailored environmental modifications this can be achieved. (1) Introduction Dementia is a loss of mental function in two or more areas such as language, memory, visual and spatial abilities, or judgment severe enough to interfere with daily life1. Dementia is not a disease itself, sufferers show a broader set of symptoms that accompany certain diseases or physical conditions1. Well known diseases that cause dementia include Alzheimers disease, Creutzfeldt-Jakob disease and multi-infarct dementia1. Dementia is an acquired and progressive problem that affects cognitive functions, behavior, thinking processes and the ability to carry out normal activities. Vision is one of the most important primary senses, therefore serious or complete sight loss has a major impact on a individuals ability to communicate effectively and function independently. Individuals who suffer from both dementia and serious vision loss will inevitably be subject to profound emotional, practical, psychological and financial problems. These factors will also influence others around the sufferer and will extend to the family and the greater society. As we get older both dementia and visual problems inevitably become much more prevalent. Current demographic trends show the increase of the number of very old in our population. Therefore it is inevitable that dementia and serious sight loss either alone or together, will have important consequences for all of us1. The vast majority of people are aware that dementia affects the memory. However it is the impact it has on the ability to carry out daily tasks and problems with behavior that cause particular problems, and in severe cases can lead to institutionalization. In the primary stages of dementia, the patient can be helped by friends and family through ‘reminders. As progression occurs the individual will loose the skills needed for everyday tasks and may eventually fail to recognize family members, a condition known as prospagnosia. The result of such progression is that the individual becomes totally dependent on others. Dementia not only affects the lives of the individual, but also the family2. Dementia can present itself in varying forms. The most common form of dementia in the old is Alzheimers disease, affecting millions of people. It is a degenerative condition that attacks the brain. Progression is gradual and at a variable rate. Symptoms of Alzheimers disease are impaired memory, thinking and changes in behaviour. Dementia with Lewy bodies and dementias linked to Parkinsons disease are responsible for around 10-20% of all dementias. Dementia with Lewy bodies is of particular interest as individuals3 with this condition not only present confusion and varying cognition, but also present symptoms of visual hallucinations2. Another common condition that causes dementia is multi-infarct dementia, also known as vascular dementia. It is the second most common form of dementia after Alzheimers disease in the elderly. Multi infarct dementia is caused by multiple strokes in the brain. These series of strokes can affect some intellectual abilities, impair motor skills and also c ause individuals to experience visual hallucinations. Individuals with multi infarct dementia are prone to risk factors for stroke, such as high BP, heart disease and diabetes. Multi infarct dementia cannot be treated, once nerve cells die they cannot be replaced1. In most cases the symptoms of dementia and serious sight loss develop independently. However some conditions can cause both visual and cognitive impairments, for example Down syndrome, Multiple sclerosis and diabetes. Dementia is most prevalent in the elderly, as is sight loss. Therefore it is inevitable that a number of people will present dementia together with serious sight loss. There have been many studies into the prevalence of dementia in the UK. An estimate for the prevalence of dementia in people over 75 years of age is 15% of the population2. The Alzheimers society suggest that 775,200 people in the UK suffer from dementia (figures taken 2001). The Alzheimers society also calculates that the prevalence of dementia in the 65-75 years age group is 1 in 50, for 70-80 years 1 in 20 and for over 80 years of age 1 in 5. Estimates suggest that by 2010 approximately 840,000 people will become dementia sufferers in the UK. Estimates suggest that around 40% of dementia sufferers are in residential institutions. One study from 1996 showed that dementia sufferers are 30 times more likely to live in an institution than people without dementia. At 65 years of age men are 3 times more likely than women to live in an institution and at 86 men and women are equally likely to be institutionalized4. Visual impairments are not associated general diagnostic features of dementia. However recent research has shown the change in visual function and visual processing may be relevant. Alzheimers disease patients often present problems with visual acuity, contrast sensitivity, stereo-acuity and color vision. These problems are believed to be more true of cognitive dysfunction rather than any specific problems in the eye or optic nerve9. Early diagnosis is essential to both dementia and sight loss patients, as drug treatments are becoming more and more available. Therefore maximizing the treatment and care for the individual. On the other hand early diagnosis of visual conditions is also essential, so that progression is slowed and treatment is commenced, therefore further progression is prevented if plausible2. The Mini-Mental State examination MMSE, is the most commonly used cognitive test for the diagnosis of dementia. It involves the patient to undertake tests of memory and cognition. It takes the form of a series of questions/answers and uses written, verbal and visual material. Poor vision or blindness is the most common cause of poor performance on this test other than dementia itself2. Visual deterioration can occur simultaneously with memory loss in most dementia sufferers. Therefore early recognition of dementia through vision tests has become of importance. Table 1 shows few possible tests that might be useful for such purpose Table 1 : Vision tests for possible early detection and monitoring of Alzheimers disease Use Benton visual retention test Might be able to predict risk for AD 10-15 years before the onset of the disease Tests visual memory Contrast sensitivity AD patients have selectively reduced CS for distinguishing large objects and faces Useful field of view Tests processing speed, divided attention and selective attention Facilitates detection of â€Å"attentional dysfunction†; patients suffering from this problem complain of poor vision and inability to identify someone in a group or an object on a patterned background Could be useful to assess fitness to drive Facial recognition AD patients do not recognize faces with large features and low contrast AD patients do not recognize familiar faces (due to impaired memory) Tests that use facial expressions with progressively diminished degree of contrast The aim of this paper is to provide information about current knowledge on the topic of visual function dementia. With regards to Alzheimers disease, there will be an inclination to several main foci of research. Namely anatomical/structural changes, functional visual changes, cognitive brain changes and other changes such as the effects of diagnostic drugs on Alzheimers disease patients. (2) Alzheimers disease Alzheimers disease is the most common cause of dementia amongst older adults. The Alzheimers research trust estimates that 700,000 individuals in the UK currently are afflicted. This number will inevitably increase exponentially in the near future with the trend of an increasingly aging UK population. Therefore it must be of the utmost of importance worldwide to have an understanding all behavioral, anatomical and physiological aspects of this disease. Alzheimers disease is a degenerative disease that attacks the brain, it begins gradually and progresses at a variable rate. Common signs are impaired thinking, memory and behavior. Health professionals and care givers agree that the memory deficit is usually the initial sign of the disease. However researchers have long known that Alzheimers disease is characterized by impairments of several additional domains, including visual function5. However these findings have not yet appeared in the diagnostic guides consulted by healthcare professionals, for example the most recent addition of the Diagnostic Statistical manual of mental disorders states that few sensory signs occur in early Alzheimers disease2. Therefore we still have a limited understanding of the true extent to which visual impairments affect Alzheimers disease sufferers. The current web site of the Alzheimers association1 and National Institute of Aging6 make no mention of the topic of sensory changes in Alzheimers disease. It has even been said that patients with Alzheimers disease report visual problems to their healthcare professionals less frequently than do healthy elderly individuals7. Nevertheless visual function is impaired in Alzheimers disease8. In terms of cognitive changes, the neuropathology of this disorder affects several other brain areas which are dedicated to processing low level visual functions, as well as higher level visual cognition and attention5.These neuropathological cognitive changes are more dominant however in the visual variant of Alzheimers disease known as posterior cortical atrophy. However visual problems are also present in the more common Alzheimers disease. Alzheimers disease begins when there are deposits of abnormal proteins outside nerve cells located in the brain in the form of amyloid. These are known as diffuse plaques, and the amyloid also forms the central part of further structured plaques known as senile or neurotic plaques1. Buildup of anomalous filaments of protein inside nerve cells in the brain can also take place. This protein accumulates as masses of filaments known as neurofibril tangles. Atrophy of the affected areas of the brain can also occur as well as the enlargement of the ventricles1. There is also a loss of the neuro transmitter Serotonin, Acetylcholine, Norepinephrine and Somatostatin. Attempts have been made to try to slow the development of the disease by replacing the neurotransmitters with cholinesterase inhibitors, such as donepezil (Aricept), rivastigmine (excelon), galantamine (Reminyl) and memantine (Namenda)1. These drugs work by increasing the levels of transmitters between cells, which otherwise beco me lacking in Alzheimers disease. The National Institute for Clinical Excellence NICE conducted a review of these drugs in March 2005 and concluded that none of these drugs provided sufficient enough advantages to the patient in order to justify their cost. They recommended against the use of such drugs in the Nhs, though the Department of Health later overturned this ruling. (3) Visual Changes in Alzheimers Patients Loss of vision is a key healthcare dilemma amongst the elderly. By the age of 65 approximately one in three people have a vision reducing eye disease. Dementia, Alzheimers disease patients and elderly patients, consequently have many visual conditions in common. Alzheimers disease impairs visual function early in the course of the disease and functional losses correlate with cognitive losses. There are several common visual functional deficits that are frequently identified in Alzheimers disease. There is evidence for deficits in Motion perception9,10 contrast sensitivity11 colour discrimination of blue short wavelength hues34 and performance on backward masking tests31.In Alzheimers disease the secondary point of damage is usually the visual association cortex and other higher cortical areas, as well as the primary visual cortex 13,14. (3.1) Some of the main changes that occur in the eye with aging include: The crystalline lens increases in thickness, therefore decreasing its transparency and elasticity; therefore there is a tendency for cataracts to appear. The conjunctiva can become thicker and wrinkled, therefore is subject to deposits such as pinguecela. The iris can atrophy, therefore pupils become constricted and their response to light becomes sluggish. The eyes ability to dark/light adapt is affected. Refractive index of the cornea decreases and it becomes less transparent. Arcus senilis can appear. The ocular globe and eyelids can shrink leading to conditions such as entropian, ectropian and trichiasis. Also while the lachrymal production is reduced the puncta lachrymalis can become stenosed and provide less drainage which gives rise to chronic watering of the eyes Anterior chamber usually becomes more shallow and the sclera more rigid, increasing the prospects of glaucoma. (3.2) Visual changes due to Alzheimers disease reported in literature are outlined below: (3.2) Anatomic Abnormal nerve fiber layer and retinal ganglion cells (Blanks et al, 1989); (Tsai et al, 1991); (Hedges et al, 1996 Imaging of the nerve fibre layer can be conducted via three techniques. These include Optical coherence topography (OCT), Scanning laser polarimetry and Confocal laser topography. Parisi et al16 conducted research upon the optic nerve fibre layer thickness using OCT. 17 Alzheimers disease individuals and 14 age matched healthy individuals were used. The findings of this study showed a definite relationship between the thickness of the nerve fiber layer and the prevalence of Alzheimers disease. There was a significant decrease in the nerve fiber layer thickness in Alzheimers individuals when compared to healthy age matched particpants. Macular cell loss (Blanks et al, 1990) Research has shown a definite decrease of the number of retinal ganglion cells located in the maculae of Alzheimers disease sufferers in comparison to age matched control individuals. It was found that the loss of retinal ganglion cells varied with eccentricity from the central macula17. Results obtained by Blanks et al, 1990 showed a 28% loss of neurons from retinal ganglion cells at 0-0.5mm from the foveola, 24% loss at 0.5-1.0mm and 47% loss at 1.0mm to1.5mm from the foveola. These losses of retinal ganglion cells were constantly greater than those seen in age matched healthy individuals. Supranuclear cataract (Goldstein et al, 2003) Cataract removal could improve not only the visual acuity but may be an important tool in helping those patients suffering from visual hallucinations (Chapman et al, 1999); however, no prospective study has been carried out to prove the role of vision improvement through cataract surgery on the well-being of patients suffering from AD; Exfoliation (Janciauskien and Krakau, 2001) Abnormal pupillary innervation [109-113] Glaucomatous optic nerve cupping (Bayer et al, 2002) (3.3) Functional Decreased visual acuity (Holroyd and Shepherd, 2001) Rapid loss of visual field in patients with AD and glaucoma (Bayer and Ferrari, 2002) Visual field loss (inferior) (Trick et al, 1995) Reduced contrast sensitivity (Holroyd and Shepherd, 2001) Abnormal colour discrimination (blue, short-wavelength hues) (Cronin-Golomb et al, 1991) Abnormal flash visual evoked potentials (VEPs) (Holroyd and Shepherd, 2001) Delayed saccadic eye movements (Holroyd and Shepherd, 2001) (3.4) Cognitive Abnormal visual sustained/divided/selective attention and visual processing speed (Rizzo et al, 2000) Inability to recognize depth (Holroyd and Shepherd, 2001) Impaired face recognition (van Rhijin et al, 2004) (3.5) Other Excessive pharmacological mydriasis/miosis [109-113] These changes summed together not only diminish the quality of vision, but many of them also make the examination of the eye much more complicated. In conjunction with the general visual symptoms of aging, Alzheimers patients can also experience visual disturbances caused by the brain rather than the visual system alone. This means that they can have problems and difficulties perceiving what they see rather than how clearly they see it3. Difficulties are usually experienced in the areas mentioned earlier, namely depth, motion, color, and contrast sensitivity. Visual hallucinations are also a common problem linked to loss of vision in Alzheimers disease patients18. Another common disorder linked to patients with Alzheimers disease is a variant of motion blindness. The patient can appear to be confused and lost; the individual will see the world as a series of still frames19. Visual changes in Alzheimers disease may also be dependent upon which brain hemisphere is more severely damaged; this factor can often be overlooked. An individual with Alzheimers disease could have damage to a greater extent on their left brain hemisphere from plaques and tangles. This would therefore cause subsequent retinal changes in only the left hemi-retinas of each eye i.e. the right visual fields. The right eye visual field would be affected in the temporal side (right) and the left eye visual field would be affected nasally (right)20. When only half the retina is impacted, smaller regions of the optic nerve and nerve fiber layer show losses. The left eye with affected temporal retina would show optic nerve damage in differing regions of the nerve than the right eye with nasal retinal damage20. Alzheimers patients commonly show selective degeneration of large ganglion cell axons located in the optic nerves. This suggests that there would be impairment of broadband channel visual function. Conversely studies have shown that broadband visual capabilities are not selectively impaired in Alzheimers disease. The magnocellular and parvocellular neurons are greatly affected in Alzheimers patients, this has been proved by studies of the dorsal Lateral geniculate nucleus(LGN)1. The geniculostirate projection system is split both functionally and anatomically into two sections. They include the parvocellular layers of the Lateral geniculate body and also incorporates the magnocellular layers. These systems are mainly divided in the primary visual cortex and go through further segregation in the visual association cortex. They conclude in the temporal and paritetal lobes1. The parvocellular layers contain smaller, centrally located receptive fields that account for high spatial frequencies (acuity), they also respond well to color. On the other hand these cells do not respond well to rapid motion or high flicker rates. The magnocellular cells have larger receptive fields and respond superiorly to motion and flicker. They are however comparatively insensitive to color differences. The magnocellular neurons generally show poor spatial resolution, although they seem to respond better at low luminance contrasts. To summarize the parvocellular system is superior at detecting small, slow moving, colored targets placed in the centre of the visual field. Meanwhile the magnocellular system has the ability to process rapidly moving and optically degraded stimuli across larger areas of the visual field1. The parvocellular system projects ventrally to the inferior temporal areas, which are involved in visual research, pattern recognition and visual object memory. The magnocellular system projects dorsally to the posterior parietal and superior temporal areas. These are specialized for motion information processing. The cerebral cortical areas to which the parvocelluar system projects receives virtually no vestibular afferents. Alternatively the cerebral areas to which the magnocelullar system projects receives significant vestibular and other sensory inputs. These are believed to be involved in maintaining spatial orientation. Research shows shows that the magnocellular system is more involved in Alzheimers disease1 Oddly, many individuals experience difficulties at low spatial frequencies instead of high frequencies as in old age. This suggests that areas controlling the low spatial frequency processing in the primary visual cortex would be affected more than those for higher frequencies processing21 After neuropathilogical studies in 1997 by Hof et al were carried out on brains with visual impairments they concluded that cortical atrophy dominated on the posterior parietal cortex and occipital lobe22. Glaucoma is also a neurodegenerative disease that has similar effects on the visual system. Lower spatial frequencies in the contrast sensitivity, deficits in the blue short wavelength color range as well as reductions in motion perception are all linked to glaucomatous patients23. When patients diagnosed with Alzheimers disease also have glaucoma, the deterioration of vision related to glaucoma is much more rapid and progression is more aggressive than in people with glaucoma solely and not Alzheimers disease as well24.Glaucoma is different from Alzheimers disease in that it affects the visual function at the early sites of neural activity, namely, the retinal ganglion cells. Glaucoma destroys the afferent axons at the nerve fiber layer in the retina. This loss of axons ultimately leads to added atrophy further up the visual pathway due to decreased neuronal input. Alternatively Alzheimers disease impacts the cells that are located terminally or intermediary in the visual pathway of the brain. The result is again reduced neuronal input due to loss of nerve fibre connections and atrophy along the visual pathway. When the two diseases exist in the same individual together it can be seen that there is likely to be a greater disruption to the visual system25. One key difference between the two diseases is that they affect the visual pathway at different points. Glaucoma is a degenerative disease starting at the beginning of the visual pathway, whereas Alzheimers disease is a degenerative process starting relatively late in the visual pathway. When the two diseases coexist then the neuronal and functional losses of vision are cumulative. (4) Optometric examination of dementia patients Dementia patients present special problems for optometrists. A standard eye test can be an audile to even the best of us. The patient is placed in an unfamiliar environment surrounded by unusual equipment, machinery and is subjected to probing questions about their medical history which will without doubt tax their already flawed memory. Dementia patients are most likely to be from the elderly. Therefore several difficulties are presented while conducting an ocular examination. The patient is required to sustain a position and has to maintain concentration throughout the testing procedures, which can be very difficult. Subjective examination requires responses from the patient, they are expected to remember and follow complex instructions given to them by the optometrist as well as make many precise discriminatory judgments in a short space of time. The multiple tasks required to be completed during the examination are often beyond dementia patients as they are limited by the disease . Therefore it is common that patients with even a minor degree of dementia fail to provide valid answers, provide unpredictable responses to the subjective examination and retreat into an apathetic state1,2. During the visual examination of Alzheimers disease patients, several key visual problems can be detected. Moderate dementia patients will often experience problems such as topographic agnosia, alexia without agraphia, visual agnosia and prospagnosia1. Such patients often cannot describe individual components of photos and routinely fail to recognize family members. The degree to which such problems are experienced is consistent with the level of cytochrome oxidase deficits in the associated cortical area. In conjunction with these problems dementia patients often have problems with texture discrimination and blue violet discrimination1. Throughout the examination of the elderly dementia patients there are two contradictory requirements, firstly is ‘assurance. The patients responses will be delayed and the patient may feel anxious in such an unfamiliar situation. Thus constant reassurance is required and they cannot be rushed. Alternatively time constraints are important, a dementia/elderly patient is likely to have a short attention span. Consequently the two factors above much be considered and balanced. The examination must be thorough yet carried out as quickly as possible. Often when examining a dementia patient a family member of the carer must be present in order to aid the communication between optometrist and patient, for example difficulties are likely to occur when recording history and symptoms without a carer present. All factors need to be considered such as family history, medication, eye treatment and knowledge of any medical conditions and if so how long they have suffered from them. In terms of an external examination firstly, gross observations should be recorded for example does the patient have an abnormal head position or is there any lid tosis. Many external observations can also be detected with the aid of pupil reflexes. Upon carrying out the external examination the optometrist must be carful to explain exactly what each procedure will involve so as not to intimidate the patient. (4.1) Internal ocular health examination Internal examination of an elderly patient often presents many problems. Older patients tend to have constricted pupils and often opacities in the media such as cataract. All of which make opthalmoscopy a much more complex task for the optometrist. Patients with dementia also show poor fixation as well as lack of concentration. Pupil dilation is often used to aid external examination however many older patients can have a poor response to the insertion of mydriatic eye drops. fddfdffdg There have been many studies into the affects of diagnostic mydriatic and miotic drugs. Many studies have shown excessive mydriatic pupil response to trompicamide (a pupil dilating drug) in patients with Alzheimers disease when compared to control individuals26-30. On the other hand studies into the use of Miotic drops, particularly Pilocarpine have shown an increased response of pupil constriction in Alzheimers disease patients upon comparison to normal control patients. These findings suggest a defect in pupillary innervation with Alzheimers disease individuals. Studies of post mortem individuals with exaggerated mydriatic pupil responses to Tropicamide found a definte disruption to the Edinger-Westphal nucleus. The Edinger-Westphal nucleus is one of the key structures of the brain involved in the autonomic nervous system, it mediates the sympathetic and para-sympathetic pupil responses. Research by Scinto et al found amyloid plaques and neurofibrillary tangles in all individuals t ested with excessive mydriatic pupil responses. The conclusion was that the Edinger-Westphal nucleus is targeted early in the progression of Alzheimers disease. In terms of intraocular pressures use of the goldman an Perkins tonometers will be limited for the elderly dementia patients, due to health and safety reasons. Sudden movements whilst carrying out pressure tests on such equipment may be dangerous. Therefore this can be overcome to a degree by the use of handheld instruments such as the pulseair. However even with the pulseair problems can still be faced with uncooperative patients. (4.2) Objective Refraction examination With uncooperative and awkward patients objective refraction through retinosopy may be difficult. Factors such as opacified media, miotic pupils, and poor fixation will influence the accuracy of the refraction. The recent introduction of hand held optometers has contributed to somewhat overcoming such problems. Instruments such as thee Nikon Retinomax are excellent for obtaining an objective refraction of the elderly patient with miotic pupils and cloudy media. When presenting the Snellen chart to a patient, the quality of their response will inevitably depend upon the degree of their dementia. Depending on which stage of dementia they are suff

Dispute Resolution Processes Essay -- Legal Process

Introduction This paper will examine when it is appropriate to attempt alternative dispute resolution (ADR) processes for disputes and conversely when it is fitting for matters to be decided in a courtroom with black-robed judges and well dressed lawyers. Complementing the correct ‘intervention [courtroom, facilitative ADR or another form of ADR] at the right time, price and place with the right disputants’ is not necessarily an easy task (Wade 2010, p. 13) and the line separating alternative dispute resolution processes and judicial intervention can be blurred especially as judicial officers conduct, refer or mandate parties to participate in ADR (Sourdin, 2009, p. 190). Proof that fine panelled courtrooms may not be the answer to dispute settlement is the move towards the ‘mandatory’ use of alternative methods prior to hearings (Ardagh and Cumes, 2007, p. 206). Do most people with problems want pain relief quickly and inexpensively? Yes most people in pain want relief quickly and inexpensively but they often want other things too. They want to be heard, they want to heal the hurt and they want a ‘satisfactory [and]†¦ enduring’ outcome (Moore, 2004, p. 2). They also want to change from having ‘a destructive interaction to a constructive one’ (Ardagh, 1999, as cited by Spencer and Hardy, 2009, p. 165). There are differing views about the suitability of facilitative ADR approaches for various types of conflict. Some believe that this type of ADR is more appropriate for addressing ‘interest disputes than rights disputes’ (Boulle & Nesic, 2001 as cited by Van Gramberg, 2006, p. 121). Van Gramberg states that ‘personal grievances’ may be adequately resolved by facilitative processes but where a law or legal right has been b... ...negotiation or mediation; this case needs a judge: When is litigation the right solution? Mediation Quarterly, Vol. 18, Iss. 3, pp. 259-280. Retrieved 12 December 2010 http://works.bepress.com/john_wade/8/ Wade, J. (2009). Negotiating with Difficult People. Professor John Wade, Faculty of Law, Bond University, August. Retrieved 12 December 2010 from http://epublications.bond.edu.au/drcn/35/ Wade, J. (2010). Matching disputes and responses: How to diagnose causes of conflict, and to respond with appropriate interventions and/or referrals. Law papers. Paper 319. Retrieved 12 December 2010 from http://epublications.bond.edu.au/law_pubs/319 Wilkins, F. (2002, January 18). Disputed territory – mediation and other ADR processes. Lawyers Weekly, pp. 14, 15. Zehr, H. (1985). Retributive justice, restorative justice, (15 pages). US Office of Criminal Justice.

Identity in Sylvia Plaths The Bell Jar Essay -- Plath Bell Jar Essays

Identity in The Bell Jar      Ã‚  Ã‚  Ã‚  Ã‚   A sense of individuality is essential for surviving the numerous emotional and physical obstacles encountered in daily life. A unique identity is perhaps one of the only true characteristics that defines an individual and is definitely a key principle for understanding and responding to one's atmosphere. In the "Bell Jar," Esther battles not only a deteriorating mental stability, but also a lack of a sense of individuality. Esther is a young, sensitive and intelligent woman who feels oppressed by the obvious social restrictions placed upon women, and the pressure she feels regarding her future. Undoubtedly these emotional burdens result not only in Esther's social and intellectual isolation, but also her impending mental breakdown. Clearly, Esther is deeply troubled by the hypocritical and often vicious world encompassing her, and feels overwhelmed and powerless to break free of her inner world of alienation. Instead of firmly establishing a genuine sense of self , Esther adopts and scrutinizes the images and personalities of the women in her life, which neither fit nor reflect her legitimate character.    Throughout the novel Esther is faced with numerous possibilities regarding her future aspirations. Although she is an extremely perceptive and bright woman, Esther has no sense of imminent direction, and instead imagines herself becoming and achieving an abundance of successes simultaneously. Upon meeting her boss, Jay Cee, Esther is immediately impressed with her flourishing balance of a career and marriage, and begins to imagine herself attaining similar achievements:    "I tried to imagine what it would be like if I were Cee...Cee, the famous editor, in an office full of p... ... The Feminine Identity. Twentieth Anniversary Edition. New York: Norton, 1983. Nizer, Louis. The Implosion Conspiracy. New York: Doubelday, 1973. Plath, Sylvia. The Bell Jar. 1963. London: Faber, 1966. ---. The Journals of Sylvia Plath. Ed. Ted Hughes and Frances McCullough. 1982. London: Anchor-Doubleday, 1998. Radosh, Ronald, and Joyce Milton, eds. The Rosenberg File: A Search for the Truth. 1983. New Haven: Yale UP, 1997. Rich, Adrienne. "Compulsory Heterosexuality and Lesbian Existence." Signs: Journal of Women in Culture and Society 5 (1980): 631-60. Rep. In Adrienne Rich's Poetry and Prose. Ed. Barbara Charlesworth Gelpi and Albert Gelpi. New York: Norton, 1993. 203-24. Stevenson, Anne. Bitter Fame: A Life of Sylvia Plath. London: Viking-Penguin, 1989. Wagner-Martin, Linda. Sylvia Plath: A Biography. New York: Simon, 1987.

Comparing Heart of Darkness and Apocalypse Now :: Movie Film comparison compare contrast

Heart of Darkness and Apocalypse Now Heart of Darkness, a novel by Joseph Conrad, and Apocalypse Now, a movie by Francis Ford Coppola can be compared and contrasted in many ways. By focusing on their endings and on the character of Kurtz, contrasting the meanings of the horror in each media emerges. In the novel the horror reflects Kurtz tragedy of transforming into a ruthless animal whereas in the film the horror has more of a definite meaning, reflecting the war and all the barbaric fighting that is going on. Conrad's Heart of Darkness, deals with the account of Marlow, a narrator of a journey up the Congo River into the heart of Africa, into the jungle, his ultimate destination. Marlow is commissioned as an ivory agent and is sent to ivory stations along the river. Marlow is told that when he arrives at the inner station he is to bring back information about Kurtz, the basis of this comparison and contrast in this paper, who is the great ivory agent, and who is said to be sick. As Marlow proceeds away to the inner station "to the heart of the mighty big river.... resembling an immense snake uncoiled, with its head in the sea, its body at rest curving afar over a vast country and its tail lost in the depths of the land" (Dorall 303), he hears rumors of Kurtz's unusual behavior of killing the Africans. The behavior fascinates him, especially when he sees it first hand: "and there it was black, dried, sunken, with closed eyelids- a head that seemed to sleep at the top of that pole, and with the shrunken dry lips showing a narrow white line of the teeth, was smiling too, smiling continuously at some endless and jocose dream of that eternal slumber"(Conrad 57). These heads that Marlow sees are first hand evidence of Kurtz's unusual behavior. The novel ends with Kurtz "gradually engulfing the atrocities of the other agents in his own immense horror"(Dorall 303). At his dying moment, Kurtz utters "The Horror! The Horror!', which for the novel are words reflecting the tragedy of Kurtz, and his transformation into an animal. Apocalypse Now is a movie that is similarly structured to the book but has many different meanings.

Foreign Players in English Football

On 30 December 2009, the Barclays Premier League football match between Arsenal and Portsmouth made English football history as the first match not to include any British players. Arsenal’s team of multi-million pound foreign stars won the game comfortably, 4-1; some would argue this is all that matters, but those who are passionate about football – the real connoisseurs of the English game – will recognize a deep underlying issue. Modern day football is unrecognizable compared to what has preceded it.In times past, teams were fashioned by nurturing young home-grown talent and bolstering the squad with a few lads from Scotland and Ireland. Now the common consensus is that to achieve any success it is necessary to catch the attention of an exceedingly wealthy oil tycoon who will buy the club and proceed to spend ? 200 million a year on overpriced talent from the four corners of the world. This ethos is destroying British football. For example in the Premier League there are 337 registered foreign players representing a total of 66 different countries.That equates to an average of 17 foreign players per squad; the averages in Italy, France and Spain are all around 10. On the first day of the inaugural Premier League season in 1992 just 22 non-British players started; on the first day of this season 124 started. It isn’t right that success should be based on finance, is it? In 2004 Russian billionaire Roman Abramovich bought Chelsea F. C. , a team which hadn’t won the league since 1954. He splashed an extravagant amount of money on the creme de la creme of foreign talent from around the globe.Three seasons later they experienced unprecedented success which, would never have happened without the cash injection. However, it was all achieved with just three regularly playing British players, who only made the squad because they were exceptional talents which money could not replace. This set a new benchmark for all the top teams in the land, making a clear statement that if they wanted to match Chelsea’s success they would have to match Chelsea’s spending and sacrifice their home-grown players or risk being left behind.In 1995 the British transfer record was ? 7,000,000; by 2006 the record had sharply risen to ? 30,800,000, and player wages were spiralling out of control. It is true that this has lead to stronger squads, and the Premier League being viewed as the strongest league in the World, with consistent success in Europe, but can it be right to sacrifice our own players for this success? I think not. Journalists, pundits and just about every football fan in England have formed their own theories concerning England’s miserable failure at the 2010 World Cup in South Africa.Many causes have been suggested, yet to me the reason is obvious. If one analyses the teams which were most successful in South Africa, a definite trend appears. Spain won the World Cup this year. Many argue that the y reached the final against Holland mainly because 77. 1% of footballers in their domestic league are qualified to play for the national team, a direct result of home-grown players being given the opportunity in their clubs' first teams. In the Premier League fewer than 40% of players are English. Jose Luis Astiazaran, president of the Spanish Football League, said. Our strategy is to work very hard with young home-grown players and to try to have a mix between them and experienced players†¦ we invest more  and more in young Spanish players than in young foreign players. England has  many times taken young players from outside†¦ these kinds of players are not English. This is one of the most important differences between Spain and England. We invest in  young Spanish players†¦ maybe this is why at the moment you are not creating young English players. † One view is that foreign players benefit the English players, who apparently perform better alongside th e World’s best. I think – don’t you? that if more money, time, and attention were put into cultivating the abundance of young English talent, the English players themselves would be the world’s best. The Premier League have recognised this, and this year the F. A. implemented new squad rules controlling the number of foreign players in each squad. This is a start towards reducing the amount of foreign players in the league, but the rules are too loose and easy to circumvent. Foreign players can be bought in from a young age and developed in the academies; this means the young Englishmen still don’t get the attention they crave in order to advance their careers.In my opinion the influx of foreign players in England is the single most detrimental factor in the game, leading to over-inflated transfer fees, increase in ticket prices, under development of home-grown players and ultimately the destruction of the national team. The Premier League must rev iew its policies, and clubs must invest in their academies or English national football will continue to deteriorate well into the future, and so many young aspiring footballers will be cast aside, and I for one cannot see that happen to the sport I and so many other Brits love.

Personal Learning

FAFM :Personal Learning Paper FAFM :Personal Learning Paper: SESSIONS : 28 DATE : 15. 11. 12- 01. 02. 13 Learning’s From FAFM: * 1st Class starts with ice breaking and course plan for upcoming session * Infosys annual report – How to read the annual report * Compare with previous year annual report – percentage change year by year. * Auditor report – is the annual report is as per AS and rules followed as per standards * Corporate governance – meetings attended by directors and maintenance of records * Notes on accounts – brief about the content in the balance sheet * Market share – value of a company in the market CXO Duties – which includes CEO, CFO, CMO * How to compare with other companies and to relate with market * And also saw the annual report of RIL , ITC , TATA Motors * Introduction to Financial analysis * How to do financial analysis * Tools and Techniques * Case Discussion * Gemini Electronics * Cash Flow Statement à ¢â‚¬â€œ will show the liquidity of the flow of cash in a company * Operating Activities – what are all the expenses will come under this, for selling , distributing etc. , * Investing Activities – what are all the expenses will come under this, investment in other companies or shares etc. * Financing Activities – what are all the expenses will come under this, dividends etc * Cash inflow and out flow * How an Income statement and Balance sheet differs from Cash Flow Statement * Lehman Brother Company * Movie about the company * About Lehman Brother company * Bankruptcy Identification * Ratios – solvency ratio, liquidity ratio, efficiency ratio, profitability ratio * Horizontal & vertical Analysis of Balance sheet and Income statement – how to compare and contrast the given numbers * Z – score calculation and analysis Cariboo Industrial ltd * Corporate Fraud * Z- score – to predict the value of the company in future as it will sustain in the market financially or not. * Liquidation and valuation * Financial Statement audit * Thaifoon Restaurant * Projected Income statement – assumption of future income or revenue * Projected Balance sheet – it consist of all except the net profit as it is full of assumptions * Seating arrangements – slightly operations related * Decision making – critical thinking of mind to go with or to drop it * Sales projection Financial Mathematics * EMI Calculation – monthly interest and principle payment. Principle rate will increase & interest will get decreased. * EPS calculation * Intrinsic Value – Future value of market price of a company * Bond Valuation * Simple Interest & Compound Interest Calculation * Financial Markets * Indian Financial System – full chart with sector wise divided. * Stock Markets * Case: Motilal Oswal IPO Case * Learn about IPO- what will be the companies value to enter into ipo.How the decision is taken * private equity shares, IPO basics & need, fixed price offer & basics of book building process * Book building process: Cut off price, method of Dutch auction, RII, NII, QII, over subscription, case – Midfield Industries Ltd, ASBA, prospectus, offer and private placement * Primary Market – New issue of shares in the market * Secondary Market – Buying & selling of shares * Under & over subscription – where the subscription of share is high or low * Stock Markets – functions of SEBI , RBI , BSE , NSE.Also learn about various stock markets in other countries * Sensex , Nifty , Otci – orgin , sustain , end of otci * Demat account * Difference between equity share and preference share * 24hrs market – ends in one country and the market starts in other country * Commercial papers * Treasury bills – pledged for money * Money Market: Harshad Mehta scam, various scams in Indian financial history, organized & unorganized money markets and treasu ry bills & its types * Case: Harshad Mehta Scam * Learn about there will not be any scam in share market. What are the tactics played to hike the price * How a person can be countered by his competitors * How big shots help them to play in market and earn money * Money Market: Commercial papers, call money market, certificate of deposits, derivatives – financial & commodities, players, forward & future contract, premium, strike price, strike data and call & put option * Forex Market: Indian forex market, features, settlement of transaction, quotations, types of transactions, factors determining exchange rate * Finally the course has been completed with how to present in the examAdditional Learning’s * Daily Business Quiz * News paper reading – make me to know some new departments process and valuation * Mini Projects for marketing * Know about DBF * IRDA * BAT