Causes and Stages of Cancer Free Essays

Introduction The World Heath Organisation (2011) estimates that without intervention 84 million people will die from cancer between 2005 and 2015. In 2008 156,723 people died in the UK alone of malignant neoplasm and 1 in 3 people will be diagnosed with the disease in their lifetime. There were 12. We will write a custom essay sample on Causes and Stages of Cancer or any similar topic only for you Order Now 7 million new cases diagnosed worldwide in the same year which led to 7.6 million deaths. (Cancer Research UK, 2011). There are over 200 different types of cancer but lung, breast, prostate and colorectal account for over 50% of cancer cases. The percentage of deaths caused by cancer varies by region with 4% in Africa, 12% in Asia, 19% in Europe, 21% in Oceania and 23% in North America (National Cancer Institute, 2010). Cancer is used to define the group of diseases in which extensive cellular proliferation occurs alongside the invasion of surrounding tissues. Cancer cells can spread through the body via the blood and lymph systems and ultimately cause death of multi-cellular organisms (National Cancer Institute, 2010). Cancer is caused by the accumulation of genetic mutations which leads to instability of genetic regulators and alters gene expression. Cancer represents not a single disease but a group of heterogeneous diseases that share the fundamental biological characteristics of immortalisation, invasion, genetic instability, erratic differentiation and uncontrolled proliferation (Vogelstein and Kinzler, 2008). Despite advances in detection and treatment of metastatic cancer, specifically breast, mortality rates still remain high because current therapies are limited by the emergence of therapy resistant cancer cells (Al-Hajj, et al, 2003). It has been documented that tumorous cells possess key stem cell characteristics such as high migration, self-renewal, drug resistance and extensive differentiation which leads to the production of a heterogeneous population. Tissue specific cells are able to self-renew and produce differentiated and functional cells within an organ. These differentiated cells are short lived and are produced from a small pool of long lived stem cells which lasts throughout the organism’s lifetime (Seo, 2007). Stem cells are essential for tissue development, replacement and repair however their longevity means they are susceptible to the accumulation of genetic damage and thereby providing a growth route for cancer recurrence following treatment (Clarke, 2005). Dean, Fojo and Bates (2005) suggest that cancer stem cells can survive chemotherapy and sustain the re-growth of a malignant tumour. Therefore if cancer stem cells are present in a tumour then they must be targeted in order to achieve a cure. Prospectively identifying cancer stem cells will allow investigation of the pathways and key molecules that can be targeted to eliminate these malignant cells (Clarke Fuller, 2006). There have been many studies which imply the existence of a sub-population of cells within tumours termed cancer stem cells which drive tumourgenesis. This paper therefore aims to isolate and characterise different sub-populations of cancer stem cells through physiological stress in human and murine models (DLD-1 and CT-26 respectively). There has been extensive evidence that CD133 and CD44 are reliable cancer stem cell markers therefore it can be hypothesised that CD133 and CD44 positive cells would demonstrate resistance to chemotherapeutic agents. This statement formed the basis of the protocol developed by Sharma (2010) where the novel technique of exposing parental cancer cells to the chemotherapy drug doxorubicin in-vitro to isolate cells resistant to drug exposure. The resulting cells will them be characterised by their ability to form spheroids and the performance of Q-PCR, immunofluorescence and western blotting to identify the presence of the CD133, CD44 and CD26 specific cancer stem cell markers. The ultimate aim is then perform microarray on parental and cancer stem cell populations to compare the difference in gene expression of the two populations. Literature Review On a cellular level cancer is caused by uncontrolled cell proliferation which enables abnormal growth leading to cancerous tumours. Just 5-10% of cancer cases can be attributed to genetic defects whereas the remaining cases (in order of influence) are a result of environmental factors such as diet, tobacco, infections, obesity, alcohol, radiation, stress and physical activity (Anand, et al, 2008). These factors lead to tumour growth as they induce DNA alterations or loss of the ability to repair DNA damage which deregulates standard gene expression (Vogelstein and Kinzler, 1998). Carcinogenesis is the term used to define the creation of cancer by which normal cells are transformed into cancer cells. This is due to the accumulation of genetic mutations and the resultant misbalance in cell death and proliferation (King Robins, 2006). Cell production is a complicated process which is kept in apoptosis via cell regulation by numerous classes of genes including oncogenes and tumour suppressor genes (Vogelstein and Kinzler, 1998). Carcinogenesis occurs when there is a genetic mutation which upsets the normal balance between cell death and proliferation. The multi-step process is driven by the accumulation of genetic alterations which gives rise to highly malignant derivatives which have the ability to elude apoptosis, invade tissues and possess unlimited potential for replication (Hanahan and Weinberg, 2000). The inheritance of a defective gene itself is not sufficient for development of cancer. Cancer manifests from the accumulation of additional somatic mutation s which occur as a result of imperfect DNA replication or DNA damage caused by environmental mutagens. Genes that, when mutated, lead to cancer predisposition normally have the function of suppressing tumourgeneis. If one allele of such gene mutates in the germ line then the cell still has the product of the wild type as a back up. If a mutation occurs in the wild type then the cell has no functional suppressor gene product remaining. The cell therefore proliferates abnormally leading to clonal expansion. Cells of proliferating clones are likely to accumulate another mutation resulting in further loss of growth control. As gradual clonal expansion takes place a tumour evolves. Oncogenes and cell suppressor cells control cell proliferation, a mutation here leads to the cells to become continually active. Caretaker genes control rates of mutation, defective caretakers therefore acquire mutations (Vogelstein and Kinzler, 1998). The three stages of carcinogenesis are promotion, proliferation and progression. Changes in the genomes structure occur across all three of the stages of neoplasm development. Additionally changes in gene expression take place at cell promotion with selective proliferation of mutation cells. Apoptosis and cell proliferation occur at different rates but still maintain a balance during initiation and promotion but during progression the balance alters and a malignancy arises as seen in figure 1 (Oliveira, 2007). The fundamental progression features of malignancies are invasion and metastasis and it is these traits which distinguish between normal and cancerous cells. Metastasis is characterised as the migration of cancer cells from the site of origin to a secondary point through the lymphatic system, connective tissues and blood supply. At this secondary point the cells then continue to invade and form new tumours (Hanahan, 2000). Cancer immunoediting has been described as the conflicting action of the immune system to protect the host from cancer development through immunosurveillance and promote tumour growth by the promoting action of immunity (Smyth, Gunn and Schreiber, 2006). The interaction of the innate and adaptive anti-cancer immunity dictates the intensity of the outcome of the endogenous anti-cancer response. Stress induced molecules on tumour cells initiates the innate response and presentation and processing of tumour associates antigens leads to an adaptive response. Both of these responses can affect the tumour in different ways. The endogenous reaction could suppress tumour formation whilst at the same time exerting a selection pressure leading to the emergence of escape variants. Additionally the host’s immune response could directly promote tumour growth, invasion and metastasis via elaboration of inflammatory mediators and cytokines. There is a complex network of interactions between tumour cells, immune elements and stromal components in the microenvironment (Jinushi and Dranoff, 2007). However currently only the capability of the immune system to identify and kill cancer cells forms the basis of therapeutic strategies and immunotherapy (Schulz, 2005). Modifications in immunotherapy protocols have been proposed to lessen the effect cancer and improve the therapeutic value of immunological approaches by targeting the elimination of cancer stem cells (Lepisto, McKolanis Finn, 2007). Stem cells originate from the haematopoietic tissue and can be characterised by the unlimited capacity to self renew, which is the result of increases telomere activity (Huntly Gilliand, 2005) and the ability to terminally differentiate into one or more cell types, which is regulated by a niche signalling pathway system (Spradling, Drummond-Barbosa Kai, 2001). The capacity of stem cells to form differentiated offspring is described in terms of their differentiation potential (Friel, Van der Sar Mee, 2005). Totipotent cells have the ability to construct a complete organism, pluripotent cells are descendants of totipotent cells and can differentiate into almost all cells, multipotent cells differentiate into a specific family of cells, oligopotent cells differentiate into lymphoid and myeloid cells and omnipotent cells are only able to produce their own cell type but have the ability of self renewal which distinguishes them from other non-stem cells (Knoepffler, Schipanski Sorgner, 2007). The differentiation of stem cells is regulated by a niche signalling pathway system (Spradling et al, 2001). It has been suggested that cancer stem cells are displaced due to lack of heritable changes in phenotype and genetic alteration leading to an absence in cancer however when stem cells were placed in defective tissue they induced tumour growth (Clarke Fuller, 2006). Charafe-Jauffret, Monville and Ginester (2008) clarify the existence of cancer stem cells which possess tumorgenic, self-renewal and multi-lineage differentiation abilities. Cancer stem cells are defined as a sub-population of cells in a tumour capable of generating phenotypically assorted cells (Gao, 2007). This petite population is accountable for the relapse of tumour growth, progress and invasion after treatment (Clarke Fuller, 2008). Although the concept that germ cells are responsible for oncogenesis has existed since 1855 the first conclusive evidence of cancer stem cell existence was that by Bonnet and Dick (1997) who isolated a CD34+/CD38– sub-population of leukemic cells which were capable of initiating tumours in NOD/SCID mice histologically similar to the donor. The cancer stem cell hypothesis states that the cancer initiating cell is a transformed tissue stem cell which retains the property of self protection through the activity of multiple drug resistant transporters. This drug resistant cell then remains at a low frequency amongst a tumour mass (Donndenberg Donndenberg, 2005). The cancer stem cell theory points to a new era of ca ncer research and is expected to yield alternative cancer treatments. It is now evident that tumours include cancer stem cells which can be isolated by antigenic markers and have the potential to develop into non-adherent spheroids (Wright et al, 2008). This concept has challenged the previous hypothesis that carcinogenesis is a result of ‘clonal evolution’ where every cell present in a tumour is capable of proliferating and forming new tumours (Max et al, 2006). Cancer stem cells have similar properties to stem cells such as similar molecular mechanisms and physiological trafficking which implies that cancer stem cells are a result of consecutive accumulated mutations in embryonic stem cells (Kucia Ratajckzak, 2006). This is supported by the correlation seen in the signalling pathways associated with maintenance of ‘stemness’ in embryonic cells and cancer pathways. These pathways such as JAK/STAT, Notch, MAPK/ERK, P13k/AKT, NF-GB and Wnt are not only inv olved in stem cell renewal governing proliferation but also express key molecules associated with malignant phenotypes which leads to tumour growth (Dreesen Brivanlou, 2007). It has therefore been deduced that normal stem cells are transformed into cancer stem cells via mutations in suppressor genes and oncogenses and mutations in repair genes and histone modifications (Costa, et al, 2006). Embryonic stem cells are dependent on the specialised microenvironment in which they reside. This niche prevents tumorgenesis by supplying signals to inhibit differentiation and proliferation. Additional signals are also provided to allow stem cell promotion, self-renewal or differentiation when necessary (Scadden, 2006). Stem cells are dependent on this niche for survival alternatively cancer stem cells do not appear to be dependant on this niche in the same way. Some believe that cancer stem cells have evolved to escape the control of a local environment whereas an additional theory suggests the cells do reside in a niche which has undergone changes itself which encourages cell growth (Burness Sipkins, 2010). Cancer stem cells are thought to evolve from an intrinsic mutation leading to self-sufficient proliferation and deregulation as the cancer cell overtakes the molecular machinery used by normal stem cells (Li Neaves, 2006). These tumour initiating cells are the source of recu rring tumours in many types of cancer (Foltz et al, 2009). Cancer stem cells make up less than 5% of a tumour and have been found in blood-borne, brain, breast, ovarian and colon cancers (National Cancer Institute, 2010). These cells are highly resistant to both chemotherapy and radiotherapy and in order to develop successful therapy it is essential to identify the cell surface markers unique to cancer stem cells and interpret their signalling pathways, figure 2 (Foltz et al, 2009). Figure 2: The impact of cancer stem cells on tumour growth and response therapy. A: Subset of cells within the tumour has the ability to replicate and sustain tumour growth. TA cell is suspected to be responsible for a majority of tumour growth and is susceptible to cancer therapy. Cancer stem cells give rise to identical immortal daughter cells. B: Possible outcome of targeting tumour cancer stem cells verses present cancer therapy techniques which do not affect cancer stem cells (Houghton et al, 2007). The developmental concept of cancer denotes the presence of a hierarchy of cells within a tumour which refers to the differences of cancer cells within a tumour where all cells do not express the same antigens. Additionally functional assays show that only a specific sub-population of cells within a tumour can propagate tumour growth. It appears that cancer cells capable of tumour growth are able to self-renew as well as generate cells which cannot propagate tumour growth (Cho Clarke, 2008). Cancer stem cells have therefore developed the ability for self-renewal and differentiation into a heterongenous population as well as the tumour related properties of uncontrolled growth and ability to form metastasis (Dalerba, et al, 2007). The ability that cancer stem cells share with stem cells to renew has changed perspectives leading to new approaches to treating the disease (Li and Neaves, 2006). Cancer stem cells show resistance to both chemotherapy and radiotherapy making them a crucial target for treatment, it is therefore essential to identify the markers present on these cells in order to therapeutically target them (Foltz, et al, 2009). Current therapeutic strategies attempt to target cancer stem cells and its microenvironment whereas Tang, Ang Pervaiz (2007) identified a novel approach of targeting the reactive oxygen species in a cancer stem cell which would facilitate apoptotic death over proliferation. Additionally the development of monoclonal antibodies to recognise cancer stem cell markers would allow for more efficient destruction of these tumour forming cells (Okamoto Perez, 2008). The use of immunocompromised mouse model have shown to reliably capulate the molecular, biological and clinical features of the human disease. With such models defining the stages of tumour development, homogenised breeding and environmental conditions. This has therefore led to the development of the concept that plasma from genetically modified cancer models contains tumour derived proteins that may be relevant in the development of markers for human cancer (Kuick, et al, 2007). There are numerous studies which cites the use of immuno-comprised mice as vehicles for cancer stem cell isolation. Mouse models have been established as highly trusted in the development of human cancer treatment through verify the cancer stem cell extent of a tumour. This has been achieved by the opening and repetitive tumour progression in immuno-compromised SCID mice (Laurie, et al, 2007). http://tpx.sagepub.com/content/38/1/62.full.pdf+html Current developed methods to isolate ‘adult’ stem cell populations includes collection of different hematopoietic cells populations staining with the antibodies of interest and sorting by magnetic bead and/or fluorescence activated cell sorters (FACS) followed by in vivo transplant experiments. This allows for the development of understanding of fundamental hematopoietic stem cell characteristics of differentiation and the ability of the cells to give rise to others cells with the same potential for proliferation whilst still maintaining the stem cell pool Cho Clarke, 2008). Additional characterisation of cancer stem cells can be carried out by identifying gene expression and cell markers via immunofluorescence, western blotting and Q-PCR. It has been stated that an immature cell population can be characterised by surface markers CD34+ and CD38+ in AML and that these markers suggest the ability of initiating tumour development (Bonnet Dick 1997). Furthermore the use of a low-adherent growth environment can be used to produce spheroids from tumorgenic cells as a basis of isolation of cancer stem cells (Grange, et al, 2008) As it has been identified that a small minority of cells present in a tumour has the ability to form new tumours. It is therefore possible to distinguish between tumorgenic and non-tumorgenic cells based on the cell surface marker expression. Al-Hajj, et al (2003) were able to isolate breast cancer cells expressing CD44+ and CD24– lineage in as few as 100 cells with tumorgenic capabilities and identified hundreds of thousands of cells with a different phenotype which failed to form new tumours. Furthermore passaging the CD44+ and CD24– lineage led to the creation of phenotypically diverse populations. Sherman, et al (2011) also identified CD133 expression correlated with prognosis of oligodendroglial and astrocytic tumors and here immunofluorescence provided an effective and reproducible assay for identifying marke rs present in cancer stem cells. Fundamentally cancer is resistant to treatment because malignant cells survive chemotherapy, CD133 positive cancer stem cells display strong compatibility with tumours resistant to chemotherapy (Liu, et al, 2006). The use of immunofluorescence to characterise cancer stem cells has been used in a great deal of cases especially where total cell count is reduced CD44+ and CD24+ can be used for markers of colorectal cancer stem cells. CD44/CD24 cells are enriched for spheroid colonies and can reform all four CD44/CD24 subpopulations (Yeung, Wilding Bodmer, 2009). Additionally a population of CD26+ cells present in a sub-population of colorectal cancer stem cells led to the development of distant metastasis when injected into a mouse cecal wall. These CD26+ cells were also associated with enhanced invasiveness and chemoresistance (Pang, et al, 2010). Lgr-5 has also been identified as a key marker expressed in cancer stem cells of colorectal cancer associated with the activation of the Wnt signalling pathway which plays a key role in cancer development (Takahashi, et al, 2010). The first report indicating the difference in gene expression of cancer cells exhibiting cancer stem cell properties and those which did not was published in 2007 by Seo, et al. Amongst the 61 differently expressed genes 12 genes were considered up-regulated in the sub-population whereas 49 were downgraded validation of these gene expressions was validated using quantitative real time reverse transcriptase PCR. It was found that genes related to drug resistance such as AKR1C1/C2 and NR0B1, or cancer metastasis (TM4SF1) were up-regulated. Further more the up-regulated gene ABCG2 could be of use as an indicator for sorting. AKR1C has been identified as a catalyst of metabolic reduction and either activates or inactivates several xenobiotics. The public database (Gene expression Omnibus) has shown significant up-regulation in expression of AKR1C1 in smokers. Reference AL-HAJJ, M., et al. 2003. Prospective identification of tumorgenic breast cancer cells. 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Discovery of cancer biomarkers through the use of mouse models. Cancer Letters, 249(1), pp. 40-48. How to cite Causes and Stages of Cancer, Essay examples

Live performance theatre Essay Example For Students

Live performance theatre Essay On Friday 9th March 2012 I attended a live performance of one of the West Ends longest running plays; The Woman in Black written by Susan Hill and adapted by Stephen Mallarat at The fortune theatre. The play proved to be a truly spine chilling experience and captured its audience from the start by using various (literary techniques) performance aspects such as sound, lighting, costume and props. Set in 1920’s England focussed around number of different venues, one of them being an empty Victorian theatre to begin with, and the former market town of Crythin Gifford. However the action centres on the Eel Marsh House; an old building in the middle of a marsh island which is also the previous residence of Mrs Drablow. It comprises of only two characters an elderly Arthur Kipps ‘whose story has to be told’, and a young actor who performs the story of the once junior solicitor. The director combines tone and atmosphere along with certain effective cinematic qualities of a horror/thriller film to achieve the plays chilling effect. The small stage and intimate quality of The Fortune Theatre made for the perfect venue and intensified the overall experience for the audience because we felt a part of the action, every creek of the floorboards; every daunting footstep was audible and added to the play’s terrifying demeanour. The action cleverly takes place in the very theatre in which we are sitting, and opens with a solicitor Arthur Kipps reading from a diary, then enters a young actor who criticizes his feeble delivery, Arthur Kipps goes on to seek the young actors opinion on how best to voice his experience of the events of 30 years prior, and so they commence to perform the terrifying tale. The director utilises an extremely minimalistic set, with the props taking on numerous uses, a large wicker props basket makes for a desk, train carriage, a horse and cart and a bed; Adding to the minimalistic theme established a simple changing of coats denotes a new character, and despite its simplicity it couldn’t have been more effective. The audience are transported to the past as the young actor plays Arthur Kipps whilst Kipps himself narrates as well as taking on the role of all the people he came across during his fateful journey to the bleak North East of England. His purpose is to attend the funeral of former client Mrs Alice Drablow and sort out some of her papers. Kipps discovers that Mrs Drablow inhabited the gothic mansion alone for more than 60 years and later died there; the house is presented to the audience by projection of an image onto the thin curtains of the stage. The events that follow become increasingly more dreadful as during the funeral Kipps catches sight of The Woman in Blacks’ gaunt, wasted and pale face in the distance and from then on terrible consequences occur. Her influence grows as the play reaches its climax and Kipps delves further into the ghastly truth of what happened all those years ago and the ghost that now haunts the house’s terrible purpose. Lighting used to great effect throughout the play to give it another dimension and add to the tension, for example a bright light was used when the actors were in the office thus indicating the story was not being told, however we, the audience were transported into the past when a dim, half- light was used whilst the story was being performed, this clearly distinguished between the two as well as giving a disturbing quality. Spot lights were used to isolate certain images projected, important parts of the set and the actors horrified facial expressions at key moments in the play for example when Kipps discovered the writing on the grave stone of Alice Drablow. Whilst Kipps is exploring the mansion at night a single torch offers the only light on stage, the effect of this is to  Susan Keats candidate number: 7865 centre number: 22066  increase tension and maximise to shock of any unexpected discovery. The audience engaged with the actor at this point and felt that they were a part of the action as they know no more than what Kipps does. .u65d988428834cddc1b574f153762fef8 , .u65d988428834cddc1b574f153762fef8 .postImageUrl , .u65d988428834cddc1b574f153762fef8 .centered-text-area { min-height: 80px; position: relative; } .u65d988428834cddc1b574f153762fef8 , .u65d988428834cddc1b574f153762fef8:hover , .u65d988428834cddc1b574f153762fef8:visited , .u65d988428834cddc1b574f153762fef8:active { border:0!important; } .u65d988428834cddc1b574f153762fef8 .clearfix:after { content: ""; display: table; clear: both; } .u65d988428834cddc1b574f153762fef8 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u65d988428834cddc1b574f153762fef8:active , .u65d988428834cddc1b574f153762fef8:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u65d988428834cddc1b574f153762fef8 .centered-text-area { width: 100%; position: relative ; } .u65d988428834cddc1b574f153762fef8 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u65d988428834cddc1b574f153762fef8 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u65d988428834cddc1b574f153762fef8 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u65d988428834cddc1b574f153762fef8:hover .ctaButton { background-color: #34495E!important; } .u65d988428834cddc1b574f153762fef8 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u65d988428834cddc1b574f153762fef8 .u65d988428834cddc1b574f153762fef8-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u65d988428834cddc1b574f153762fef8:after { content: ""; display: block; clear: both; } READ: Bottom lines EssaySound, both diegetic and non-diegetic were also used effectively during the play, for example whilst the actors were in the horse and carriage the noisy sound effects of hoofs and the clatter of the carriage was utilised, movement was linked to this as the actors were jerked around in the carriage especially going over humps, this made the play more realistic and credible as well as offering a certain comedic value, it lightened the mood which is essential in any horror performance, film or theatre as it lures the audience into a false sense of security which then heightens the shock and alarming quality of the moment/scene that follows. Another time sound is employed is when the blood curdling scream is heard numerous times throughout, this startles the audience and kept us on edge as we never know when it was going to come. To give the play another dimension a voiceover of Mrs Drablow simultaneously reading an old letter with Kipps fills the theatre, this captures the audience and creates an eerie atmosphere sending a chill down the audience’s spine, as realisation hits us we make connections and the plot develops. There are numerous other times where sound is utilised to produce the plays frightening attributes. Whilst Kipps is asleep the night he decides to stay over at the Drablow house night, he is suddenly woken by the imaginary dog, ‘Spider’, who was taken along to provide Kipps with some desperately required company and sense of security, he senses something, an ominous rocking noise is then heard in a distant quarter of the house and continues as Kipps decides to investigate, he ascends the staircase gradually, closely followed by ‘Spider’; this is where his footsteps are made audible adding to the tension of the moment. As he arrives at a door and stops outside the audience notice that the rocking noise has become quieter. Music is also used to add to the plays eeriness, a child’s music box is played during his discovery of an infant’s room. However in contrast to this, music is also employed to give the play a lighter feel for example the music of a fair ground is used at the end despite its spine chilling twist. Dry ice was also used to high effect at times to create the illusion of a foggy marsh that surrounded the mansion. This gave a sense of apprehension and foreboding as well as creating mystery and an impression of the unknown which in turn contributed to the uneasy quality of the play. In spite of the plays obvious horrifying qualities at times in did have comedic values that eased the tension. The overall thrilling experience of the play was unfortunately tarnished by the frustrating untimely screams of the young school girls seated around me which at times frightened me more than the actual goings on of the performance in front of me. Despite this, for the most part of the play I was either kept on the edge of my seat or had closed eyes in anticipation and dread of what was going to happen. The performance included a range of acting techniques, lighting, and sound effects, the actors themselves David Acton as Arthur Kipps and Den Deery as The Actor are to be credited for their effective use of communication, miming, body language, proxemics and voice modulation. They delivered a truly amazing and credible performance as they captured the essence of the characters. However at times of shocking moments I think they should have waited for the audience to quieten before they started their next line as it was sometimes unclear. It is evident that the director Robin Herford gave much thought to the dynamics of the play and overall thrilling ambience as there was not a moment where the audience were not engaged. The great vocal and spatial awareness of actor David Acton really brought his character to life and captured the audience’s attention. In conclusion, I think the director has successfully brought together all these techniques in order to create a spine chilling, captivating and thrilling production of The Woman in Black.

David Essay Example For Students

David Essay Sometime soon after the year 1430, a bronze statue of David stood in the courtyard of the house of the Medici. The work was commissioned of Donatello by Cosimo dMedici himself, the founding father of the Republic of Florence. It was the first free-standing, life sized nude since classical victorious athletes of Greece and Rome. But soft, and some how oddly unheroic. And the incongruity of the heads: of hair and shaded by a laurel-crowned peasants hat; Goliaths tragic, contorted expression, made sharper by the pentagonal helmet and coarse, disheveled beard. Innocence and evil. The weak triumphing over the strong. The city of Florence triumphing over the aggressive dukes of Milan? David as a civic-public monument. In the year 1469, Ser Piero from the Tuscan town of Vinci moved to Florence to become a notary. He rented a house on the Piazza San Firenze, not far from the Palazzo Vecchio. His son, who was a mere 17 years old upon their arrival, began and apprenticeship in the Florentine studio of the well known artist, Andrea Verrocchio. At this time, Veracchio was at work on a bronze sculpture of the young David. Might the head of this fine piece be a portrait of the young Leonardo da Vinci?For many years a block of marble lay untouched, tossed aside as unusable, irretrievable evidence of a botched attempt to carve a human form. It was eighteen feet high. A young sculptor, 26 years old, riding high after the enormous success of his figure of the Virgin Mary holding the dead Christ, decided to ask for the piece. The wardens of the city in charge of such things let the artist have it. What did they have to lose? Getting anything out of it was better than nothing. So this young sculptor named Michelangelo measured and calculated. He mad a wax model of David with a sling in his hand. And he worked on his David continuously for some three years, until, a man named Vasari tells us, he brought it to perfect completion. Without letting anyone see it. A century later, a young sculptor, 25 years old, stares into a mirror at his steeled jaw and determined brow. A contemporary source tells us that on this day, perhaps, the mirror is being held by Cardinal Maffeo Berberini while Bernini transfers what he sees in himself to the face of his David. Bianlorenzo Bernini: sculptor and architect, painter, dramatist, composer. Bernini, who centuries later would be called the undisputed monarch of the Roman High Boroque, identifying with David, whose adversary is seen only by him. The great transformation in style that occurred between the Early renaissance and the Boroque can be followed in the evolution of David. Look at them: A boy of 12, perhaps, looking down incredulously at the physical self that felled an unconquerable enemy; a boy of 14 or 15, confident and reckless, with enough adrenaline pumping to take on an army; an adolescent on the brink of adulthood, captured at the moment when, the Greeks say, sound mind and sound body are one; and another full-grown youth at the threshold of his destiny as KingBibliography:The Davids of the WorldSometime soon after the year 1430, a bronze statue of David stood in the courtyard of the house of the Medici. The work was commissioned of Donatello by Cosimo dMedici himself, the founding father of the Republic of Florence. It was the first free-standing, life sized nude since classical victorious athletes of Greece and Rome. But soft, and some how oddly unheroic. And the incongruity of the heads: of hair and shaded by a laurel-crowned peasants hat; Goliaths tragic, contorted expression, made sharper by the pentagonal helmet and coarse, disheveled beard. .u1e6ebf01e28b40c4e6460ea42dfae9f9 , .u1e6ebf01e28b40c4e6460ea42dfae9f9 .postImageUrl , .u1e6ebf01e28b40c4e6460ea42dfae9f9 .centered-text-area { min-height: 80px; position: relative; } .u1e6ebf01e28b40c4e6460ea42dfae9f9 , .u1e6ebf01e28b40c4e6460ea42dfae9f9:hover , .u1e6ebf01e28b40c4e6460ea42dfae9f9:visited , .u1e6ebf01e28b40c4e6460ea42dfae9f9:active { border:0!important; } .u1e6ebf01e28b40c4e6460ea42dfae9f9 .clearfix:after { content: ""; display: table; clear: both; } .u1e6ebf01e28b40c4e6460ea42dfae9f9 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u1e6ebf01e28b40c4e6460ea42dfae9f9:active , .u1e6ebf01e28b40c4e6460ea42dfae9f9:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u1e6ebf01e28b40c4e6460ea42dfae9f9 .centered-text-area { width: 100%; position: relative ; } .u1e6ebf01e28b40c4e6460ea42dfae9f9 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u1e6ebf01e28b40c4e6460ea42dfae9f9 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u1e6ebf01e28b40c4e6460ea42dfae9f9 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u1e6ebf01e28b40c4e6460ea42dfae9f9:hover .ctaButton { background-color: #34495E!important; } .u1e6ebf01e28b40c4e6460ea42dfae9f9 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u1e6ebf01e28b40c4e6460ea42dfae9f9 .u1e6ebf01e28b40c4e6460ea42dfae9f9-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u1e6ebf01e28b40c4e6460ea42dfae9f9:after { content: ""; display: block; clear: both; } READ: Thirty years ago, on October 8, 1967, gunfire echo Essay Innocence and evil. The weak triumphing over the strong. The city of Florence triumphing over the aggressive dukes of Milan? David as a civic-public monument. In the year 1469, Ser Piero from the Tuscan town of Vinci moved to Florence to become a notary. He rented a house on the Piazza San Firenze, not far from the Palazzo Vecchio. His son, who was a mere 17 years old upon their arrival, began and apprenticeship in the Florentine studio of the well known artist, Andrea Verrocchio. At this time, Veracchio was at work on a bronze sculpture of the young David. Might the head of this fine piece be a portrait of the young Leonardo da Vinci?For many years a block of marble lay untouched, tossed aside as unusable, irretrievable evidence of a botched attempt to carve a human form. It was eighteen feet high. A young sculptor, 26 years old, riding high after the enormous success of his figure of the Virgin Mary holding the dead Christ, decided to ask for the piece. The wardens of the city in charge of such things let the artist have it. What did they have to lose? Getting anything out of it was better than nothing. So this young sculptor named Michelangelo measured and calculated. He mad a wax model of David with a sling in his hand. And he worked on his David continuously for some three years, until, a man named Vasari tells us, he brought it to perfect completion. Without letting anyone see it. A century later, a young sculptor, 25 years old, stares into a mirror at his steeled jaw and determined brow. A contemporary source tells us that on this day, perhaps, the mirror is being held by Cardinal Maffeo Berberini while Bernini transfers what he sees in himself to the face of his David. Bianlorenzo Bernini: sculptor and architect, painter, dramatist, composer. Bernini, who centuries later would be called the undisputed monarch of the Roman High Boroque, identifying with David, whose adversary is seen only by him. The great transformation in style that occurred between the Early renaissance and the Boroque can be followed in the evolution of David. Look at them: A boy of 12, perhaps, looking down incredulously at the physical self that felled an unconquerable enemy; a boy of 14 or 15, confident and reckless, with enough adrenaline pumping to take on an army; an adolescent on the brink of adulthood, captured at the moment when, the Greeks say, sound mind and sound body are one; and another full-grown youth at the threshold of his destiny as King

Biomed Central Health Services Research †MyAssignmenthelp.com

Question: Discuss about the Biomed Central Health Services Research. Answer: Introduction: The use of information communication technology to improve the healthcare provision in the hospital is one of the approaches which sparks different opinions in health care. This idea has been seen to have both merits and demerits. I believe that use of ICT could have facilitated Jades to access efficient and convenient health care. First and foremost, the use of ICT enhance efficacy, improve the safety of the patient and further improve patient's outcome. When a hospital adopts the use of ICT, the services such as patients registration and provision of pathology survives would be much efficient. Lack of ICT services has resulted in the manual provision of patient information and referral processes. However, the use of ICT can facilitate care patient to enquire their care providers on issues pertaining health through emails (Buccoliero et al, 2016). Several studies have indicated that the use of ICT has improved the efficiency of the clinic and also it is cost effective. On the other hand, lack of electronic health record (EHR) services in health care have resulted in duplication of data entry processes. The storage of information in HER portal raises lots of ethical concerns and confidentiality regarding patient and their physicians (Shaw et al, 2018, p.10). The use of the ICT services within health care Centre would depend on the e-health literacy of the community, access to the internet and patient age. References Buccoliero, L., Bellio, E., Mazzola, M. Solinas, E. (2016). A marketing perspective to delight the patient 2.0: new and challenging expectations for the healthcare provider. Biomed Central Health Services Research, 16:47. DOI:10.1186/s12913-016-1285-x Shaw, T., Hines, M., Kielly-Carroll, C. (2018). Impact of Digital Health on the Safety and Quality of Health Care. Sydney: Australian Commission on Safety and Quality in Health Care.

The Truths and Lies of Belief - A Definition of Truth

The Truths and Lies of Belief - A Definition of Truth'Where does this I believe in come from?' If you ask most people, they'll answer that question with a lot of confusion. There are lots of beliefs out there that we call 'true' and then there are many more 'lies' that we accept without a second thought. So what is really the definition of truth or lies?Most of us assume that the truth is somewhere in between those two extremes. What most people don't understand is that the truth does exist in the middle area of lies and truths. When we're asked about our beliefs, people will tend to gloss over the fact that they may be just like everybody else. However, some of us truly are born with a sense of belief and direction.When you ask someone to identify their beliefs, you'll find that the answer will vary from person to person. For some, belief can be more generalized than others. When we look at many different people and try to determine who their beliefs are, we tend to be able to pick out a few characteristics that stand out. However, when we take a closer look at the actual people that we know personally, we'll find that the answer changes from one to the next.You will also find that the beliefs that you bring with you from one situation to the next may be slightly different than the beliefs that you've adopted in the past. However, it seems like the responses tend to be pretty similar. People will have a tendency to repeat things that they hear, see or read.However, when you ask the people that you know about their beliefs, they will often have no idea what you're talking about. Instead, they'll tell you that they're not really sure what you're talking about, but they assume that you're asking about religion. They may even assume that you're referring to religion. In other words, their response will vary from person to person and each will have a different answer for a different question.As far as we can tell, there are certain people that aren't inclined to sh are their beliefs. There are others that share their beliefs but they're not proud of them. These are the ones that are probably the ones that you should ask about their beliefs. You'll find that they're a little less concerned about making you feel good than you were in the past.The people that you meet in your social circle will likely have a lot of opinions and beliefs, but they won't tell you who they are. If you need to find out who they are, then ask them about their beliefs. Just because they're the ones in the social circle doesn't mean that they have to come right out and say it. When you ask them about their beliefs, they may have something to say, but you might have to wait for a little while to get a straight answer.When you're trying to figure out if someone's beliefs are true or not, the best thing to do is ask them. Don't keep your suspicions to yourself or you'll get a whole lot of pointless questions. Of course, the only real way to find out is to ask, so don't let the silence hold you back.

Discuss some of the similarities and differences between Independence Day and War of the Worlds with particular reference to narrative and genre features Essay Example

Discuss some of the similarities and differences between Independence Day and War of the Worlds with particular reference to narrative and genre features Essay The War of the worlds by Steven Spielberg can be categorised as a hybrid genre, containing a mix of a sci-fi and a family drama. The audience establishes that it is a sci-fi with aspects of family drama right from the start of the film, as there seems to be two openings to the film. The first opening is a voice over by Morgan Freeman, using scientific words to describe how people (referred to as a swarm of ants small and insignificant) were being watched by another intelligent group of people. The speech finishes with the use of paralanguage, a technique whereby his voice takes a more serious tone when discussing how others are going to take over the world. These words are combined with the imagery that appears, as a white light starts to increase, which could be described like an eye, which obviously portrays someone watching. The other opening to the film is used to establish the main character Ray Ferrier and his family. This is where the other genre of a family drama appears. Dr amatic irony is instantly set up as the audience knows that doom is about to occur; however the characters dont. We follow the family throughout the film as they struggle to survive against the aliens, and watch their relationships with one another being tested, as Ray learns more about his family. This is completely contrasted to Independence Day by Roland Emmerich, as this film is categorised as a sci-fi and action film. This film is a lot more involved with the government rather than the family aspect, unlike War of the Worlds. However, there are elements of romance during Independence Day, as one couple gets married and the second couple who broke up before the film started, hold hands and we see a shot of the wedding ring that the man has worn throughout the whole time of their separation. There is also an opening sequence at the beginning of Independence Day. As the title credits appear, the music is very military like, which includes snare drums and even gunshots. The very first image that the viewer sees is the American flag, together with a stretch of footprints on top of the moon. This portrays to the audience past glories that the Americans have achieved. However, this does not last long as the footprints slowly vanish from the scene, perhaps showing an extermination of mankind. After this opening scene finishes, the scene cuts to a shot where the music that starts up contains the lyrics its the end of the world as we know it. This is subtle irony, as obviously the audience knows the end of the world is about to come. Numerous other clichà ¯Ã‚ ¿Ã‚ ½s like this one appear constantly throughout the film such as the use of cigars, to highlight the stereotypical America, but are completely taken out during the War of the Worlds. We will write a custom essay sample on Discuss some of the similarities and differences between Independence Day and War of the Worlds with particular reference to narrative and genre features specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Discuss some of the similarities and differences between Independence Day and War of the Worlds with particular reference to narrative and genre features specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Discuss some of the similarities and differences between Independence Day and War of the Worlds with particular reference to narrative and genre features specifically for you FOR ONLY $16.38 $13.9/page Hire Writer The music in War of the Worlds is completely different to Independence Day. This is because the music heard at the beginning of War of the Worlds is not military and is more thrilling and emotive. This highlights further that the genre of War of the Worlds is not just a sci-fi/thriller movie, but also more of a family drama. Narrative is constantly used to make sense and to create meaning out of our chaotic experiences and is essential to our understanding of experiences of the world. Narrative structure is also used to give order and shape to the series of events. The structure identified in War of the Worlds is linear owing to the fact that it is single stranded as there is only one main story throughout the film. The film starts off as a low concept film and ends as a high concept film. This is completely contrasted to Independence Day, which has a multistranded narrative and is very fast paced with a collection of short sequences. This represents the chaos that everyone is experiencing, and the fact that everyone is bewildered. From all of these different narratives occurring through the film Independence Day, the viewer knows we will eventually come to a conjunction with all these different storylines and this appears true when the audience arrives at July the 4th and the narrative from then on is s ingle stranded. Narrative also requires a narrator, someone who tells the story from his or her point of view. In War of the Worlds, the entire film is from the point of view of Ray Ferrier and his family. This helps the viewer to relate to the characters and become more emotionally involved. This does not happen in Independence Day, as there are several main characters and all different storylines and therefore it becomes increasingly difficult for the audience to participate in the action of the film, and has to merely sit on the sidelines as an observer. The narrative of War of the Worlds also contains references to the 9/11 attacks. This is noticeable at the beginning of the film where the voice over is heard and suggests we are being watched by another intelligent group of people. Furthermore, throughout the film there are other references that signify this, such as the plane crash, clothes falling from the sky, and ash fogging up the sky. This is clearly a post 9/11 film, unlike Independence Day, which is a pre- 9/11 film that suggests that America is confident that they are the leaders and everyone else is following them. The film Independence Day portrays an idealistic view of how they would like to think America is. Firstly, President Whitmore is an idealistic representation of a president, as he is clearly hardworking, witty, an ex-warrior and a family man. Furthermore, throughout the film there are shots of certain landmarks, which show the very iconic America, such as shots of the moon landing, and the Statue of liberty. In addition to this, the scenes in Independence Day are completely varied from City scenes to the deserts. This suggests to the viewer that America is a country of a multi-ethnic society. The stereotypical America is also represented further in this film by the use of glasses being worn by important and clever people, showing that glasses signify intelligence. Also, it contains every type of character including young and old, and straight and gay. The mise-en-scene presented in War of the Worlds is a lot bleaker and darker than Independence Day, which portrays more War-like imagery. Furthermore, there is a lot more death and destruction than there is in Roland Emmerichs film. The vulnerability of the children is also a lot stronger, which highlights again the fact that War of the Worlds focuses on the family point of view. The whole script of the film is a lot more authentic than Independence Day, and contains more realism, for example when Ray says to always put yourself first. The overall film doesnt pay attention to the sci-fi genre, but is more of a sci-fi played on a modern film. This is also emphasized right from the beginning of the film, as we learn that this film is taking place in the 21st century, and the majority of sci-fi films are set in the future. Throughout War of the Worlds, there are many shots that are over exposed, which suggests that the things that are happening are beyond reality, and hyper-real. This is completely juxtaposed to Independence Day, which has a lot of different creeds of colour situated in the film. This suggests Independence Day is a more light-hearted film, rather than War of the Worlds, which is a lot more dismal. Throughout War of the Worlds, the News on the television in the film acts as an exposition tool, which gives the audience the background of the characters and the present situation. This does not happen in Independence Day, the script of this film plays out contemporary anxieties and fears which Americans have, and expresses important US values. Having looked at the similarities and differences of Independence Day by Roland Emmerich, and War of the Worlds by Steven Spielberg, it is clear that the way each film is portrayed, through the use of mise-on-scene, the music, the characters, and the way the films are structured, generates the type of genre and narrative each film can be identified as. War of the Worlds can be described as a hybrid genre, containing a mix of a sci-fi and a family drama, owing to the emotive elements and scenes of the film, whereas Independence Day could be categorised as a sci-fi/action film, owing to the usage of the strong, military music, the government, and the general alpha-male context. Although both of the films narratives are extremely identical, the structure of it is completely different. This is due to the fact War of the Worlds has a basic narrative structure, owing to the fact it is linear and single stranded, as the film has one storyline which commences as a low concept film and ends a s a high concept film. This is contrasted to Independence Day, as this film contains a multi-stranded narrative up to the last day, which keeps the film fast paced, and highlights further the chaos and tension of Americas society.

Basic Family Systems Theory free essay sample

Running Head: BASIC FAMILY SYSTEMS THEORY AND MICROSKILLS Basic Family Systems Theory and Microskills Used by the Helper Basic Family Systems Theory and Microskills Used by the Helper In terms of a system, the meaning is a consistent arrangement of things connected to form unity or to operate as a whole. These systems are dated back in origins to the 1950’s and 1960’s. In this theory we must understand an individual’s family and how it works for that family daily in the community, neighborhood, social aspect, and etcetera. When one part of the system changes, the whole system changes. When everything is balanced it is said to be in equilibrium or homeostasis which seemingly is a good thing (Poorman, 2003). There are many skills involved in working in the family system. I will address the three main microskills that I would use in my own setting as a helper toward this theory. We will write a custom essay sample on Basic Family Systems Theory or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page There are a few basic things that need to be addressed first to begin to understand the concept of working in family systems. Within the family system as a whole there are similar smaller systems knows as subsystems. Generally, there has been focus on three primary subsystems: marital (or couple), parental, and sibling. These can also branch off into other systems. This is where the saying, â€Å"A family is greater than the sum of its parts† comes into context (http://web. pdx. edu, 2009). The subsystems are defined by who makes up each and what their purpose or goal is in the family as a whole. Related to this concept are boundaries. Boundaries occur at every level of the system and subsystems (http://family. jrank. org, 2009). Depending on the family and how they work, some have very open boundaries and other may have tight restrictions. These boundaries affect who and what is let in or out of the family as a whole and among the subsystems. There have been many developments in approaches to family systems theories. There are a number of professionals in this field, I will try to discuss a few here in some detail and how they may be used in a helper setting. Salvador Minuchin focused primarily on structure of the relationships within the system and subsystems. I would tend to agree that you have to first identify the makeup of the whole family system and then also each individual subsystem to understand its organization. This is when you can address and understand the problems that shape not only the family problems and issues, but the individual problems and issues also. Minuchin believes there are two types of family structure; disengaged family and the enmeshed family. I believe you have to identify which family type you are working with so you can focus on how to handle and help deal with the issues at hand. The boundaries and manner in which the system and subsystems approach each other directly affects how you as the helper should and would tackle your job. Disengaged families have rigid boundaries and share little or no contact with family members. They operate in a very neglectful and isolated manner. On the opposite end of the spectrum are the enmeshed families. In this situation the boundaries seem to overlap and become over involved in each other’s subsystems (Poorman, 2003). This being said, it is my belief that when these are present they have to be addressed to get to the root of the problems or issues among the family and its subsystems. Even if you need to address one individual’s behavior above all others, it is still vital to understand the context of the family and how such problems develop. It is very crucial not to ignore or deny the importance of each individual that makes up the family system. Murray Bowen, in a sense, built on Minuchin’s beliefs and thoughts about structure. Bowen believed that triangulation would improve issues- with a third parties involvement. Bowen believed that a triangle made a strong family structure (Poorman, 2003). With this, as a helper I would see it fit to use the Family Systems Theory because using the whole family would seem to be a sure way to bring about changes. If one person can change, but nothing else can, like the environment in which the problems are occurring, then what is really going to be achieved? It is my job as the helper to facilitate the whole process. I would join the family in the discovery process, then help them understand and use their interacting with one another, then challenge them to change their interpretation of the problems and try to think of alternative ways to make things happen. It is not my job to be above them or against them but to join them and help the process. I am not there to preach or sit back and try to let them blindly discover something on their own. Communication is a very important skill for everyone to have. An equally important skill that I think gets overlooked a lot of the time is the non-verbal communication. As a helper who is focusing on the family as a whole, you will need to be able to read and understand non-verbal quos and positioning, but you will need to be able to use them well. To be affective, you need to try to help the family as a whole understand non-verbal communication. Be aware of the setting, your position in consideration to the client(s), physical distance, posture, gestures, eye contact, facial expression, and other things that your client could take one way or the other. Be aware also that silence is a non-verbal skill and use it as a listening skill. Non-verbal communication may sprout some other forms of communication that can get things that may not have been relayed out into the open. There are many ways of being a sort of intervention with a family in this type of situation. First you are going to want to use another of your micro skills and being asking questions. When your client(s) are there a lot of the time they are going to be in shut down mode. So, asking questions is a way to dig down into what is really going on and start from there. Asking questions is a skill that you want to use when a client(s) experience, thoughts and/or feelings become unclear. Sometimes probing and exploring more into the experience, thought or feeling can be useful. It may also be beneficial to help your client(s) hear what they are saying so they can begin to understand more or start a different direction so that something can be more easily understood. You want to be sure that when you are working with your client or in this situation your family that you be careful not to use poor judgment on the type of questions that you ask, or ow you ask them; it is important not to be accusatory or ask double-barreled questions, as this could lead to anger, frustration, misunderstanding and confusion. You want to be careful not to use questions that only require a yes or no answer also. Using questioning the whole time as your only approach will not get you very far, you do not want to seem controlling and uninterested in the issues (Poorman, 2003 ). When beginning with your family, you are going to want to know what their definition of family is. You also will want to identify certain other characteristics in the family concept; boundaries, power and intimacy, freedom of expression, organization and value systems (Stratman, 2009). Then you are going to want to work on addressing what the factors are that are causing the problems. Lastly, you are going to want to use Preparing for Action! In preparing for action there are many requirements that you are going to want to meet with your client(s), but the main focus of this skill is to set goals. Make the goals realistic and obtainable. You want to write them all down and then make a plan of action of how to make the goals happen. You have to operationalize the goals also. Set up a schedule with the client(s). Make time for brainstorming, a timeline and a written plan! In working with families it is definitely different from working with the individual. Working with the individual you focus on just that- the individual. Working with family in the theory is everyone combined into the system called family and finding out how it works and what makes up everything about them. Even when you are working with an individual I think the Family Systems Theory is a good one to use, to find out the root of the problems and get things on course. Poorman, P. B. (2003). Microskills and Theoretical Foundations for Professional Helpers. Pearson Education Inc. Family Systems Theory-Basic Concepts, â€Å"Family Systems Theory. † http://www. family. jrank. org (Accessed 9. 29. 09) Using Family Therapy, â€Å"Family Systems Theory. † http://web. pdx. edu (Accessed 9. 28. 09) Stratman, T. (2009) Power Point, â€Å"Family Systems Theory. † (Accessed 10. 1. 09)